Reduce your risk by targeting the 5 main causes of heart disease
June 12, 2026
Like the moon landing or the global spread of the internet, progress made in the fight against heart disease is one of humankind's greatest modern achievements. Collaboration among doctors, public health professionals, and researchers has cut the risk of cardiovascular disease nearly in half over the past 50 years.
This reduction is significant. But success does not mean we should become complacent in our work to better understand and prevent heart disease and stroke, particularly in young adults.
Stroke prevalence rose 14.6% among people ages 18-44 and 15.7% among those in the 45-64 age group from 2011–2022. Deaths from a first-time heart attack among adults 18-54 increased 1.2% during the same period. Heart disease is still the leading cause of death in the U.S., with stroke coming in fourth.
But the most important takeaway? 80% of these cases are preventable.
Since UT Southwestern launched the preventive cardiology program just over 20 years ago, we have seen doctors and patients become more vigilant about preventing first-time heart attacks and strokes by managing five main cardiovascular risk factors earlier in life.
Top cardiology risk factors
Here are the top five risk factors for cardiovascular disease:
Cardiovascular disease is a slow-growing condition whose origins begin in childhood, making prevention a lifelong project. While some risk factors are influenced by genetics, your personal risk is much more in your control than you might think. Let’s discuss the latest advancements in each of these risk factors and how you can reduce your personal risk of serious health complications associated with heart disease.
Related: “Four people who should see a preventive cardiologist”
Tips to reduce heart attack and stroke risk
1. Hypertension
Hypertension, or high blood pressure, affects nearly half of U.S. adults. It is the leading preventable cause of cardiovascular disease and contributes to one in five deaths globally. Hypertension has been called "the silent killer" for decades and for good reason: Most people do not notice physical symptoms of the disease until it causes damage to the heart, brain, or kidneys.
In 2025, the American Heart Association (AHA) and the American College of Cardiology (ACC) released new guidelines for the prevention, detection, and treatment of high blood pressure. One of the biggest changes is the recommendation that people start blood pressure treatment sooner – when it is regularly at or above 130/80 mm Hg instead of 140/80 mm Hg, and occasionally treating to get BP under 120/80 in those at highest risk.
What blood pressure readings mean:
Your blood pressure is measured in millimeters of mercury - mm Hg - and involves two numbers: a systolic pressure on top and a diastolic number on the bottom.
- Normal blood pressure: Less than 120/80 mm Hg
- Elevated blood pressure: 120-129 mm Hg and <80 mm Hg
- Stage 1 hypertension: 130-139 mm Hg or 80-89 mm Hg
- Stage 2 hypertension: ≥140 mm Hg or ≥90 mm Hg
Lifestyle changes are key in preventing hypertension. Follow these steps, along with specific recommendations from your doctor:
- Avoid alcohol, which increases blood pressure and inflammation and disrupts sleep. If you drink, limit yourself to two drinks a day for men and one a day for women. A drink is 12 ounces of beer (5% alcohol), 8 ounces of malt liquor (7% alcohol), 5 ounces of wine (12% alcohol), or 1.5 ounces of liquor (80 proof). It is important to note that even one drink a day can increase blood pressure and the risk of hypertension.
- Follow the Dietary Approaches to Stop Hypertension (DASH diet) and consume less sodium – a known driver of high blood pressure
- Eat potassium-rich foods such as bananas and sweet potatoes. Use salt substitutes with potassium to help your kidneys remove excess sodium and promote the normal functioning of your blood vessels.
- Maintain a healthy weight to reduce inflammation and reduce the heart’s workload.
Most people with high blood pressure benefit from taking medication to keep their numbers in check. There are numerous traditional medications, and more recently, long-acting drugs such as small interfering ribonucleic acid (siRNA) medications that can help control blood pressure with daily, monthly, or semi-annual doses. Stay on top of your blood pressure by taking readings regularly at home. Share the results with your doctor for a big-picture look at your blood pressure trends over time. Together, you can set a goal for your optimal blood pressure – for most patients, this should be below 120/80 mm Hg.
2. Type 2 diabetes
Type 2 diabetes, a disease in which the body does not properly respond to insulin, is common in the U.S. More than 40 million Americans have diabetes, and 90%-95% of those people have Type 2. Rates of Type 2 diabetes have climbed in tandem with rates of obesity.
Diabetes can cause a variety of health problems, including:
- Increased risk of heart disease and stroke
- Increased inflammation
- Eye and vision problems, including vision loss
- Kidney disease, which can lead to kidney failure
- Nerve problems, such as neuropathy
Diabetes is diagnosed by the amount of glucose (sugar) circulating in your blood. This is measured by an A1C test, which is a simple blood test that reflects your average blood sugar levels over the previous three months. For most people, a healthy A1C level is below 5.7%; a level between 5.7% and 6.5% indicates prediabetes – the precursor to Type 2 diabetes. Unfortunately, many people do not get diagnosed until they have already had diabetes or pre-diabetes for a decade or more.
Basic lifestyle measures, such as exercising regularly and eating a diet rich in fiber and whole grains, and GLP-1RA medications such as semaglutide and tirzepatide can help prevent and even reverse Type 2 diabetes. If you have or are at risk for this disease, talk with a doctor about what you can do to reduce and control it. And importantly, make sure you know your blood glucose numbers.
