Hem » Articles » Health » Risk factors and cardiovascular health

This is the final post of our series on cardiovascular health. Here, we focus on the critical risk factors that influence heart well-being. These factors are closely intertwined with the health behaviors discussed in our preceding articles, emphasizing the interconnected nature of cardiovascular health (Figure 1). In this concluding article we discuss four key elements: maintaining a healthy weight, managing blood lipids, regulating blood glucose levels, and the significance of healthy blood pressure. Understanding these risk factors is essential for fostering a comprehensive approach to cardiovascular well-being.

Healthy weight 

Figure 1: Life’s Essential 8: healthy diet, participation in physical activity, healthy levels of blood lipids, glucose and blood pressure, healthy weight, avoidance of nicotine, and healthy sleep. Adopted from (1).

According to the World Health Organization, more than half of adults worldwide are overweight or obese (1). Obesity rates are still rising in many parts of the world. If this continues, by 2025, about 18% of men and over 21% of women globally will be obese. This is a serious concern as it puts much strain on individuals, societies, and healthcare systems.Obesity has been characterized as a modern epidemic (1). 

Obesity is linked to various heart-related diseases, including coronary heart disease, heart failure, high blood pressure, stroke, irregular heartbeat, and sudden heart-related death (1). It’s also connected to sleep disorders that negatively affect heart health.

Obesity can increase the risk of heart disease in two ways (1). First, it can directly cause changes in the heart and blood vessels due to the extra body weight and the effects of certain fat-related substances that promote inflammation and disrupt normal blood flow (i.e., adipokines, lipids, glucose, polyunsaturated fatty acids, pro-inflammatory mediators, and others). Second, it can indirectly increase risk through associated health problems like insulin resistance, type 2 diabetes, excess belly fat, high blood pressure, and abnormal cholesterol levels.

In conclusion, obesity is a global health concern linked to various heart diseases and sleep disorders. It increases heart disease risk through direct and indirect effects involving changes in the heart and blood vessels and associated health problems like insulin resistance and high blood pressure. 

Healthy levels of blood lipids 

Figure 2: Life’s Essential 8: healthy diet, participation in physical activity, healthy levels of blood lipids, glucose and blood pressure, healthy weight, avoidance of nicotine, and healthy sleep. Adopted from (1).

Lipids play a crucial role in cardiovascular health. They contribute to atherosclerosis, the underlying cause of many cardiovascular diseases (CVD), and influence inflammatory processes and the function of vascular and cardiac cells, ultimately impacting the vessels and the heart (2). Lipids, such as cholesterol and triglycerides, are transported in the body through lipoprotein particles and are involved in processes that promote atherosclerosis progression (2). 

Low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol are intricately linked to CVD. The “cholesterol hypothesis” proposes that LDL cholesterol is causative in developing atherosclerosis, a key process underlying CVD. Epidemiological studies have demonstrated a direct association between high LDL cholesterol levels and increased risk of cardiovascular events, mainly related to atherosclerotic vascular disease (2). 

The “cholesterol hypothesis” refers to the proposition that high LDL cholesterol levels are causal for the development of atherosclerosis, and consequently, lowering LDL cholesterol would reduce the risk of myocardial infarction and other cardiovascular events (2). This hypothesis was born based on the demonstration of a direct association of high blood cholesterol levels, particularly LDL cholesterol, with increased risk of cardiovascular events as shown in epidemiological studies such as the Framingham Study, the Multiple Risk Factor Intervention Trial, and the Seven Countries Study (2). The “cholesterol hypothesis” has been pivotal in shaping the understanding of lipid-induced cardiovascular burden and has led to the development of lipid-lowering therapeutics targeting LDL cholesterol, such as statins, to reduce the risk of cardiovascular events.  

HDL cholesterol, on the other hand, has been inversely correlated with mortality from coronary heart disease. HDL is associated with atheroprotective properties such as promoting reverse cholesterol transport, exerting anti-inflammatory and anti-thrombotic effects, and maintaining endothelial function (2). Understanding the roles of LDL and HDL cholesterol in CVD and the “cholesterol hypothesis” has been pivotal in shaping the understanding of lipid-induced cardiovascular burden and has led to the development of lipid-lowering therapeutics targeting LDL cholesterol, such as statins to reduce the risk of cardiovascular events.

