Causes and Risk Factors (2024)

Your risk of coronary heart disease goes up based on the number of risk factors you have and how serious they are. Some risk factors — such as high blood pressure andhigh blood cholesterol— can be adjusted throughheart-healthy lifestyle changes. Other risk factors, such as your age, sex, family history, and race and ethnicity, cannot be changed.

Age

Genetic or lifestyle factors can cause plaque to build up in your arteries as you age. Age-related changes in the small blood vessels of the heart also raise the risk for coronary microvascular disease.

In men, the risk for coronary heart disease starts to increase substantially around age 45. Before menopause, women have a lower risk of coronary heart disease than men. After around age 55, the risk for women goes up. This is probably because of hormone changes after menopause.

Environment and occupation

Air pollution in the environment can put you at higher risk of coronary heart disease. The increase in risk may be higher in older adults, women, and people who have diabetes orobesity. Air pollution may cause or worsen other conditions that are known to increase your risk of coronary heart disease, such ashigh blood pressure and inflammation.

Your work can raise your risk if you:

• Are exposed to toxins, radiation, or other hazards
• Have a lot of stress at work
• Sit for long periods
• Work more than 55 hours a week or work long, irregular, or night shifts that affect your sleep

Family history and genetics

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 genesare linked with a higher risk for coronary heart disease.

Lifestyle habits

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

• Being physically inactivecan worsen other heart disease risk factors, such as high blood cholesterol and triglyceridelevels, high blood pressure, diabetes andprediabetes, andoverweight and obesity.
• Not getting enough good-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(chest pain related to the heart) andheart attacks.
• Smoking or long-term exposure to secondhand smokecan damage your blood vessels.
• Stresscan 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 high amounts 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 moreheart-healthy lifestyle.

Other medical conditions

Other medical conditions affecting 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

There are also several medical conditions that are not directly related to your heart and blood vessels that may increase your risk for coronary heart disease, such as:

• Autoimmune and inflammatory diseases, such as Crohn’s disease, ulcerative colitis, psoriasis, lichen planus, pemphigus, histiocytosis, lupus erythematosus, and rheumatoid arthritis
• Chronic kidney disease
• Diabetes
• HIV/AIDS,especially among older adults, in part because of side effects of HIV treatments
• Mental health conditions,including anxiety, depression, and post-traumatic stress disorder (PTSD)
• Metabolic syndrome
• Overweight and obesity
• Sleep disorders,such assleep apneaorsleep deprivation and deficiency

Race or ethnicity

Heart disease is the leading cause of death for people of most racial and ethnic groups in the United States, including African Americans and white people.

For people who are Hispanic, Asian American or Pacific Islander, and American Indian or Alaska Native, heart disease is second only to cancer in causing death. People of South Asian ancestry have a higher risk of developing coronary heart disease and serious complications than others who are Asian American.

Sex

Coronary heart disease affects both men and women. Obstructive coronary artery disease is more common in men. However, 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 are.

If you are a woman who has chest discomfort or shortness of breath during physical activity, ask your healthcare provider about tests to check for nonobstructive coronary artery disease or coronary microvascular disease. Learn about more conditions that increase risk forwomen.