Risk Factors

If you are experiencing any of the conditions below, we urge you to contact your Primary Care physician to discuss steps for contol and stabilization of these conditions. 


  • Diabetes is a condition of abnormal blood sugar (glucose) regulation that occurs as a result of abnormal insulin production by the pancreas or developed resistance to the action of insulin on cells of the body, in particular liver, muscle and fat cells.
  • >8% of all Americans are diabetic and >24% are "pre-diabetic".
  • Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations.
  • Obesity and physical inactivity are major factors leading to resistance to insulin which can lead to abnormally high blood sugar levels (type 2 diabetes).
  • About 2/3 of the deaths in diabetics are due to heart disease and stroke.
  • It is well established that proper diet, regular exercise and weight loss can dramatically improve the control of blood sugars in type II diabetics.
  • Excellent control of blood sugars with diet, weight loss, exercise, insulin or other medication is critical to reducing risk, not only from atherosclerosis, but eye, kidney and nerve damage which to commonly leads to blindness, kidney failure, amputations and chronic pain in diabetics.
  • Hemoglobin A1c is a blood test that tells your doctor what your average blood sugar has been over the last 3 months. A normal level is <6. The target for diabetics is at least <7.
  • Being involved in a diabetes management program with frequent monitoring of blood sugars is essential for optimal glucose control, especially when blood sugars are poorly controlled.

High Blood Pressure

  • In general, the higher your average blood pressure, the higher your risk for heart and vascular disease. Optimal blood pressure is < 120/80. This risk doubles for each 20/10-mm Hg increase.
  • Traditionally blood pressures over 140/90 have been considered elevated and these people were diagnosed with "hypertension" if they were found to have this blood pressure after 5 minutes of rest on 2 or more occasions.
  • Hypertension is associated with an increased incidence of stroke, coronary heart disease, heart failure, peripheral arterial disease, kidney dysfunction and death.
  • Lowering blood pressure can be accomplished with exercise and healthy diet changes, but often requires drug therapy.
  • Many studies have shown large benefits of lowering blood pressure. One study that assessed the combined outcomes of multiple trials showed that drug therapy significantly reduced cardiovascular death by 18-21% in patients with hypertension. The risk of stroke was reduced by 30% and coronary artery disease conditions were reduced by 14-23%.
  • The American Heart Association and American College of Cardiology currently recommends lowering blood pressure to at least a target of <140/90. Patients with diabetes, heart failure, kidney disease should have a target of <130/85. Recent studies also suggest that lowering blood pressure to <130/85 may benefit all patients with coronary artery disease.

High Cholesterol

  • Elevated levels of LDL (bad cholesterol), elevated levels of triglycerides and low levels of HDL (good cholesterol) have proven to be major risk factors for the development of cardiovascular disease.
  • Improving cholesterol levels through exercise, diet changes, and medical therapy have proven to greatly reduce future risk of cardiovascular disease.
  • The most dramatic risk reductions have occurred from lowering LDL cholesterol.
  • The most powerful way to reduce LDL cholesterol is with medical therapy. The most effective medications are called "statins".
  • "Statins" have proven to reduce the risk of death, heart attack and stroke in patients with established coronary heart disease even when LDL levels are not elevated.
  • Medications, exercise, diet changes and weight loss can all improve LDL, HDL and triglyceride levels. Improving HDL and triglyceride levels has also shown to reduce risk, but not as dramatically as lowering LDL levels.


  • Modern culture requires less physical activity and encourages the consumption of large amounts of calories. Because of sedentary lifestyle and the abundance of high calorie foods, the prevalence of overweight adults in North America has increased by >50% in the past decade.
  • 2/3 of US adults are overweight as defined by a body mass index (BMI >25). 30% are obese (BMI>30).
  • 24% of US adults have the metabolic syndrome (a combination of obesity, abnormal blood glucose, hypertension and high triglycerides.)
  • Obesity and physical inactivity are major factors leading to resistance to insulin which can lead to abnormally high blood sugar levels(type 2 diabetes).
  • The number of deaths due to obesity rose 33% during the last decade and experts estimate that obesity will soon overtake tobacco as the leading preventable cause of death.
  • Severe obesity may reduce life expectancy by as much as 22%.
  • Obesity is often associated with hypertension, cholesterol problems & increased blood glucose, all of which can be improved with proper diet, exercise and weight loss.
  • Managing your weight (click to open)

