By Daniel G. Graetzer, Ph.D.
Faculty Member, School of Health Sciences

Note: For American Heart Month, this article is part 1 of a two-part series on heart health. This article discusses the secondary risk factors for heart disease and what you can do to maintain better physical and mental health.

There are several secondary risk factors for heart disease. Some of these risk factors – such as age, gender and race – cannot be changed. However, other risk factors such as a sedentary lifestyle, obesity, or a high stress level can be altered to increase your cardiovascular health and reduce your risk of heart disease.

Age, Gender and Race

Increasing age is associated with an increase in heart disease, probably related to an increase in your body weight due to a poor diet and sedentary lifestyle. Males have a substantially higher risk of heart disease than females. This higher risk continues until women pass menopause, after which the risk of heart disease remains equal.

Physicians once thought that female hormones such as estrogen provided some protection against heart disease in premenopausal women. However, recent studies investigating this possibility showed just the opposite. Men given female hormones during these studies were found to have a greater incidence of heart disease.

Race may also be a distinct risk factor in heart disease. For instance, Blacks generally have higher blood pressure than whites.

Sedentary Lifestyle

Becoming more active, especially as you age, can be beneficial for your heart. Individuals who expend less than 2,000 calories per week through exercise have a higher risk of heart disease than active persons. The relative risk of heart disease among the sedentary is about twice that of moderately active individuals.

Maintaining your physical fitness during the aging process improves blood supply to the heart, increases the amount of blood the heart can pump out per heartbeat (thus reducing your heart rate) and improves blood clotting. In addition, physical fitness reduces blood pressure in hypertensive persons, normalizes the blood lipid profile, reduces body weight and relieves psychological stress.

The American College of Sports Medicine (ACSM) recommends that moderate-intensity exercise sessions be conducted three times per week for 30 continuous minutes at 50 to 85% of the maximum heart rate reserve. You can estimate your target heart rate at 70% of its maximum capacity by using the following formula:

1. Subtract your age from 220 for your maximum heart rate. For example, if you are 40 years of age, your maximum heart rate would be 180.
2. Calculate your resting heart rate by measuring it when you’re at rest (generally 60-100 for an average adult).
3. Subtract your resting heart rate from your maximum heart rate.
4. Multiply the resulting number by .70.
5. Add the resulting number to your resting heart rate.

Exercises that use large muscle groups, can be maintained continuously and are rhythmic in nature are most effective in improving your physical health. These activities include regular walking, jogging, running, cycling, swimming and rowing. Weight training is generally less effective than endurance activities, but it can be useful in improving your muscle strength.

Obesity

The relationship of obesity to heart diseases appears to be co-dependent; being overweight also causes hypertension, elevated cholesterol, diabetes and sedentary living. Obesity is generally defined as a body weight that exceeds 20% of the desirable weight for a given age, gender, and skeletal frame.

A diet and exercise program with the goal of reducing one to two pounds of body fat per week is the most flexible, effective way to reduce body fat percentage, decrease body weight and maintain muscle mass. When energy input is equally compensated by energy output, the body is said to be in equal caloric balance. In other words, if you burn off the same number of calories you consume, your body weight will remain the same.

 When input exceeds output, your body will gain weight (positive caloric balance); when output exceeds input, your body will lose weight (negative caloric balance). To lose one pound of fat per week, your body needs to be in a negative caloric balance of 500 calories per day. 

A diet and exercise program allows considerable flexibility in accomplishing this goal. For example, eliminating a 300-calorie milkshake from your diet and adding a 200-calorie half-hour workout in a day will achieve a 500-calorie deficit.

Over seven days, this change burns the 3,500 calories that are stored in one pound of fat. A nutritionally sound diet with a mild calorie restriction, combined with regular exercise, can safely reduce your percentage of body fat and your body weight, while also enabling you to develop and maintain lean muscle mass.

Psychological Stress

People with an extreme sense of time urgency, aggressiveness and competitiveness (Type A personalities) are generally at higher risk for heart disease. These individuals are usually deeply dedicated to their profession – often to the exclusion of other aspects of their lives – and have a sense of restlessness and guilt during leisure hours.

Job burnout leading to chronic fatigue syndrome and suppression of the immune system is also associated with emotional stress. Although classifying people into Type A and Type B personalities may be greatly oversimplified, recent research shows that anger and hostility may account for the increased heart disease in persons classified as being Type A.

This increase in heart disease may be related to increased sympathetic nervous system activity and the secretion of catecholamines such as epinephrine (adrenaline). For example, higher epinephrine levels in the morning may account for why heart attacks occur three times more often in the morning than later in the day.

Related link: 5 Habits to Improve Your Physical and Mental Health

Now Is an Especially Important Time to Maintain Your Health

Unfortunately, the current COVID-19 pandemic has created a “perfect storm” for mental health challenges related to isolation, anxiety, and depression – all of which can elevate heart disease risk both in the short and long term. A recent writeup in Psychology Today suggests these tips to deal with pandemic-induced stress:

1. Remember you are not alone.
2. Establish healthy habits.
3. Do not dwell on grief.
4. Remember to laugh.
5. Understand good vs. bad anxiety.

A clear focus on maintaining physical and mental health is important all the time but is particularly critical during this pandemic. Do all you can to reduce risk factors you can control, and do not stress out too much about factors that you cannot control. In the words of the Serenity Prayer written by Reinhold Neibuhr (1892-1971), have the “serenity to accept the things I cannot change; courage to change things I can, and wisdom to know the difference.”