Heart Disease Risk Factors

The leading modifiable (controllable) risk factors for heart disease and stroke are:

Over time, these risk factors cause changes in the heart and blood vessels that can lead to heart attacks, heart failure, and strokes. It is critical to address risk factors early in life to prevent the potentially devastating complications of chronic cardiovascular disease.

Controlling risk factors for heart disease and stroke remains a challenge. High blood pressure and cholesterol are still major contributors to the national epidemic of cardiovascular disease. High blood pressure affects approximately 1 in 3 adults in the United States,3 and more than half of Americans with high blood pressure do not have it under control.3 High sodium intake is a known risk factor for high blood pressure and heart disease,4 yet about 90 percent of American adults exceed their recommendation for sodium intake.5

The risk of Americans developing and dying from cardiovascular disease would be substantially reduced if major improvements were made across the U.S. population in diet and physical activity, control of high blood pressure and cholesterol, smoking cessation, and appropriate aspirin use.

Source: Healthy People (DHHS)1

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Back to: « Heart Disease

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Disease does not occur in isolation, and cardiovascular disease is no exception. Cardiovascular health is significantly influenced by the physical, social, and political environment, including:

  • Maternal and child health
  • Access to educational opportunities
  • Availability of healthy foods, physical education, and extracurricular activities in schools
  • Opportunities for physical activity, including access to safe and walkable communities
  • Access to healthy foods
  • Quality of working conditions and worksite health
  • Availability of community support and resources
  • Access to affordable, quality health care

Source: Healthy People (DHHS)2

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Young Adult Obesity May Affect Later Heart Disease

The longer a young adult is obese, the greater the chance of developing heart disease in middle age, a new study reports. The finding hints that preventing or even delaying the onset of obesity might help reduce heart disease in later years.

Heart disease is the leading cause of death nationwide, and obesity boosts the risk for heart disease. Past studies have linked both body mass index (BMI)—a ratio of weight to height—and waist circumference to heart disease risk. However, few studies have looked at whether the length of time a person is obese affects heart disease as well.

Source: NIH News in Health (NIH)3

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A large NIH-supported study published last month underscores the importance of managing your risk factors. Scientists found that middle-aged adults with one or more elevated risk factors, such as high blood pressure, were much more likely to have a heart attack or other major heart-related event during their remaining lifetime than people with optimal levels of risk factors.

“For example, women with at least 2 major risk factors were 3 times as likely to die from cardiovascular disease as women with none or 1 risk factor,” says Dr. Susan B. Shurin, acting director of NIH’s National Heart, Lung and Blood Institute. “You can and should make a difference in your heart health by understanding and addressing your personal risk.”

Source: NIH News in Health (NIH)4

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Some conditions and lifestyle choices increase a person's chance for heart disease, including diabetes, overweight and obesity, poor diet, physical inactivity, and excessive alcohol use.

High blood pressure, high LDL (low-density lipoprotein) cholesterol, and smoking are key risk factors for heart disease. LDL is considered the "bad" cholesterol because having high levels can lead to buildup in your arteries and result in heart disease and stroke. Lowering your blood pressure and cholesterol and not smoking will reduce your chances for heart disease.

Source: CDC Features5

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Risk Factors

High blood pressure, high LDL cholesterol, and smoking are key heart disease risk factors for heart disease. About half of Americans (49%) have at least one of these three risk factors.5

Several other medical conditions and lifestyle choices can also put people at a higher risk for heart disease, including:

Source: CDC DHDSP6

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Risk Factors

High blood pressure, high LDL cholesterol, and smoking are key risk factors for heart disease. About half of Americans (49%) have at least one of these three risk factors.[4]

Several other medical conditions and lifestyle choices can also put people at a higher risk for heart disease, including:

Source: CDC DHDSP7

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Risk Factors

High blood pressure, high LDL cholesterol, and smoking are key risk factors for heart disease. About half of Americans (49%) have at least one of these three risk factors.[5]

Several other medical conditions and lifestyle choices can also put people at a higher risk for heart disease, including:

Source: CDC DHDSP8

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Over time, high blood glucose from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. The longer you have diabetes, the higher the chances that you will develop heart disease.1

Source: NIDDK (NIH)9

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What else increases my chances of heart disease or stroke if I have diabetes?

