Risk factors and risk score

The importance of a healthy lifestyle affects everyone and in particular if you have been diagnosed with a heart condition. The narrowing or blockages within the coronary arteries may be slowed down if a healthy lifestyle is continued.

Deaths from cardiovascular disease

Cardiovascular disease refers to all the diseases of the heart and circulation, including stroke and coronary heart disease.

Coronary Heart Disease (CHD) - or heart disease - is preventable, yet it kills, according to the Heart Research Institute UK, around 18,050 people in Scotland each year. The disease is caused when the heart’s blood vessels, the coronary arteries, become narrowed or blocked and can’t supply enough blood to the heart. This can cause a heart attack or angina.

The good news is that if we tackle these risk factors, we can reduce our numbers of people developing heart disease.

How can we prevent heart disease?

We can lower the risk of people developing heart disease in the first place.

We can also prevent further illness and death in people who already have heart disease.

We can break down risk factors into what we can’t change (non-modifiable) and what we can change (modifiable).

What are the risk factors?

Scotland has a high prevalence of the risk factors associated with heart disease, like:

  • smoking - if you have a heart condition, one of the most important things you can do for yourself is to stop smoking
  • poor diet - a healthy diet can help reduce your risk of developing coronary heart disease and stop you gaining weight, reducing your risk of diabetes and high blood pressure
  • being overweight - this increases the work the heart has to do, and it leads to high blood pressure and abnormal levels of fat in the blood. It’s also associated with diabetes, respiratory disease, gall bladder problems and some cancers.
  • too much alcohol - too much can affect blood pressure and cholestorol, and can cause weight gain
  • physical inactivity - being physically active can keep your weight and blood pressure down to healthy levels

Risk factors we can’t change (non-modifiable)

These include:

  • family history of heart disease and/or stroke - father or brother who developed heart disease or a stroke before they were 55, or a mother or sister before they were 65
  • age - the risk of heart disease increases with age
  • ethnic origin - people with an Afro-Caribbean or South East Asian ethnic background have an increased risk of heart disease
  • gender - men have an increased risk of heart disease

Risk factors we can change (modifiable)

Other cardiovascular risk factors are concerned with your lifestyle choices. Making changes to your lifestyle can improve your overall health and reduce your risk of heart disease. These ‘lifestyle risk factors’ include:

  • smoking 
  • diet and weight
  • diabetes 
  • exercise
  • alcohol 
  • recreational drugs
  • other issues, like high blood pressure, stress and impotence

You can also work out your "risk score" or likelihood of developing cardiovascular or heart disease.

Risk score

When working out the risk of developing cardiovascular or heart disease, we can use a "risk score". In Scotland, the risk score health professionals use is the ASSIGN score. This can be useful for looking at the risk factors people may have.

This score is used in GP surgeries and clinics to assess your risk of heart disease. The assessment consists of discussing your risk factors, and measuring your blood pressure, pulse, height and weight. You will also have a chat about your lifestyle, including diet and smoking habits. You will be directed to useful resources and sometimes asked to visit your GP for further tests.

British Heart Foundation’s tool can help you check your heart age

Smoking

If you have a heart condition, one of the most important things you can do for yourself is to stop smoking. At first it may feel overwhelming to think about stopping. Don’t waste time feeling guilty about the past. Instead, try to think about the future. It’s never too late to stop smoking. Smokeline can help.

You need to make the decision that you really want to stop. Then you can get the help and support you need to give up.

Smoking causes various damage to your body:

  • smoking makes atherosclerosis worse
  • smoking makes the smooth lining of blood vessels rough - this encourages the build up of fatty material that narrows and blocks blood vessels
  • smoking increases the amount of fibrinogen (blood-thickening agent) in the blood and makes it stickier - this increases the chance of blood clots forming that can cause heart attacks and strokes
  • smoking increases blood pressure and speeds up the heart
  • smoking increases your chance of having of heart disease, strokes and many cancers
  • smoking damages the lungs, causing chronic lung disease

The good news is that from the moment you stop smoking, the risks to your health start to decline.

Smoking and heart disease (https://www.youtube.com/watch?v=0zrrqHIrTHI)

Watch Lisa's story on the benefits of giving up smoking on this British Heart Foundation video

For information, support and advice on giving up smoking, try:

Diet and weight

A healthy Mediterranean diet can help reduce your risk of developing coronary heart disease and stop you gaining weight, reducing your risk of diabetes and high blood pressure.

Eating the right amount of the right foods means you get the right amount of energy and nutrients you need to keep your body healthy. Habits developed over the years may contribute to long-term health problems in later life. It’s not just fried breakfasts or regular takeaway meals that are unhealthy for us - any mildly unhealthy food habits are bad for us if we enjoy them frequent enough, like chocolate or sugary drinks. But habits can be changed.

