In Your Hands

More than anything else, how you live your life determines your likelihood of developing coronary heart disease (CHD).

Even if you have risk factors you can't do a thing about, making changes to your lifestyle can go a long way toward ensuring you don't ever suffer a heart attack or other so-called coronary event.

Smoking
Smoking accounts for about one in five deaths from cardiovascular disease. Women who smoke are two to six times more likely to suffer a heart attack than those who don't. The risk increases with the number of cigarettes smoked each day. But if you quit, within one year your CHD risk plummets 50 percent; within 15 years your relative risk of dying from CHD approaches that of a lifetime nonsmoker.

About 70 percent of smokers say they want to quit. If you're one of them, talk to your doctor about stop-smoking strategies. In addition to providing the kind moral and medical support you'll need, your doctor can prescribe medications shown to help smokers break the habit.

How does smoking affect your heart disease risk? It lowers beneficial HDL (high-density lipoprotein) and damages the blood vessels, making them less elastic (thereby reducing blood flow and causing high blood pressure) and turning them into virtual Velcro, so that gunk (like fatty deposits) is more likely to stick to them. Smoking also reduces oxygen levels in the blood, which further irritates vessel walls.

Smoking may also contribute to insulin resistance and the cascade of events that leads to metabolic syndrome. When researchers at Stanford University had 20 smokers and 20 nonsmokers drink a sweet solution, they found that while glucose levels of both remained about the same, the smokers had much higher levels of insulin, a sign of insulin resistance. Also, while total cholesterol levels were the same in both groups, VLDL (very low-density lipoprotein) was higher and HDL lower in smokers.

Unless your cholesterol is off the charts, quitting smoking may be even more important than fixing the cholesterol problem. Research has shown that male smokers with low cholesterol have a substantially higher risk of death than nonsmokers with high cholesterol. Of course, doing both is best.

Lack of Exercise
Could our lives be any easier? We have clickers to change the channel, increase the stereo volume, even turn lights on and off. We can drive through for hamburgers, dry cleaning, and doughnuts. We can hire someone to clean the house, cut the grass, and walk the dog. Is it any wonder that one in four Americans are not physically active at all? Or that more than 6 in 10 don't get enough exercise to do any good for their health?

While lack of exercise is bad for the whole body (and the mind), it's particularly bad for the heart. If you're sedentary, you're almost twice as likely to suffer a heart attack as someone who exercises regularly. Exercise increases HDL, reduces LDL (low-density lipoprotein), improves insulin sensitivity, and lowers blood pressure. It also helps to control your weight and keep your heart in shape. If you do have high cholesterol or other CHD risk factors, exercise can help nullify some of those risks by creating healthier, stronger blood vessels -- in some instances, even new blood vessels for blood to flow through.

If you're living the couch potato life, your body is storing calories as fat instead of burning them, which leads to high triglycerides and LDL. In fact, lack of exercise is so dangerous for your heart that some experts think a history of no regular physical activity should count as a risk factor for heart disease -- one just as dangerous as high LDL.

You don't have to do much to make a difference; just 20 minutes of brisk walking per day will help your body burn calories instead of storing them as fat.

Your Balanced Self

Your Diet
There's simply no way around it: You are what you eat. And if you eat a diet high in saturated fat and trans fatty acids (the stuff McDonald's cut back on in late 2002), you're more likely to have high cholesterol.
The fewer fruits, vegetables, whole grains, and fiber you get, the more likely you are to have high cholesterol as well as an overall increased risk of heart disease, even without the high cholesterol. Eating a more balanced diet not only lowers your cholesterol and your risk of heart disease, but helps unclog your arteries as well.

Your Weight
America has a weight problem. Just consider the seat situation. To accommodate our girth, seats in auditoriums, stadiums, even subway cars have been widened. And some airlines are beginning to enforce policies whereby people who spill out of the seat they purchase must buy a second. According to the latest figures, nearly 65 percent of American adults are either overweight or obese.

Being overweight has repercussions far beyond where you buy your clothes. It's associated with increased LDL and decreased HDL. Where you gain weight also matters. Pounds packed around the waist (the old spare tire or beer belly) increase your risk of CHD as well as your risk of metabolic syndrome. Extra padding around the hips (more typical for women) is less dangerous. Wherever you carry your extra weight, if you're a woman it may be even more important for you to lose the pounds. One long-term study of 116,000 women found that almost 40 percent of their CHD risk was related to weight.

Stress and Hostility
The phrase "stress" has become so ubiquitous in our culture that it can at times seem meaningless. But to your heart and blood vessels, it's anything but. Stress -- especially the chronic type you suffer with financial, health, or marital problems -- plays a critical role in your risk for CHD. For instance, one study found that levels of LDL rose about 5 percent in a group of middle-aged male airline pilots when they experienced episodes of high occupational stress. Stress also affects your endothelial function (which indicates the all-important health of your artery walls) and how quickly you're able to clear triglycerides from your blood after eating. (Remember, the higher your triglyceride level, the more triglycerides are delivered to your liver, where they are transformed into LDL and VLDL -- the "bad" and "very bad" kinds of cholesterol.) Stress can also raise your blood pressure and make your blood more likely to clot.