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July 10, 2020  
HEART NEWS: Feature Story

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  • Heart Attack Risk Factors

    Heart Attack Risk Factors: Take Control Of Your Health

    April 15, 2002
    Monitoring and controlling the following risk factors will reduce your chances of suffering a heart attack - even if you already have coronary artery disease (CAD) or have had a previous episode. It will also improve your general health.

  • Cholesterol
  • Diabetes
  • Obesity
  • High Blood Pressure
  • Race
  • Lifestyle

  • Cholesterol

    High cholesterol levels cause as many as half of all deaths due to heart disease in the United States.
    When there is too much cholesterol (a fat-like substance) in the blood, it builds up in the walls of arteries. Over time, this buildup causes arteries to become narrowed, and blood flow to the heart is slowed or blocked. If the blood supply to a portion of the heart is completely cut off, a heart attack results. Unfortunately, high cholesterol causes no symptoms, meaning many people who are at risk are never tested. Doctors recommend that adults (over age 20) get their cholesterol level measured every five years.

    The most common cholesterol test in called a lipoprotein profile. It measures the levels of three types of cholesterol found in your blood: low density lipoproteins (LDL), high density lipoproteins (HDL) and triglycerides. LDL is known as "bad cholesterol" because it can collect on artery walls and harden, forming what is known as plaque. LDL can also lower your body's levels of nitric oxide, which helps blood flow. HDL, also known as "good cholesterol," scrapes plaque off artery walls and brings it to the liver for processing. Triglycerides are a combination of fat molecules and cholesterol that can make LDL more dangerous. Triglycerides may also cause blood clot formation, which can lead to a heart attack.

    Your total cholesterol level should be under 200 mg/dl. LDL level should be below 160 mg/dl in healthy people and below 100 mg/dl in people who already have heart disease. HDL levels should be above 40 mg/dl, and above 50 is best.

    Medications are available to treat high cholesterol levels, but a healthy diet and an active lifestyle are imperative to keeping levels low. Most cholesterol-lowering diets stress high fiber and fresh fruits and vegetables while avoiding saturated fats, such as those found in animal products, and trans-fatty acids, typically found in commercial baked goods and fast foods.

  • More on cholesterol

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    High Blood Pressure (Hypertension)

    About one in four Americans has high blood pressure, or hypertension. Blood pressure is the measurement of the force of blood against the artery walls. If blood pressure is too high, the heart has to work harder to pump blood. This increases the risk of heart attack. Hypertension can also harden artery walls, which further raises the risk of developing heart disease.

    Like high cholesterol, hypertension often has no symptoms, so many people are unaware they have it. It is sometimes referred to "the silent killer." Once high blood pressure develops, it's hard to reverse.

    There are two numbers that make up your blood pressure measurement. The systolic pressure measures pressure as the heart beats, and the diastolic pressure measures pressure between beats. Ideal blood pressure is less than 120 mm Hg (millimeters of mercury) systolic pressure, and less than 80 mm Hg diastolic pressure. This measurement would be expressed as 120/80, or "120 over 80". Blood pressure above 140/90 is considered potentially dangerous, and should be treated.

    Sometimes, especially in older adults, the first number may be high while the second is normal. This is called systolic hypertension, and should be treated.

    High blood pressure can be genetic, and is known to occur more frequently in racial minorities (see race for more). It can also be caused by other medical problems. In those cases, hypertension can only be cured once the original problem is treated. Lifestyle factors such as obesity, excessive alcohol consumption and high levels of sodium (salt) in the diet can also adversely affect blood pressure.

  • More on high blood pressure

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    Heart disease is the most common serious complication of diabetes, but most diabetes patients are relatively unaware of the risk. It is estimated that over 80 percent of people with diabetes mellitus and two-thirds of all diabetes patients die from heart and blood vessel conditions.

    A key ingredient in diabetes-related heart disease is insulin resistance, which is commonly present in type 2 diabetes. If you have insulin resistance, you cannot use effectively the insulin your body produces. This can aggravate cholesterol imbalances, increasing the ratio of LDL ("bad cholesterol") to HDL ("good cholesterol"). Triglycerides, the third type of cholesterol, may also increase.

    Furthermore, elevated blood sugar levels can damage blood vessels. This can lead to atherosclerosis, a leading cause of heart disease. Atherosclerosis is commonly known as "hardening of the arteries." It starts to form when the inner wall of an artery is scratched or damaged, by LDL or excess blood sugar, for example. Fatty tissues like triglycerides attract to those legions and begin to build up. White blood vessels are also attracted to the site, and try to clean up the irritation. The WBCs, however, just cause the area to become sticky, attracting more harmful molecules. Eventually these molecules build up and form "plaque." Plaque clogs arteries, making it harder for blood to flow through them.