High levels of LDL cholesterol raise the risk of heart disease and stroke. High HDL cholesterol levels can lower the risk of heart disease and stroke. Too much LDL cholesterol can build up on the walls of the blood vessels, causing plaque formation and atherosclerosis and leading to heart disease.  

Besides monitoring LDL cholesterol, it is also crucial to keep an eye on Apolipoprotein B levels. As we have previously discussed the impact of Apolipoprotein B on CVD, it is worth emphasizing its significance once again due to its importance in assessing heart health. Read the article here.

The connection between high LDL cholesterol and Apolipoprotein B levels leading to plaque formation and atherosclerosis is well established.

We do not want plaque in our arteries, and the only way to prevent that is to keep our LDL-cholesterol and Apolipoprotein B in check. 

Apolipoprotein B, or Apo B, serves as the carrier protein for LDL cholesterol in the bloodstream. The level of Apolipoprotein B indicates the quantity of LDL molecules and generally correlates with LDL cholesterol levels. Keeping track of Apolipoprotein B levels can help in evaluating the potential for conditions such as heart attack and strokeCholesterol-rich, Apolipoprotein B-containing lipoproteins are now widely accepted as the most important causal agents of atherosclerotic CVD (3). You should know your Apolipoprotein B value. 

NEM recommends checking your Apolipoprotein B value. Ask your doctor about it.  

High LDL cholesterol and Apoliprotein B levels are causing the development of atherosclerosis (2). That is a well-known fact with overwhelming evidence.  Lowering LDL cholesterol and Apolipoprotein B reduces the risk of myocardial infarction.

Heart attacks often occur suddenly, and some individuals may die instantly as a result. There is a prevalent yet misleading notion that those who succumb to heart attacks were previously in good health and suddenly experienced cardiac arrest leading to death. However, the reality is quite different – many individuals already have atherosclerotic coronary artery disease well before experiencing a heart attack, with ongoing damage to their blood vessels that often goes unnoticed. The process of plaque formation can begin early in life, even as early as one’s 30s, and it is possible to have a healthy lifestyle while still developing early-stage atherosclerosis. Elevated levels of Apolipoprotein B and LDL cholesterol often present no symptoms until it’s too late to intervene.

Learn how to get your Apoliprotein B levels checked here.

Healthy levels of blood glucose 

Figure 3: Life’s Essential 8: healthy diet, participation in physical activity, healthy levels of blood lipids, glucose and blood pressure, healthy weight, avoidance of nicotine, and healthy sleep. Adopted from (1).

The impact of glucose on CVD is significant (4). A rise in glucose levels has been linked to an increased likelihood of adverse cardiovascular events. This correlation is evident in both individuals with and without diabetes. Specifically, the continuous, steady increase in mortality risks with a rise in fasting blood glucose indicates that glucose levels may be a powerful predictor of mortality in high-risk patients. 

There is a potential relationship between glucose and atherosclerosis, indicating that high glucose levels can worsen atherosclerosis or heart failure. That suggests glucose levels could be used as an independent prognostic tool for CVD.

Glucose can impact heart health in several ways. When glucose levels are high, it can directly harm the lining of blood vessels through a process known as non-enzymatic glycosylation. This process involves the modification of LDL cholesterol and other apolipoproteins by glucose, leading to the formation and progression of atherosclerotic plaques within the blood vessels, thus increasing the risk of atherosclerosis. 

Additionally, high glucose levels can lead to increased oxidative stress, activation of specific pathways, and changes in the basement membrane, all of which can worsen atherosclerosis or heart failure. Moreover, insulin resistance, which is often linked to high glucose levels, can also exacerbate CVD. Insulin resistance can lead to decreased utilization of glucose, increased utilization of free fatty acids, and elevated oxygen demand, all of which can negatively affect the heart. 

In conclusion, high glucose levels can directly damage blood vessels, worsen atherosclerosis, and heart failure, and contribute to insulin resistance, all of which can have harmful effects on heart health.

Healthy blood pressure

Figure 4: Life’s Essential 8: healthy diet, participation in physical activity, healthy levels of blood lipids, glucose and blood pressure, healthy weight, avoidance of nicotine, and healthy sleep. Adopted from (1).