If you have diabetes, other factors add to your chances of developing heart disease or having a stroke.

Smoking

Smoking raises your risk of developing heart disease. If you have diabetes, it is important to stop smoking because both smoking and diabetes narrow blood vessels. Smoking also increases your chances of developing other long-term problems such as lung disease. Smoking also can damage the blood vessels in your legs and increase the risk of lower leg infections, ulcers, and amputation.

High blood pressure

If you have high blood pressure , your heart must work harder to pump blood. High blood pressure can strain your heart, damage blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems.

Abnormal cholesterol levels

Cholesterol is a type of fat produced by your liver and found in your blood. You have two kinds of cholesterol in your blood: LDL and HDL.

LDL, often called “bad” cholesterol, can build up and clog your blood vessels. High levels of LDL cholesterol raise your risk of developing heart disease.

Another type of blood fat, triglycerides, also can raise your risk of heart disease when the levels are higher than recommended by your health care team.

Obesity and belly fat

Being overweight or obese can affect your ability to manage your diabetes and increase your risk for many health problems, including heart disease and high blood pressure. If you are overweight, a healthy eating plan with reduced calories often will lower your glucose levels and reduce your need for medications.

Excess belly fat around your waist, even if you are not overweight, can raise your chances of developing heart disease.

Health care professional measures a man’s waistline.

Even if you are a normal weight, excess belly fat can raise your risk for heart disease.

You have excess belly fat if your waist measures

  • more than 40 inches and you are a man
  • more than 35 inches and you are a woman

Learn how to correctly measure your waist.

Family history of heart disease

A family history of heart disease may also add to your chances of developing heart disease. If one or more of your family members had a heart attack before age 50, you may have an even higher chance of developing heart disease.3

You can’t change whether heart disease runs in your family, but if you have diabetes, it’s even more important to take steps to protect yourself from heart disease and decrease your chances of having a stroke.

Source: NIDDK (NIH)10

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The main preventable risk factors affecting the heart are:

Source: Queensland Government11

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Heart disease risk factors

Your general health, everyday habits, and family health history can affect your risk for heart disease. Although you can control some of these risk factors, like your habits, others, like your age or race and ethnicity, can't be controlled. The more risk factors you have for heart disease, the higher your risk.

Source: OWH (DHHS)12

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Heart Disease Risk Factors

You Can Reduce Your Risk

Certain traits, conditions, or habits may raise your risk for coronary heart disease (CHD). These conditions are known as risk factors. Risk factors also increase the chance that existing CHD will worsen.

Women generally have the same CHD risk factors as men. However, some risk factors may affect women differently from men. For example, diabetes raises the risk of CHD more in women. Also, some risk factors, such as birth control pills and menopause, only affect women.

Having just one risk factor doubles your risk for CHD. Having two risk factors increases your risk for CHD fourfold. Having three or more risk factors increases your risk for CHD more than tenfold. Also, some risk factors, such as smoking and diabetes, put you at greater risk for CHD and heart attack than others.

About 91 percent of women aged 40 to 60 have one or more modifiable risk factors for CHD. Many risk factors start during childhood; some even develop within the first 10 years of life. You can control most risk factors, but some you can't.

To find out whether you're at risk for CHD, talk with your doctor or healthcare provider.

Risk Factors You Can Control

Smoking—Smoking is the most powerful risk factor that women can control.

