Many factors can influence your risk of heart disease. Some can be controlled, others can't. Some factors greatly increase the risk of cardiovascular disease, whereas others may exert only a mild influence. Knowing the contribution of your various risk factors combined can help you and your health care provider determine your overall risk for cardiovascular disease.
Risk Factors You Can't Control
Both gender and age exert strong effects on cardiovascular health. Generally, men have a greater risk than women and at an earlier age. For men, risk begins to increase by age 45 and continues to grow with each passing year. For women, the risk generally doesn't start to climb until after menopause. By age 65, however, the cardiovascular disease risk in women escalates substantially.
Race also plays a role in heart health, though it isn't entirely clear why. In general, African Americans have a higher risk for health problems such as high blood pressure and diabetes. These two health problems greatly increase a person's risk for cardiovascular disease.
There is also a genetic risk—cardiovascular disease may be more likely in some families compared to others. If your parents, grandparents or aunts and uncles suffered heart attacks or strokes at an early age, the chance that you will too is higher than if your relatives remained healthy.
Risk Factors You Can Control
While we can't control our age and family history, we can influence a lot of other cardiovascular disease risk factors.
Diet, exercise and smoking all profoundly influence heart health. The three are often called lifestyle factors. Though a healthy diet and regular exercise both contribute greatly to cardiovascular health, smoking is one of the worst offenders, and aside from its negative impact on atherosclerosis and blood pressure, it also increases the risk for lung cancer and emphysema.
One very common risk factor for many people is having levels of blood fats—lipids, such as cholesterol and triglycerides—that are out of the healthy range. Unhealthy changes usually mean that your total cholesterol, your "bad" cholesterol (LDL), or your triglycerides are too high, or that your "good" cholesterol (HDL) is too low. Poor diet, lack of exercise, smoking and ARV therapy can all contribute to lipid problems. If your levels are abnormal, most doctors will first recommend lifestyle changes—healthier diet, exercise and quitting smoking—sometimes combined with changes to your ARV treatment or drugs designed to reduce cholesterol and triglycerides.
High blood pressure is another risk factor that most people can control. A healthy diet, exercise and quitting smoking can all help control blood pressure. When lifestyle changes don't do the trick, doctors sometimes prescribe drugs to control blood pressure.
Diabetes is also a major risk factor for cardiovascular disease. In particular, every time your blood sugar climbs too high and stays too high, it contributes to cardiovascular disease. If you have diabetes, a healthy diet and regular exercise are even more important, but so too is regularly monitoring your blood sugar and appropriately using whatever medication your doctor prescribes to treat your diabetes.
HIV infection itself may also be a risk factor. Studies have shown that HIV-positive people not on ARV therapy have lower HDL cholesterol and higher triglycerides than people not infected with the virus. There is also evidence that the body's hyperactive response—inflammation—to the presence of HIV, especially if it is not being treated, can cause gradual damage to the heart and blood vessels, potentially increasing the risk of cardiovascular disease. And while people living with HIV can't (yet) control whether or not they remain infected with the virus, they can help manage many of the health problems that HIV can cause.
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