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Risk Factors for Heart Attack & Heart Disease

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

Dr. Donnica:
The good news is that according to American Heart Association (AHA) estimates, half of all heart attacks are linked to known risk factors that can be reduced or eliminated.  The bad news is that most Americans don't implement these steps. The risk factors listed are called "major risk factors"; and all but age and family history are modifiable.

Major risk factors for heart attack:

  1. Age itself, for men; age and menopausal/HRT status for women.  The risk of heart attacks and heart disease increases directly with age.  In general, women begin having heart disease 10 years later than men, due to the protective effects of estrogen before menopause. While you can't change your menopausal age, you can change the estrogen deficiency responsible for menopause. Data show that HRT can cut the risk of heart disease in half and can reduce the risk of heart attack by 40%! In menopausal women, estrogen lowers LDL by 15% and raises HDL by 20-25%.  It may increase triglyceride levels, however.  Estrogen also keeps the arterial walls flexible and elastic, which improves blood pressure and blood flow. 
  2. Family history of CAD or previous personal history of heart attack.  You are at increased risk if you have a first degree family member who has had a "cardiac event":  a heart attack, open-heart surgery, angioplasty, etc.  You are at greatly increased risk for a second heart attack once you have already had your first.
  3. Smoking.  Just stop.  If you need data, consider this. Among pre and post-menopausal women, smoking triples the risk of heart attack.  Even women who smoke only 5 cigarettes per day or less have more than a doubled risk of heart attack compared to non-smokers!  Cigarette smoking also lowers the age for initial heart attack more for women than for men.  Birth control pills further increase the risk for heart attack in smokers, but not in non-smokers.  The good news is that women who quit smoking can decrease their risk of cardiovascular causes of death by 24% within 2 years.  Former smokers may approach the coronary risk level of a nonsmoker within 3-5 years of quitting.
  4. *Elevated cholesterol, especially LDL and triglycerides. The goal is to get your "good cholesterol" (HDL) as high as possible and to reduce your triglycerides and "bad cholesterol" (LDL) to as low as possible. 
  5. *Control your blood pressure.
  6. *Exercise.  Studies show that regular exercise can reduce your risk of heart attack by 40%!  Physical inactivity is associated with a doubled risk for cardiovascular events.  Aerobic exercise increases your circulation, strengthens your heart, inhibits blood clotting, helps with weight control, lowers blood pressure, helps control blood-sugar levels, and increases your "good cholesterol" (HDL). 
  7. *Control blood sugar.  Diabetes is a major risk factor for heart disease, especially in women.  The build-up of blood sugar can damage the walls of blood vessels.  Having diabetes also greatly increases one's risk of a "silent" heart attack.
  8. *Being overweight.  The more overweight you are, the more demand you put on your heart.  In addition, obesity increases the risks of developing or worsening high blood pressure, diabetes, and cholesterol problems.   Central adiposity (having the "apple shape" rather than the "pear shape") further increases your risk of heart disease significantly.
  9. *Stress.  Stress and repressed anger have been shown to increase blood pressure and heart rate, which can trigger a heart attack.  Exercise, relaxation, meditation, yoga, religious activities, and massage can help alleviate stress; psychotherapy may be indicated for those with hostility, repressed anger, and unhealthy or dangerous behaviors such as road rage.

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

 Half of all heart attacks are linked to known risk factors that can be reduced or eliminated. 

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