CHD Risk Factors: An Update
Chester J. Zelasko, Ph.D. | September 2, 2003

You probably know of people who seemed to be doing everything right but died suddenly of a heart attack. They were normal weight, didn't smoke, and didn't have high cholesterol, high blood pressure, or diabetes. They seemed to be healthy--yet they had a heart attack and died. Until now, physicians and scientists have acknowledged that 50% of those who die of coronary heart disease (CHD) have no risk factors; they simply attributed it to genetics. New research may change that perception.

In a recently published study in the Journal of the American Medical Association (1), researchers demonstrated through a meta-analysis (analysis of the results of many studies) that 90% of those who die from heart attacks have at least one of four risk factors for CHD:

  • High blood pressure
  • High cholesterol
  • Cigarette smoking
  • Diabetes
The overwhelming top risk factor was high blood pressure. In a past Newsletter, we discussed the new recommendations for desirable blood pressure (2). While controversy still rages in the medical community over these recommendations months after they were published, this Risk Factor Study clearly demonstrates that a systolic blood pressure greater than 120 mm Hg and/or a diastolic blood pressure greater than 80 mm Hg is a risk factor for CHD. The same is true for cholesterol. The risk for CHD began to increase at 200 mg/dl, not 240 mg/dl as previously thought.

What's interesting is that all these risk factors are modifiable through lifestyle changes.

  • Lose weight: hypertension, elevated cholesterol, and the risk of developing diabetes can be decreased by attaining a normal body weight.
  • Exercise: regular exercise reduces blood pressure, lowers total cholesterol and increases HDL cholesterol, and reduces the risk of developing diabetes.
  • Eat a better diet: more fruits and vegetables, less saturated fat, and fewer refined carbohydrates can lower all risk factors.
  • Quit smoking: cold turkey, the patch, whatever it takes to quit--do it!
  • Take dietary supplements: fish oil and bonito protein can help blood pressure, fish oil, garlic, and theaflavin (green tea extract) can help with cholesterol, and chromium picolinate and vitamin E can help with diabetes. No supplement cures a disease, but supplements can provide the nutrients your body needs to help itself get well.
As always, work with your physician in putting together a plan to address each risk factor with lifestyle changes and if necessary, medications as well. It's more important to reduce the risk factor than it is to debate whether you want to take a medication or not.

What about those people who didn't have risk factors? It may be more correct to say that they didn't have any apparent risk factors. This research is suggesting that we should be screened early--beginning at 18 years of age--and we should address any negative changes in our risk factors immediately.

If you're going to live life to its fullest, you must have good health. Not addressing each of your risk factors for CHD is like playing Russian roulette with only one chamber empty. You don't have to address each risk factor at once, but you should systematically work on each risk factor until it's in the healthy range.


  1. Greenland, P et al. Major Risk Factors as Antecedents of Fatal and Nonfatal Coronary Heart Disease Events. JAMA. 2003;290:891-897.
  2. High Blood Pressure: An Update. The Newsletter, 5/20/2003.
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