By the numbers:
Introduction
Risk factors for heart disease and stroke are common — so common in fact, that nine in 10 people in Canada have at least one key modifiable risk factor1. The good news is that almost 80% of premature heart disease and stroke can be prevented by adopting healthy behaviours2–4 and additional risk factors can often be effectively treated and controlled—although some remain beyond our ability to change.
According to a recent Heart & Stroke poll, only half of Canadians know their own risk for heart disease and stroke. At the same time, virtually all Canadians (more than nine in 10) believe it is important not only to know the factors that put them at risk but also to take action by understanding, reducing and managing their personal risk factors.5 Eating a healthy diet, being physically active, and not smoking are important steps, as well as knowing blood pressure and cholesterol levels and keeping them in check. Some risks are not modifiable including sex, age and genetics, and risk can change throughout an individual’s life. Personal circumstances and environmental factors also influence overall health.
Prevention, progress and more work to do
Tremendous progress has been made in supporting heart and brain health. This includes advances in the prevention, control and management of risk factors as well as improving the diagnosis and treatment of heart disease and stroke. As a result, the death rate from heart disease and stroke has decreased by more than 80%6,7 over the past seven decades. Heart & Stroke, along with other key players, has contributed to this progress by funding groundbreaking research, increasing awareness and understanding, advancing health systems, and advocating for supportive public policies. Key
examples include improvements in diagnosing, treating, and managing high blood pressure and cholesterol; public awareness campaigns, programs and resources; smoke-free public places and health warnings on cigarette packages; and measures that support healthy eating including eliminating trans fats from the food supply and mandatory front-ofpackage nutrition labelling.
And yet, many risks are increasing, and new data reveal that more than 6 million8 people across the country are living with heart disease or stroke. Upwards of 108,000 strokes9 and more than 62,000 heart attacks10 happen in Canada each year and almost 135,000 people are diagnosed with heart failure.10 One in five deaths in Canada is caused by heart disease or stroke —that’s a life taken every seven minutes11
Much more can be done to support the heart and brain health of Canadians.
About this report and highlights
This report draws on the most up-to-date data for risk factors, from a variety of sources, including government surveys, to provide a snapshot of current cardiovascular risk in Canada. Where data is available, trends over time are noted, and areas are identified where certain groups face a greater risk burden. The issue is complex and requires multi-faceted solutions. The report concludes with calls to action for individuals, healthcare providers, and governments to improve heart and brain health across the country.
Highlights:
• Adult smoking rates have decreased dramatically from 50% in 1965 to 11% in 2024 but smoking remains the leading cause of preventable death and disability, killing 46,000 Canadians each year.
• More than one in four grade 12 students vape
• Only about half of adults meet their weekly physical activity recommendations. Just over half of children and only two in 10 youth meet their daily physical activity recommendations.
• Fruit and vegetable consumption has been declining since 2015 across all age groups. Currently nearly eight in 10 adults and youth eat limited amounts of fruits and vegetables (fewer than five times per day). Females eat more fruit and vegetables compared with males.
• Almost eight in 10 Canadians report meeting the daily sleep recommendations.
• Nearly one in four adults report that most days are quite a bit or extremely stressful, and this rate has generally been stable since 2015.
• The number of Canadian adults living with high blood pressure has increased each year since 2000. More than 8.2 million adults have been diagnosed with high blood pressure.
• More than one in four Canadians aged 18–79 and six in 10 aged 60–79 have high cholesterol
• More than 3.9 million Canadians (all ages) are living with diabetes — more than three times the amount since 2000.
• A substantial proportion of an individual’s cardiovascular risk is based on their genetics
• Age is a risk factor for heart disease and stroke, and the Canadian population is aging.
What’s a risk factor?
A risk factor is something that increases the likelihood of an individual developing a condition or disease. Some risk factors for heart disease and stroke are lifestyle related including diet, physical activity, tobacco and nicotine use, and sleep. Making healthy choices and changes in these areas is easier for some people than others and depends on a variety of circumstances and available supports.
“Our environment is not neutral. We are living in an often healthdisrupting environment with social and structural determinants that can prevent people from being able to make decisions that would improve their health and wellbeing. The choices we make are dictated by the choices that we have, and in some cases there’s not even a choice,” says Dr. Sara Kirk, professor, health promotion, Dalhousie University.
Medical risk factors are diagnosable health conditions such as high blood pressure (hypertension), high cholesterol or
diabetes. They can often be managed through lifestyle changes and medication. Non-modifiable risks — the ones that cannot be controlled — include genetics and family history, age, sex and gender, race, ethnicity and/or Indigeneity, socioeconomic status and other factors. Mental health, including stress and mood disorders also impact physical health.
