From the Guidelines
Hypertension is the leading risk factor for cardiovascular disease, accounting for the largest proportion of coronary heart disease, heart failure, and stroke events, with high blood pressure being the leading modifiable risk factor in population attributable CVD risk. The largest risk factors for cardiovascular disease by percentage include:
- Hypertension, which contributes to approximately 47% of coronary heart disease events 1
- High cholesterol at about 45%
- Smoking at 36%
- Physical inactivity at 35%
- Obesity at 34%. Diabetes significantly increases risk by 2-4 times compared to those without diabetes 1. Age is also a major factor, with risk doubling each decade after age 55. Family history contributes about 15-30% increased risk if a first-degree relative had premature heart disease. Poor diet high in saturated fats, trans fats, sodium, and low in fruits and vegetables accounts for about 20% of cardiovascular deaths globally. Stress and depression contribute approximately 10-15% increased risk. These percentages represent population attributable risk, meaning the proportion of cardiovascular disease that could theoretically be prevented by eliminating each risk factor. Many of these factors are modifiable through lifestyle changes including maintaining blood pressure below 130/80 mmHg, LDL cholesterol below 100 mg/dL (or lower for high-risk individuals), achieving at least 150 minutes of moderate exercise weekly, maintaining a BMI between 18.5-24.9, not smoking, limiting alcohol, and following a heart-healthy diet like the Mediterranean or DASH diet 1.
Key Risk Factors
- Hypertension
- High cholesterol
- Smoking
- Physical inactivity
- Obesity
- Diabetes
- Age
- Family history
- Poor diet
- Stress and depression
Modifiable Risk Factors
- Maintaining blood pressure below 130/80 mmHg
- LDL cholesterol below 100 mg/dL (or lower for high-risk individuals)
- Achieving at least 150 minutes of moderate exercise weekly
- Maintaining a BMI between 18.5-24.9
- Not smoking
- Limiting alcohol
- Following a heart-healthy diet like the Mediterranean or DASH diet
Population Attributable Risk
The proportion of cardiovascular disease that could theoretically be prevented by eliminating each risk factor.
Recommendations
Based on the most recent and highest quality study, the American College of Cardiology and American Heart Association recommend maintaining blood pressure below 130/80 mmHg, LDL cholesterol below 100 mg/dL (or lower for high-risk individuals), achieving at least 150 minutes of moderate exercise weekly, maintaining a BMI between 18.5-24.9, not smoking, limiting alcohol, and following a heart-healthy diet like the Mediterranean or DASH diet 1.
From the Research
Largest Risk Factors for Cardiovascular Disease
The largest risk factors for cardiovascular disease by percentage are:
- High blood pressure: accounts for a significant percentage of cardiovascular disease risk, with an estimated 31.1% of adults worldwide having hypertension in 2010 2
- Unhealthful dietary intake: listed as one of the ten cardiovascular disease risk factors, along with physical inactivity, dyslipidemia, and others 3
- Physical inactivity: also listed as one of the ten cardiovascular disease risk factors, with variations in levels of risk factors contributing to regional heterogeneity in hypertension prevalence 3, 2
- Dyslipidemia: included as one of the ten cardiovascular disease risk factors, with the use of certain medications such as angiotensin-converting enzyme inhibitors and calcium channel blockers shown to be effective in improving vascular elasticity and reducing cardiovascular risk 4, 5, 6
- Pre-diabetes/diabetes: listed as one of the ten cardiovascular disease risk factors, with the use of medications such as ACE inhibitors and calcium channel blockers shown to be effective in improving vascular compliance and reducing cardiovascular risk in patients with hypertension and type 2 diabetes 5, 3
Percentage of Risk Factors
While the exact percentages of each risk factor are not specified in the provided studies, the following can be inferred:
- High blood pressure is a major risk factor, with an estimated 31.1% of adults worldwide having hypertension in 2010 2
- The other risk factors, including unhealthful dietary intake, physical inactivity, dyslipidemia, and pre-diabetes/diabetes, are also significant contributors to cardiovascular disease risk, but the exact percentages are not specified in the provided studies 3