Risk Factors for Heart Disease:

By the time you finish reading this sentence one more Indian will have died of heart disease.  To tackle this growing epidemic, we need to take steps to prevent it.  In earlier articles, we have discussed ‘what is heart disease’ and what are the tests to detect it.   Today we shall discuss the risk factors for heart disease.

What are the risk factors for heart disease?

Scientific studies have shown that certain traits and lifestyle habits increase the risk of a heart attack.  These danger signs are called “risk factors.”  The progression of heart disease is a long-term process in which cholesterol and other substances build up in the inner lining of artery walls.  They form plaques, which block the flow of blood to the heart muscle.  Risk factors tend to speed the development of plaque, and by reducing them, we can block the progression of plaque formation and decrease the chances of having a heart attack.  There are two types of risk factors- those which can be modified and those which cannot.

Risk factors that cannot be modified

Age and sex.

As you get older your risk of a heart attack increase.  In our country, men over 35 and women over 55 are at a much greater risk.  Heart disease is no more considered a “man’s disease”.  Women are at equal risk; they just develop it a later age.  Before menopause, women are at a lower risk due to the protective effect of female hormones.

Family history of heart disease.

If a member of your immediate family has heart disease, your risk increases.  This increase in risk may or may not be genetic in origin.  For example, there may be a defect in your liver’s cholesterol clearing mechanism, which may be a genetic trait.  On the other hand, maybe generations in your family have believed in adding large quantities of “ghee” to food, which may be responsible for increased cholesterol levels and subsequently heart disease.

 Risk factors that can be modified.

Diabetes

Indians have one of the highest genetic risks for diabetes.  It is a very serious disease in itself and leads to complications in the eyes, kidneys, and blood vessels, besides being one of the major risk factors for heart disease.  In clinical practice we are observing more patients (and at younger ages) with Syndrome X, also called the ‘Metabolic Syndrome’, in which high blood sugar, high blood pressure, a large waistline, and abnormal lipid values are all clustered together.

High blood cholesterol.

Cholesterol is a waxy substance that is present in the body and is essential for certain functions.  However, when there is excess cholesterol in the body, it deposits in the walls of the arteries supplying blood to the heart and starts the build-up of plaque.  There are different types of cholesterol, but the two most important ones are LDL and HDL.  LDL is called “bad cholesterol”, while HDL is the “good cholesterol.”  You should try and keep your LDL levels down and boost up the HDL level. 

South Asian Genetic Risk Factors (ApoB & Lp(a)): While standard cholesterol tests are important, recent 2026 guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC) highlight that people of South Asian descent possess higher genetic risks that do not always show up on a standard test.

Apolipoprotein B (ApoB): South Asians often carry smaller, denser LDL particles. This means your standard LDL number might look normal, but your ApoB (which counts these more dangerous, plaque-causing particles directly) could be dangerously high.

Lipoprotein(a) or Lp(a): This is a genetically determined, extremely sticky type of cholesterol. Approximately 25% to 35% of South Asians have elevated levels of Lp(a), which significantly increases the risk of early heart attacks. You must explicitly ask your doctor to test for these markers.

Cigarette Smoking and tobacco chewing.

Smoking is the one of the most important preventable causes of premature death.  And it is the most important of the known modifiable risk factors for heart disease.  A smoker’s risk of having a heart attack is more than twice that of a nonsmoker.  Smoking speeds up the development of plaque in the arteries, reduces the level of the good HDL cholesterol, and increases the stickiness of blood cells causing blood clots inside the arteries. 

Blood Pressure

High blood pressure, or hypertension, is often referred to as the "silent killer." The reason for this is that people often suffer severe problems related to arterial damage without being aware that their pressure is high. Modern medical guidelines, including the 2025 ACC/AHA updates, have lowered the target thresholds. High blood pressure is now defined as a reading of 130/80 mm Hg or higher. For every 10 mm Hg reduction in systolic pressure, patients experience a dramatically reduced risk of stroke and heart failure.

Physical Inactivity

This is the easiest risk factor to avoid, and yet for many people, it seems to be the hardest. You do not need to be a marathon runner to reap the benefits of physical activity. The current global standard recommendation is 150 minutes of moderate-intensity aerobic exercise per week (such as brisk walking) to significantly reduce your risk for a heart attack.

Obesity:

As Mumbai becomes more prosperous, so do the waistlines of its citizens. Obesity can lead to diabetes, high blood pressure, and other complications. However, for people of South Asian descent, excess weight—particularly visceral or "belly" fat—accumulates at lower Body Mass Indexes (BMIs). Therefore, monitoring your waist circumference is often a more critical metric than BMI alone. A sensible diet combined with an exercise program is the best way to lose weight; crash diets do not work in the long term and may actually be harmful to the body.

Stress:

Chronic psychosocial stress, anxiety, and depression are now recognized by major cardiac organizations as significant, independent risk factors for heart disease, on par with smoking or hypertension. High stress levels increase inflammation in the body and elevate blood pressure. Actively managing stress through mindfulness, hobbies, or professional support is a critical component of preventing heart disease.

If you manage to keep the above risk factors in tight control, then your risk of developing heart disease will be very low.

Author: Dr. Aashish Contractor is India's pioneer in cardiac rehabilitation and the Founding Medical Director of the Mumbai Marathon. With over 25 years of experience, he has guided hundreds of heart patients to run safely.