High Blood Cholesterol and High Triglyceride Levels—Cholesterol travels in the bloodstream in small packages called lipoproteins. The two major kinds of lipoproteins are low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol. LDL cholesterol is sometimes called "bad" cholesterol. This is because it carries cholesterol to tissues, including your heart arteries. HDL cholesterol is sometimes called "good" cholesterol. This is because it helps remove cholesterol from your arteries.

Guidelines for those levels are currently changing, depending on your age and other factors unique to you.

High Blood Pressure—Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps blood. If this pressure rises and stays high over time, it can damage the body in many ways. Women who have blood pressure greater than 120/80 mmHg are at increased risk for CHD. (The mmHg is millimeters of mercury—the units used to measure blood pressure.)

Diabetes and Prediabetes—Diabetes is a disease in which the body's blood sugar level is too high. This is because the body doesn't make enough insulin or doesn't use its insulin properly. Insulin is a hormone that helps move blood sugar into cells, where it's used for energy. Over time, a high blood sugar level can lead to increased plaque buildup in your arteries. Prediabetes is a condition in which your blood sugar level is higher than normal, but not as high as it is in diabetes. Diabetes and prediabetes raise the risk of CHD more in women than in men.

Overweight and Obesity—The most useful measure of overweight and obesity is body mass index (BMI). BMI is calculated using your height and weight. In adults, a BMI of 18.5 to 24.9 is considered normal. A BMI of 25 to 29.9 is considered overweight. A BMI of 30 or more is considered obese.

You can use the National Heart, Lung, and Blood Institute's (NHLBI's) online BMI calculator to figure out your BMI, or your healthcare provider can help you. (http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm)

Metabolic Syndrome—This is the name for a group of risk factors that raises your risk for CHD and other health problems, such as diabetes and stroke. A diagnosis of metabolic syndrome is made if you have at least three of the following risk factors:

Metabolic syndrome is more common in African American women and Mexican American women than in men of the same racial groups.

Birth Control Pills—Women who smoke and take birth control pills are at very high risk for CHD, especially if they're older than 35. For women who take birth control pills but don't smoke, the risk of CHD isn't fully known.

Lack of Physical Activity—Inactive people are nearly twice as likely to develop CHD as those who are physically active.

Unhealthy Diet—An unhealthy diet can raise your risk for CHD. For example, foods that are high in saturated and trans fats and cholesterol raise your LDL cholesterol level. A high-sodium (salt) diet can raise your risk for high blood pressure.

Stress or Depression—Stress may play a role in causing CHD. Stress can trigger your arteries to narrow. This can raise your blood pressure and your risk for a heart attack. Getting upset or angry also can trigger a heart attack. Stress also may indirectly raise your risk for CHD if it makes you more likely to smoke or overeat foods high in fat and sugar. People who are depressed are two to three times more likely to develop CHD than people who are not. Depression is twice as common in women as in men.

Risk Factors You Can't Control

Age and Menopause—As you get older, your risk for CHD and heart attack rises. This is due in part to the slow buildup of plaque inside your heart arteries, which can start during childhood.

Family History—Family history plays a role in CHD risk. Your risk increases if your father or a brother was diagnosed with CHD before 55 years of age, or if your mother or a sister was diagnosed with CHD before 65 years of age. Also, a family history of stroke—especially a mother's stroke history—can help predict the risk of heart attack in women.

Making lifestyle changes and taking medicines to treat risk factors often can lessen genetic influences and prevent or delay heart problems.

Source: MedLinePlus Magazine (NIH)13

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The main risk factors for CVD are outlined below.

High blood pressure

High blood pressure (hypertension) is one of the most important risk factors for CVD. If your blood pressure is too high, it can damage your blood vessels.

Read more about high blood pressure.

Smoking

Smoking and other tobacco use is also a significant risk factor for CVD. The harmful substances in tobacco can damage and narrow your blood vessels.

High cholesterol

Cholesterol is a fatty substance found in the blood. If you have high cholesterol, it can cause your blood vessels to narrow and increase your risk of developing a blood clot.

