Heart Disease: Insufficient Sleep ✔ Diet ✔✔ Inactivity ✔✔✔ - Inactivity is the #1 Risk Factor for Heart Disease Across Adult Lifespan. Plus: Top 10 Reasons For Global Disease

You don't have to do kettlebell handstands. Just be active, girls!

We are often talking about the importance of sleep, and in fact, people who don't sleep enough have an increased risk of developing heart disease (+45%) and the fact that sleeping "too much" 9h+ is associated with a similar increase in (+38%) risk of heart disease in women (Ayas. 2003; similar data is available for men), alone, would not justify discarding the important contribution of short sleep durations to the ever-increasing number of patients with heart disease.

Similarly, a hypercaloric high fat + high sugar Western / Standard American style convenience + fast food based diet and its unwanted consequences, i.e. obesity, diabetes, etc. are unquestionably among the cornerstones of the heart disease epidemic.
And still, according to a recent study from the Centre for Research on Exercise, Physical Activity and Health at the School of Human Movement Studies of the University of Queensland  inSt Lucia, Queensland, Australia, says: "From about age 30, the population risk of heart disease attributable to inactivity outweighs that of other risk factors, including high BMI" (Brown. 2014)

Now, we cannot tell, whether the same is true for men, as well, but even if it wasn't, the data from Table 1 would obviously be both, remarkable and memorable.

Table 1: Age-specific relative risks for ischaemic heart disease (IHD) for four risk factors in women (Brown. 2014)

If you look at the "population attributable risk (%)"-graph from the original paper (Figure 1), it becomes even more obvious: physical activity is the key to heart health - actually even more so for young vs. old women (187% increased risk in 20-24-year-olds vs. 95% risk increase in 53-58-year-olds; see Table 1).

Figure 1: Population attributable risk (%) for four risk factors for IHD in women across the adult lifespan (Brown. 2014)

Even smoking is not match for inactivity, when it comes to the downstream effects on heart health. It is thus not surprising that scientists from the Albert Einstein College of Medicine report in a recent paper that for otherwise healthy middle-aged women who are overweight or obese, physical activity may be their best option for avoiding heart disease.

According to a study that followed nearly 900 women for seven years. These findings were reported in a paper led by authors at Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, the University Hospital for Einstein, and published today in the Journal of Clinical Endocrinology & Metabolism.
Throughout the seven-year study, the women were tested annually for heart disease risk factors. They also completed an annual survey describing their physical activity for the prior 12 months, which ranged from active living, caregiving and doing household chores to exercise and sports.

METs, i.e. metabolic equivalents are a way to measure the intensity of physical activity (occupational data based on Church. 2011)

During the seven years, 373 of the participants—43 percent of the total—had progressed from having at most a single risk factor for heart disease (i.e., metabolically benign overweight/obese) to at-risk overweight/obese, meaning they had developed two or more of the following five heart-disease risk factors: hypertension; low blood level of HDL ("good") cholesterol; elevated blood levels of triglycerides, elevated fasting glucose level (indicating pre-diabetes or diabetes); and elevated levels of C-reactive protein ( indicating inflammation).

And contrary to what you may have expected in view of the constant upheaval about "eating healthy", low-to-moderate physical activity—at the start of the study and during it—was the only lifestyle factor found to protect overweight/obese women from becoming at-risk for heart disease - to be specific, their heart disease risk was reduced by 16%.
Reference: 

• Ayas, Najib T., et al. "A prospective study of sleep duration and coronary heart disease in women." Archives of Internal Medicine 163.2 (2003): 205-209.
• Brown, Wendy J., Toby Pavey, and Adrian E. Bauman. "Comparing population attributable risks for heart disease across the adult lifespan in women." British journal of sports medicine (2014): bjsports-2013.
• Church, Timothy S., et al. "Trends over 5 decades in US occupation-related physical activity and their associations with obesity." PloS one 6.5 (2011): e19657.
• Wang, D, et al. "Progression from Metabolically Benign to At-risk Obesity in Perimenopausal Women: A Longitudinal Analysis of Study of Women Across the Nation (SWAN)." JCEM (2014).