Cardiovascular disease (CVD) is a group of heart diseases that affect the blood vessels. It includes coronary artery disease (CAD, which affects the heart muscle), cerebrovascular disease (which affects the brain), and peripheral arterial disease (which affects the arms and legs).

CVD is the leading cause of death and disability worldwide, resulting in more than 17.9 million deaths each year. In the United States alone, CVD is responsible for one in every three deaths, with 85% of these due to heart attacks and strokes. Alarmingly, one-third of these occur prematurely in people under 70 years of age.

There’s a lot to unpack there, so let’s focus in on one of the most common cardiovascular diseases, coronary artery disease, including how it happens, modifiable and non-modifiable risk factors for heart disease, and what you can do about it. 

What is Coronary Artery Disease?

Coronary artery disease is when your coronary arteries, a major blood supply to your heart, are damaged and diseased, typically from hardened deposits and inflammation in the blood vessels. This can cause a narrowing of blood vessels and a taxed burden on your heart to do its daily functions.

Atherosclerosis and Coronary Artery Disease

One of the main mechanisms of CAD is called atherosclerosis. Atherosclerosis is the hardening and narrowing of the arteries due to the build-up of plaque, a thick and hard substance composed of fatty materials. 

When plaque accumulates here, it narrows the space for blood to flow throughout the body. As time progresses, it can occlude the entire pathway, or a piece can break off and create a blockage that leads to a heart attack or stroke.

Atherosclerosis is progressive. It can take years, or even decades, to appear on blood tests, starting in early childhood as deposits of cholesterols and fats. It’s a painless and otherwise silent disease, so you may have no idea that you have it until it may be too late. That’s why it’s so important to be aware of your risk factors and take preventive action, which we’ll get into later.

The exact cause of the start of atherosclerotic plaque buildup is unknown. However, science has proposed that damage to the blood vessel lining may be caused by high blood pressure, high cholesterol, high triglycerides, diabetes, smoking (or other sources of tobacco), insulin resistance, obesity, and/or inflammation from various diseases such as arthritis, lupus, and infections. All of these risk factors for atherosclerosis are controllable if you take action.

Once the inner wall of an artery is injured, blood cells and other substances often clump at the injury site and build up in the inner lining of the artery. This acceleration increases the risk of premature heart attacks and strokes, which could have been prevented through science-based lifestyle medicine.

Research shows that both the trigger and cause of death from CAD are largely due to unhealthy diets and physical inactivity. Nutrition can influence the development of these diseases by affecting the underlying processes that cause or exacerbate the condition. 

What’s Your CVD Risk?

The term ‘risk factor’ is used to describe physical and biochemical attributes, as well as features of lifestyle and behavior, which predict an increased likelihood of developing CAD. 

Millions of people worldwide struggle to control the risk factors that lead to CAD, while many others remain unaware that they are at high risk. The good news is that 80% of heart attacks and strokes can be prevented by controlling major risk factors through dietary and lifestyle interventions. That’s huge!

Modifiable Risk Factors for Heart Disease

There are many risk factors for heart disease that you can influence by making positive changes to your diet and lifestyle, such as:

• High blood LDL cholesterol
• Low blood HDL cholesterol
• High blood pressure (hypertension)
• Diabetes, hyperglycemia, and insulin resistance
• Obesity (especially abdominal obesity)
• An ‘atherogenic’ diet (high in saturated fats and low in vegetables, fruits, nuts and whole grains)
• Physical inactivity
• Cigarette smoking
• Dyslipidemia
• High levels of inflammatory markers
• High levels of homocysteine, an amino acid that can lead to blood clots or blood vessel blockages when elevated

Non-Modifiable Risk Factors for Heart Disease

On the other hand, there are also risk factors that you can’t modify, but it’s still important and helpful to be aware of them. Some of these include your genetic predisposition, gender (men are at higher risk), age (increased risk with aging), and race or ethnicity (Hispanics, and African Americans have a higher risk).

What to Do Now

If you’re looking at those lists of CVD risk factors and feeling a little overwhelmed, the best thing to do now is to take it one step at a time. Think about a handful of modifiable risk factors you can change and consider some ways you could improve them. 

For example, if you smoke, now would be a good time to seek help to quit. If you typically lead a sedentary lifestyle, think about some ways you could move your body more. Perhaps you have a friend who goes to the gym and could give you a tour of it or a neighbor who you could walk with every morning. (For ideas, check out this post on Best Exercises for Heart Health). 

If you have diabetes, abnormal lipids including high triglycerides, apoB, LDL, blood pressure, or any cardiometabolic risk factor that isn’t very well controlled, now would be a good time to speak with your healthcare provider, including registered dietitian who specializes in cardiometabolic disease, for personalized guidance. 

Need guidance? I’d love to help! I offer 1:1 nutrition counseling for my clients as well as a 6 week Heart Health Optimization Group Program you can find more out about here. Let’s get your coronary artery disease risk down and improve your overall wellness. 

References

1. Flora GD, Nayak MK. A Brief Review of Cardiovascular Diseases, Associated Risk Factors and Current Treatment Regimes. Curr Pharm Des. 2019;25(38):4063-4084. doi:10.2174/1381612825666190925163827
2. Cardiovascular diseases (CVDs). World Health Organization. Publushed 11 June 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) 
3. Ravera A, Carubelli V, Sciatti E, et al. Nutrition and Cardiovascular Disease: Finding the Perfect Recipe for Cardiovascular Health. Nutrients. 2016;8(6):363. Published 2016 Jun 14. doi:10.3390/nu8060363
4. What Is Atherosclerosis? National Heart Blood and Lung Institute. Updated 24 March 2022 Available from: https://www.nhlbi.nih.gov/health/atherosclerosis 
5. Spagnoli LG, Bonanno E, Sangiorgi G, Mauriello A. Role of inflammation in atherosclerosis. J Nucl Med. 2007;48(11):1800-1815. doi:10.2967/jnumed.107.038661
6. McGill HC Jr, McMahan CA, Herderick EE, Malcom GT, Tracy RE, Strong JP. Origin of atherosclerosis in childhood and adolescence. Am J Clin Nutr. 2000;72(5 Suppl):1307S-1315S. doi:10.1093/ajcn/72.5.1307s
7. Rafieian-Kopaei M, Setorki M, Doudi M, Baradaran A, Nasri H. Atherosclerosis: process, indicators, risk factors and new hopes. Int J Prev Med. 2014;5(8):927-946.
8. Willett WC, Koplan JP, Nugent R, et al. Prevention of Chronic Disease by Means of Diet and Lifestyle Changes. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006. Chapter 44. Available from: https://www.ncbi.nlm.nih.gov/books/NBK11795/ Co-published by Oxford University Press, New York.
9. Prevention of Cardiovascular Disease Guidelines for assessment and management of cardiovascular risk. World Health Organization. 2007. Available from: https://iris.who.int/bitstream/handle/10665/43685/9789241547178_eng.pdf;jsessionid=E2523AA8BEB3BEEDDE4A5ACA58471F70?sequence=1 
10. Ganguly P, Alam SF. Role of homocysteine in the development of cardiovascular disease. Nutr J. 2015;14:6. Published 2015 Jan 10. doi:10.1186/1475-2891-14-6
11. Brown JC, Gerhardt TE, Kwon E. Risk Factors for Coronary Artery Disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; January 23, 2023.
12. Leigh JA, Alvarez M, Rodriguez CJ. Ethnic Minorities and Coronary Heart Disease: an Update and Future Directions. Curr Atheroscler Rep. 2016;18(2):9. doi:10.1007/s11883-016-0559-4