Read more about high cholesterol.

Diabetes

Diabetes is a lifelong condition that causes your blood sugar level to become too high. High blood sugar levels can damage the blood vessels, making them more likely to become narrowed.

Many people with type 2 diabetes are also overweight or obese, which is also a risk factor for CVD.

Inactivity

If you don't exercise regularly, it's more likely that you'll have high blood pressure, high cholesterol levels and be overweight. All of these are risk factors for CVD.

Exercising regularly will help keep your heart healthy. When combined with a healthy diet, exercise can also help you maintain a healthy weight.

Being overweight or obese

Being overweight or obese increases your risk of developing diabetes and high blood pressure, both of which are risk factors for CVD.

You're at an increased risk of CVD if:

  • your body mass index (BMI) is 25 or above - use the BMI healthy weight calculator to work out your BMI
  • you're a man with a waist measurement of 94cm (about 37 inches) or more, or a woman with a waist measurement of 80cm (about 31.5 inches) or more

Read more about obesity.

Family history of CVD

If you have a family history of CVD, your risk of developing it is also increased.

You're considered to have a family history of CVD if either:

  • your father or brother were diagnosed with CVD before they were 55
  • your mother or sister were diagnosed with CVD before they were 65

Tell your doctor or nurse if you have a family history of CVD. They may suggest checking your blood pressure and cholesterol level.

Ethnic background

In the UK, CVD is more common in people of South Asian and African or Caribbean background.

This is because people from these backgrounds are more likely to have other risk factors for CVD, such as high blood pressure or type 2 diabetes.

Read more about South Asian health issues and black health issues.

Other risk factors

Other factors that affect your risk of developing CVD include:

  • age - CVD is most common in people over 50 and your risk of developing it increases as you get older
  • gender - men are more likely to develop CVD at an earlier age than women
  • diet - an unhealthy diet can lead to high cholesterol and high blood pressure
  • alcohol - excessive alcohol consumption can also increase your cholesterol and blood pressure levels, and contribute to weight gain

Source: NHS Choices UK14

Risk Factors for Heart Disease

Depression: People with depression have an increased risk of cardiovascular disease, diabetes, stroke, and Alzheimer’s disease, for example. Research also suggests that people with depression are at higher risk for osteoporosis relative to others. The reasons are not yet clear.

Source: NIMH (NIH)15

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Air Pollution: Air pollution has been linked to a wide range of health problems, including breathing difficulties, cardiovascular disease, and even death. In Southern California—long known for its high levels of air pollution—public policies have helped to improve air quality over the past few decades.

Source: NIH News in Health (NIH)16

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Sugar: Over time, excess sweeteners can take a toll on your health. “Several studies have found a direct link between excess sugar consumption and obesity and cardiovascular problems worldwide,” Bremer says.

Source: NIH News in Health (NIH)17

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Inactivity: A lack of physical activity in childhood raises the risk for obesity and the many health problems it can contribute to later in life, including heart disease and diabetes. The 2005 Dietary Guidelines for Americans recommends that children and teens get at least 60 minutes of physical activity on most, if not all, days.

Source: NIH News in Health (NIH)18

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Preeclampsia: Researchers have also found that preeclampsia greatly increases a woman’s risk for developing heart-related problems later in life.

Source: NIH News in Health (NIH)19

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Migraines: Migraines Tied to Heart Attack Risk

Men who suffer from migraine headaches may be at greater risk for heart attack and other types of cardiovascular disease, according to a new study funded by NIH. The findings parallel last year’s report that women with a history of migraines also face a higher risk of cardiovascular disease.

Source: NIH News in Health (NIH)20

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Sleep Deficiency: Both the body and mind need sleep. People who don’t get enough sleep have more memory lapses and are more likely to develop behavioral problems and moodiness. Recent research even links disrupted sleep patterns with excessive weight gain and metabolic syndrome, a cluster of conditions that increases the risk of heart disease and stroke.