Among the risk factors for CVD, high blood pressure is associated with the strongest evidence for causation, and it is also very common (5). Interestingly, what we consider “normal” blood pressure (BP) is higher than what our bodies naturally need. 

High BP is one of the most important risk factors for CVD.  

BP is the leading cause of CVD, as shown in studies and clinical trials (23). Extensive studies have demonstrated that high BP is a major risk factor for many health problems, including heart failure, irregular heartbeat, kidney disease, heart valve diseases, aortic syndromes, and dementia, as well as heart disease and stroke.

In a recent study, researchers proposed a theory that CVD in humans is primarily caused by this right-sided shift in the distribution of BP (5). A proper shift in BP distribution refers to a change in the overall population distribution of BP towards higher levels (5). That shift is considered to be a consequence of various factors, including lifestyle changes and dietary habits. It occurred over time due to factors such as acculturation, increased consumption of dietary sodium, and other lifestyle changes as observed in different populations (5). Studies of isolated unacculturated societies living in environments with low sodium intake demonstrate substantially lower average blood pressure levels (5). This concept suggests that an increase in the prevalence of higher BP levels within the population contributes to the overall burden of CVD.

Tips: Different ways to lower blood pressure include lifestyle changes and medication. 

Some of the lifestyle changes that proved effective in decreasing blood pressure include (6):

  1. Eating a healthy diet
  2. Keeping a healthy weight
  3. Exercising regularly
  4. Reducing sodium (salt) intake
  5. Limit alcohol and quit smoking
  6. Getting a good night’s sleep 
  7. Reduce stress

Finally, it is important to monitor blood pressure as hypertension is often asymptomatic. 

As we conclude our series on cardiovascular health, exploring the pivotal risk factors—healthy weight, blood lipids, glucose levels, and blood pressure—we emphasize their profound impact on heart well-being. Obesity, disrupted lipid levels, elevated glucose, and high blood pressure contribute significantly to the cardiovascular burden. 

One crucial aspect is the interpretation of “average” or “healthy.” For instance, data indicates that biomarkers such as BP have gradually shifted towards higher values over the years. What might be considered “normal” today could have been deemed too high in the past. Similarly, the average human weight has increased in recent decades, altering the definition of an “average” weight. This raises the question: 

Is average synonymous with optimal?

At NEM Health, we think that it is not.

Unlike conventional healthcare, which takes action when levels enter the “unhealthy” range, we proactively address shifts by monitoring your health trends, even if they are within the conventional “average” or “healthy” range. We believe in the power of prevention for optimal health. Our NEM360 offering includes comprehensive blood glucose, lipid, and lipoprotein testing, with the availability of additional advanced imaging diagnostics, enabling a thorough understanding of your risk profile. We work collaboratively with our clients, guiding them toward improved health outcomes by addressing and optimizing these crucial factors. The journey to a healthier heart begins with awareness, prevention, and personalized care.


Silviya Demerzhan, Ph.D.

Chief Scientific Officer, Nordic Executive Medicine
Medical review by: Dr. Mahir Vazda MD

  1. Koliaki C, Liatis S, Kokkinos A. Obesity and cardiovascular disease: revisiting an old relationship. Metab – Clin Exp. 2019 Mar 1;92:98–107. 
  2. Soppert J, Lehrke M, Marx N, Jankowski J, Noels H. Lipoproteins and lipids in cardiovascular disease: from mechanistic insights to therapeutic targeting. Adv Drug Deliv Rev. 2020;159:4–33. 
  3. Shapiro MD, Fazio S. Apolipoprotein B-containing lipoproteins and atherosclerotic cardiovascular disease. F1000Research. 2017 Feb 13;6:134. 
  4. Poznyak AV, Litvinova L, Poggio P, Sukhorukov VN, Orekhov AN. Effect of Glucose Levels on Cardiovascular Risk. Cells. 2022 Sep 28;11(19):3034. 
  5. High Blood Pressure and Cardiovascular Disease | Hypertension [Internet]. [cited 2024 Jan 8]. Available from: https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.119.14240
  6. Mayo Clinic [Internet]. [cited 2024 Jan 11]. 10 drug-free ways to control high blood pressure. Available from: https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20046974