Heart disease is the number one cause of death in the United States, leading to about 695,000 fatalities per year. What’s even scarier: Heart issues can sneak up on you.
“Cardiovascular disease is known as the silent killer for a reason. Unfortunately, the most common symptom of cardiovascular risk is sudden cardiac death,” says Lifeforce Physician Renae Thomas, MD, MPH. “That's why screening, such as through the Lifeforce Diagnostic, is critical to take a proactive approach to your health. Knowing your cholesterol numbers (and their breakdown, such as lipoprotein (a), apolipoprotein B, triglyceride/HDL ratio), and your levels of other key markers such as hs(cardiac)-CRP, hormones, and metabolic health goes a long way to understanding what actions you can take to reduce your risk.”
Beyond your biomarkers, it’s also essential to understand lifestyle liabilities — and not just the obvious ones. “Many people are aware of the big heart health risks such as smoking, cholesterol, high blood pressure, and diabetes. However, there are some risk factors that may go under the radar but can lead to cardiovascular disease if left unchecked,” says Lifeforce Physician Kimberly Hartzfeld, DO, IFMCP.
That may sound alarming, but there’s heartening news, too. You have the power to take your heart health into your hands. “While genetics and family history can influence your cardiovascular risk, there is a lot you can do to minimize your personal risk, and that’s empowering!” Dr. Thomas says. “It does not need to be complicated or expensive. Many relatively simple measures can lead to significant improvements and sizable risk reductions.”
What better time to protect your ticker than American Heart Month? In honor of the occasion, we’re breaking down cardiovascular risks you may have missed, plus ways to counteract them.
8 Heart Health Risks You May Not Be Thinking About…Yet
1. Chronic Stress
Studies show that prolonged periods of stress are linked to an increased risk of cardiovascular events like heart attacks and strokes. “Chronic stress increases cortisol, our stress hormone, which can elevate blood sugar, cholesterol, and blood pressure,” Dr. Hartzfeld explains.
She also notes that takotsubo cardiomyopathy, also known as broken heart syndrome, can occur after sudden and extreme stress like a traumatic event. This phenomenon typically describes a heart attack-like syndrome, where the left side of the heart malfunctions, but without the typical heart attack causes, such as a blockage in an artery or plaque rupture. The condition is most common in women, and it is usually reversible with treatment.
How to lower your risk: We can’t stress this enough: “Making stress management a daily priority is a must,” Dr. Hartzfeld says. “If you can remove the cause of the stress, great! If not, it’s important to learn how to cope with stressors.”
Dr. Hartzfeld suggests stress management techniques like meditation, deep breathing exercises, yoga, walks in nature, and practicing mindfulness. Research shows that people who did regular meditation and mindfulness exercises reduced their cortisol levels and significantly improved their sleep habits, which is also linked to heart health (more on that below). Dr. Hartzfeld recommends the meditation app Insight Timer as a simple hack to get into meditation. (Find more self-care and mindfulness apps here.)
“Some nutraceuticals, specifically adaptogens such as ashwagandha, can help balance cortisol and manage stress,” Dr. Hartzfeld adds. Magnesium has also been shown to support a calm, healthy stress response. Lifeforce Magnesium includes magnolia extract, which can help maintain healthy cortisol levels.
2. Low Testosterone Levels
Low testosterone not only impacts your sex drive, muscle mass, and energy — it can also hurt your heart. In men, observational studies have noted an association between low testosterone and metabolic syndrome and diabetes, Dr. Hartzfeld notes. “Chronically elevated sugar in diabetes can cause damage to blood vessels and nerves in the heart, leading to a higher risk of heart disease,” she says.
A 2009 study showed an increase in transient ischemic attack (TIA) or stroke in men with low-normal testosterone levels. Additionally, a review of the literature in 2011 found an increase in all-cause and cardiovascular death among men with low testosterone levels.
How to lower your risk: It’s crucial to keep on top of your testosterone because, on average, levels drop about 1 to 2% each year starting in your mid-30s. “I recommend consulting a physician if you are experiencing symptoms of low testosterone such as fatigue, brain fog, lack of motivation, reduced libido, and difficulty increasing muscle mass,” Dr. Hartzfeld says. “At Lifeforce, we check hormone labs along with other important biomarkers to assess your hormone health. If testosterone levels are low, there are treatment options — natural and hormone therapy — to help optimize hormones.”