Source: NIH News in Health (NIH)21

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PCOS: Several factors related to PCOS, including insulin resistance, metabolic syndrome, and obesity, increase a woman's risk of cardiovascular disease.1

Source: NICHD (NIH)22

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Sleep apnea: Cardiovascular disease

Sleep apnea, a condition in which a person temporarily stops breathing while sleeping, causes an increase in a person's risk for several different cardiovascular conditions, including hypertension, stroke, coronary heart disease, and irregular heartbeat.6

Source: NICHD (NIH)23

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Anxiety disorders: Cardiovascular disease. Anxiety and depression increase the risk for heart disease, the leading cause of death for American women. Anxiety can also make recovery harder after a heart attack or stroke.

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High blood pressure: High blood pressure, also called hypertension, raises your risk for heart disease. Blood pressure is the force your blood makes against your artery walls when your heart beats. If this force (pressure) is too high, it can damage your heart over time.

Your risk for high blood pressure goes up as you age. Two out of every 3 women 60 and older have high blood pressure.[1]

You are also more likely to have high blood pressure if you have a family history of high blood pressure. Other risk factors for high blood pressure include eating unhealthy food often, not exercising, and being overweight.

In the United States, African-American women are at the highest risk for high blood pressure. This may be because African-American women are more likely to be obese or have diabetes, which can cause high blood pressure. Research has also found a gene common in African-Americans that increases sensitivity to salt. In people who have this gene, just one extra half a teaspoon of salt a day could raise blood pressure.[2]  Also, studies show that blood pressure levels are higher among African-Americans in the United States even after controlling for other health factors, and some of the difference is likely due to the effects of discrimination.[3]

Many women — more than men — get "white coat hypertension." This means that your anxiety or stress level goes up when you are at the doctor's office, and this can make your blood pressure go up. If medical visits increase your anxiety level, ask your doctor for a monitor to wear at home to get a more accurate blood pressure reading.

Source: OWH (DHHS)24

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High cholesterol: High cholesterol and triglycerides

Cholesterol is a waxy, fat-like substance that is found in all cells of your body. Your body makes all the cholesterol you need. You also get cholesterol and saturated fat from food such as meat and dairy products. Fruits and vegetables do not have any cholesterol or saturated fat.

Source: OWH (DHHS)25

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Overweight: Overweight and obesity

The more overweight you are, the higher your risk of heart disease is. This is true even if you have no other risk factors.

Source: OWH (DHHS)26

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Diabetes: Diabetes seriously raises your risk for heart disease and makes you less likely to survive a heart attack. This is true for women and men. But the number of men with diabetes who develop heart disease has gone down. The number of women with diabetes who develop heart disease has not gone down in recent years. Experts think this may be because of the link between heart disease, diabetes, and obesity, especially extra body fat that is carried around the waist. This link may be stronger for women, especially postmenopausal women, than for men.5 

Source: OWH (DHHS)27

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Metabolic syndrome: Metabolic (met-uh-BOL-ihk) syndrome is the name for a group of risk factors that happen together and are related to your metabolism. Metabolism is the process your body uses to convert food into energy. Having metabolic syndrome doubles your risk of heart disease. Metabolic syndrome is more common in women than men.[7]

Source: OWH (DHHS)28

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Excessive blood clotting: Excessive, or extra, blood clotting is when blood clots form too easily or break apart too slowly. Blood clots can narrow arteries and veins or block blood flow completely. This can lead to heart attack, stroke, or damage to the kidneys, lungs, or other parts of the body.

Source: OWH (DHHS)29

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Depression: Also, research found that women 55 and younger who are depressed are twice as likely to have a heart attack or to die of heart disease as women who are not depressed.[13]

Depression also increases your risk for another heart attack if you've had one already. Depression can hurt your heart's ability to beat correctly. It also can speed up the buildup of plaque in your arteries.