An individual’s risk of heart disease and stroke is shaped by a complex web of interacting factors across lifestyle behaviours, physical and psychological conditions, social determinants and genetics. While some risk factors may act independently, they more often cluster and reinforce one another. For example, where someone lives and their income can limit their access to healthy food and time for physical activity, increasing the likelihood of hypertension and high cholesterol, particularly in genetically susceptible individuals. Because these influences rarely act in isolation, understanding someone’s risk requires a holistic approach. Additionally, many of the risk factors for heart disease and stroke are shared with other chronic diseases such as certain cancers and lung diseases.
Statistical terms explained
Incidence is the number of new cases of a disease, condition or risk factor within a population over a specific period (often one year). Incidence is often expressed per a given population, such as “per 100,000 Canadians” to account for changes in population size. For example, “over 260,000 Canadians are newly diagnosed with diabetes each year” or “there are 700 new cases per 100,000 Canadians.” This reflects how often something happens which can help to identify trends over time and to understand why something is increasing or decreasing.
Prevalence is the number of individuals who have a disease, condition or risk factor at a given time. It includes both new and existing cases and indicates how widespread something is. Prevalence is often expressed as a percentage of a population. For example, “more than 3.9 million Canadians — or almost 10% of the population — are living with diabetes.” This kind of data helps with planning and allocating health resources based on the extent of a disease within that population.
Age-standardized incidence or prevalence is a way to compare these metrics between groups with different age distributions. For example, Canada’s current population skews older than it did 20 years ago. By adjusting incidence or prevalence to a common age standard, fair comparisons can be made over time or between groups, which is particularly relevant if a risk varies by age as it does with conditions like high blood pressure.
Lifestyle related risk factors
Smoking, youth vaping and other nicotine products
Smoking
Adult smoking rates in Canada have decreased dramatically since 1965 when they were at 50%.12 This is due to measures such as smoke-free public places, taxation, plain packaging, health warnings, cessation support, and increased awareness. Despite these significant advances smoking remains the leading cause of preventable death and disability in Canada, killing 46,000 Canadians each year13 — more than 1 million Canadians since 2000.14 And approximately 3.6 million Canadian adults still smoke.15 Considerable work remains to meet Canada’s Tobacco Strategy endgame target of less than 5% tobacco use by 2035.16
The smoking rate among Canadian adults declined from 19% in 2015 to 11% in 2024, however, rates did not change significantly within the most recent years of available data (2023 to 2024).15 The largest declines between 2015 and 2024 occurred among those aged 18–34 whose smoking rates dropped by more than half, from just over 22% in 2015 to just under 10% in 2024. Adults aged 65+ have had the lowest smoking rates since 2015, but they have only decreased slightly from just under
10% in 2015 to almost 9% in 2024. Males have consistently had higher smoking rates than females, and males aged 50–64 have the highest rate at 16%.
Smoking is higher among non-racialized populations than all other racialized groups (except Arab and West Asian) and higher among those born in Canada compared with newcomers.17 Lower socioeconomic status, including lower household incomes and education, are associated with higher rates of smoking.18 Smoking rates (commercial tobacco use) are significantly higher among Indigenous peoples: 55% of Inuit, 22% of First Nations people living off-reserve, and 18% of Métis adults (aged 18+) living in Canada smoke.19
Smoking rate (%) among Canadian adults aged 18+, by age group, 2015 to 2024
Youth vaping and other nicotine products
Canada has some of the highest youth vaping rates in the world.20 Since the introduction of e-cigarettes in Canada, vaping rates skyrocketed among adolescents and young adults. These rates remain high despite the federal government implementing key policies to protect youth, including restricting marketing and promotion, limiting nicotine content and increasing taxation. Several provinces have also implemented partial or full restrictions on vape flavours and taken other measures.
Vaping is not harmless. The latest evidence shows a list of proven harms associated with vaping, including increased risk of infections, weakened immune system, respiratory problems, high blood pressure, damaged blood vessels and an increased risk of cardiovascular disease.21–26 Nicotine is recognized by Health Canada as addictive and highly toxic and it is especially dangerous to developing brains.27 Emerging evidence shows there is potential for vaping to act as a gateway to smoking. In fact, teens who vape have four times higher odds of future tobacco use.28–30
More grade 7–12 girls vape (18%) than boys (14%), and vaping rates are higher among 2SLGBTQI+ students at almost 21%.20 A higher percentage of students who attend schools in rural areas vape (22%) compared to those in urban locations (13%), and rates are higher among Indigenous students (35%).
Past 30-day use of e-cigarettes (%), Canadian students grades 7–12, 2023/24
In 2014/15, youth vaping in Canada was at 6% among students in grades 6–12, compared with 15% among students in grades 7–12 in 2023/24 (excludes Quebec).20 Vaping is lowest among students in grade 7 (4%) and highest among those in grade 12 (more than 27%) meaning more than one in four grade 12 students vape.
