10 Must-Know Risk Factors for Cardiovascular (Heart and Blood Vessel) Disease

What’s one thing heart attacks, strokes, arrhythmias, and heart valve disease have in common? Answer: they all fall under the large umbrella of cardiovascular disease (CVD).¹ Also known as “heart and blood vessel disease,” CVD refers to conditions that affect your heart and/or blood vessels.

Heart disease and stroke are the leading causes of death for all Americans, and the burden on Black communities is significant. Research shows that Black women have a 2.4-times higher risk for CVD than white women do and that Black men have a 1.6-times higher risk for CVD than white men do.² In 2018 alone, CVD was the cause of death for more than 53,000 Black women and more than 56,000 Black men.³

Because CVD has a major impact on the health of Black communities, it’s important to know what conditions CVD includes and what characteristics or behaviors could increase — or decrease! — your risk of CVD.

What is cardiovascular disease?

Chances are, you’ve heard of heart disease before, but heart disease is just one type of cardiovascular disease. Specific types of heart disease or CVD include¹:

• Heart attacks – A heart attack happens when blood flow to the heart is blocked, usually due to a blood clot. Heart attacks are one of the most common forms of CVD.⁴ Every 40 seconds, someone has a heart attack in the US.

• Strokes – There are multiple types of strokes. An ischemic stroke happens when the brain’s blood supply is cut off, usually when a blood clot is blocking a blood vessel. A hemorrhagic stroke happens when a blood vessel inside the brain bursts. This usually happens in people who have high blood pressure that is not well-controlled. Compared to white Americans, Black Americans are 50 percent more likely to have a stroke.⁵

• Arrhythmias – Also known as an abnormal heart beat, arrhythmias happen when the heart beats too slowly (called bradycardia), too fast (called tachycardia), or irregularly. Specific examples of arrhythmias include atrial fibrillation (AFib), ventricular fibrillation, and ventricular tachycardia. When the heart isn’t beating at the pace it should be, it’s not as effective at pumping blood throughout the body. 

• Valvular heart disease – The heart has four valves that help make sure blood is flowing through the heart in the right direction.⁶ Heart valve disease happens when those valves aren’t working well. Perhaps they aren’t opening enough, aren’t closing enough, are leaking, or are poking out into one of the heart’s chambers. Many people aren’t familiar with heart valve disease even though it affects about 2.5% of the U.S. population.^6,7 Research from 2017 shows that Black patients were more than 50% less likely to be referred to the appropriate surgeon for heart valve disease treatment. At the same time, Black patients are 33% more likely to refuse treatment for heart valve disease than white patients are.⁸ 

• Heart failure – When someone is living with heart failure — also called congestive heart failure — their heart is still working, but not as well as it should be. Because the heart isn’t able to do its job efficiently, the body isn’t getting enough blood and oxygen. Black patients are 2.5 to 3 times more likely to die from heart failure than white patients are, and they’re also more likely to be hospitalized due to the disease.⁹ 

Even though CVD directly involves the heart and/or blood vessels, potential complications from CVD extend far beyond those two organs. Your heart is responsible for pumping blood and your blood vessels carry blood and oxygen through your whole body. Any condition that affects how well your heart and blood vessels are working is bound to impact other organs. The brain, kidneys, and eyes are organs that could be affected by CVD.¹⁰

What are the risk factors for cardiovascular disease?

Risk factors you can’t change

When it comes to heart disease, there are certain risk factors you can’t do much about because they’re based on your family and your biology. 

1. Family history – Your family’s history with CVD can influence how likely you are to develop CVD, and can also influence your risk of developing many of the preventable risk factors for CVD like high blood pressure and diabetes.¹¹ Having first-degree relatives — i.e., parents or siblings — with CVD can increase your risk of developing CVD, and even moreso if those relatives were diagnosed or died at younger ages.¹²
2. Age – Like family history, age itself is a risk factor for CVD, and it’s also a risk factor for many of the other preventable risk factors for CVD like obesity and diabetes. According to the American Heart Association (AHA)¹³:
   • About 40% of men and women in the US between ages 40 and 59 have CVD
   • About 75% between ages 60 and 79 have CVD
   • About 86% of people who are 80 or older have CVD 
3. Race – A person’s race used to be considered a risk factor for CVD. Black individuals were considered to have a higher risk for CVD simply because of their racial background. But newer research and understanding of how social factors influence a person’s health suggests that race itself isn’t necessarily the risk factor. Instead, racism, discrimination, and social factors that affect certain racial and ethnic communities — like Black communities — causes inequity in the health care, leading to an increased risk of chronic diseases like CVD.² If racism, discrimination, and health inequities are considered to be more accurate risk factors for CVD, then these risk factors can be changed, but not necessarily by an individual person. These changes must happen on a societal level. 

