A nurse is teaching a client about risk factors for heart disease. Which of the following risk factors is modifiable? (Select All that Apply.)

Choice A rationale Family history of heart disease is considered a non-modifiable risk factor because it involves genetic predisposition and shared familial traits that cannot be altered by lifestyle changes. This includes congenital anomalies or inherited conditions like familial hypercholesterolemia, which significantly influence an individual's lifetime cardiovascular risk profile, making it a fixed variable. Choice B rationale Exercise is a key modifiable risk factor for heart disease because the lack of physical activity, or a sedentary lifestyle, directly contributes to poor cardiovascular health. Regular aerobic exercise improves endothelial function, lowers blood pressure, increases HDL cholesterol, and helps manage weight, thereby significantly reducing the overall atherosclerotic burden and cardiovascular risk. Choice C rationale Smoking is a major modifiable risk factor for heart disease because it directly damages the endothelial lining of the arteries, leading to atherosclerosis, vasoconstriction, and increased blood coagulability. Quitting tobacco use, which is a behavioral change, rapidly decreases the risk for myocardial infarction and stroke due to improved vascular health and oxygen-carrying capacity. Choice D rationale Diet is a highly modifiable risk factor, as dietary choices directly impact cholesterol levels, blood pressure, and body weight, all central to heart disease development. A diet high in saturated fats and sodium, and low in fruits and vegetables, promotes hypertension and dyslipidemia, whereas adopting a heart-healthy diet can substantially mitigate these risks. Choice E rationale Age is a non-modifiable risk factor because the risk of developing heart disease, especially atherosclerosis, naturally increases as an individual ages due to accumulated cellular damage, decreased vascular elasticity, and decades of exposure to other risk factors. This factor cannot be changed, although managing modifiable risks can improve heart health at any age.