There is a lack of consensus and population-level research on the effectiveness of e-cigarettes as a smoking cessation tool. Research shows that smokers who use e-cigarettes are less likely to quit smoking when compared to smokers who do not use e-cigarettes.31–34
Nicotine pouches were approved for sale in Canada in 2023 as a natural health product and sold and promoted in convenience stores and gas stations, in colourful packages.35 Currently nicotine pouches can only be legally sold behind the counters in pharmacies, and restrictions on flavours, marketing and packaging have been imposed. A recent Quebec study found almost 3% of adolescents in that province use nicotine pouches. Of those 72% also vaped and 28% also smoked cigarettes.36
Our environment is not neutral. We are living in an often health-disrupting environment with social and structural determinants that can prevent people from being able to make decisions that would improve their health and wellbeing. The choices we make are dictated by the choices that we have, and in some cases there’s not even a choice .
— Dr. Sara Kirk
Grade 8 Grade 7
Excludes Quebec and Territories
Physical activity
Physical activity is an important factor in heart and brain health, contributing to both prevention and management of heart disease and stroke.37 It plays a role in preventing high blood pressure and cholesterol, reducing stress and improving sleep among other benefits.38 The Canadian 24-Hour Movement Guidelines recommend that adults get at least 150 minutes of moderate to vigorous physical activity per week and children and youth get 60 minutes each day.39
According to the most recent data (2022/24), less than half of adults (46%) aged 18–79 get the recommended amount of weekly physical activity.40 This is similar to previous data (2018/19), when 49% of adults met the recommendations.41 Fewer than one in three adults aged 65+ (30%) meet the physical activity recommendations (2022/24), compared with half (50%) of those aged 18–64. Among children aged 5–11, just over half (52%) meet their daily recommendations. Youth aged 12–17 are the least likely to meet recommendations, with only two in 10 (21%) doing so. This is a significant drop from 2018/19, when more than one-third (36%) of youth met the recommendations.
Across all age groups, males are more likely than females to meet recommendations.40 The gap was especially pronounced among youth aged 12–17, where 33% of males met the guidelines compared to just 8% of females, making males nearly four times more likely to meet guidelines. Additionally, among adults, 53% of males meet the recommendations compared with only 39% of females.
The Canadian 24-Hour Movement Guidelines recommend limiting sedentary time to less than eight hours per day.
According to the most recent data (2022/24), Canadian adults spent an average of more than nine hours per day being sedentary, and youth spent more than 10 hours a day.42
Between 2015 and 2018, newcomers to Canada, some ethnic groups and people living on lower socio-economic status were less likely to meet the physical activity guidelines.43 A recent Canadian study found members of equity-denied groups continue to lack access, opportunities, and engagement in physical activity because of systemic barriers and discrimination although more data is needed to understand and mitigate barriers.44
Nutrition
Good nutrition can help lower the risk of heart disease and stroke by improving cholesterol levels, reducing blood pressure, and controlling blood sugar. A healthy diet includes lots of vegetables and fruit, whole grain foods, and protein foods, and limiting ultra-processed foods as they are high in one or more of saturated fat, sugar or salt, and avoiding sugary drinks.
According to the most recent data (2023), an estimated 24 million Canadian adults (nearly eight in 10) reported eating limited amounts of fruits and vegetables (fewer than five times per day), and rates have been declining across all age groups.15 From 2015 to 2023 fruit and vegetable consumption rates among adults dropped from 32% to 22%. In 2023, those aged 18–34 reported the lowest rate of fruit and vegetable consumption at 18%, while those 65+ had the highest rate of 25%. The most recent data available (2021) for youth (aged 12–17) reveals a similar drop in consumption from 31% in 2015 to 22% in 2021.45 This means nearly eight in 10 youth are eating low amounts of fruits and vegetables. Consumption is higher among females than males in all age categories.15,45 Some groups face greater food insecurity than others including newcomers, Indigenous people, and racialized Canadians.46
Ultra-processed foods contribute nearly half of the total daily energy for Canadians overall. Consumption is highest among
children and youth who get more than 50% of their total daily energy from these foods.47 Only one-third (34%) of Canadians adhere to the World Health Organization recommendations for free sugar (any sugars added to food or drink, plus sugars naturally present in syrups, purées and juices etc.) intake limits.48 The average sodium intake is estimated at 2760 mg per day, which is above the recommended maximum daily intake of 2300 mg per day,49 and on average Canadians consume only half of the recommended amount of dietary fibre.50
Body composition, weight and waist circumference
Body composition, weight and size can all influence the risk for heart disease and stroke. Body composition refers to the balance of fat and muscle in a person’s body, and where fat is stored or carried on a person’s body, which can influence risk.51
Body mass index (BMI) has historically been used as a screening tool to identify individuals who may be at risk for weight-related health issues. It is a ratio of height to weight and classifies results as underweight, normal weight, overweight or obese (several classes), noting increased risk with both the underweight and overweight categories (highest risk in the obese classes). This measurement for classification and use as an indicator of risk has been criticized for its limitations. For example, it does not account for body composition and it “overlooks important factors such as age, sex and race.” 52
Waist circumference is a measurement that provides an indicator of abdominal fat and excess fat carried around the waist, which can increase the risk of high blood pressure, high cholesterol, heart disease and type 2 diabetes.53,54 Even when a person is at a weight indicated as “healthy” using BMI, if they carry excess fat around the waist, this can increase their cardiovascular risk. BMI and waist circumference are only one part of a health risk assessment.