Risk factors you can change

Fortunately, there are many things you can personally do to lower your risk of CVD, and most of those actions involve addressing the risk factors below.

4. Poor diet – If your diet is high in cholesterol or certain types of fats — like saturated fat and trans fat — your risk of CVD will be higher. That’s because bad cholesterol and fats can clog up your blood vessels, creating what’s known as plaque. Plaque buildup can slow down blood that is traveling through your blood vessels and can even completely block your blood vessels, possibly leading to a heart attack or causing structural changes to your heart. Poor diet can also increase your risk of obesity, which is also a risk factor for CVD. According to the AHA, almost 70% of Black men and 82% of Black women aged 20 and up are overweight or obese.¹⁴ 
5. Physical inactivity – Like poor diet, physical inactivity can also lead to obesity or being overweight. On the other hand, regular exercise can help strengthen your heart and blood vessels and reduce your risk of other conditions like high blood pressure and diabetes.¹⁴ As a goal, the AHA recommends that adults aim for at least 150 minutes of moderately intense physical activity every week or at least 75 minutes of vigorous activity each week.¹⁴ AHA also recommends resistance training — for example, lifting weights — at least two days per week.¹⁵
   • Examples of moderately intense physical activity: Gardening, water aerobics, walking at a speed of at least 2.5 miles per hour, biking slower than 10 miles per hour
   • Examples of vigorous activity: Running, hiking uphill, biking 10 miles per hour or faster, jumping rope, lap swimming
6. Smoking and secondhand smoke exposure – Smoking causes about 1 out of every 4 CVD deaths.¹⁶ The more cigarettes a person smokes per day, and the longer they’ve been smoking, the higher their risk of CVD. Secondhand smoke exposure can also increase a person’s risk of CVD. Even if you have a history of smoking, quitting can significantly lower your risk of developing CVD within just a year.¹⁶
7. High blood pressure – High blood pressure increases the risk of heart disease and stroke.¹⁴ When your blood pressure is high, it means that there is too much pressure inside your heart and your blood vessels, which creates stress on those organs. Consistently high blood pressure can actually damage the structure of your heart, even if you have no symptoms. It’s why high blood pressure is often referred to as the silent killer. Although Black American adults are 40 percent more likely to have high blood pressure, they are less likely than white Americans to have their blood pressure under control.⁵ Managing blood pressure with lifestyle changes — like physical activity and improved diet — and medications, if needed, can help you lower your risk for CVD.
8. Diabetes – Black individuals are more likely to have diabetes than white people, and diabetes is a significant risk factor for CVD.¹⁴ If you do have diabetes, making sure your blood sugars are controlled and your condition is well managed can help you reduce your risk of heart-related complications.
9. “Bad” cholesterol  – There are two primary types of cholesterol: LDL, also known as
   “bad” cholesterol, and HDL, also known as “good” cholesterol.¹⁷ As mentioned in the section about diet, bad cholesterol can cause plaque build up in the blood vessels throughout the body, leading to CVD.¹⁸ 

A lesser known risk factor

The 10th risk factor for CVD is a lesser known one: lipoprotein(a). Lp(a), for short, is another type of cholesterol and people who are born with high Lp(a) levels may have an increased risk of CVD.¹⁹ Lp(a) is believed to cause plaque buildup in the arteries, inflammation, and blood clots. Even if you have low levels of LDL (bad cholesterol), you might still have high levels of Lp(a).²⁰

Researchers are still unclear about whether Lp(a) levels are mostly determined by the genes you’re born with or whether a heart-healthy diet and regular exercise can cancel out some of the CVD risk. Right now, researchers are still learning about Lp(a) and trying to design effective tests and treatments for Lp(a). 

