Risk Factors

Risk factors are behaviors or conditions that increase your chance of developing a disease. Risk factors for cardiovascular disease are also often risk factors for other chronic diseases. Many risk factors are related. For example, if someone is not physically active, that person is more likely to become overweight and more likely to develop high blood pressure. The following are common risk factors that can lead to cardiovascular disease:

Tobacco Use

People who smoke cigarettes increase their risk for high blood pressure, heart attack, stroke, lung cancer, emphysema, and asthma. In 2013, about 16.6% of adults in New York State were current smokers (Behavioral Risk Factor Surveillance System (BRFSS) - a telephone survey of adults). To learn more about smoking and health, visit the Centers for Disease Control and Prevention and visit the NYSDOH Web site to learn about New York State's efforts to reduce tobacco use.

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Physical Inactivity

Lack of physical activity is a primary risk factor for cardiovascular disease. The risk for cardiovascular disease associated with physical inactivity is similar to that of cigarette smoking. Research clearly shows that physically active people have better health than physically inactive people. Physical activity can reduce the risk of heart disease, type 2 diabetes, osteoporosis, depression, obesity, and some cancers. Physical activity can also help people sleep better, feel better emotionally and mentally and maintain the ability to do activities of daily living, such as putting away groceries or washing hair in the shower.

Some examples of moderate activities include:

  • walking, at a pace of 15 - 20 minutes per mile,
  • climbing stairs,
  • gardening,
  • yard work,
  • moderate to heavy housework, and
  • dancing.

More is better. The health benefits increase with additional minutes and variety of activity. The largest health gains seem to be in people changing from being inactive to getting some physical activity.

The 2008 Physical Activity Guidelines for Americans recommend accumulating 150 minutes of moderate or 75 minutes of vigorous physical activity per week. The time can be accumulated in 10 minute segments. Most New Yorkers don't get enough exercise.Only 57.8% met PA recommendations and 26.7% reported no leisure time physical activity (2013 BRFSS Brief 1505 - a telephone survey of adults).

Walking is the most popular form of physical activity reported by adult New Yorkers on the BRFSS. Forty one percent of NY adults meet the physical activity guidelines by walking. Studies show people can maintain walking for many years. Walking requires no special equipment or training, can be done by most people, and has beneficial health effects. The health benefits of walking include decreased risk of brain function loss, obesity, heart disease, and other chronic diseases. To learn more about physical activity, visit the Centers for Disease Control and Prevention National Physical Activity Plan.

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Poor Diet

Many studies have shown the relationship between diet and cardiovascular disease. A diet rich in fruits and vegetables can prevent the development of and reduce high blood pressure, a major risk factor for cardiovascular disease. When people eat more fruits and vegetables, their blood pressure goes down. Eating certain fruits and vegetables can also benefit your eyes.


As a first step to decrease high blood pressure, the Dietary Approaches to Stop Hypertension (DASH) diet recommends:

  • 8 – 10 servings of fruits and vegetables (equal to 4-5 cups),
  • three servings of low-fat dairy products per day, and
  • for added benefit, the diet recommends decreasing sodium consumption.


A diet high in salt can increase blood pressure and most Americans eat much more than they need. The American Heart Association and the Centers for Disease Control and Prevention recommend consuming less than 2,300 milligrams (mg) of sodium per day. People with high blood pressure or at risk of high blood pressure should eat less salt – no more than 1,500 mg per day. Over 75 percent of the sodium in people's diets comes from processed foods, such as soups, luncheon meats, canned foods, and prepared mixes. To learn more about sodium and high blood pressure, visit the American Heart Association.


Saturated fat and trans fats increase blood cholesterol levels, especially the "bad" LDL cholesterol. Leading sources of saturated fat in the U.S. include:

  • whole milk dairy products, and
  • ground beef.

Trans fats naturally occur in small amounts in meat and dairy products, but the main source of trans fats in the American diet are:

  • commercially fried foods, and
  • baked goods.

Fats that are better for your heart include mono and polyunsatured fats found in:

  • olive and canola oils, and
  • nuts and seeds.

Eating Out

Where people eat influences what they eat. When people eat out, they tend to eat more fat, calories, and sodium and less calcium and fiber than when they eat at home. More than one-third (36%) of adults in NYS consume fast food at least one or more times weekly (Behavioral Risk Factor Surveillance System BRFSS 2013). However, when healthier items cost less than less healthy items, people are more likely to buy them. Also, when people are served smaller portions, they eat less. Increasing portion sizes seem to be related to the increase in obesity and obesity is a significant risk factor for cardiovascular disease. The larger the portion served to a consumer, the more the person eats. This is a large problem in restaurants, where consumers have little control over the size of portions served to them.

The posting of calories in chain restaurants would assist people in making healthier food choices. For more information on calorie posting, visit the Center for Science in the Public Interest.

Some counties in NYS and New York City require chain restaurants to post calories on their menus and menu boards. The calorie postings can help people make healthier choices by selecting meals under 600 calories.

Sugary Beverages

Drinking sugar-sweetened beverages (SSB), such as soda and energy drinks, increases the risk of becoming overweight or obese. Even drinking just one soda per day has been linked with an increased risk. In New York State, more than one in five adults (22.3%) drinks at least one or more soda or other SSB per day. (Behavioral Risk Factor Surveillance System (BRFSS) 2013 BRFSS Brief 1503). The best drinks for good health are water and low-fat milk. For more information on SSB and health, visit the Center for Science in the Public Interest.

Dietary Guidelines for Americans

For overall good health, the Dietary Guidelines for Americans recommend eating:

Key Recommendations

  • Consume a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level.

