When most people think of heart disease, they think of high cholesterol. And while cholesterol is an important piece of the puzzle, it’s far from the only cause.
Heart disease—especially the kind that leads to heart attacks and stroke—is the result of many different factors working together.
Some of these are related to lifestyle, some to other health conditions, and others to genetics. Understanding all the causes, not just cholesterol, can help people better protect their hearts.
One of the most important and often overlooked causes of heart disease is high blood pressure. Also called hypertension, this condition puts extra force on the walls of the arteries.
Over time, that constant pressure damages the arteries and makes them more likely to become stiff and narrow.
According to the World Health Organization, high blood pressure is the leading risk factor for death worldwide and plays a major role in heart attacks, heart failure, and strokes—even when cholesterol levels are normal.
Another major factor is diabetes, especially type 2 diabetes. High blood sugar levels damage blood vessels and the nerves that control the heart. A 2014 review in the Journal of the American College of Cardiology showed that people with diabetes are two to four times more likely to develop heart disease than those without it.
Even people with “pre-diabetes,” where blood sugar is higher than normal but not high enough to be diagnosed as diabetes, are at increased risk.
Chronic inflammation in the body also plays a critical role. Inflammation is the body’s way of fighting infection or injury, but when it becomes long-term (chronic), it can damage blood vessels and promote the buildup of plaque in the arteries.
C-reactive protein (CRP), a marker of inflammation found in blood tests, has been linked to a higher risk of heart attacks. Research in The New England Journal of Medicine found that people with high CRP levels were more likely to have heart disease, even if their cholesterol was low.
Smoking is another powerful cause of heart disease. The chemicals in tobacco smoke damage the lining of the arteries, raise blood pressure, lower good cholesterol (HDL), and increase blood clotting—all of which raise the risk of a heart attack. Secondhand smoke is also dangerous, especially for children and older adults.
Sedentary lifestyle—not getting enough physical activity—is another key factor. Exercise helps keep blood vessels flexible, lowers blood pressure, improves blood sugar control, and raises HDL cholesterol. People who don’t move enough are more likely to be overweight, have diabetes, or develop high blood pressure—all of which increase heart risk.
Stress also plays a surprising role. Long-term stress raises levels of hormones like cortisol and adrenaline, which can increase blood pressure and promote inflammation.
People under chronic stress may also be more likely to smoke, overeat, or avoid exercise—further raising their risk. A study in The Lancet found that chronic stress was just as dangerous for heart health as traditional risk factors like smoking or obesity.
Sleep problems, especially sleep apnea, have also been linked to heart disease. Sleep apnea is a condition where breathing repeatedly stops and starts during sleep, often causing poor oxygen levels and disrupted rest. Studies have found that untreated sleep apnea can raise the risk of heart failure, high blood pressure, and stroke.
Lastly, genetics and family history matter. Some people are born with a higher risk of heart disease, even if they live a healthy lifestyle. Genetic factors can influence blood pressure, cholesterol levels, inflammation, and how the body processes sugar. However, even if someone has a strong family history, healthy habits can still lower their risk significantly.
In summary, high cholesterol is only one piece of the heart disease puzzle. High blood pressure, diabetes, inflammation, smoking, inactivity, stress, sleep issues, and genetics all play a major role. The more of these risk factors someone has, the higher their chances of developing heart problems.
The good news is that many of these causes are preventable or manageable with lifestyle changes, regular check-ups, and, when needed, medication. A heart-healthy life is about more than just lowering cholesterol—it’s about caring for the whole body, every day.
If you care about heart disease, please read studies that herbal supplements could harm your heart rhythm, and how eating eggs can help reduce heart disease risk.
For more health information, please see recent studies that apple juice could benefit your heart health, and results showing yogurt may help lower the death risks in heart disease.
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