Heart Disease: Risk Factors

Several factors influence your risk of having a heart attack or stroke, or developing another form of heart disease. Some of these you can’t change; some you can.

Non-modifiable risk factors (risk factors you can’t change) include: age, gender, genes, and ethnic origin. There’s also strong evidence that your early development in the womb and during childhood helps set the stage for heart health or heart disease.

Risk factors that can be modified include habits and choices such as: tobacco use, physical activity, and what you eat and drink.

And all of the above affect physiologic factors like blood pressure, cholesterol level, and blood sugar.

Other potentially modifiable risk factors include air pollution, noise, stress, and infection, though these are not as easy for an individual to control directly.

Having a risk factor doesn’t automatically mean you will develop heart disease. But the more of them you have, the higher your odds—unless you take action.

Calculating Risk

Several models have been developed to help individuals predict their risk of having a heart attack or developing heart disease. The American Heart Association has endorsed the use of these models in the primary prevention setting. [1]

  • The most commonly used calculator was developed by Framingham Heart Study researchers. The National Heart, Lung, and Blood Institute has an online version of this risk calculator. It uses seven pieces of information (age, gender, total cholesterol, HDL cholesterol, smoking status, blood pressure, and the use of blood pressure medicine) to calculate the odds of having a heart attack in the next 10 years.
  • The Reynolds Risk Scores, one for men and one for women, include the Framingham variables plus family history of a heart attack; the level of C-reactive protein, a marker of inflammation; and the level of hemoglobin A1c, a marker of blood sugar control among diabetic patients.
  • The Heart Risk Calculator, developed as part of the 2013 American College of Cardiology and American Heart Association (ACC/AHA) Guideline on the Assessment of Cardiovascular Risk, includes sex- and race-specific estimates of both 10-year and lifetime risks for atherosclerotic heart disease.

These calculators are useful for estimating the risk of developing heart disease among individuals who already have strong risk factors and who are at high risk for having a heart attack or stroke or other cardiovascular event. However, these calculators may underestimate the true lifetime burden of heart disease, especially in middle-aged adults, as more than half of all such cardiovascular events occur in individuals who aren’t classified as high risk. [2] In addition, while most American adults have low short-term risk of heart disease, two-thirds of them have a high lifetime risk. [3]

Overview of Healthy Heart Score - Cardiovascular Healthy CalculatorThe Healthy Heart Score was created by a team from the Department of Nutrition at Harvard T.H Chan School of Public Health to fill this gap. It estimates heart disease risk in seemingly healthy individuals. The Healthy Heart Score is a simple tool that can be used to identify individuals at high risk for heart disease due to unhealthy lifestyle habits. Its use is intended to complement, not replace, existing primary prevention risk scores, since different calculators may be most appropriate for different populations.

Learn four key habits that can reduce your chances of developing heart disease.


  1. Greenland P, Alpert JS, Beller GA, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2010;122:e584-636.
  2. Polonsky TS, Greenland P. CVD screening in low-risk, asymptomatic adults: clinical trials needed. Nat Rev Cardiol. 2012;9:599-604.
  3. Marma AK, Berry JD, Ning H, Persell SD, Lloyd-Jones DM. Distribution of 10-year and lifetime predicted risks for cardiovascular disease in US adults: findings from the National Health and Nutrition Examination Survey 2003 to 2006. Circ Cardiovasc Qual Outcomes. 2010;3:8-14.

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