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Risk Factors for Heart Attack & Heart Disease, Part II

Q: What are the additional risk factors for heart attack and heart disease?

Dr. Donnica:
Aside from the major risk factors, there are some additional risk factors to consider:

  1. Race.  African Americans are at highest risk for heart disease and heart attacks: in the US, the age-adjusted death rate for coronary heart disease is nearly one-third higher for black than white women; the death rate after heart attack for black women in twice than for white women.  In contrast, coronary heart disease outcomes are more favorable for black men than white men.   It is also important to note that blacks have significantly higher rates of diabetes, hypertension and elevated cholesterol than whites and that this may account for much of the statistical differences in outcomes.
  2. Sleep apnea. This is a sleep disorder in which a person with heavy snoring may temporarily stop breathing.  The nervous system usually shocks the person back to breathing normally, but this temporary lack of oxygen increases the risk for heart attack significantly.  This can be treated.
  3. Motherhood. My favorite saying about motherhood is that "Becoming a mother means making the decision to forever watch your heart walk around outside your body".  One would think that this stress alone would increase one's risk of heart disease!  A recent study from the University of Minnesota, however, found that when women became mothers, their risk for heart disease actually did increase, but it was attributed to the fact that mothers did fewer leisure-time physical activities, thus making them more sedentary.  Interestingly, these findings were true for all mothers (single or married), but not true for fathers.
  4. *Depression.  While heart disease or having had a heart attack can certainly cause or contribute to depression, depression itself is a risk for worsening heart disease and increased risk of heart attack.  This condition should be treated as seriously as any medical problem, just like diabetes or high blood pressure.   See a psychiatrist if necessary for the appropriate counseling and drug therapy if necessary.
  5. *Vitamin deficiencies. Long term data collected on 80,000 women over 14 years found that women who consume at least 400 mcg folic acid (folate) per day and more than 3 mg Vitamin B6 can cut their risk of heart attack by nearly half.  The heart benefit of these vitamins is related to their ability to lower a potentially damaging substance called homocystine in the blood.  Low levels of Vitamin B12 have also been associated with high homocystine levels.  People over age 50 may have decreased absorption of B vitamins; it is recommended that they get at least 6 mcg B12 per day.  These amounts are easily obtained in a daily multivitamin.
  6. Vitamin E-an anti-oxidant--has also been shown to reduce heart attack risk.  If you follow a low fat diet, however (which you should) it is difficult to get sufficient dietary Vitamin E.  Supplements of 100-400 IU are generally recommended; higher doses are NOT advisable, however. 

    Evidence is weak about the potential cardio-protective role of other anti-oxidants such as Vitamin C and beta-carotene.

    Data is increasing that having adequate calcium intake (1,500 mg/day for menopausal women; 1,000-1,200 mg/day for premenopausal women) is important for several aspects of optimal cardiac health as well as bone health.  If you consume a diet low in dairy products, this amount will be difficult to obtain from diet alone.  Estimate your daily dietary intake of calcium, subtract this from your recommended amount, and get the rest form a supplement.

  7. *Infections.  It has long been known that infections can travel through the blood to the arteries in the heart where they can cause an inflammatory response.  This can start a chain reaction that leads to plaque build-up on the artery walls.  Some infections (viral and bacterial) may even cause cardiac infections, such as endocarditis or pericarditis, which may precipitate a heart attack.  Infections to be particularly vigilant about include strep throat, respiratory infections, ulcers, rheumatic fever and tuberculosis.  Recent data also show that the bacteria that cause gum disease increase risk significantly; this is another reason to practice vigilant dental hygiene. 

Created: 9/28/2000  -  Donnica Moore, M.D.

 Becoming a mother means making the decision to forever watch your heart walk around outside your body 

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