Poor Compliance with Taking Prescribed Medications

  • Multiple medications have proven to have significant benefits in terms of decreasing risk of death, morbidity and improving quality of life in patients with coronary heart disease.
  • All patients with atherosclerotic disease (hardening of the arteries) should be taking aspirin and a "statin" drug if tolerated. All patients with a history of a heart attack should be taking a "beta blocker" if tolerated.
  • Like most medications designed to help prevent future disease, medications like aspirin, cholesterol medications and blood pressure medications don't necessarily make people feel better or worse on a daily basis. Because of this and other reasons, many patients are often not compliant with taking medications on a daily basis.
  • Lack of adherence to blood pressure lowering medications is a major reason for poor blood pressure control. Many large studies have shown that less than half of hypertensive patients are achieving target blood pressure goals in many parts of this country and the world.
  • Studies show that between 10-50% of patients are no longer compliant with important preventative medications such as aspirin, statins and blood pressure medication by 6 months to 2 years after starting them. Because of this, many opportunities are lost to prevent bad health outcomes.
  • Please inform your doctor if you are having trouble getting your medication, taking your medication as directed or have stopped or changed medicine.

Sedentary Lifestyle — Physical Inactivity

Exercise has many proven health benefits:

  • lowers LDL and triglycerides, increases HDL
  • lowers blood pressure
  • improves insulin sensitivity leading to better blood sugar control
  • improves coronary vasodilatation and helps develop coronary collaterals
  • improves angina
  • lowers depression and hostility scores
  • improves overall feelings of wellness.

Blair and colleagues reported in the Journal of the American Medical Association that men >60 years of age who improved their physical activity level had a 50% lower risk of death compared with those who did not improve their exercise level.

Participation in a cardiac rehabilitation program after a heart attack has been shown to lower the risk of death and recurrent heart attack. Guidelines and experts recommend cardiac rehabilitation after heart attack, bypass surgery and in some patients with heart failure and chronic angina.

National guidelines recommend > 30 minutes of moderate exercise most days of the week at minimum. Other public health recommendations advise that all adults should have 30 minutes of exercise per day, which can be as simple as 3 ten minute walks. Even small gradual increase in exercise is of great benefit.

Target exercise should be the equivalent to walking at a speed during which you are warm, lightly perspire and breath deeply without being "out of breath" or having symptoms of dizziness, chest pressure or pain.


  • Smoking has direct toxic effects on endothelial cells which line blood vessels. Damage to endothelial cells is thought to be an initiating factor in atherosclerosis or "hardening of the arteries".
  • Lung cancer has surpassed breast cancer as the leading cause of female cancer death. About 90% of all lung cancer deaths are attributed to smoking.
  • Smoking caused almost 5 million premature deaths in the year 2000. In industrialized countries, smoking accounts for 19% of total adult mortality.
  • On average, men who smoke cut their lives short by 13.2 years and female smokers lose 14.5 years. It has been estimated that smoking leads to $75 billion in direct medical costs each year in the United States.
  • For patients with coronary heart disease, quitting smoking showed a 36% reduction in all-cause mortality compared to people who continued to smoke.

Unhealthy Diet

  • The average American diet includes high intake of "fast food", foods high in fat, cholesterol and simple sugars. This diet and physical inactivity have led to the obesity epidemic in this country.
  • A diet rich in fruits, vegetables, whole grains, and low fat dairy products and low in fat, refined carbohydrates and sodium was found to lower blood pressure, by about 6mmHg (systolic) in the DASH study.
  • In a Harvard study, the intake of sweetened sodas and fruit drinks were highly correlated with obesity and type 2 diabetes. Women who changed habits from about one of these drinks per week to one or more per day gained an average of 19.5 lbs in the 8 year follow-up.
  • Most people have found weight loss difficult in part because of the confusion about what a "healthy" diet is. Even among health care providers there is confusion regarding what is the best diet. There are many diet plans publicized today. The Dean Ornish diet, Atkins diet, South Beach diet, Mediterranean diet, NCEP Diet, AHA "common sense" diet, Zone diet, etc. Although the perfect diet for each person may not be established, there are many principles that should be followed for a "Heart Healthy Diet."