Both pediatric and adult Canadian obesity guidelines provide detailed criteria for obesity diagnosis and management, to support people living with obesity and prioritize improvements in their health and quality of life. Obesity is a complex chronic disease in which excess body fat (adiposity) can affect physical health such as increasing risk for diabetes, heart disease and stroke, as well as impacting mental health and wellbeing. People living with obesity face substantial bias and stigma.55
According to the latest data (2022/24), one in three Canadian adults aged 18–79 (33%) had a BMI classification as having obesity, up from one in four (25%) in 2016/19.56,57 The increase was most pronounced among young adults aged 18–39 among whom obesity rose from one in five (20%) to nearly one in three (31%). Nearly half of adults (49%) had a waist circumference above the threshold for abdominal obesity (greater than 102 cm for males and greater than 88 cm for females), and this percentage increased with age, affecting 55% of males and 66% of females aged 60–79. Among children and youth aged 5–17, 19% had a BMI classified as overweight and 11% as having obesity in 2022/24. These rates have not changed substantially since the 2016/19 period.
Compared with the average increase during the 11 years before the COVID-19 pandemic, the prevalence of obesity rose at a greater rate during the four years after the onset of the pandemic (2020–2023).58
Sleep
Sleep plays a role in heart and brain health and overall health; both quality and length of sleep can impact cardiovascular risk.59 Chronic sleep issues, such as difficulty falling or staying asleep, poor sleep quality or waking too early have been linked to high blood pressure, inflammation and changes in blood sugar regulation, all of which can strain the heart and blood vessels.60,61 Sleep apnea (when breathing repeatedly stops and starts during sleep) lowers oxygen levels in the blood and disrupts rest. If not treated, it can contribute to high blood pressure, abnormal heart rhythms and inflammation in the blood vessels, potentially leading to a stroke or heart attack.62 Additionally, increased tiredness can affect the ability to make healthy lifestyle choices and cope with normal life challenges. It can increase stress levels, anxiety and depression as well.59
According to the latest data (2022/24), almost eight in 10 adults in Canada (77%) reported meeting the daily adequate sleep recommendations for their age group: seven to nine hours for those aged 18–64 and seven to eight hours for those aged 65+.40 According to a 2021 survey, two in 10 adults (19%) reported having trouble going to sleep or staying asleep most or all the time. This was higher among females (23%) compared to males (15%).63
Alcohol
Frequency and amount of alcohol consumption can impact the risk of heart disease and stroke, including by increasing blood pressure.64
Alcohol sales have decreased on a volume basis every year since 2021/22.65 Sales dropped almost 4% during the most recent year of available data (2023/24), which is the largest volume decline since the government began tracking alcohol sales in 1949.66
In 2023 more than half (54%) of adults reported having zero drinks in the seven days preceding the survey, 15% had one or two drinks, 15% had three to six drinks and 15% had seven or more drinks.67 More than three-quarters (77%) of adults reported having at least one drink in the past 12 months. Nearly twice as many men (19%) as women (11%) reported drinking seven or more drinks in the past seven days. Those with a higher income and those living in rural areas consumed more drinks in the week prior to the survey compared to those with a lower income or living in an urban area.
