Why it matters
Cardiovascular diseases (heart attack, stroke, peripheral artery disease) are the leading cause of death worldwide, with about 18 million deaths a year according to the World Health Organization (WHO). In France, they are the second leading cause of death after cancer. Yet much of this risk builds up silently over years, and can be reduced.
Eight factors you can change
The large international INTERHEART study, conducted in 52 countries, showed that a small number of measurable factors explain most of the risk of heart attack, in both men and women and on every continent. This profile is built around eight modifiable factors:
- smoking, even at low levels;
- high blood pressure, which most often causes no symptoms;
- diabetes, and the prediabetes that precedes it;
- cholesterol: LDL cholesterol (the "bad" cholesterol, Low-Density Lipoprotein) that is too high, or HDL cholesterol (the "good" cholesterol, High-Density Lipoprotein) that is too low;
- excess weight, particularly fat around the waist;
- physical inactivity: too little exercise and too much sitting time;
- alcohol, with risk rising with the amount consumed;
- chronic stress and depression.
On top of these, sleep apnea is very common and often unrecognized, and it promotes high blood pressure and heart rhythm disorders. Age, sex and family history matter too, but they can't be changed: prevention focuses on the rest.
Factors that add up
These factors don't simply add together: they reinforce one another. Slightly elevated blood pressure, mild excess weight and moderate smoking can together represent a substantial risk, even when none of them looks concerning on its own. That's the idea behind overall cardiovascular risk, measured by two scores depending on the country:
- SCORE2 (Systematic COronary Risk Evaluation 2), recommended in Europe by the European Society of Cardiology, and its SCORE2-OP variant (Older Persons) after age 70;
- ASCVD (Atherosclerotic CardioVascular Disease), calculated with the Pooled Cohort Equations recommended in the United States.
Both estimate the risk of a cardiovascular event over the next ten years.
Medical follow-up: irreplaceable
No online tool replaces a doctor. Medical follow-up measures what a questionnaire can't (blood pressure taken correctly, blood tests, a heart and artery exam), takes your medical history into account, and helps decide with you whether treatment is useful. In the United States, the AHA/ACC 2019 primary prevention guideline recommends regular check-ups to reassess your risk over time. Your Hygietest summary is a good starting point for that conversation.
Day to day: concrete, high-impact actions
1. The Mediterranean diet. It centers on vegetables, fruit, legumes (lentils, chickpeas), whole grains and nuts; extra-virgin olive oil as the main fat; fish at least twice a week; little red meat, processed meat, sugary products or ultra-processed food. In the PREDIMED trial, conducted in Spain with 7,447 adults at high cardiovascular risk, this diet enriched with olive oil or nuts reduced heart attacks, strokes and cardiovascular deaths by about 30% over just under five years, compared with a low-fat diet.
2. The DASH diet, for blood pressure. DASH stands for Dietary Approaches to Stop Hypertension. It favors fruit, vegetables, low-fat dairy, whole grains, fish, poultry and nuts, and limits saturated fat, red meat, sweets and sugary drinks. Rich in potassium, calcium, magnesium and fiber, it lowered systolic blood pressure by about 11 mmHg over eight weeks in people with high blood pressure in the original trial — an effect close to that of a medication. Combined with less salt, the effect is even stronger.
3. Diabetes and prediabetes: eating to stabilize blood sugar. There is no single "diabetic diet": several eating patterns work (Mediterranean, DASH, plant-forward), as long as they favor vegetables, legumes and whole grains, and limit added sugars, sugary drinks and refined flours. For prediabetes, the US Diabetes Prevention Program (DPP) trial showed that losing about 7% of body weight plus 150 minutes of activity a week reduces the risk of developing type 2 diabetes by 58%, a result also found in the Finnish DPS study.
4. Physical activity: about 3 hours a week. The WHO recommends 150 to 300 minutes of moderate activity a week (brisk walking, cycling, swimming), or 75 to 150 minutes of vigorous activity, plus muscle-strengthening on two days a week. The 2018 Physical Activity Guidelines for Americans (HHS) recommend the same ranges. A large analysis of six US and European cohorts (over 660,000 adults, Arem et al., 2015) shows this clearly. Compared with people with no leisure-time activity, mortality was 20% lower among those who moved less than the recommended minimum, 31% lower among those who reached one to two times that minimum (150 to 300 minutes of moderate activity a week), and 37% lower at two to three times that minimum. The benefit then plateaued at around 39%, with no harm observed even at very high volumes, and the same pattern held for cardiovascular mortality. In short: every step counts, and about 3 hours a week already captures most of the benefit. Activity also lowers blood pressure, improves blood sugar and cholesterol, helps control weight, and lifts mood.
If you're short on time: intensity matters as much as duration. A 2022 study in Nature Medicine (UK Biobank, 25,241 adults who did no exercise) found that three short bursts of vigorous activity lasting one to two minutes a day, built into daily life (climbing stairs briskly, carrying heavy shopping, walking very fast), were associated with nearly half the cardiovascular mortality. Other research shows that concentrating activity into one or two days a week ("weekend warrior") also brings a benefit. Before starting vigorous activity, talk to your doctor if you have heart disease or symptoms during exertion.
5. Reducing stress. Chronic stress raises blood pressure and cardiovascular risk, and promotes smoking, drinking and snacking. Several simple tools help: physical activity, regular sleep, yoga, mindfulness meditation, slow breathing. The American Heart Association notes that meditation, being low-cost and low-risk, can be considered alongside other measures, even though its direct effect on cardiovascular events still needs confirmation. If stress becomes overwhelming or comes with lasting sadness, talk to your doctor.
6. Quitting smoking, limiting alcohol. Quitting smoking lowers cardiovascular risk starting in the first few years, and support markedly increases the chances of success. For alcohol, less is better: risk rises with the amount consumed.
How this profile helps
The profile starts with 14 simple questions. Based on your answers, it only offers the tests that are useful for you, ranked from the most important factor for you to the least, with the time each one takes. You choose which ones to take. All of them are published tests, used by doctors. At the end, a summary ranks your factors from most to least concerning, with advice drawn from official guidelines.
When to see a doctor
This profile is a screening tool, not a diagnosis. It does not replace a consultation. Show your summary to your doctor: they can complete the assessment and suggest the right follow-up.
If you have chest pain, sudden shortness of breath, weakness on one side of the body, or trouble speaking, call 911 or your local emergency number immediately.
