Scientists now know far more about the major controllable risk factors for coronary artery disease (CAD) than for most other diseases. A risk factor merely increases the probability that you will develop CAD; it doesn't guarantee that you will develop it, nor does its absence (or even the absence of all risk factors) guarantee that you won't have a heart attack. For healthy people, the following steps have been shown to help reduce the risk factors for CAD. Keep in mind that reducing one risk factor may help reduce others. Exercising, for example, can help you control your weight, as can efforts to lower your cholesterol level through a low-fat diet.

1 Quit smoking. This is perhaps the single most effective step you can take. Anywhere from 20 to 40% (100,000 to 200,000 every year) of all CAD deaths in the U.S. are directly attributable to smoking. It more than doubles your chance of eventually having a heart attack and increases the chance of dying from it by 70%; it is also the leading cause of sudden cardiac death. The good news: Quitting smoking quickly reduces your CAD risk; within five to ten years of quitting, your risk of heart attack declines to a level similar to that of people who never smoked, regardless of how long you smoked.

2 Reduce your blood cholesterol. For every 1% reduction in high blood cholesterol, there's a 2 to 3% decline in the risk of heart attack.

3 Avoid or control hypertension. High blood pressure is a risk factor for stroke and heart attack. For every one-point reduction in diastolic blood pressure, there's a 2 to 3% decline in the risk of heart attack. If you can reduce your blood pressure by making the appropriate lifestyle changes¡ªincluding limiting intake of sodium, calories, and alcohol¡ªthe coronary benefits are likely to be particularly great.

4 Stay active. Exercise protects against CAD by helping the heart work more efficiently, reducing blood pressure, raising HDL cholesterol, decreasing the tendency of blood to form clots, moderating stress, helping the body use insulin, and helping people maintain a healthy weight. Sedentary people who begin a regular program of exercise reduce their risk of a heart attack by 35 to 55%. Low-intensity activities, such as gardening or walking, if done regularly and over the long term, can decrease the risk of heart attack.

5 Maintain a healthy weight. About one in three American adults is obese (weighing at least 20% above the "suggested" weight for their height), which doubles their risk for CAD at a given age. Obesity also increases the risk for diabetes, hypertension, and high blood cholesterol, which further worsen the risk for CAD.

6 Avoid or control diabetes. Type 2 diabetes (non-insulin-dependent), which afflicts more than 14 million Americans, is an important risk factor for both CAD and hypertension. Diabetic men have two to three times the risk of having coronary heart disease than those without diabetes. Weight control and exercise can improve the utilization of blood sugar and prevent or slow down the onset of diabetes¡ªand reduce the incidence of heart disease.

7 Consider a drink a day. There's a growing consensus that light to moderate alcohol consumption¡ªthat is, two drinks or less a day for a man, one drink for a woman (a drink is defined as 12 ounces of beer, 4 ounces of wine, or 1.5 ounces of 80-proof spirits) can help prevent heart attacks. However, drinking more than that can increase the risk of heart attack and stroke, as well as cirrhosis, cancer, and accidents.

8 Consider low-dose aspirin. The recommended regimen¡ªa baby aspirin (81 milligrams) daily or half a regular aspirin (160 milligrams) very other day¡ªcan lower the risk of heart attack by about one-third by reducing the ability of platelets in the blood to stick together and thus form a clot. It is particularly advisable if you have an elevated risk of CAD. Aspirin can have side effects and isn't right for everyone, so be sure to consult with your physician first.

Note on diet: Although eating a healthful, low-fat diet is not generally considered a separate preventive measure, cutting back on fat, particularly saturated fat, and eating foods that provide complex carbohydrates clearly plays a role in many of the listed measures, such as controlling cholesterol, blood pressure, and body weight.

In addition, there has been accumulating evidence that a high intake of antioxidant vitamins¡ªparticularly vitamin E¡ªhelps reduce the risk of CAD. (See 14 Keys to a Healthy Diet.)

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