And remember: While testosterone is the primary male sex hormone, it isn’t just a concern for men. Testosterone is also essential for women’s health, so everyone should get their levels checked.
3. Perimenopause and Menopause
The change of life also changes your cardiovascular risks, which surprises many women, says Dr. Thomas. Again, this comes down to hormones.
“Estrogens, which decrease significantly after menopause, have a profound protective effect for cardiovascular health, and many women see their cholesterol levels shoot up as they transition into perimenopause and menopause,” says Dr. Thomas. “This — combined with increasing risk for high blood pressure, metabolic changes, increasing body fat, decreasing activity, and high stress that often happens concurrently around this time — predispose women for changes in their vasculature and arterial structures. Additionally, they can experience increased inflammation and oxidative stress, all of which contribute to higher risk for cardiovascular disease.” Basically, even if you don't have symptoms typically associated with menopause (such as hot flashes and night sweats), you may be facing the perfect storm of factors that can put stress on your heart and increase your risk.
How to lower your risk: During perimenopause and menopause, changing small habits can have a big impact. “You can help mitigate this increased cardiovascular risk with lifestyle shifts such as a low-sodium Mediterranean-style or plant-based diet rich in whole plant foods, smoking cessation, healthy weight loss if indicated, regular physical activity including strength training, and stress management techniques,” Dr. Thomas says. “Some of my favorite simple interventions include consuming psyllium husk and ground flax seeds (1 to 3 tablespoons of each per day).”
You may also want to consider hormone optimization with HRT. “Bioidentical hormone replacement therapy can significantly reduce post-menopause cardiovascular risk when prescribed in an evidence-based fashion to an appropriate candidate,” Dr. Thomas says. Talk to your Lifeforce Clinician about whether this is a fit for you.
Plus, find more ways to protect your ticker during menopause and perimenopause here.
4. Insufficient Quality Sleep
Poor sleep patterns can be a nightmare for your heart. “Insufficient quality sleep increases the chance of developing cardiac risks like high blood pressure, insulin resistance, diabetes, and body fat gain,” cautions Dr. Thomas.
Sleep apnea, which often goes undiagnosed, also increases your risk of high blood pressure, heart failure, coronary artery disease, stroke, and heart irregularities such as atrial fibrillation. In fact, the prevalence of obstructive sleep apnea is as high as 40 to 80% in patients with high blood pressure and cardiovascular disease, according to Dr. Thomas. “Sleep apnea can lead to changes in oxygenation and carbon dioxide, the nervous system, and intrathoracic pressure, which can lead to increased inflammation and atherosclerosis, endothelial dysfunction, hypercoagulability, and metabolic dysregulation,” says Dr. Thomas.
How to lower your risk: Don’t sleep on getting support. “If anyone has ever said you snore, you have daytime sleepiness, high blood pressure, a weight struggle, or just feel like you don’t sleep well, I recommend chatting with your doctor about getting a sleep study and if indicated, appropriate treatment,” Dr. Thomas recommends.
If you don’t have a medical sleep problem, but still have trouble falling or staying asleep, you can work with your Lifeforce Health Coach to find solutions. “Some of my favorite techniques include having a calming nighttime tea, a bedside journal to jot down any racing thoughts, and paraliminal soundtracks,” Dr. Thomas says.
Dr. Hartzfeld also recommends shutting down devices at least an hour before bed, setting a consistent bedtime and wake cycle to support your circadian rhythm, keeping the bedroom cold (65 to 67 degrees), and avoiding caffeine within six to eight hours of bed.
Lifeforce also offers Peak Rest™️, which helps optimize your circadian rhythm for deep, uninterrupted sleep.
5. Poor Dental Health
Here’s a surprising one to sink your teeth into. Studies show that poor dental health can indirectly lead to an increased risk of heart disease. Dr. Hartzfeld explains, “Gum disease develops when there is a buildup of bacteria in the mouth, leading to plaque formation and inflammation of the gums. Bacteria from the mouth can travel through the blood and cause inflammation in the blood vessels, which can damage the blood vessel wall and increase the risk for blood clots, stroke, and heart attack.”
How to lower your risk: Time to brush up on the basics of dental hygiene. Dr. Hartzfeld reminds you to brush your teeth at least twice a day, floss daily, use mouthwash to help reduce bacteria and plaque, and see your dentist regularly for cleaning and checkups. “They can help with early detection of gum disease and plaque buildup,” she notes. Also consider tongue scraping: Research found that tongue scraping twice a day for seven days reduced bacteria in the mouth that causes dental decay and bad breath. Another study showed that tongue scraping impacts the oral microbiome, which can support blood flow and help reduce blood pressure. (More on that here.)
