Updated on December 1, 2023.
You’re likely aware of some of the major risks for heart disease, like smoking, living a sedentary lifestyle, and eating an unhealthy diet. But there are certain subtler factors—including habits and environmental influences—that may affect your heart disease risk without your even realizing it, according to the American Heart Association (AHA). Here are five to consider.
Air pollution
Dirty air can be a hazard, according to the AHA, especially for the elderly or those who have already been diagnosed with heart issues.
“We know that in cities within certain countries that experience increased air pollution, like in China, instances of coronary artery disease are on the rise,” says Oleg Chebotarev, MD, a cardiologist with Hamilton Cardiology Associates and director of the coronary care unit at St. Francis Medical Center in Trenton, New Jersey.
“The problem is that there’s not much you can do about air pollution if you live in certain areas,” explains Dr. Chebotarev. That said, you can check the air quality index before leaving the house and stay indoors on poor air quality days. Or, if you must go out on a day with unhealthy air quality, consider wearing a protective mask.
But you don’t necessarily have to be a city dweller to be exposed to air pollution. Things like wildfires can affect air quality. Smoking, needless to say, also has a big impact.
It's worth remembering that air pollution doesn't always come from the outdoors. Cooking or heating with solid fuels (such as wood or coal), for example, creates indoor air pollution, which research suggests may contribute to an increased risk of heart disease.
Whatever the source of the pollution, keep in mind you can still adopt heart-healthy lifestyle habits. A study published in July 2018 in the Journal of the American Heart Association found that the benefits of regular outdoor physical activities like walking, gardening, and cycling outweigh the potential risk of exposure to outdoor air pollution. If you have the choice, it’s always better to avoid exercising along busy roads and to opt whenever possible for small streets, local parks, or green areas (more on that below).
If you need another reason to stick to a heart-healthy eating plan, the Mediterranean diet may help ease the negative effects of pollution on heart health.
Lack of access to green space
Don’t let the idea of pollution scare you—it’s still essential to get outside on a regular basis. That’s because spending time outdoors is connected with healthy behaviors like being active and eating right, as well as improved mental health, according to the AHA.
What’s more, people who have access to green space near their homes may have a lower risk of heart disease, suggests a study published in December 2018 in the Journal of the American Heart Association. Access to green space may also have a protective effect when it comes to heart attack- and stroke-related mortality.
Not everyone lives close to parks, of course. The key is to carve out time when you can to be outdoors as much as possible. “The issue is more problematic in northern states and cities, and it’s broader than just a lack of green space itself,” says Chebotarev. “It’s also important to spend time outside and get natural sunlight.”
If your community has insufficient access to green space or safe places for walking, don’t be afraid to get in touch with local officials to push for action. “While putting in more parks and green spaces in cities would be nice, it’s also about making towns and cities more pedestrian- and bike-friendly,” adds Chebotarev.
Loneliness or social isolation
One’s mental and emotional well-being can also have an impact on heart health. Loneliness and social isolation are risk factors for heart disease and have been found to increase cardiovascular-related mortality.
“Issues like loneliness and depression can result in a lack of interest in and a lack of compliance with medication and proper diet and exercise, which directly affect heart health,” explains Chebotarev.
So, it’s important to prioritize your mental health just as much as your physical health. The good news? Taking certain steps to live a heart-healthy lifestyle can help you stay physically and mentally well.
“My personal recommendation is to join different sports groups,” says Chebotarev. “I’ve found that to be a great way to socialize, particularly in this age of social media where most interactions are not in real life.” Meeting people while working out at the gym, playing soccer or softball—or simply walking through your neighborhood if it's safe to do so—can provide a bonus mental health benefit akin to what you’d find with support groups, classes, or spiritual gatherings.
Unmanaged stress
“Stress is unavoidable, regardless of your age, occupation and level of education,” says Chebotarev. “Each and every one of us is exposed to stressful situations.” Over time, stress can contribute to heart issues by raising blood pressure and cholesterol levels.
“The important thing is how you deal with stress,” says Chebotarev. Avoid coping mechanisms like smoking, drinking, and stress-eating, as these habits can negatively affect your heart health.
“I recommend spending more time with friends and family to help combat stress,” says Chebotarev. Doing so can also help stave off loneliness and social isolation. Adopting other healthy lifestyle habits, like exercising regularly or pursuing mindfulness practices like meditation or yoga can also help reduce stress and improve heart health.
Poor sleep
“Lack of sleep is a big problem,” says Chebotarev. Most adults should aim to get seven to nine hours of sleep each night, but regularly falling short can lead to high blood pressure and increase your risk of heart disease.
By focusing on getting quality sleep each night, you can help lower your heart disease risk. A good place to start? Evaluating your sleep routine.
“My advice is to aim to have your last meal by six or seven o’clock in the evening, and to go to sleep at the same time each night and wake up at the same time every morning,” says Chebotarev. Exposing your body to daylight each day—particularly first thing in the morning—getting regular physical activity, and keeping your bedroom cool, dark, quiet, and free of electronic devices can also help promote a good night’s sleep.
If you consistently wake up tired and unrefreshed even after taking steps to improve your sleep hygiene, Chebotarev recommends asking your healthcare provider (HCP) about getting evaluated for a sleep study. This kind of test screens for underlying health issues like sleep apnea so you can get treated and improve your ability to sleep soundly.
Evaluate your heart disease risk with your doctor
It’s important to talk to your HCP about your individual risk of heart disease and to understand which factors may increase your odds. From there, you can work together to outline a plan that addresses your risk factors so you can live a heart-healthy life.
