A Cardiologist Says the Top Risk Factor for Heart Trouble Isn’t Smoking

Most people would probably say smoking is the worst thing you can do for your heart, and that instinct is understandable. Tobacco is widely known to be harmful to the cardiovascular system. But when it comes to heart risk, the full picture is more complex than one unhealthy habit.

Heart disease is still the leading cause of death in the United States, and it usually develops because of several factors rather than just one. Genetics, age, diet, physical activity, sleep and stress all influence risk, and many of the most important changes happen without obvious warning signs. That is part of what makes heart health so difficult to monitor: You can feel well for years while damage is quietly building.

The hopeful part is that much of heart disease is considered preventable. The Cleveland Clinic estimates that about 90% of cases could be avoided through diet and lifestyle choices. Even if heart disease runs in your family, your genes do not determine everything.

So which risk factor deserves the most attention? One cardiologist says the answer may surprise you, and it is not smoking.

What Is the Biggest Risk Factor for Heart Problems?

According to one cardiologist, the biggest risk factor is high LDL cholesterol. Dr. Norman Lepor, MD, a cardiologist at Cedars-Sinai, previously told Parade that although tobacco causes the most harm as a habit, LDL cholesterol is the risk factor people should watch most closely.

“Using tobacco is the worst habit for heart health, but having high levels of LDL cholesterol is the biggest risk factor [for experiencing cardiovascular health issues],” Dr. Lepor said. He noted that the distinction comes down to behavior: habits are actions people choose, while risk factors are something else.

LDL is often called “bad” cholesterol because too much of it can lead to plaque buildup in the arteries. Over time, that buildup can narrow blood vessels and increase the risk of heart attack and stroke. High cholesterol usually does not cause symptoms, which is why blood tests are the only reliable way to know your levels.

That said, tobacco is still extremely dangerous. “Smoking and vaping significantly increase the risk of stroke, heart attack and peripheral vascular disease, which can lead to leg amputations in severe cases,” Dr. Lepor said. He also explained that regular tobacco use can contribute to plaque buildup in the coronary arteries and may raise LDL cholesterol levels, meaning the worst habit and the biggest risk factor are closely linked.

How to Lower Your LDL Cholesterol

The good news is that there are many ways to help keep LDL cholesterol under control. Dr. Lepor recommended avoiding trans fats, which are often found in fried foods, and limiting foods high in sodium and saturated fat. Instead, he suggested choosing foods rich in unsaturated fats, such as seafood, avocado and nuts. He also often recommends the Mediterranean diet, which focuses on plant-based foods and healthy fats.

Exercise is important too. Dr. Lepor said staying active is another key way to help lower LDL cholesterol.

If your cholesterol is already high, Dr. Lepor strongly advised speaking with your doctor about prescription medications such as statins. And if you have already been prescribed one, taking it consistently matters just as much as filling the prescription. “It’s easy to forget to take your heart health medication because you aren’t necessarily seeing or feeling a difference, but they really do help keep LDL cholesterol levels down,” he said.

The bottom line: Quitting tobacco remains one of the best things you can do for your heart, but knowing your cholesterol numbers and taking steps to manage them may matter even more.

Adapted from Parade’s This Is the Worst Habit for Heart Health, According to Cardiologists by Emily Laurence Sardinha.

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