How Can the Risk Be Reduced?

CORONARY artery disease (CAD) is associated with a number of genetic, environmental, and life-style factors. CAD and a heart attack can result from years, if not decades, of risks associated with one or more of these factors.

Age, Gender, and Heredity

With increased age comes an increased risk of heart attack. About 55 percent of heart attacks occur in people over 65. Some 80 percent of those who die of heart attacks are 65 or older.

Men under 50 are more at risk than women of the same age group. After menopause, a woman’s risk increases because of the sharp decrease in the protective hormone estrogen. According to some estimates, estrogen replacement therapy may reduce the risk of heart disease in women by 40 percent or more, although there may be an increased risk of some cancers.

Inheritance can play a key role. Those whose parents had an attack before the age of 50 have an increased risk of an attack. Even if parents had an attack after age 50, there is an increased risk. When there is a history of heart trouble in the family, the offspring are more likely to develop similar problems.

The Cholesterol Factor

Cholesterol, a type of lipid, is essential for life. The liver produces it, and the blood carries it to the cells, in molecules called lipoproteins. Two types are low-density lipoproteins (LDL cholesterol) and high-density lipoproteins (HDL cholesterol). Cholesterol becomes a risk factor for CAD when too much LDL cholesterol is concentrated in the blood.

HDL is thought to play a protective role by removing cholesterol from tissues and carrying it back to the liver, where it is altered and eliminated from the body. If LDL tests high and HDL low, the risk of heart disease is high. Lowering the LDL level can result in a significant drop in risk. Dietary measures are a keystone in treatment, and exercise can be helpful. Various drugs can bring results, but some have unpleasant side effects.a

A diet low in cholesterol and saturated fats is recommended. Replacing foods high in saturated fats, such as butter, with foods that are lower, such as canola oil or olive oil, can lower LDL and conserve HDL. On the other hand, the American Journal of Public Health notes that hydrogenated or partially hydrogenated vegetable oils found in most margarine and vegetable-shortening products can raise LDL and lower HDL. Cutting down on high-fat meats and substituting low-fat cuts of chicken or turkey is also recommended.

Studies have shown that vitamin E, beta-carotene, and vitamin C can slow down atherosclerosis in animals. A study concluded that these may also reduce the incidence of heart attack in humans. Daily consumption of vegetables and fruits rich in beta-carotene and other carotenoids and vitamin C, such as tomatoes, dark leafy greens, peppers, carrots, sweet potatoes, and melons, may provide some protection from CAD.

Also said to be useful are vitamin B₆ and magnesium. Whole grains like barley and oats as well as beans, lentils, and some seeds and nuts can be helpful. Additionally, it is thought that eating fish such as salmon, mackerel, herring, or tuna at least twice a week may reduce the risk of CAD, as these are rich in omega-3 polyunsaturated fatty acids.

Sedentary Life-Style

Sedentary people have a higher risk of heart attack. They spend most of the day physically inactive and do not exercise regularly. Heart attacks often occur in these people after strenuous activities, such as heavy gardening, jogging, picking up heavy weights, or shoveling snow. But the risk decreases among those who exercise regularly.

A brisk 20- to 30-minute walk three or four times a week may lower the risk of an attack. Regular exercise improves the heart’s ability to pump, helps weight loss, and may decrease cholesterol levels and lower blood pressure.

Hypertension, Excess Weight, and Diabetes

High blood pressure (hypertension) can injure artery walls and enable LDL cholesterol to enter the artery lining and promote the buildup of plaque. As plaque deposits increase, there is more resistance to blood flow and thus an elevation in blood pressure.

Blood pressure should be checked regularly, as there may not be any outward sign of a problem. For every one-point reduction in diastolic pressure (the bottom number), the risk of heart attack may be reduced by 2 to 3 percent. Medication to lower blood pressure may be effective. Dieting, and in some cases restricting salt intake, together with regular exercise for weight reduction can help control high blood pressure.

Excess weight promotes high blood pressure and lipid abnormalities. Avoiding or treating obesity is a primary way to prevent diabetes. Diabetes accelerates CAD and increases the risk of heart attack.

Smoking

Cigarette smoking is a strong factor in the development of CAD. In the United States, it is directly responsible for about 20 percent of all heart-disease deaths and nearly 50 percent of the heart attacks in women under 55 years of age. Cigarette smoking increases blood pressure and introduces toxic chemicals, such as nicotine and carbon monoxide, into the blood stream. These chemicals, in turn, damage the arteries.

Smokers also put those who are exposed to their smoke at risk. Studies reveal that nonsmokers living with smokers have an increased risk of heart attack. Thus, by quitting smoking, a person can reduce his own risk and may even save the lives of nonsmoking loved ones.

Stress

When under severe emotional or mental stress, those who have CAD face a much higher risk of heart attack and sudden cardiac death than people who have healthy arteries. According to one study, stress can cause arteries laden with plaque to constrict, and this decreases the flow of blood by as much as 27 percent. Significant constriction was seen even in mildly diseased arteries. Another study suggested that severe stress can create the environment for plaque in the artery walls to rupture, triggering a heart attack.

Consumer Reports on Health states: “Some people seem to go through life with a bad attitude. They’re cynical, angry, and easily provoked. Whereas most people let minor aggravations slide, hostile people shift into emotional overdrive.” Chronic anger and hostility raise blood pressure, increase the heart rate, and stimulate the liver to dump cholesterol into the bloodstream. This damages coronary arteries and contributes to CAD. Anger is thought to double heart-attack risk, and this remains an immediate danger for at least two hours. What can help?

According to The New York Times, Dr. Murray Mittleman said that people who tried to remain calm in emotional conflicts might be able to reduce their risk of heart attack. This sounds much like the words recorded in the Bible centuries ago: “A calm heart is the life of the fleshly organism.”—Proverbs 14:30.

The apostle Paul knew what it was like to be under stress. He spoke about anxieties that rushed in on him daily. (2 Corinthians 11:24-28) But he experienced help from God and wrote: “Do not be anxious over anything, but in everything by prayer and supplication along with thanksgiving let your petitions be made known to God; and the peace of God that excels all thought will guard your hearts and your mental powers by means of Christ Jesus.”—Philippians 4:6, 7.

While there are other factors related to heart problems, the ones discussed here can help identify risk so that a person can take appropriate action. Some, though, have wondered what it is like for those who must live with the aftermath of a heart attack. How much recovery is possible?

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Smoking, becoming angry easily, eating fatty foods, and leading a sedentary life increase the risk of heart attack