A healthy eating pattern includes:

  • A variety of vegetables from all of the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other
  • Fruits, especially whole fruits
  • Grains, at least half of which are whole grains
  • Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages
  • A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products
  • Oils

A healthy eating pattern limits:

  • Saturated fats and trans fats, added sugars, and sodium

Key Recommendations that are quantitative are provided for several components of the diet that should be limited. These components are of particular public health concern in the United States, and the specified limits can help individuals achieve healthy eating patterns within calorie limits:

  • Consume less than 10 percent of calories per day from added sugars
  • Consume less than 10 percent of calories per day from saturated fats
  • Consume less than 2,300 milligrams (mg) per day of sodium

New Yorkers are not meeting dietary recommendations. In 2013, one in three adults (34.5%) in NYS reported consuming fruit less than one time per day, while 22% reported consuming vegetables less than one time daily. (Behavioral Risk Factor Surveillance System (BRFSS) 2013 BRFSS Brief 1504). The average American adult only consumes one ounce of whole grain products per day.

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Obesity by itself puts people at risk for cardiovascular disease. Obesity is also a risk factor for increased blood pressure, diabetes, arthritis, and some cancers. In 2013, one-quarter (25.4%) of adults in New York State (NYS) are obese and another 36% are overweight, an estimated 8.9 million residents (Behavioral Risk Factor Surveillance System (BRFSS) 2013 BRFSS Brief 1502). To learn more, visit the NYSDOH obesity pages and the Centers for Disease Control and Prevention. If overweight or obese, losing even a little weight decreases people's risk for cardiovascular disease.

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High Blood Pressure

Blood pressure is the force of blood against the wall of the arteries. Blood pressure is often written as two numbers. The systolic pressure, the top number, measures the force of blood when the heart contracts and pumps blood into the arteries. The diastolic pressure, the bottom number, is the pressure when the heart is relaxed between beats.

There are three levels for blood pressure:

  • Normal Blood Pressure is a systolic pressure less than 120 mm/Hg and a diastolic pressure less than 80 mm/Hg
  • Prehypertension is a systolic pressure between 120-139 mm/Hg or a diastolic pressure between 80-89 mm/Hg
  • Hypertension is systolic pressure of 140 mm/Hg or higher or a diastolic pressure of 90 mm/Hg or higher (For people with Diabetes hypertension is defined as systolic pressure of 130 mm/Hg or higher or diastolic is 80 mm/Hg or higher)

Having high blood pressure, also known as hypertension, increases your risk for heart disease, stroke and other serious conditions, such as kidney disease and blindness. If you have high blood pressure, keeping it controlled (below 140/90 mm/Hg) can reduce your risk. Nearly 1 in 3, or 4.6 million adults in New York report being told by a health professional they have high blood pressure (30.7%). Among that group, three-quarters (77.6%) are taking medication to control their HBP. (Behavioral Risk Factor Surveillance System (BRFSS) 2011 BRFSS Brief 1303).

High Blood Pressure has many risk factors, some you have control over and can reduce through lifestyle changes:

  • Overweight or Obesity
  • Diet high in salt or sodium
  • Lack of physical activity
  • Drinking too much alcohol
  • Smoking tobacco

Some risk factors you cannot control:

  • Age – Risk increases with age
  • Race – African Americans have a higher risk
  • Family History – People with family members with hypertension have a higher risk

For people with prehypertension, paying attention to their health is very important to reduce the chance of developing hypertension and needing to take medication for the rest of their lives to control it. To avoid prehypertension and hypertension:

  • be physically active,
  • eat more fruits and vegetables,
  • lose weight if overweight,
  • maintain weight if normal weight, and
  • eat less sodium.

To learn more about high blood pressure visit the Center for Disease Control and Prevention, the American Heart Association and the National Heart Lung and Blood Institute.

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High Blood Cholesterol

Cholesterol is a waxy, fat-like substance in the body. It is needed for normal body function, such as making hormones and vitamin D. When there is too much, it can build up in arteries causing heart disease and stroke. The two major types of blood cholesterol are low density lipoprotein (LDL) and high density lipoprotein (HDL). LDL is the "bad" cholesterol that can clog arteries and HDL is the "good" cholesterol that carries excess cholesterol away. In 2011, 80% of adult New Yorkers had their cholesterol checked in the past five years, and 39% who had their cholesterol checked were diagnosed with elevated cholesterol (Behavioral Risk Factor Surveillance System (BRFSS) 2011 BRFSS Brief 1307). To learn more about elevated blood cholesterol, visit the Centers for Disease Control and Prevention.

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Diabetes is a disease in which the body does not make any insulin or can't use the insulin it does make as well as it should.

Insulin is a hormone made in the body. It helps glucose (sugar) from food enter the cells where it can be used to give the body energy. Without insulin, glucose remains in the blood stream and cannot be used for energy by the cells.

Over time, having too much glucose in the blood can cause many health problems, including:

  • heart disease,
  • kidney disease,
  • blindness, and
  • limb loss.

In 2011, an estimated 1.5 million adult New Yorkers (10.4%) have been diagnosed with diabetes. (Behavioral Risk Factor Surveillance System (BRFSS) 2011 BRFSS Brief 1306). To learn more about diabetes, visit the NYSDOH diabetes pages.

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Multiple Risk Factors

Cardiovascular disease rarely develops from a single risk factor. Risk factors usually occur together. Even a small increase in one risk factor becomes more important when combined with others. This makes it very important to reduce the risk factors one can control. Regardless of the number of risk factors people have for cardiovascular disease, they should work with their health care providers to reduce those risks.

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