Coronary Heart Disease Risk Factors

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Heart disease can happen at any age, but the risk increases as you age. Genetic and lifestyle factors can cause plaque to build up in your arteries over time. 

Coronary heart disease is the leading cause of death for both men and women in the United States. Men’s risk for coronary heart disease starts to increase significantly around age 45. Before menopause, women have a lower risk of coronary heart disease than men. Around age 55, the risk for women increases more rapidly. 

Environmental risk factors

Outdoor or indoor air pollution can increase your risk of coronary heart disease. The increase in risk may be higher in older adults, women, and people with diabetes or obesity. Air pollution may cause or worsen other conditions known to increase your risk of coronary heart disease, such as high blood pressure and inflammation.

Being outside can be good for your health. But both hot and cold weather can stress your body. This stress may worsen some coronary heart disease symptoms and lead to serious heart problems. High outdoor temperatures can also worsen air pollution, further increasing the risk of heart problems. 

Smoke from wildfires can lead to inflammation that raises your risk for coronary heart disease and its complications, including death.

Work-related risk factors

Your job may increase your risk if you:

• Work more than 55 hours a week or work long, irregular, or night shifts that affect your sleep
• Are exposed to toxins, radiation, secondhand smoke, or other hazards
• Have a lot of stress at work
• Sit for long periods
• Experience racism, violence, or harassment on the job

A family history of early heart disease is a risk factor for coronary heart disease. This is especially true if your father or brother was diagnosed before age 55, or if your mother or sister was diagnosed before age 65. Research shows that some genes are linked to a higher risk for coronary heart disease.

Over time, unhealthy lifestyle habits can lead to plaque buildup in the heart's blood vessels.

• Being physically inactive can worsen other heart disease risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, and overweight and obesity.
• Drinking too much alcohol can raise your blood pressure and your risk for heart disease. Drinking more than two drinks a day for men or one drink a day for women can raise your levels of cholesterol and triglycerides. Binge drinking (when a woman has four or more drinks, or a man has five or more drinks within about 2 hours) is a key risk factor.
• Not getting enough quality sleep, including waking up often throughout the night, may raise your risk of coronary heart disease. While you sleep, your heart does not work as hard as it does when you are awake. Waking up suddenly can cause a sharp increase in blood pressure and heart rate, which has been linked to angina and heart attacks.
• Smoking or long-term exposure to secondhand smoke can damage your blood vessels.
• Stress can cause your arteries to tighten. Stress may also indirectly raise your risk of coronary heart disease if it makes you more likely to smoke or overeat foods that are high in fat and added sugars.
• Unhealthy eating patterns, including consuming a lot of saturated fats and refined  carbohydrates  (such as white bread, pasta, and white rice), can lead to overweight and obesity, high blood cholesterol,  atherosclerosis , and plaque buildup in the heart's arteries.

Learn about steps you can take to lead a more heart-healthy lifestyle.

Other medical conditions that affect your heart and blood vessels can raise your risk of developing coronary heart disease, including:

• Atherosclerosis
• Congenital coronary artery defects (heart problems you are born with)
• High blood LDL cholesterol (sometimes called "bad" cholesterol)
• High blood pressure
• High blood triglycerides

Some medical conditions not directly related to your heart and blood vessels may increase your risk for coronary heart disease. These include:

• Autoimmune and inflammatory diseases, such as psoriasis, lichen planus, pemphigus, lupus erythematosus, and rheumatoid arthritis
• Chronic kidney disease
• COVID-19
• Diabetes
• HIV/AIDS, especially among older adults, in part because of side effects of HIV treatments
• Metabolic syndrome
• Overweight and obesity
• Sleep disorders, such as sleep apnea or sleep deprivation and deficiency

Heart disease is the leading cause of death for people of most racial and ethnic groups in the United States. This includes Black people, White people, and American Indian/Alaska Native people.

In the United States, Black adults are more likely to have socio-economic disadvantages, such as high blood pressure, obesity, diabetes, a family history of heart problems, exposure to environmental hazards such as air pollution, and other socio-economic issues. These result in Black adults having a death rate due to heart and blood vessel disease that is twice that of White adults. Similarly, American Indian/Alaska Native people have a death rate that is 1.5 times higher than the rate for White people.

For Asian American, Pacific Islander, or Hispanic people, heart disease is second only to cancer  in causes of death. 

People of South Asian ancestry have a higher risk of developing coronary heart disease and its serious complications. They also tend to develop coronary heart disease at a younger age. South Asia includes Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. 

Stress, depression, anxiety, and post-traumatic stress disorder can raise people's risk of coronary heart disease. Scientists are looking into links between mental health and coronary heart disease. Studies show that improving emotional health can help lower the risk of heart and blood vessel disease.

The conditions in which people are born, grow, live, work, and age also affect health. These "social determinants of health" include:

• Economic stability
• Neighborhood environment
• Education
• Social and community factors
• Access to health care

Heart-healthy living can be challenging in areas where healthy food is hard to find, or where it may not be safe to exercise outdoors. Factors such as understanding health information, having social support, experiencing racism, and being able to access health care, all affect heart health.

Coronary heart disease affects both men and women. Obstructive coronary artery disease is more common in men, while nonobstructive coronary artery disease is more common in women. Since the nonobstructive type is harder to diagnose, women may not be diagnosed and treated as quickly as men.

Coronary microvascular disease is more common in women. Age-related changes in the small blood vessels of the heart raise the risk for coronary microvascular disease. Some reproductive and pregnancy-related conditions may also increase women's risk. Learn about more conditions that increase risk for women.