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One million people will have a heart attack or die from coronary heart disease this year according to the American Heart Association. Think of it as the entire population of San Jose, Calif., being wiped out. With an increase in obesity, sedentary lifestyles and an aging population, heart disease is a real threat.

Heart disease refers to conditions that can affect how the heart works. Arteries supply blood to the heart muscle and brain, but when there is a buildup of plaque containing cholesterol inside the artery walls, the arteries begin to narrow or become blocked resulting in a decrease in blood flow. This accumulation of plaque in the arteries can cause a heart attack, heart failure (known congestive heart failure), coronary artery disease or stroke.

Ever Ponciano, M.D., internist with Meritus Internal Medicine, explains that risk factors outside of your control include age and family history, but you can decrease your risk for developing heart disease by changing or controlling:

• High blood pressure
• High cholesterol
• Diabetes
• Tobacco use
• Alcohol abuse
• Unhealthy diet
• Obesity
• Lack of exercise
• Stress
• Poor dental hygiene

“The annual well visit is an ideal time to discuss your overall health with your primary care provider,” says Dr. Ponciano. Working with the patient, he looks at heart disease risk factors and formulates a plan to control or reduce the onset of the disease. Specifically, Dr. Ponciano addresses:

Diet. Carbohydrates do count and they have a significant effect on weight, blood sugar, blood pressure and triglycerides or fat in the blood. Reducing carbohydrates like bread, pasta, sweets, starchy vegetables and soda can reduce or even reverse risk factors for cardiovascular disease and diabetes.

Weight. The older you get, the more likely you are to put on extra pounds. Carrying too much body fat raises cholesterol and triglyceride levels, increases blood pressure and the chance of developing diabetes. Losing a few pounds can provide you with cardiovascular benefits.

Smoking. This troublesome habit puts you at two to four times the risk of developing heart disease and three times the risk of having a stroke. Quitting smoking can lower your blood pressure and heart rate almost immediately in addition to lowering your cholesterol and improving lung function.

Sleep and stress. Lack of sleep (less than six hours) and stress changes the cortisol levels in your body and increases blood pressure and blood sugar. Sleep apnea, where breathing stops and starts, is also a risk factor for developing heart disease, diabetes and high blood pressure. Dr. Ponciano encourages his patients to monitor sleep patterns and try relaxation techniques like deep breathing or yoga to offset the response to stress.

“After an open discussion, patients have a plan to adjust behaviors to improve health,” says Dr. Ponciano. However, in some cases, Dr. Ponciano may prescribe a statin to lower cholesterol. Statins come with side effects like muscle and joint pain and mental fuzziness. As a result, he discusses benefits and risks, medication options and coping strategies.

You can prevent heart disease by making real changes to your lifestyle. Start with an honest conversation with your primary care provider.