Heart disease is the leading cause of death in the U.S., accounting for one in four mortalities nationwide. However, according to the American Heart Association (AHA), you can reduce your risk of heart disease and adverse coronary events by knowing which red flags signal high risk, and by making health and lifestyle changes accordingly. In a study published this week in the AHA journal Circulation, researchers identified two major predictors of heart disease risk that can be determined with little more than a blood test. Read on to discover if you’ve got these heart attack risk factors and what you can do to lower your risk.

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According to the Circulation study, there are two significant blood-related factors that influence your likelihood of a heart attack. Having either high levels of cholesterol or high blood sugar were each found to increase a person’s risk of heart attack by a whopping 42 percent.

The research team behind the study analyzed the routine health records of 3.5 million patients aged 20-39, which were stored in a nationwide database from the Korean National Health Insurance Services. They assigned seven-point cardiovascular health (CVH) scores based on the AHA’s “Life’s Simple 7” metrics—a series of health factors that influence one’s risk of poor heart health. Patients received one point for each positive health factor on the list, earning each patient a score between zero and seven. Ultimately, the team determined that a higher CVH score by even one point was associated with a 42 percent reduced risk of premature heart attack. Conversely, those with a score of zero had the highest rates of cardiovascular events before the age of 55.

For this reason, the AHA recommends that after the age of 20, your doctor should screen you for high cholesterol every four to six years as long as your risk is otherwise determined to be low. After the age of 40, you may require more frequent evaluation. Your doctor may also order a blood sugar test if they have reason to suspect diabetes or pre-diabetes.

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In addition to high cholesterol and high blood sugar, three lifestyle factors also featured on the list. Maintaining a healthy weight, not smoking, and leading an active lifestyle were all found to minimize risk of heart attack, while the absence of these were associated with the 42 percent increased risk.

The researchers also found that having even one risk factor also increased risk of heart failure by 30 percent, cardiovascular death by 25 percent, and stroke by 24 percent.

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The final of the seven factors listed in AHA’s “Life’s Simple 7” metrics is your blood pressure—and it’s one of the most significant predictors of a future coronary event. It also has a wide-ranging impact on your overall health. Beyond the association between hypertension and heart attack, high blood pressure is also known to cause stroke, heart failure, kidney disease, vision loss, peripheral arterial disease, aneurism, and sexual dysfunction.

The AHA says you can mitigate these risks by partnering with your doctor to create a blood pressure management plan. This may include weight loss, at-home monitoring, dietary changes, medication, and more.

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The study found that while those who began with and maintained good heart health suffered the fewest hospitalizations or deaths from heart attacks, strokes, or heart failure, those who suffered poor heart health but improved over time also saw vast improvements in their outcomes.

The researchers explain that their results underscore the need for consistent monitoring of heart health among younger adults, which can lead to interventions in the seven categories the AHA identified. “Most people lose ideal cardiovascular health before they reach midlife, yet few young people have immediate health concerns and many do not usually seek medical care until approaching midlife,” said the study’s senior author Hyeon Chang Kim, MD, PhD, in a statement. “We need strategies to help preserve or restore heart health in this population because we know poor heart health in young adults is linked to premature cardiovascular disease.”

Not sure how you’d rank on the researchers’ scale? Talk to your doctor to find out how your cholesterol, blood sugar levels, and other factors may be influencing your heart health.

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