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    There are some risk factors for heart disease that you cannot control. These include age, gender, race and family history.

    If your family has a history of heart disease, you should make sure to monitor all of your risk factors, including your cholesterol levels and blood pressure. While experts recommend cholesterol testing every five years, if your family has a history of heart disease, you may want to monitor cholesterol more frequently. Talk to your doctor about what is right for you.

    Young men have a greater risk of developing heart disease than young women. However, as women age and reach menopause, their risk increases. This is due to the role estrogen plays in combating heart disease. Taking estrogen supplements after menopause can help women lower their risk.

    Among older people, women and men have similar heart attacks survival rates, but younger women are more likely to die from a heart attack than younger men.

    African Americans, particularly African American women, face higher risks of death from heart attacks. Socioeconomic factors, such as poor diet and lack of access to health care, play a role in this disparity. However, there appear to be biological factors as well. Some African Americans may have a genetic trait that increases the danger of triglycerides, a type of cholesterol. And African Americans may also produce less nitric oxide in response to stress than their white counterparts. Nitric oxide is critical for maintaining blood flow.

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    Being obese or overweight can increase your risk of heart attack. One study found that overweight or obese patients had their first heart attacks at a younger age than people who were not overweight.

    Contrary to popular belief, being overweight not does necessarily indicate poor health. Some experts argue that sedentary lifestyle and poor diet-which can, but do not always, accompany excess weight-cause heart disease, rather than the excess weight itself.

    But there is also evidence that weight itself can be harmful. As the amount of body fat increases, fat cells enlarge and produce a number of harmful chemicals that can increase risk of high blood pressure and diabetes, two common risk factors for heart attacks. Fat cells in different parts of the body have different properties, and studies show that abdominal fat-the "beer belly"-is more risky than fat distributed around the hips, buttocks and thighs.

    Healthy weight is calculated using the body mass index (BMI), which measures weight in relation to height. A BMI level over 25 indicates "overweight," and a BMI over 30 is considered "obese." The lowest risk for heart attack is in people with a BMI of 21-24. Risk increases slightly with values between 25 and 27, and only becomes significant at levels of 27 and higher.

  • More on obesity

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    Smokers are more than twice as likely to have heart attacks than nonsmokers. In addition, smoking is the number one risk factor for sudden cardiac death. For those regularly exposed to secondhand smoke, risk of heart disease increases by more than 25 percent.

    Smoking increases risk of heart attack by lowering HDL ("good cholesterol") levels and causing blood vessels to narrow.

    Physical Activity

    A sedentary lifestyle greatly increases your chance of developing heart disease. Even moderate exercise increases blood flow, lowers blood pressure, lowers levels of LDL ("bad cholesterol"), fights blood clots and reduces stress.

    The National Institutes of Health emphasize that "exercise programs must be customized for each individual" according to his or her capacity, needs, and interest. The NIH suggests that children and adults should accumulate at least 30 minutes of moderate intensity physical activity on most days of the week. Those 30 minutes do not have to come all at once; it can come in 10- or 15-minute increments throughout the day. More exercise is of course better, but the NIH recommends "even the most inactive individuals should gradually begin doing some form of activity which can become physically more challenging with time." In fact, studies show that people are more likely to adhere to exercise regimens that start out low-intensity and become more strenuous over time.


    A diet low in saturated fats, which are found in animal products, and trans-fatty acids, which are found in commercial baked goods and fast food, is important in minimizing risk of heart attack. The effects of unsaturated fat on heart health are more debated. It is generally advisable to maintain a moderate intake of unsaturated fats, somewhere between 15 and 30 percent of calorie intake.

    A heart-healthy diet should also be high in fiber, whole grains and fresh fruits and vegetables. Fish has been shown to be protective, though it should not necessarily be eaten every day. Garlic, cooked tomatoes, onions, wine and tea have also been shown to be beneficial. And make sure to maintain moderate levels of sodium (salt) intake.


    One to two drinks a day, particularly of wine, can protect the heart, especially if you are already high-risk. Heavy drinking, however, can raise blood pressure and damage the heart.

    Stress and Depression

    Stress can increase risk of developing atherosclerosis in men and women. It can also act as a trigger for a heart attack.

    Depression can increase risk of heart disease in men, even decades after the depression is over. Some studies have also shown an increased risk of heart disease in women who have been depressed, but other studies did not find any such link.

    Choose another risk factor

  • Last updated: 15-Apr-02


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