There are several risk factors for developing heart disease; high LDL cholesterol is only one. Family history plays a significant role. If your father had a heart attack or stroke prior to age 55 or your mother had a heart attack or stroke prior to 65, you have a higher risk. The same increased risk factor applies if your siblings had heart attacks or strokes in those age brackets. High blood pressure, smoking cigarettes, diabetes, chronic kidney disease, being 30% or more over your ideal body weight (as determined by your BMI), metabolic syndrome, leading a sedentary lifestyle, HDL of less than 40 mg/dL and women with premature menopause all increase your heart attack and stroke risk factors. A previous personal history of any kind of cardiac event also puts you at a higher risk of having a heart attack or stroke.

Exercise and other physical activity a preventive for heart disease

Steady exercise or physical activity is a very real and effective way to reduce the risk of heart attacks and strokes. Cardiovascular exercise is the best way to strengthen your heart muscle, raise HDL levels and reduce blood pressure. To get the most heart health benefit out of any exercise routine, you need to get your heart rate elevated. If you have not exercised for an extended period of time and otherwise lead a sedentary lifestyle, you should consult your physician before starting any exercise program. Once you have been given the go ahead you still need to start slow and increase your exertion at a rate you are comfortable with for two reasons. First is your muscles including your heart need time to build up. Trying to do it all at once will make you sore and may not be the smartest for your heart. The second reason is that if you injure yourself by using muscles and tendons that are not accustomed to that kind of intense use, you may end up with injuries or be so sore that you don’t feel like staying consistent with your exercise routine. Consistency is the most important aspect. You will increase your conditioning quickly if you are regular with your newfound exercise routine.

Knowing the offsetting factors

There are various positive factors that help offset risk factors. High levels of HDL or "good" cholesterol are very beneficial in preventing heart disease or at least offsetting risk factors. The Framingham study and others have suggested that for each single point increase in HDL, there is a corresponding drop in your risk of having a heart attack by 2%-3%. Some of us are just plain lucky and are born with high HDL. Others are not so fortunate and struggle to raise their HDL and even with excessive physical activity are helpless to raise it. HDL below 40 is considered a risk factor. HDL of over 60 is considered a positive factor for heart disease. Total cholesterol readings are not the best barometer of heart disease risk. Even though high HDL levels and low LDL levels are no guarantee, your risk factors are most assuredly reduced with high HDL and further reduced with low LDL levels. Overall or total high cholesterol levels are less accurate as a predictor but most often a high total cholesterol reading is attributable to high LDL.

Estrogen production, is it another factor?

Women who have not gone through menopause have a much lower rate of heart attacks and strokes than men. It is said that Estrogen production reduces heart disease risk. However after menopause, women are 2-3 times more likely to have heart attacks than women who have yet to go through menopause and are the same age. Although premenopausal women are less likely to have heart attacks than men that is not the case after they stop producing estrogen with menopause. A 2002 study showed that women on hormone replacement therapy had more heart attacks, strokes, breast cancer and blood clots than women not taking hormones. Therefore, Hormone replacement therapy is not the answer.

What risks provide the most benefit?

There are differences in each risk factor as it relates to lessening the chance of heart attacks or strokes when changes are made. A survey of risk-reduction strategies by Harvard researchers showed these risks and benefits:

A person who maintains a healthy body weight as he or she gets older, or keeps body weight near "ideal," has a 45% lower risk.

Decreases the risk for heart attack by 50% one year after a person quits smoking

10% of reducing total cholesterol cuts heart attack risk by 20 to 30%

Being inactive almost doubles the risk of coronary artery disease.

Other risk factors for heart disease are currently under further investigation.

Lipoprotein(a) or Lp(a) is a molecule of LDL with an extra protein attached. There is a hypothesis that the existence of Lp(a) and high levels of LDL are of concern. Not so much for people with normal LDL levels.

Elevated fibrinogen levels although present in people with heart disease, it has not been proven that lowering fibrinogen lessens the risk of heart attacks. Ways to reduce fibrinogen include exercise, weight loss, smoking cessation, low dose aspirin, low dose alcohol and eating a lot of fish.

Homocysteine level reductions have not been proven to lessen the risk of heart attacks.

C-Reactive Protein or CRP is the most recognized of the risk factors and measures the amount of inflammation in the arteries.