A nurse is teaching a class about risk factors for heart disease. Which of the following risk factors is modifiable? (Select all that apply)

Choice A reason: Exercise is modifiable, as increasing physical activity improves cardiovascular health by reducing LDL cholesterol, blood pressure, and insulin resistance. It enhances endothelial function, promotes vasodilation, and increases cardiac efficiency, lowering the risk of atherosclerosis and coronary artery disease through improved lipid profiles and metabolic health. Choice B reason: Smoking is a modifiable risk factor, as cessation reduces heart disease risk. Nicotine and carbon monoxide damage endothelial cells, increase LDL oxidation, and promote platelet aggregation, accelerating atherosclerosis. Quitting restores vascular function, decreases inflammation, and lowers the risk of myocardial infarction within months. Choice C reason: Family history is a non-modifiable risk factor, as genetic predisposition influences lipid metabolism and vascular health. Inherited conditions like familial hypercholesterolemia increase LDL levels, promoting atherosclerosis. While lifestyle can mitigate some genetic risks, family history itself cannot be changed, remaining a fixed contributor to heart disease risk. Choice D reason: Age is a non-modifiable risk factor, as advancing age increases arterial stiffness and endothelial dysfunction, promoting atherosclerosis. Cumulative exposure to risk factors like hypertension or hyperlipidemia exacerbates cardiovascular damage over time. While lifestyle interventions help, age itself cannot be altered, making it a fixed risk factor. Choice E reason: Diet is modifiable, as reducing saturated fats, trans fats, and sodium lowers LDL cholesterol and blood pressure. A diet rich in fruits, vegetables, and omega-3 fatty acids improves lipid profiles, reduces inflammation, and enhances vascular health, decreasing the risk of coronary artery disease and myocardial infarction.