Conclusion

At your next doctor’s visit, ask about any of the risk factors you learned about above in order to get a sense of your own individual risk for CVD. It’s important to know what your risk factors are so that you can be actively involved in limiting your risk for heart and blood vessel disease.

References

1. American Heart Association. What is Cardiovascular Disease? https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease
2. Northwestern Now. Black Adults’ High Cardiovascular Disease Risk Not Due to Race Itself. https://news.northwestern.edu/stories/2022/05/black-adults-high-cardiovascular-disease-risk-not-due-to-race-itself/ 
3. American Heart Association. 2021 Heart Disease & Stroke Statistical Update Fact Sheet Black Race & Cardiovascular Diseases. https://professional.heart.org/-/media/PHD-Files-2/Science-News/2/2021-Heart-and-Stroke-Stat-Update/2021_Stat_Update_factsheet_Black_Race_and_CVD.pdf 
4. Centers for Disease Control and Prevention. Heart Disease Facts. https://www.cdc.gov/heartdisease/facts
5. US Department of Health and Human Services Office of Minority Health. Stroke and African Americans. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=28 
6. Association of Black Cardiologists. Heart Valve Disease: What We Don’t Know is Killing Us. https://abcardio.org/recent-news/heart-valve-disease-what-we-dont-know-is-killing-us/ 
7. Centers for Disease Control and Prevention. Valvular Heart Disease. https://www.cdc.gov/heartdisease/valvular_disease.htm 
8. DiGiorgi, P. L., Baumann, F. G., O’Leary, A. M., Schwartz, C. F., Grossi, E. A., Ribakove, G. H., Colvin, S. B., Galloway, A. C., & Grau, J. B. (2008). Mitral valve disease presentation and surgical outcome in African-American patients compared with white patients. The Annals of thoracic surgery, 85(1), 89–93. https://doi.org/10.1016/j.athoracsur.2007.07.048 
9. Nayak, A., Hicks, A. J., & Morris, A. A. (2020). Understanding the complexity of heart failure risk and treatment in black patients. Circulation: Heart Failure, 13(8). https://doi.org/10.1161/circheartfailure.120.007264   
10. National Health Service. Cardiovascular disease. https://www.nhs.uk/conditions/cardiovascular-disease/
11. UCI Health. Does a family history of heart attacks increase your risk? https://www.ucihealth.org/blog/2017/02/family-history-heart-attacks 
12. Kolber, M. R., & Scrimshaw, C. (2014). Family history of cardiovascular disease. Canadian family physician Medecin de famille canadien, 60(11), 1016. 
13. Rodgers, J. L., Jones, J., Bolleddu, S. I., Vanthenapalli, S., Rodgers, L. E., Shah, K., Karia, K., & Panguluri, S. K. (2019). Cardiovascular Risks Associated with Gender and Aging. Journal of cardiovascular development and disease, 6(2), 19. https://doi.org/10.3390/jcdd6020019 
14. American Heart Association. African Americans and Heart Disease, Stroke. https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/african-americans-and-heart-disease-stroke 
15. American Heart Association. American Heart Association Recommendations for Physical Activity in Adults and Kids. https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults 
16. Centers for Disease Control and Prevention. Smoking and Cardiovascular Disease. https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/pdfs/fs_smoking_CVD_508.pdf 
17. Centers for Disease Control and Prevention. LDL and HDL Cholesterol: “Bad” and “Good” Cholesterol. https://www.cdc.gov/cholesterol/ldl_hdl.htm 
18. Centers for Disease Control and Prevention. Know Your Risk for Heart Disease. https://www.cdc.gov/heartdisease/risk_factors.htm 
19. Amgen. 10 Things to Know about Lipoprotein(a).
20. Reyes-Soffer, G., Ginsberg, H. N., Berglund, L., Duell, P. B., Heffron, S. P., Kamstrup, P. R., Lloyd-Jones, D. M., Marcovina, S. M., Yeang, C., Koschinsky, M. L., & American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Radiology and Intervention; and Council on Peripheral Vascular Disease (2022). Lipoprotein(a): A Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease: A Scientific Statement From the American Heart Association. Arteriosclerosis, thrombosis, and vascular biology, 42(1), e48–e60. https://doi.org/10.1161/ATV.0000000000000147