Some risk factors for heart disease, including your age and family history, cannot be changed. But other risk factors, including diet and exercise, can be modified. Even if you already have heart disease, you may be able to limit your heart attack risk by keeping your blood cholesterol and blood pressure under control. (1) Most heart attacks happen in people with coronary artery disease (CAD). (1) This condition involves a buildup of a waxy substance called plaque in the arteries that supply blood to your heart. Plaque is a combination of fat, cholesterol, and other substances that can build up inside your arteries. As plaque accumulates over time, the inside of your arteries can become narrowed. This condition is known as atherosclerosis, or “hardening of the arteries.” Eventually, an area of plaque may rupture, resulting in a blood clot forming to stop the ruptured plaque from releasing its contents into your bloodstream. When a blood clot forms in an already narrowed artery, the artery may become partially or completely blocked and limit or cut off the blood supply to your heart. This is a heart attack. Because blood carries oxygen to your heart, if blood flow to your heart isn’t restored quickly, a portion of the heart muscle may become permanently damaged. (1,2)
Other Heart Attack Causes
Less commonly, a heart attack may be caused by a severe spasm, or tightening, of a coronary artery. A coronary artery spasm may cut off blood flow to your heart. This can happen in people who do not have coronary artery disease or atherosclerosis and is more common in females than males. While it isn’t always clear what causes a coronary artery spasm, risk factors include smoking, high blood pressure, and high cholesterol levels. Other potential triggers of a coronary artery spasm may include:
Certain stimulant drugs (such as amphetamines and cocaine)Tobacco useSevere emotional distressExposure to extreme cold (1,2)
Nonmodifiable Risk Factors for Heart Attack
Risk factors for having a heart attack fall into two categories: modifiable (behaviors you can change) and nonmodifiable (characteristics you cannot change). Heart disease risk factors that you cannot control include:
Older Age
Your risk of having a heart attack increases as you get older, no matter how healthy you are. About 80 percent of people who die of heart disease are 65 or older, according to the Centers for Disease Control and Prevention. (3) Heart attack risk begins to rise substantially for men after age 45, and for women after age 55, according to the Mayo Clinic. (1)
Male Gender
Men are at greater risk for a heart attack earlier in life than women. For women, heart disease risk begins to increase after menopause.
Family History of Heart Disease
Having a close family member (parent or sibling) with heart disease means that you may be more likely to develop the disease. Your risk of heart attack may be substantially higher if a close relative has had an early heart attack, before age 55 for men or age 65 for women. (1,2)
Certain Racial and Ethnic Backgrounds
Heart disease risk is higher in African-Americans than in white Americans. This may be due to both genetic factors as well as disparities in resources and access to healthcare. Mexican-Americans, American Indians, and Alaska Natives also experience a higher rate of diabetes, which is associated with an increased heart disease risk. And rates of obesity are higher in African-American and Mexican-American women, which is also associated with an increased heart disease risk.
Preeclampsia
This condition may develop during pregnancy, and involves elevated blood pressure and protein in your urine. Preeclampsia doesn’t just affect your risk during pregnancy, but is associated with an increased lifetime risk of heart disease — including heart failure, coronary artery disease, and heart attack. (2)
Modifiable Risk Factors for Heart Attack
There are certain risk factors that you may be able to change. These include:
Smoking
People who smoke are 2 to 4 times more likely to develop cardiovascular diseases than nonsmokers and 2 to 3 times as likely to die from it, according to the American Heart Association. Smoking may raise women’s heart attack risk more than men’s. One study found that women who smoked 20 cigarettes a day had double the risk of heart attack than men who smoked the same amount. (4)
High Cholesterol
As blood cholesterol rises, so does your risk of heart disease. It’s important to focus not just on total cholesterol, but on your levels of HDL (“good”) and LDL (“bad”) cholesterol, as well as triglycerides.
High Blood Pressure
High blood pressure makes your heart work harder and may cause the heart muscle to not work properly over time, increasing your heart attack risk.
Lack of Physical Activity
Inactivity is a major risk factor for heart disease, and regular exercise can greatly lower your risk. Physical activity can improve your cholesterol and triglyceride levels, and it may help with weight control and blood pressure.
Being Overweight or Obese
People with excess body fat are more likely to develop heart disease. The good news is that if you’re overweight or obese, shedding just 3 to 5 percent of your current body weight can significantly reduce certain heart disease risk factors. Greater weight loss can lead to even more improvement.
Diabetes
At least 68 percent of people with diabetes over age 65 die of heart disease, according to the American Heart Association. If you have type 1 or type 2 diabetes, it’s extremely important to work with your doctors to manage your blood glucose levels and reduce other heart attack risk factors.
Excess Alcohol Intake
Drinking heavily can raise your blood pressure and contribute to high triglyceride levels. To limit your heart disease risk and other risks, it’s best to consume no more than two drinks a day for men and one drink a day for women.
Poor Diet
A heart-healthy diet includes a variety of nutrient-rich foods with an emphasis on fruits, vegetables, and whole grains, as well as legumes, poultry, fish, nuts and seeds, and low-fat dairy products. (5) Additional reporting by Quinn Phillips.
