The seven heart disease risk factors you can control, including one nearly all of us struggle with

Still, the numbers aren't good. Heart disease is associated with more than 700 thousand deaths annually in the United States and more than seven million hospitalizations. It affects more than 80 million adults with health care costs totaling more than $300 billion.

There are many things that can affect your risk for developing heart disease. Two of them you cannot control: your age and your family history.

However, according to the American Heart Association*, there are seven modifiable risk factors for heart disease, meaning there are things you can do to decrease your risk. As you will see, many of them are interrelated and affect each other. Many are associated with the build-up of plaques and other fats in your blood vessels, a process known as atherosclerosis.

Fewer than one percent of Americans have all seven of their modifiable risk factors under control, and there's one, an unhealthy diet, that seems to be the hardest for most of us to manage.

For the first three, there are medications that can help control them, and the final four are what we call "behavioral" risk factors, meaning you control them either through your own action or inaction.

Let's take a quick look at each risk factor:

1. High Blood Pressure -- Blood pressure is a measure of the force of the blood in your arteries. Elevated or high blood pressure increases your risk for heart disease and stroke. While there are medications that can help to control high blood pressure, losing weight and getting regular physical activity can also play an important role in lowering your blood pressure. You should work with your doctor to find out what works best for you.

2. Abnormal Cholesterol -- Cholesterol is a naturally occurring fat in our bodies. However, too much cholesterol can build up in blood vessels, leading to atherosclerosis. A cholesterol check is one of the basic tests to determine your risk for heart disease.

Again, losing weight, a healthy diet and regular exercise can help get cholesterol numbers down, however there are medications that can be of help. Some people may have a genetic predisposition to higher cholesterol levels. You should talk to your doctor about how often you should have your cholesterol tested and whether you need medication to get it into normal ranges.

3. Diabetes -- Diabetes is a disorder involving elevated blood sugar levels, often caused by too little insulin and/or insulin resistance. Diabetes can affect the blood vessels, leading to plaque build- up and heart disease.

There are medications to help control diabetes, but diet plays a key role as well. People with diabetes should work with their doctors, nutritionists and diabetes educators to learn how to monitor their blood sugar levels and manage their diets.

4. Cigarette Smoking -- There is a clear causative relationship between smoking and heart disease, meaning cigarettes cause heart disease and stroke. Stopping smoking can improve survival rates for heart disease patients within two-to-three years of quitting. Quitting is associated with a 36 percent reduction in death among patients with heart disease, greater than any other invention.

If you don't smoke, don't start. If you do smoke, you can work with your doctor to find ways to help you quit.

5. Obesity -- More than 40 million Americans are obese. For every two pounds someone is over his/her "ideal" body weight, there is a three percent increase in fatal and non-fatal heart attacks. The obesity rates in the United States have been rising steadily for several decades, and have paralleled the rise in the prevalence of diabetes.

Losing weight, while it can be challenging, can bring big benefits in lowering your risk for heart disease and diabetes.

6. Physical inactivity -- We are learning more about how a sedentary lifestyle can hurt your health.

Regular physical activity can increase good cholesterol and lower bad cholesterol, it helps in maintaining optimal body weight, it can reduce blood pressure, and it can lead to better control of blood sugar in patients with diabetes. Many people have jobs where they sit all day. Find ways to move more. You don't have to invest in a big exercise program. Take a few walks during the day. Take the stairs. Find ways to make exercise fun. If you are watching TV on your couch, get up and walk during the commercials. Studies have shown that as little as 30 minutes of moderate intensity activity (such as a brisk walk) five days per week can have a beneficial effect in reducing the risk of heart disease.

7. Unhealthy diet -- This may be the hardest for us to get under control. In our culture, there is food everywhere. Portion sizes have ballooned over the last several decades. For example, restaurant servings in the United States are about 25 percent larger than in France, and ice cream servings are more than 40 percent larger.

The availability of processed foods with "empty calories" (high in sugar, fat, salt and calories) makes them hard to avoid. Be mindful about what you are eating. A heart healthy diet consists of lots of fruits, vegetables, whole grains and lean meats. Try to cut down on saturated fat, added sugar and sodium.