The number 1 indicator for if you are at high risk for CAD is your family history and any genetic predisposition you may have been born with.  Coronary artery disease begins in childhood, so that by the teenage years, there is evidence that plaques that will stay with us for life are formed in most people. Preventive measures instituted early are thought to have greater lifetime benefits. Healthy lifestyles will delay the progression of CAD, and there is hope that CAD can be regressed before it causes heart disease, said Edward A. Fisher, M.D., Ph.D., M.P.H., who is the Leon H. Charney Professor of Cardiovascular Medicine and also of the Marc and Ruti Bell Vascular Biology and Disease Program at the NYU School of Medicine.

Some of my earliest memories were of attending my grandfather's funeral (heart attack) and my grandmother's bypass surgery and her death shortly after.  One by one my uncles passed away from CAD and heart attacks that they didn't survive.  The link between untimely death (death below age that is the national average) and heart disease in my family is undeniable.

Once you've established that CAD is something that runs in your family or not (in my case it's an all caps "YES"), the following list of indicators all represent lifestyle and diet choices one can make to put them at greater risk for CAD.

Risk factors for the development of CAD:

Conventional risk factors:

  • Age: Over age 45 years in men and over age 55 years in women - plaques build up over time; the older you get the more likely that stenosis can and will develop
  • Family History: Likelihood of increased risk with positive family history is significant due to a number of genes now identified that are linked to CAD and are known to be hereditary
  • Race: Among persons with CAD, the cardiovascular death rate for African Americans is reported to be particularly high; in Asians, low levels of high-density lipoprotein cholesterol (HDL-C), which are considered to be a risk factor for coronary heart disease, appear to be especially prevalent; South Asians appear to have a higher independent risk for cardiovascular disease as well.

Modifiable risk factors:

  • High blood cholesterol levels (specifically, low-density lipoprotein cholesterol [LDL-C])
  • High blood pressure
  • Cigarette smoking: Cessation of cigarette smoking constitutes the single most important preventive measure for CAD
  • Diabetes mellitus
  • Obesity
  • Lack of physical activity
  • Metabolic syndrome
  • Mental stress and depression

Nontraditional or novel risk factors: High levels of the following are considered to be risk factors for CAD:

  • C-reactive protein (CRP): High levels are related to the presence of inflammation and, according to some research results, may be associated with an increased risk of CAD development and heart attack
  • Lipoprotein(a)
  • Homocysteine: In the general population, mild to moderate elevations are due to insufficient dietary intake of folic acid, but homocysteine levels may also identify people at increased risk for heart disease
  • Small, dense LDL-C particles - In some people LDL-C particles are more dense than in the general population; these smaller particles allow for plaque build-up and stenosis
  • Fibrinogen: a blood plasma glycoprotein that is important in the formation of blood clots; higher levels of fibrinogen are associated with CAD; it is unknown if this is a reaction to stenosis or yet another variable that indicates a trigger for the clotting mechanisms that are typically associated with heart attacks (MI). 

Various medical conditions that can contribute to CAD include the following:

  • End-stage renal disease (ESRD)
  • Chronic inflammatory diseases affecting connective tissues (eg, lupus, rheumatoid arthritis)
  • Human immunodeficiency virus (HIV) infection (acquired immunodeficiency syndrome [AIDS], highly active antiretroviral therapy [HAART])
  • Xanthelasmata (raised yellow patches around the eyelids)

The following are also considered to be risk factors:

  • Tissue plasminogen activator (tPA): An imbalance of the clot dissolving enzymes (eg, tPA) and their respective inhibitors (plasminogen activator inhibitor-1 [PAI-1]) may predispose individuals to myocardial infarctions
  • Low serum testosterone levels: Have a significant negative impact on patients with CAD
  • Hysterectomy: A study suggests that this becomes a risk factor later in life in women who have the surgery at or before age 50 years
  • Lack of sleep
When looking at the exhaustive list of contributing factors above remember that just because you have family history and you are overweight it doesn't mean that you are going to develop CAD.  It simply means that you are at greater risk

When looking at the indicators above it becomes clear that there are two types of risk factors: those that are beyond your control such as family history, age, race, sex, and any hereditary/genetic traits you may have inherited, and there are those that are in your control such as your weight, diet, exercise and fitness choices, and lifestyle choices such as smoking. 

If you can indentify 4 or 5 risk factors above in your lifestyle and could choose one that would have the greatest impact on improving your health; to quit smoking would be the risk factor you'd want to eliminate.  Smoking puts a person at risk for a number of life-threatening, deadly diseases and conditions, the first of which is CAD.  Not all smokers develop lung cancer, but lung cancer and cancer of the throat, mouth, and sinuses are certainly a major risk.  Chronic Obstructive Pulmonary Disease (COPD) is another deadly disease that smokers are at a significantly higher risk for.  Complications from smoking include high blood pressure.  And since CAD is the number one cause of death in the world, the risk of CAD from smoking is probably the single largest consideration anyone concerned about developing CAD should have. 

Exercise and a healthy diet in themselves can fix so many things with your health.  With exercise and a healthy diet comes weight loss and more energy.  Risk for Diabetes is greatly reduced.  Cholesterol levels in the blood improve.  People who exercise regularly report feeling less stress and anxiety.  Exercise conditions your heart and circulatory system, lowering blood pressure and improving the efficiency of your lungs.  

It is easy to look at your current lifestyle if it is unhealthy and feel overwhelmed.  People do not suddenly go from a healthy lifestyle to a high risk lifestyle overnight.  These choices are made over time.  Therefore it is fair to say that changing your lifestyle and making better choices for your health doesn't come overnight.  But make a concerted effort to change the way you live for the better by changing your diet to reduce unhealthy food and increase healthy ones.  Or add daily exercise (20 minutes a day).  And in a short period of time, 60-90 days, you'll see a dramatic change in how you feel and the amount of energy you have to face each new day. 
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