Nine risk factors account for well over 90 percent of heart attacks. In addition to the four major factors — cigarette smoking, diabetes, hypertension and high cholesterol — other risk factors include being sedentary, having excess abdominal (belly) fat, not consuming vegetables and fruits daily, and consuming alcohol. Last but certainly not least is stress, which represents up to 25 percent of heart disease risk. In fact, I would place stress at the top of the list of cardiac risk factors for two important reasons. First, unlike cholesterol, blood pressure and glucose, it can't be directly measured. This makes it impossible for health care providers to appreciate the amount of stress a patient may be experiencing on a day-to-day basis. Second and most importantly is that stress is the only risk factor that can directly impact all of the other eight risk factors. Think about it. When you are under a great deal of stress, blood pressure tends to increase, you are more likely to light up if you're a smoker, others will stop exercising and replacing their veggies with "comfort foods" that raise blood lipids, etc.