Source: OWH (DHHS)30

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C-reactive protein: C-reactive protein (CRP) is made by the body and released into the blood in response to swelling. Swelling (or inflammation) is how your body reacts to heal infections or cuts. Swelling can also happen over time in response to high stress levels or poor eating habits. Swelling for infections or cuts will raise your CRP levels for a short time, but swelling that continues for a long time may mean your arteries are damaged, which puts you at risk for heart disease.

Source: OWH (DHHS)31

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Rheumatoid arthritis: If you have rheumatoid arthritis, you're at a higher risk of developing cardiovascular disease (CVD) than the population at large.

Source: NHS Choices UK32

Protective Factors for Heart Disease

High HDL Cholesterol: HDL cholesterol seems to have the opposite effect of LDL; higher HDL levels are associated with a lower risk for heart disease.

Source: NIH News in Health (NIH)33

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References

  1. Source: Healthy People (DHHS): healthypeople.gov/ 2020/ topics-objectives/ topic/ heart-disease-and-stroke
  2. ibid.
  3. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ issue/ sep2013/ capsule1
  4. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ issue/ feb2012/ feature1
  5. Source: CDC Features: cdc.gov/ Features/ WearRed/ index.html
  6. Source: CDC DHDSP: cdc.gov/ dhdsp/ data_statistics/ fact_sheets/ fs_heart_disease.htm
  7. Source: CDC DHDSP: cdc.gov/ dhdsp/ data_statistics/ fact_sheets/ fs_men_heart.htm
  8. Source: CDC DHDSP: cdc.gov/ dhdsp/ data_statistics/ fact_sheets/ fs_women_heart.htm
  9. Source: NIDDK (NIH): niddk.nih.gov/ health-information/ diabetes/ overview/ preventing-problems/ heart-disease-stroke
  10. ibid.
  11. Source: Queensland Government: qld.gov.au/ health/ staying-healthy/ men-women/ men/ heart
  12. Source: OWH (DHHS): womenshealth.gov/ heart-disease-and-stroke/ heart-disease/ heart-disease-risk-factors
  13. Source: MedLinePlus Magazine (NIH): medlineplus.gov/ magazine/ issues/ winter14/ articles/ winter14pg26-27.html
  14. Source: NHS Choices UK: nhs.uk/ conditions/ Cardiovascular-disease/ 
  15. Source: NIMH (NIH): nimh.nih.gov/ health/ publications/ chronic-illness-mental-health-2015/ index.shtml
  16. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ issue/ apr2015/ capsule1
  17. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ issue/ oct2014/ feature1
  18. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ 2008/ September/ capsules.htm
  19. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ 2007/ July/ docs/ 01features_01.htm
  20. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ 2007/ June/ docs/ 02capsules.htm
  21. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ 2005/ September2005/ docs/ 02capsules.htm
  22. Source: NICHD (NIH): nichd.nih.gov/ health/ topics/ PCOS/ conditioninfo/ Pages/ conditions-associated.aspx
  23. Source: NICHD (NIH): nichd.nih.gov/ health/ topics/ sleep/ conditioninfo/ Pages/ inadequate-sleep.aspx
  24. Source: OWH (DHHS): womenshealth.gov/ heart-disease-and-stroke/ heart-disease/ heart-disease-risk-factors/ health-conditions
  25. ibid.
  26. ibid.
  27. ibid.
  28. ibid.
  29. ibid.
  30. ibid.
  31. ibid.
  32. Source: NHS Choices UK: nhs.uk/ conditions/ rheumatoid-arthritis/ complications/ 
  33. Source: NIH News in Health (NIH): newsinhealth.nih.gov/ 2008/ January/ docs/ 01features_01.htm

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Note: This site is for informational purposes only and is not medical advice. See your doctor or other qualified medical professional for all your medical needs.