Stress
Too much stress may increase blood pressure68 and lead to depression and anxiety.69 Approximately 7.4 million Canadian adults — or nearly one in four — report that most days are quite a bit or extremely stressful.15 Overall, the rates of perceived life stress among Canadian adults have generally been stable since 2015, but the experience of stress is not uniform across ages and by sex. Among Canadian adults in 2024, females reported higher rates of stress compared to males in every age group, and rates of stress are higher among younger adults compared to older ones, with those aged 65+ reporting the lowest rates of daily life stress (11%). Among females aged 18–49, nearly one in three report that most days are quite a bit or extremely stressful. A similar pattern is seen among youth aged 12–17. In 2024, 24% of female youth reported daily life stress compared to 14% of males.70 Just under 30% of adults aged 25–64 report that most days at work are quite a bit or extremely stressful, with women aged 45–64 experiencing the most stress at work (36%).71
Socioeconomic factors such as income, employment status, and education all play a significant role in shaping mental health. People with lower incomes and those experiencing food insecurity report lower life satisfaction and lower selfrated mental health.72 Racism and discrimination have also been consistently linked to depression, anxiety and chronic stress.73 Unpaid care (for children or care-dependent adults) often has an impact on the carer’s physical and mental health, including making them feel tired, worried or anxious. Women are more likely both to provide unpaid care and to report negative impacts than men.74 Compared with their cisgender heterosexual peers, 2SLGBTQ+ youth and young adults in Canada are at elevated risk for several indicators of poor mental health including substance use disorder and considering suicide.72
Perceived life stress (%), most days quite a bit or extremely stressful, Canadian adults aged 18+, by age and sex, 2024
Females Males
Medical risk factors
High blood pressure (hypertension)
Blood pressure is a measure of the pressure or force of blood against the walls of blood vessels (arteries), based on two measures. The top number (systolic) is the measure of the pressure when the heart contracts and pushes blood through the arteries. The bottom (diastolic) number is the measure of the pressure when the heart relaxes between beats. According to the most current Canadian guidelines (2025) from Hypertension Canada, the definition of high blood pressure in adults is at or above 130/80 mmHg as recent evidence shows a substantially increased cardiovascular risk starting at this revised threshold.75 This is a stricter threshold than previously recommended in the guidelines, which ranged from 120/80 as low risk to 135+/85+ as high risk.
Factors that influence high blood pressure include unhealthy diet (including food high in sodium), physical inactivity, smoking, overweight, stress, age, ethnicity, family history, and gender. While the risk of high blood pressure increases with age, the younger the age of onset, the higher the cardiovascular disease risk.76 High blood pressure is the number one risk factor for stroke77 and a major risk factor for heart disease.78,79
In 2023, more than 420,000 adults aged 20+ were newly diagnosed with high blood pressure (excluding gestational hypertension) — the highest number of newly diagnosed cases in a one-year period since 2005.10 The number of Canadian adults living with diagnosed high blood pressure
has increased each year since 2000. As of 2023 there are more than 8.2 million adults living with diagnosed high blood pressure. The percentage of adults with diagnosed high blood pressure rose from 16% in 2000 to 24% in 2009 and has remained relatively stable since, currently at approximately 25%, or one in four adults. However, this is likely a substantial underestimation of the true burden, as 22% of Canadian adults aged 20–79 with high blood pressure have not been diagnosed or treated for their condition (2016/19).80 Additionally, the most recent data was collected before the release of the updated, stricter hypertension guidelines. In fact, a study based on data from between 2013 and 2015 estimated that over 40% of Canadian adults would be considered to have high blood pressure based on the new threshold.81
High blood pressure is strongly related to age; nearly eight in 10 Canadians aged 80+ are living with the condition.10 High blood pressure in Canada is more common among males in all age categories except among those aged 80+.
Age-standardized rates
When adjusting for the aging population, the percentage of Canadian adults living with diagnosed high blood pressure increased until 2011 and has been gradually declining since.10
“This could reflect a decline in the primary care focussed national hypertension education program and a reduction in diagnosis, as what is not captured are those with undiagnosed hypertension,” says Dr. Norm Campbell, professor emeritus, University of Calgary. The most recently available data (2016/19) shows the percentage of adults (aged 20–79) with hypertension who had been diagnosed had decreased.80
“Several countries have reported a decline in hypertension control post COVID. And we are not expecting very good results in Canada because of a limited focus on chronic diseases and their risks, fewer in-person primary care visits and reduced overall access to primary care providers,” says Dr. Campbell. Looking at newly diagnosed cases of hypertension, the age-standardized incidence rate declined consistently between 2000 and 2017 but rose in 2023 to the highest level since 2014.10 While data quality issues during the COVID-19 pandemic years (2020 to 2022) complicate interpretation, this recent increase warrants close monitoring.
Some populations are at higher risk, for example, Indigenous peoples, as well as Black and South Asian Canadians have higher rates of high blood pressure compared to the general population.43,82–86 High blood pressure is more prevalent among people with lower income levels and with lower levels of education, as well as those living in rural and remote areas.43 The association between income and high blood pressure is most pronounced for Black women, compared to white Canadians or Black men.87Additionally, hypertension treatment and control rates declined among women between 2007 and 2017 while remaining mostly stable among men.88
Several countries have reported a decline in hypertension control post COVID. And we are not expecting very good results in Canada because of a limited focus on chronic diseases and their risks, fewer in-person primary care visits and reduced overall access to primary care providers.
— Dr. Norm Campbell
High cholesterol (hypercholesterolemia)
Cholesterol is a fat found in the blood. There are two main types of blood cholesterol: high density or HDL cholesterol and low density or LDL cholesterol. LDL cholesterol is referred to as “bad” cholesterol because it can form plaque or fatty deposits on artery walls and block blood flow to the heart and brain. High blood cholesterol – also known as hypercholesterolemia, is one of the major controllable risk factors for heart disease and stroke. High cholesterol is detected through a simple blood test.