Everyone should aim for a varied, well-balanced diet. The best way to make sure you get a bit of everything you need is to eat a variety of foods from different food groups every day, like:

  • plenty of fruit and vegetables
  • choose wholegrain varieties of starchy foods like bread, rice, potatoes and pasta
  • some milk and dairy products (lower-fat options if possible)
  • some meat, fish, eggs, beans and other non-dairy sources of protein
  • only a small amount of foods and drinks high in fats and/or sugar, particularly processed foods like cakes, biscuits and pastry
  • choose options that are lower in fat, salt and sugar whenever you can

What is your "five a day" of fruit and vegetables?

Fruit and vegetables are a good source of essential vitamins and minerals. They contain lots of special nutrients called antioxidants that help protect the cells in your body from damage and illness.

As a rough guide, fruit and vegetables should make up about a third of everything you eat each day, or at least five portions a day (for example, two portions of fruit and three portions of vegetables).

Some examples of one portion:

  • a banana
  • two plums
  • a couple of broccoli florets
  • one carrot
  • a handful of strawberries
  • two tablespoons of peas
  • fruit juice
  • beans and pulses

All dried, canned and frozen fruit and vegetables count towards your daily portions.

Potatoes don't count, as they're carbohydrates.

Eating at least five portions of fruit and vegetables every day may seem a lot at first. Try to get into the habit of eating some fruit and/or vegetables with each meal.

Eating healthily doesn’t mean you can’t enjoy your favourite foods - it’s all about getting the balance right. Eating healthily can also help to control your weight.

This "eatwell plate" can help you consider the portions of different food groups that are recommended for a healthy eating lifestyle.

More about the eatwell guide

Salt

Too much salt (sodium) in the diet can contribute to high blood pressure which increases the risk of heart disease and stroke. Reducing a high salt intake can help to lower your blood pressure.

Useful small ways to begin to reduce your salt intake include:

  • trying other spices
  • reducing your intake by removing salt from table
  • not adding to cooking are all

Most of the salt we eat is already in everyday foods.

You can lower your salt intake by checking the labels to compare products, and choosing the option lower in salt.

You should aim to have no more than 6g salt per day, and children under 11 should have less than this.

Read more from Chest Heart & Stroke Scotland from their leaflet on Salt (PDF) and from the Food Standards Agency.

Fats and cholestorol

To help look after your heart health, make sure you choose the right type of fats.

Saturated fat - too much saturated fat can increase the amount of cholesterol in the blood, which can increase the risk of developing coronary heart disease. A useful way to remember the difference is to remember saturated fat is usually solid when cold, like butter, lard, and fat on meat.

Unsaturated fats - these can be monounsaturated fats (like olive oil, rapeseed oil, almonds, unsalted cashews and avocado) or polyunsaturated fats (like walnuts, sunflower seeds and oily fish). Both are a healthier choice.

Blood levels

Triglycerides - these are a fatty substance that your body needs. Their main function is to store energy for your body to use. Like cholesterol, triglycerides are produced in your body and are linked to carbohydrate and alcohol intakes.

Cholesterol - cholesterol is produced naturally within your body, mainly in your liver. Cholesterol is often described as "good" or "bad".

LDL-C (low-density lipoprotein cholesterol) is known as "bad cholesterol". It carries cholesterol from your liver to the tissues around your body. The recommended LDL level is below 3.0mmol/l.

HDL-C (high-density lipoprotein cholesterol) is known as "good cholesterol" because it carries surplus cholesterol from the tissues back to your liver to be recycled or excreted. The recommended HDL level is above 1.0mmol/l (for men) and above 1.2mmol/l (for women). It’s useful to "know your number", so ask your doctor or health professional what your number is.

Non-HDL cholesterol (Total-C minus HDL-C) is increasingly used as a measurement, as it gives a better assessment of the risk of heart disease than measuring only LDL. Your non-HDL cholesterol level is found by subtracting your HDL cholesterol from your total cholesterol.

Cholesterol and heart disease (https://www.youtube.com/watch?v=mOPy1f9-L38)

Watch this British Heart Foundation video on cholesterol

Read Chest Heart & Stroke Scotland leaftlet on Cholestorol (PDF) and see more from Heart UK.

Weight 

Being overweight:

  • increases the work the heart has to do
  • leads to high blood pressure
  • causes abnormal levels of fat in the blood
  • is also associated with diabetes, respiratory disease, gall bladder problems and some cancers

Being able to control your weight and keep it within healthy levels can reduce your risk of cardiovascular disease and prevent chronic disease from worsening. It’s a good idea to be as close as you can to your ideal weight. You can do this by controlling your weight through a balance of eating healthily and keeping as active as you can. See Chest Heart & Stroke Scotland’s leaflet Losing weight (PDF).

Your body mass index (BMI) and your waist measurement are both accurate ways of assessing if your weight is within the normal range.