6. Migraines
Besides being a headache, migraines are associated with a higher risk of heart disease and stroke, says Dr. Hartzfeld. This is especially true in migraines with an aura, which is a visual or sensory dysfunction that typically occurs before the onset of a headache. “The mechanism is thought to be due to cortical spreading depression, which is a neurovascular event in the brain that results in a wave of electrical inhibition,” explains Dr. Hartzfeld.
How to lower your risk: Head right to the doctor. “It is important to see a physician if you experience recurrent or severe headaches,” says Dr. Hartzfeld. “Migraines often have triggers such as alcohol, MSG, sugar substitutes, intense exercise, and hormone imbalances, to name a few. Identifying and removing triggers can help reduce the frequency of migraines. If women have migraines with aura, it is recommended to avoid oral estrogen, as it can increase the risk of stroke. Transdermal estrogen is a safer alternative.”
7. Lack of Strength and Muscle Mass
Another reason to hit the gym: There is strong evidence that high skeletal muscle mass is associated with a significantly lower risk of dying from heart disease, especially in men. “It is also linked to lower levels of cardiovascular risk factors, such as high blood pressure, diabetes, and obesity,” says Dr. Thomas. Studies show that muscle strength also has a significant inverse association with cardiovascular-related death.
How to lower your risk: “Physical activity, especially resistance training, is the most straightforward and effective way to increase strength and muscle mass,” says Dr. Thomas. “It is never too late to start! Resistance training has been shown to effectively increase strength and muscle size even for those aged 80+.”
No matter your age, “It is best to start low and go slow, meaning starting with a level of strength training that is relatively easy to begin with, and that you can easily recover from. Then, gradually increase the intensity and quantity over time as your body adapts and improves,” Dr. Thomas suggests.
For those able to perform free weight training, Dr. Thomas recommends compound movements that work multiple muscle groups at once like deadlifts, chest presses, and weighted squats. If you’re not comfortable using free weights (yet!), she suggests machines such as the leg press, shoulder press, and chest press machines. Bodyweight moves like lunges and squats can also be a solid place to start.
8. Elevated Homocysteine Levels
We all know the big-name biomarkers like LDL and HDL cholesterol, but did you ever look at your Lifeforce biomarkers and see homocysteine and think, ‘What’s that?’ “Homocysteine is an amino acid that your body naturally makes, but if it is elevated, it is an independent risk factor for cardiovascular disease,” Dr. Thomas explains. “High homocysteine can cause endothelial cell injury and dysfunction, increased vascular smooth muscle changes, increased platelet adhesiveness, enhanced oxidation of LDL cholesterol, and atherosclerotic plaque build up. The most common causes of elevated homocysteine I see are low methylated B12 levels, low methylated folate levels, low vitamin B6, smoking (both tobacco and marijuana), excess animal protein, genetic influence, and excess alcohol.”
How to lower your risk: Dr. Thomas’s top tips to reduce homocysteine include minimizing alcohol intake, quitting smoking, and increasing fruit and vegetable intake.
She also suggests talking to your Lifeforce Clinician about supplementing with Lifeforce Methylation. It provides critical nutrients including methylated B12 and folate, helps protect your body from environmental pollutants, and supports liver detoxification to help regulate levels of homocysteine.
These tips are just a few ways to take your cardiovascular health to heart. “I often joke with patients and say there are 101 ways to lower your cardiovascular risk, and to some extent that is true!” Dr. Thomas says. “It can often feel overwhelming to try and do them all at once, so I encourage people to pick the easiest ones first and build on your success from there. For example, if finding time to exercise is really hard for you, maybe try a meat-free meal. If you don’t want to change your nutrition just yet, maybe it’s time to get that snoring checked out with a sleep study. The good news is that your efforts all count and can compound over time to significantly decrease your risk.”
This article was medically reviewed by:
Renae Thomas, MD, MPH; ABFM Board Certified in Family Medicine, ABPM Board Certified in Public Health, & General Preventive Medicine; ABLM Board Certified in Lifestyle Medicine
Kimberly Hartzfeld, DO, ABOG American Board of Obstetrics and Gynecology, IFMCP Institute for Functional Medicine Certified Practitioner