High cholesterol can be inherited and can also result from lifestyle behaviours. For example, a diet rich in saturated fat, a lack of physical activity, and smoking can increase the risk of high cholesterol, as can living with obesity or diabetes.89 People with familial or inherited high cholesterol have a much higher risk of developing heart disease early in life.90 For those with a family history of premature heart disease or very high cholesterol at a young age, genetic testing could be available.
According to the most recent data (2016/19) high cholesterol affects more than one in four Canadians (28%) aged 18–79 and this climbs to six in 10 (60%) among those aged 60–79.91 More males (34%) have high cholesterol compared with females (22%) however, males are more likely to have it diagnosed and controlled (52%) compared with females (35%). Older adults (aged 60–79) are also significantly more likely to have their high cholesterol diagnosed and controlled.
Diabetes
Diabetes is a life-long condition where the body does not produce enough insulin (type 1) or cannot effectively use the insulin it produces (type 2).92 The body uses insulin to break down and control how much sugar is in the blood. Sugar (glucose) is a major source of energy for the cells in tissue, muscles, the heart and the brain. When the body is unable to break down the sugar it needs for energy, the result is an excess of glucose which can damage organs and blood vessels.
Type 1 diabetes usually begins in childhood, but it can also develop in adulthood. Type 2 diabetes is the most common type, accounting for 90–95% of all diabetes cases in Canada.93 While it typically develops in adults, children can be affected as well. Gestational diabetes is a temporary condition where the body can’t properly use insulin during pregnancy. Having gestational diabetes increases the risk of the mother and child developing diabetes later in life. It can also increase the mother’s risk of heart disease and stroke — especially if it occurs during multiple pregnancies.92,94 Having diabetes approximately doubles the risk of developing heart disease and stroke and dying from one of these conditions.95
As of 2023, there are more than 3.9 million Canadians (all ages and types 1 and 2 but excluding gestational diabetes) living with diagnosed diabetes.10 That is nearly one in 10. This number has increased every year since 2000, more than doubling from 4.2% of the population in 2000 to 9.7% in 2023. More than 260,000 Canadians were newly diagnosed with diabetes in 2023. Diabetes is strongly related to age and nearly three in 10 Canadian adults aged 80+ are living with diagnosed diabetes. For adults aged 40+ diabetes is more prevalent among males.
Age-standardized rates
When adjusting for the aging population, diabetes’ prevalence has continued to rise annually since 2000, though the pace of the increase has slowed considerably over time.10 The age-standardized incidence rate (which reflects new diagnoses) was relatively stable from 2012 onward, following fluctuations in the early 2000s. However, in 2023, this rate rose to 753 new cases per 100,000 Canadians, the highest number since 2010. As with hypertension, data from the COVID-19 pandemic years (2020–2022) makes recent trends challenging to interpret, but this rise in diabetes incidence warrants close monitoring in the years ahead.
Despite a lack of robust data, there is evidence that some populations in Canada are at higher risk of diabetes including Indigenous peoples, and Black, South Asian, and Arab/West Asian Canadians.43,82–86,96
1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 3,500,000 4,000,000
Non-modifiable and other risk factors
Genetics and family history
Genetics and family history are related but they are not interchangeable terms, and both influence risk for heart disease and stroke. Genetic risk is passed down from parent to child by way of genes and relates to the probability of an individual carrying a specific disease-associated mutation or being affected by a specific genetic disorder.
Age
Age is a risk factor for heart disease and stroke – as an individual’s age increases, so does their risk. For example, both hypertension and diabetes increase with age.10 The population of seniors in Canada is projected to increase to about 10.7 million by 2040, which would be close to one-fourth of the overall population. The population of people aged 80+ is growing fast and of those aged 100+ even faster.103 According to the latest population projections, the 80+ population could more than double within 20 years and is expected to more than triple over the next 50 years.104
In 2025, the median age of Canadians was 41 years; 19% of Canadians were aged 65+ (8.1 million people), and 5% were aged 80+.105 Among those aged 80 +, nearly six in 10 (58%) were women.
Although senior men and women in Canada have a similar demographic profile, there are some notable differences. Women are more likely to live below low-income cut-offs, more likely to be retired or not working full-time, less likely to be married or in common-law partnerships and more likely to live alone.103
Having a close relative (parent or sibling) with premature heart disease or stroke increases an individual’s risk.97–100 Family history of heart disease is a standalone risk factor, meaning it should be assessed even if no other risk factors are present. A substantial proportion of an individual’s cardiovascular risk is based on their genetics and studies have shown that about half of the risk of dying from heart disease is genetic.101,102 Making healthy lifestyle choices and managing medical risk factors plays an equally important role in supporting heart and brain health, despite genetic predisposition.