Find out how to measure your BMI 

Diabetes

Diabetes is a condition caused by the lack of the hormone insulin - or your body's inability to use insulin properly - which alters your body’s ability to store or use glucose (the source of energy that comes from carbohydrates/sugars).

It also causes problems in metabolising fats and speeds up the degeneration of blood vessels.

There are two main types of diabetes, each of which require slightly different treatment:

  • type 1 diabetes - you don’t produce any insulin and you have to take regular insulin injections
  • type 2 diabetes - this is mostly caused by insulin resistance linked to being overweight and/or not producing enough insulin. You may have to take tablets, and some people with type 2 have to take insulin eventually.

Diabetes is linked to heart disease and stroke and is one of the major risk factors of heart disease. People who have diabetes are between two and five times more likely to develop heart disease and stroke than people who don't.

Uncontrolled diabetes contributes to damage to the blood vessels and the build-up of fatty deposits in the arteries, which increases the risk of heart disease and stroke.

Chest Heart & Stroke Scotland also have information on controlling diabetes for your heart

Type 2 diabetes and heart disease (https://www.youtube.com/watch?v=O4dw8_ck-LY)

Watch this British Heart Foundation video on type 2 diabetes and heart disease

Exercise

Any increase in your level of physical activity brings benefit both physically and mentally. What and how much you can do will depend on the extent of your heart condition and your individual ability.

If you have a mobility issue or any condition that may make exercise difficult, ask your GP how much and what kind of exercise would be suitable for you before you begin.

You should be fairly active for at least 30 minutes a day, but this doesn't have to be in one go. It can be divided into three lots of 10-minute sections or two lots of 15-minute sections.

Read more from:

Visit Active Scotland if you're looking for ways to get more active but you're not sure where to start.

Alcohol

It’s important to watch your alcohol intake, because drinking more than is recommended can:

  • increase blood pressure
  • affect cholesterol levels
  • cause weight gain

Binge drinking - drinking large amounts over a short period of time - is particularly harmful.

It’s important to be aware of how much alcohol you drink. This is measured by counting units.

In the UK, a unit of alcohol is equivalent to 8g or 10mls of pure alcohol. The strength of alcohol is measured by the percentage of alcohol by volume (%ABV).

It’s the strength and size of a drink that determines how many units it contains. Read the label to know for sure. Home measures are often more generous than those in a pub or restaurant.

It’s also advised you should have at least two alcohol-free days a week.

Find out more about how to drink sensibly

Recreational drugs

There is an increasing issue within prevention of heart disease to recognise the problems that some recreational drugs - like cocaine, amphetamines (speed) and ecstasy - can cause. This can be a problem for your blood pressure which can rise to dangerous levels.

Cocaine causes your coronary arteries to constrict, raising your blood pressure and reducing the blood supply to your heart. During the first hour after cocaine use, the risk of a heart attack increases by nearly 24 times.

The risk of heart disease amongst cocaine users is compounded by other risk factors including smoking and drinking excess alcohol - the combination of all three can be a lethal cocktail.

Learn more from Chest Heart & Stroke Scotland on avoiding recreational drugs.

Talk To Frank if you’re worried about your - or anyone else’s - drug use.

Other issues

High blood pressure isn’t usually something that you can feel or notice, but if you have it, you’re more likely to develop coronary heart disease or have a stroke. You may have undiagnosed high blood pressure and not realise you’re at risk.

Everyone should know their blood pressure, so have it measured by your GP or practice nurse - especially if you’re over 40 - to check your risk of getting cardiovascular disease.

Stress

Some people worry about stress being a heart disease risk factor - stress is not considered a risk factor. However, if you’re under stress, it can become a trigger for unhelpful behaviour which can increase your risk of heart disease, like smoking, drinking too much alcohol, eating poorly and not getting enough physical activity.

To make the necessary lifestyle changes that may reduce your risk of heart disease, it’s helpful to reduce and control the amount of stress in your life as much as possible. This includes recognising if your mood is low.

Breathing Space is a free, confidential phone and web-based service for people in Scotland experiencing low mood, depression or anxiety.

Our mental wellbeing information can help you to improve your mental health and wellbeing by providing high-quality, trustworthy information on different aspects of mental health and wellbeing.

See our Living with a heart condition section for more about coping with a heart condition.

Impotence (erectile dysfunction)

Impotence is the inability to get and maintain an erection that’s sufficient for satisfactory sexual intercourse and is an important issue regarding coronary heart disease risk.

If you’re affected, discuss it with a health professional. This should include screening for heart disease. This is because for around 40% of men who are affected, it’s related to the build up of fatty deposits within the arteries in the legs and the blood supply to the penis.

In around 30% of men, it can be due to diabetes, and diabetes is a risk factor for heart disease. This can be a warning sign that there’s a higher risk of developing heart disease in the following 10 years.

Learn more about erectile dysfunction from British Association of Urology and British Heart Foundation.