Are You at Low Risk for Heart Disease? Probably Not

A new study released yesterday sounds pretty shocking: Fewer than 10 percent of Americans qualify as being at low risk for heart disease. Just 7.5 percent of us (to be exact) have none of the following risk factors that put our hearts in danger: being overweight (a body mass index above 25), being a smoker, having high cholesterol (above 200 mg/dL) or high blood pressure (above 120 mm Hg/80 mm Hg), or having diabetes, according to the study, which was published in the journal Circulation. That's a decrease from 15 years ago, when 10.5 percent of us fell into the low-risk category. So the news here is that we're going backward despite the fact that experts know a lot more today about preventing heart disease than they did a decade or two ago.

Starting in the late 1970s, when quitting smoking first came into fashion, an increasing number of us fell into the low-risk category. Blame the backsliding on our ever expanding waistlines. "Increasing adiposity is likely to be a major driver," write Harvard Medical School researchers in an editorial that accompanied the study. This is just the tip of the iceberg, they warn. As the growing number of overweight kids reach adulthood, "low-risk" Americans will become an endangered species. And, yes, this will certainly drive up healthcare costs and the price tag of reform.

Women, though, fare better than men. More than 10 percent of us have no risk factors for heart disease, compared with fewer than 5 percent of men. We can thank our bodies' production of the female hormone estrogen, which protects our hearts before menopause and is thought to explain why we develop heart disease, and accompanying risk factors, about a decade later than men, on average.

The question is: What can we do to keep our risk from creeping up as we age and our estrogen levels plummet?

For starters, young women need more encouragement not to smoke. Nearly 30 percent of those ages 25 to 44 are smokers compared with just 11 percent of folks over 65. Many women start smoking in their teens in the mistaken belief that it will help them control their weight. They then don't want to quit for fear of gaining weight. While women typically gain about 5 to 10 pounds after quitting, there's no question that smoking is a far greater risk to your heart health than being overweight, especially if you're over 35 and take oral contraceptives.

Exercise can help offset the quitter's weight gain, but a recent Temple University study found another surprising method that works: body image therapy. Former smokers who took a body image workshop, in which they talked about issues they had with their bodies, wound up, on average, losing a few pounds. They followed the book Body Image: A Handbook of Theory, Research, and Clinical Practice by Thomas F. Cash, Ph.D, and Thomas Pruzinsky, Ph.D., and attended group discussions every week. If you're not into joining a support group, try to encourage a few friends to read the book along with you and discuss its themes like the influence of waiflike magazine models and how to retrain the brain to think differently about perceived body flaws. Over time, you'll find yourself thinking about your body in a more positive light, and this can actually help dissuade you from overeating. (Contrary to what you might think, it's the self-loathing that causes us to binge—usually after an episode of self-punishing starvation.) In fact, nonsmokers, too, can benefit from an improved body image to help ward off the midlife spread.

In addition to not smoking, we need to double our efforts to keep the scale steady as we age. We can do this by increasing our activity levels and cutting down on supersize portions. Check out this slide show for more tips.