Beyond inherited genes, the family environment also plays a role in family history and risk. “When people hear ‘family history,’ they usually think about genetics, and that’s important because genes do account for a lot of risk. But families also pass down lifestyle habits, and communities do the same. Healthy habits spread, but unfortunately unhealthy habits spread just as easily,” says Dr. Guillaume Paré, professor, pathology and molecular medicine, McMaster University.
Other risk factors
Sex and gender, Indigenous heritage, ethnicity, socioeconomic status, geography, discrimination and racism all affect heart and brain health. Consequently, some populations may face higher risks, and intersecting inequities put some individuals at greater risk than others.
Sex and gender
Women face some distinct risk factors for heart disease and stroke and at different points in their lives, including during their reproductive years, and around menopause and after menopause. For example, pregnancy can lead to hypertension and gestational diabetes, both of which increase the lifetime risk of heart disease and stroke, and as estrogen levels drop during menopause, risk increases. Yet, only 11% of women in Canada can name one or more risk factors specific to women for heart disease and stroke.106
Canada is home to approximately 1.3 million people who are Two-Spirit, lesbian, gay, bisexual, transgender, queer or who use other terms related to gender or sexual diversity (2SLGBTQ+), representing more than 4% of the Canadian population aged 15+.107 There is mounting evidence that 2SLGBTQ+ people as a group face more health inequities than their cisgender, heterosexual peers.108
Indigenous heritage
According to the latest available data (2021 Census) there were 1.8 million Indigenous people living in Canada representing 5% of the total population.107 For Indigenous peoples in Canada, settler colonialism has created conditions that have led to wide disparities in health outcomes. They continue to face extensive discrimination and mistreatment within the healthcare system and as a result, they’re much less likely to seek care and much more likely to get misdiagnosed if they do.109–112 Indigenous peoples are more likely to be at risk for or living with heart disease and stroke compared to the general population.83,113–116 Some of this increased risk is associated with difficulty accessing health care, taking prescription medications and affording prescription medications.117 The Truth and Reconciliation Commission of Canada Call to Action 18 states: “We call upon the federal, provincial, territorial and Aboriginal governments to acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies.” Call to Action 19 highlights the need “to establish measurable goals to identify and close the gaps in health outcomes between Aboriginal and non-Aboriginal communities.”
Ethnicity
In the latest Census (2021) 9.6 million people in Canada reported themselves as members of a racialized group.107 Some racialized groups face a bigger burden of heart disease and stroke risk, for example, Black Canadians have higher prevalence of some cardiovascular risk factors compared to white Canadians,84,85 and are less likely to have a regular healthcare provider and 118 people of South Asian descent are also more likely to be affected by some cardiovascular risk factors.86
Environmental risks
Some regions have higher rates of air pollution or lower overall air quality, and according to the World Health Organization, exposure to air pollution is strongly linked to stroke and heart disease.119 Air pollution causes an estimated over 1,000 cardiac emergency department visits and over 800 cardiac hospital admissions per year in Canada120 and even low-level air pollution exposure is associated with increased risk of death from heart disease or stroke.121 Some equity-deserving groups in urban areas are exposed to higher levels of air pollution including people living on low incomes, newcomers, Indigenous people, and racialized populations.122
When people hear ‘family history,’ they usually think about genetics, and that’s important because genes do account for a lot of risk. But families also pass down lifestyle habits, and communities do the same. Healthy habits spread, but unfortunately unhealthy habits spread just as easily.
— Dr. Guillaume Paré
Addressing risk factors in Canada
For more than 70 years, with the generous support of donors and volunteers, and working with partners, Heart & Stroke has been raising awareness, funding research, and leading advocacy and system change efforts that promote health, save lives and enhance recovery.
What Heart & Stroke is doing
• For more than 70 years Heart & Stroke has invested $1.73 billion in world-class research to promote health, prevent disease, save lives and enhance recovery. Research funding has contributed to a better understanding of the risk factors for heart disease and stroke including how they can be modified. This includes areas such as nutrition, physical activity, tobacco, nicotine, and sleep, as well as the treatment and management of high blood pressure and cholesterol. Heart & Stroke-funded research has also investigated the role of genetics in heart and brain health risk.
• Heart & Stroke, along with partners, has successfully advocated for healthy public policies at all levels of government across the country to support heart and brain health. These efforts have resulted in:
• Smoking, vaping and nicotine products: smoke-free and vape-free public places; restrictions around promotion and marketing; plain packaging and health warnings on packages; increased taxation; cessation support; recovering costs for government’s tobacco control activities from the industry; tobacco lawsuit settlement resulting in payments to provinces/ territories and people who smoke along with the establishment of a foundation that will fund research on tobacco-related diseases; and regulations addressing nicotine pouches.
• Healthy eating: eliminating industrial trans fats from the food supply, revising the Food Guide, implementing mandatory front-of-package nutrition labelling on food and beverages, and establishing the National School Food Program.