Related: Read “How diabetes reached epidemic proportions, and what we can do about it”
3. Obesity
In the U.S., nearly 42% of adults and 20% of children have obesity. This metabolic disease causes dysfunction in the use and storage of energy (calories) a person consumes. Obesity is complicated by multiple risk factors, from environment and genetics to lifestyle, emotional wellness, nutrition, and societal barriers to regular health care.
Obesity involves more than just weight; it increases the risk of heart attack, stroke and other life-altering illnesses, including:
- Depression
- Diabetes
- Cancer
- Osteoarthritis
- Sleep apnea
- High blood pressure
Preventive care and guidance from medical experts can reduce the chances of a metabolic condition progressing to heart disease. Your relationships with your body, with food, and with physical activity and exercise will always be deeply personal parts of your life. Having a broad range of treatment options means that your care plan for preventing and treating obesity can be highly personalized as well.
Part of this evolution is the emergence of GLP-1RA medications designed to treat weight loss. Other methods to support sustained weight wellness include:
- More sophisticated body composition measurements such as dual-energy X-ray absorptiometry (DEXA) scans, which measure bone density, fat distribution, and muscle mass
- Bariatric surgery, which revises the stomach and affects hormonal pathways that influence appetite
- Team-based weight wellness care, which brings together experts in nutritional, psychological, and physical aspects of obesity treatment to your care plan
4. High LDL cholesterol
LDL cholesterol is low-density lipoprotein cholesterol, the form commonly referred to as "bad" cholesterol. Like all cholesterol, LDL cholesterol is a waxy, fat-like substance that your liver produces to help transport helpful fats and proteins to different parts of your body. Having too much of it can cause plaque buildup that clogs your arteries, which can lead to a heart attack or stroke.
For most people, having high LDL cholesterol is a result of long-term nutrition and exercise habits. About 1 in 250 people have familial hypercholesterolemia, an inherited genetic disorder that causes high levels of LDL cholesterol independent of diet and lifestyle, increasing the risk of cardiovascular problems.
Fortunately, we have made great progress in reducing levels of LDL cholesterol across the population. Lifestyle changes are key:
- Follow the Mediterranean diet, which emphasizes plant-based foods, lean proteins, and whole grains; reduce foods high in saturated fat and cholesterol
- Exercise for at least 30 minutes a day, at least five days a week
- Achieve and maintain a healthy weight
Along with lifestyle changes, many people also benefit from cholesterol-lowering drugs. UT Southwestern has been at the forefront of the development and research on these advanced medications.
UTSW scientists Michael Brown, M.D., and Joseph Goldstein, M.D., won a Nobel Prize in 1985 for discovering the low-density lipoprotein (LDL) receptor, which controls the level of cholesterol in the blood and in cells. That discovery led to the development of statins, one of the most well-studied and widely used medications to help regulate cholesterol. They reduce the amount of cholesterol the liver makes and help it remove more cholesterol from the blood. Statins are proven safe and effective in preventing heart attacks and strokes, especially when combined with healthy lifestyle changes.
UTSW cardiologist Ann Marie Navar, M.D., Ph.D., Associate Professor of Internal Medicine and in the Peter O’Donnell Jr. School of Public Health, was a co-author on a new set of guidelines for cholesterol management published in 2026, which highlights better risk assessment and treating high cholesterol earlier.
Helen H. Hobbs, M.D., an Investigator of the Howard Hughes Medical Institute and Professor of Internal Medicine and Molecular Genetics at UT Southwestern, won the Breakthrough Prize in Life Sciences for identifying key genes involved in lipid metabolism with research partner Jonathan Cohen, Ph.D. This research contributed to the groundbreaking development of PCSK9 inhibitors, which block the PCSK9 protein, enhancing the body’s ability to remove LDL cholesterol from the blood. PCSK9 inhibitors medications can reduce LDL cholesterol by up to 60%.
Choose UTSW for cardiovascular care
UT Southwestern’s cardiovascular specialists use the latest diagnostic tools and treatments to help our patients live longer, healthier lives.
5. Smoking
Cigarette smoking used to be the leading preventable cause of death in the U.S. Cigarette smoke wafted through airplanes and restaurants, even in offices and college classrooms. Along with lung cancer and emphysema, smoking is also a major cause of heart disease. Toxic chemicals in cigarettes can cause or accelerate a range of cardiovascular issues, including:
- Damage to blood vessels and heart chambers
- Plaque buildup in arteries
- Hypertension
- Chronic inflammation
- Blood clot formation
Nicotine-containing products such as vapes are often targeted at young people and have replaced cigarettes among many populations. But there is good news: Research suggests that less than 10% of the population smokes cigarettes, a number that has declined significantly since 2009. This is a public health victory that should give us all optimism about the potential for unhealthy behaviors to change over time. However, with the many new nicotine products emerging, we have to remain vigilant to these new threats to heart health.
Related: “Kicking the nicotine habit: get free support to quit smoking or vaping”
Keep the momentum going
Countless doctors, researchers, nurses, patients, and family members have contributed to the collective victories against heart disease. Prevention starts with awareness. By being more conscious of these five major contributing factors day to day, we can continue to improve our nation’s heart health.
To talk with an expert about heart disease prevention, make an appointment by calling 214-645-8000 or request an appointment online.
