February is Heart Disease Awareness month, but it is an issue that should be heeded all year. The American Heart Association estimates that more than 81 million Americans have heart disease, which includes high blood pressure, heart failure, stroke and other conditions. Heart disease is also the No. 1 killer in the United States, causing one in four deaths.

The majority of heart disease deaths occur from coronary heart disease, said Dr. Hossein Ardehali, assistant professor of medicine, molecular pharmacology and biological chemistry at the Feinberg Cardiovascular Research Institute at the Northwestern University School of Medicine. Coronary heart disease is caused by plaque that builds up inside the heart’s arteries, Ardehali explained. This is also the easiest type of heart disease to prevent.

Cholesterol, family history, smoking, high blood pressure and age all play a role in heart disease, Ardehali said. While genetics factor in as well and this is something that cannot be controlled, Ardehali said there is a need for better preventive techniques.

“My personal belief is that in most people environment is a major factor,” he said.

If people control factors within their means, such as what they eat and what unhealthy habits they indulge in, the chances of heart disease are greatly reduced.

“I’m really emphasizing diet and exercise,” Ardehali said.

Dr. Vincent Bufalino, cardiologist and president and CEO of Midwest Heart Specialists, said while younger adults are not at risk for catastrophic heart problems, the disease process starts young. A recent study in

Chicago found that children as young as 5 years old had high cholesterol.

A study from the 1980s showed that children as young as 8 were already developing plaque in their arteries, Bufalino said. Since the ’80s, the rate of obesity has doubled.

“Heart healthy habits are never too early to begin,” he said. “Get kids out from their video and computer games and get them exercising.”

Bufalino recommended paying attention to saturated fat intake from foods such as dairy products, fried foods and red meat. While these items are fine in moderation, consumption should not exceed more than a couple of times a week, he said.

“It’s nothing profound, it’s not rocket science, it’s getting [people] to do it that’s the challenge,” Bufalino said.

Smoking is also a very big factor in heart disease. Smokers with a family history of heart disease are the highest risk group, he said, with more than double the risk of developing heart disease.

“If there’s a single thing that predicts heart disease in young people it’s smoking,” Bufalino said.

Dr. Philip Greenland, cardiologist and professor of preventive medicine at the Feinberg School of Medicine at Northwestern,said it’s important to tell young adults that the decisions they make now can prevent heart disease.

“The sense that I have is that people are aware [of heart disease], but the consequences seem so remote, like ‘It’s not going to happen to me,’” he said. “At 20 [years old], do you really stop and think about the day you’re going to die? I don’t think so.”

One factor people don’t often consider when trying to establish a healthier life is the company they keep. Our behavior often comes from or is reinforced by our friends.

“If you want to be healthy, it’s important to hang out with other healthy people.”

One problem with preventing heart disease is most people tend to only seek treatment once they get sick, rather than make changes before health issues arise. With heart disease this approach does not work; you cannot reverse damage already done.

“Artery problems don’t start in your 40s or 50s. They’re detectable in your teens or early 20s,” Greenland said. “These diseases really do begin early in life. The evidence is very clear, it’s not debatable.”

Not only is the damage detectable, but a lot of these behaviors that eventually lead to heart disease get solidified at the college age, he said.

“A lot of diseases that become important later in life start way before the symptoms,” Greenland said. “If you wait until they show, it’s pretty late.”