• Physical activity: creating infrastructure to support active transportation.
• Pharmacare: getting legislation for a national pharmacare program passed in October 2024, with several provinces/ territories signing bilateral agreements.
• Heart & Stroke continues to advocate for policies that support heart and brain health such as taxation for tobacco and nicotine products, vape flavour restrictions, regulations to restrict unhealthy food and beverage marketing to children, and outstanding pharmacare bilateral agreements.
• In 2024 Heart & Stroke launched a multi-year awareness and education campaign to support women’s heart and brain health focused on risk factors across women’s unique life stages.
• In 2025 Heart & Stroke launched Risk Screen, an online screening tool to help people understand their heart and brain health risks and support them to take action. Risk Screen considers individual factors including lifestyle behaviours, medical history, sex, age, and life stages specific to women such as pregnancy and menopause. It also provides a customized action plan.
• Heart & Stroke continues to develop and action a health equity strategy, taking a partnership approach to promote heart and brain health for equity-deserving populations and communities.
What can individuals do?
• Know your risks. Take the Heart & Stroke Risk Screen tool. Built on the most up-to-date evidence, it is free, and easy to complete. heartandstroke.ca/riskscreen
• Take medications as prescribed.
• Be physically active. Adults should accumulate at least 150 minutes of moderate- to vigorous-intensity aerobic physical activity per week, in bouts of 10 minutes or more. Start slow and aim to gradually meet the recommended requirements.
• Eat a healthy balanced diet including lots of vegetables and fruit, whole grains and protein foods. Limit ultra processed foods which are usually high in saturated fat, sugar and/or salt. Avoid sugary beverages and make water your drink of choice. Follow Canada’s Food Guide and use front of package labelling to help you make decisions in the grocery store.
• Be smoke and nicotine-free. If you smoke or vape, make a plan to quit using supports and therapies that are proven effective, and speak to your healthcare provider.
• If you drink alcohol, limit yourself to small amounts, pace yourself and drink plenty of water at the same time.
• Manage your stress. Identify your stressors and try to remove them if possible. Use stress reduction tools and strategies such as doing physical activity, practicing relaxation exercises and getting enough rest.
• Get enough sleep. If you suspect you may have a sleep disorder, speak to a healthcare provider about referrals and sleep testing.
• Anyone with a family history of premature heart disease or stroke should have early and ongoing discussions with their healthcare providers to help reduce their risk.
• If you have any concerns about your physical or mental health, speak with a healthcare professional.
• Visit heartandstroke.ca for more information.
What can healthcare providers do?
• Focus on health promotion and disease prevention in clinical practice.
• Speak with your patients about risk factors for heart disease and stroke and recommend credible information and tools available from governments and other trusted organizations, including Heart & Stroke. Visit heartandstroke.ca
• Follow clinical practice guidelines for risk factor prevention, diagnosis and management.
• Refer patients to resources and programs in the community.
• Provide counselling around quitting smoking/vaping, healthy eating, alcohol consumption, physical activity, mental health and stress, and sleep. Support people on their journey to better heart and brain health.
• Screen for high blood pressure, high cholesterol and diabetes, and provide support around managing these conditions through healthy lifestyle behaviours and/or medication.
• Advocate for changes to curriculum for healthcare professionals to include a better understanding of health promotion and chronic disease prevention.
• Participate in unconscious bias and cultural safety training.
What can governments do?
• Implement policies that support healthy eating, physical activity, tobacco and nicotine control and risk factor management including:
• Introduce regulations around marketing unhealthy foods and beverages to children.
• Implement a tax on sugary drinks to reduce consumption.
• Ensure mandatory physical activity is part of school curriculum and continue to invest in active transportation infrastructure.
• Restrict the sale of flavoured vape products across the country.
• Uphold existing federal nicotine pouch regulations to protect youth from nicotine addiction.
• Increase taxes on tobacco and vaping products.
• Invest a significant amount of the funds the provincial governments are receiving from the historic tobacco settlement in preventing and reducing tobacco use and nicotine addiction, including providing cessation support and addressing youth vaping.
• Finalize national pharmacare bilateral agreements between the federal government and remaining provincial and territorial governments.
• Expand the national pharmacare formulary to cover prescription medications for heart disease and stroke, starting with cardiovascular medication commonly used by people with diabetes such as prescription drugs for high blood pressure and high cholesterol, as well as heart failure and other conditions.
• Continue to update guidelines and guidance around healthy eating, physical activity, alcohol consumption and other relevant areas.
• Support efforts to increase public awareness among health professionals, health system leaders and decision makers, educators and the public risk factors related to heart disease and stroke, including those unique to women.
• Through a federal/provincial/territorial collaboration, develop a pan-Canadian monitoring system for major risk factors for chronic disease, including cardiovascular disease, based on the existing surveillance system with analysis developed collaboratively with the scientific community and reported on an annual basis.
References
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