Smoking

This is the most important risk factor you can change. Smoking causes inflammation and damages the smooth muscle that lines the arteries. This makes them less flexible. It also raises your blood pressure, causing more damage to the artery lining. Smoking also increases your risk that your blood may clot, block an artery, and lead to a heart attack or stroke. This risk is further increased if you take birth control pills (oral contraceptives). Smoking also damages your lungs, which can affect the delivery of oxygen to the body. Research shows that smoking makes women up to 6 times more likely to have a heart attack. It's also important to stay away from secondhand smoke. This is smoke from other people’s tobacco products. If you smoke, it's never too late to protect your heart. Ask your healthcare provider about ways to help you quit. You may want to try nicotine replacement products, other medicines, or counseling.

Diabetes

Diabetes causes high blood sugar, which can damage blood vessels if not kept under control. Having diabetes also makes you more likely to have a silent heart attack—one without any symptoms. This occurs because long periods of high sugar levels in your blood eventually break down nerve conduction. This reduces your sensation. You may then have less chest pain during a heart attack than would be felt in a person without diabetes. You’re at risk if your fasting blood sugar level is above 100 mg/dL.

High cholesterol

Cholesterol is a fat-like substance in your blood. It can build up along the artery walls. This is called plaque. Over time, plaque narrows the arteries and reduces blood flow to your heart or brain. If a blood clot forms or a piece of the plaque breaks off, it can completely block the artery and cause a heart attack or stroke. Your risk of heart disease goes up if you have high levels of LDL ("bad") cholesterol or triglycerides (another fatty substance that can build up). You’re also at risk if you have low HDL ("good") cholesterol. HDL helps clear the bad cholesterol away. You’re at risk if you have:

• HDL cholesterol of 50 mg/dL or lower

• LDL cholesterol of 100 mg/dL or higher

• Triglycerides of  150 mg/dL or higher

High blood pressure

High blood pressure occurs when blood pushes too hard against artery walls. It causes damage to the artery walls and then the formation of scar tissue as it heals. This makes the arteries stiff and weak. Plaque sticks to the scarred tissue narrowing and hardening the arteries. High blood pressure also causes your heart to work harder to get blood out to the body. High blood pressure raises your risk of heart attack and stroke. The brain tissue is very sensitive to high blood pressure damage. You’re at risk if your blood pressure is 120/80 mmHg or higher.

Extra weight

Extra weight makes your heart work harder. This raises your risk for a heart attack. Being overweight also puts you at risk of developing diabetes and high blood pressure. Extra weight around the waist or stomach increases your risk the most even if you are not obese. Being obese puts you at risk of developing heart disease.

Lack of exercise

Without regular exercise, you’re more likely to develop other risk factors, such as extra weight and diabetes. High blood pressure and unhealthy cholesterol levels are also more likely. Exercise helps improve blood flow and makes sure your heart is able to meet the demands placed on it.

Negative emotions

Emotions such as stress and pent-up anger have been linked to heart disease. Over time, these emotions could raise your heart disease risk. If you have heart disease, conditions such as anxiety and depression can make it worse. Managing your emotions is important. They have been shown to reduce hormones that increase stress on the heart over time.

Metabolic syndrome

This syndrome is caused by a combination of certain risk factors. It puts you at extra high risk for heart disease, stroke, and diabetes. You have metabolic syndrome if you have 3 or more of the following:

• Low HDL cholesterol

• High triglycerides

• High blood pressure

• High blood sugar

• Extra weight around the waist

Risks you can’t control

A few risk factors can’t be changed. But they still raise your heart disease risk.

• Family history. If your mother or sister had heart trouble before age 65, or your father or brother before age 55, you’re at higher risk of having a heart attack.

• Age. The older you are, the higher your heart disease risk.

• Being female (assigned female at birth). Post-menopause is another risk factor for women. So is getting your first menstrual period at a young age.

For more information

• Talk to an expert about quitting smoking at www.smokefree.gov/speak-to-an-expert

• Find tools and tips to help you quit smoking at www.women.smokefree.gov

• National Cancer Institute Smoking Quitline, 877-44U-QUIT (877-448-7848)