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Are you at risk of having a heart attack?

Heart and stethoscope

Every year in the UK 240,0001 people have heart attacks, and 145,000 die as a result. But many of these people could have reduced their risk of suffering a potentially fatal heart attack if only they knew what to do. There are lots of things you can do to keep your heart healthy.

What is a heart attack?

The heart is a strong muscle that pumps blood around the body. The heart muscle needs oxygen to work. Most heart attacks are caused by ischaemic heart disease (IHD), which means the heart muscle is not getting enough oxygen. It is similar to an acutely painful cramp a person may get in the muscles of the arms or legs when doing vigorous exercise. It is very painful but doesn't do lasting damage to the muscle. People often refer to that pain as “angina.” It is due to narrowing of the arteries by the formation of fatty plaques. But if these fatty plaques crack and a clot forms in the artery, it can be blocked off completely, starving the muscle of oxygen irreversibly and causing the muscle to die. That process is called a heart attack. Although doctors can try to clear the blockage quickly, some damage will inevitably be done.

Of the six main risk factors for IHD, four may be modified through long-term lifestyle changes.
 
Smoking
 
Smoking doubles your risk of dying from IHD. The amount you smoke and the duration of time you have been smoking for, determines your risk. If you stop, your risks start to drop immediately. It may take 20 years for the risks to be completely reversed, however. If you are thinking of quitting smoking, see your GP. They can assist you by providing aids such as:
  • Nicotine gum
  • Nicotine patches
  • Nicotine inhalators
  • Access to support groups
  • New medications such as Varenicline.
High blood pressure
 
If you have a family history of high blood pressure, you will have less control of reducing your risks for IHD, but there still are things you can do to mitigate your circumstances. If you already suffer with high blood pressure, your GP can offer you medication aimed at keeping your blood pressure at acceptable levels. You can also make lifestyle changes like:
  • Reducing your salt intake
  • Stopping smoking
  • Taking more exercise
  • Losing weight
If you don't have high blood pressure, then the aim should be to keep it that way. Our blood pressure tends to increase with age and certain lifestyle factors. Those of us who are overweight and don't take enough exercise tend to suffer with high blood pressure. If you are overweight, consider discussing an exercise and nutritional plan with your doctor. Studies show that people who engage in regular moderate intensity exercise (e.g. brisk walking 3-4.5 mph), will reduce their blood pressure.
 
Diabetes
 
Diabetes is a crucial factor for IHD. One of the most common misconceptions is that diabetes is just about a lack of insulin and high sugar. People forget that diabetes affects many organs including nerves, blood vessels, heart and kidneys. Having diabetes can increase your risk of having a heart attack up to five times. The increased glucose levels causes damage to blood vessels, promoting the formation of fatty plaques. Patients with diabetes are also far more likely to have risk factors like high blood pressure and a poor cholesterol profile. Patients with diabetes should aim to have:
  • Blood pressure less than 140/802
  • Low cholesterol (LDL and triglycerides) levels
  • HbA1c target of 7%2,3

The issue of how tightly blood sugar should be controlled is still contentious, as all the evidence has not yet been reconciled (see ACCORD3, ADVANCE4 and DCCT5 trials). However, it is absolutely clear that blood sugar must be kept under control for the sake of your heart and the other organs that can be damaged if you have diabetes.

If you don't have diabetes, but are overweight or have a family history of diabetes, weight loss combined with exercise lowers the risk of developing diabetes by increasing the body's sensitivity to insulin (see our understanding diabetes article).

High cholesterol

There is a consensus among heart specialists that the lower your cholesterol, the lower your risk of a heart attack, although not everyone agrees on how low treatment for high cholesterol should aim to achieve. Figures by the British Heart Foundation state that total cholesterol should be lower than four in those with established IHD or those with a high risk of developing IHD.

If you are worried about your cholesterol, speak to your GP, who can organise a blood test for you. In the meantime, focus on your nutrition. It is generally advised that you should:
  • Eat red meat only once a week.
  • Eat chicken (without the skin).
  • Eat more oily fish, particularly salmon and mackerel, which are rich in omega 3 fatty acids.
  • Avoid frying. Try other methods of cooking such as baking, steaming and grilling.
  • Use olive oil in dressings, as it is the only oil that does not reduce your high-density lipoprotein (HDL) levels (“good cholesterol”).

HDL reduces the formation of those fatty plaques that block arteries in the heart. Exercise is another factor that will increase your HDL levels. In some cases patients will have very high levels of “bad” cholesterols (triglycerides and LDL) due to genetic factors, medical conditions and/or poor lifestyle choices. In these cases, tablets belonging to a group called statins4, can be used to reduce the levels of “bad” cholesterol.

Risk factors you cannot change

Men are at greater risk of IHD than women. Oestrogen (the female sex hormone) protects against IHD. Until the menopause, women have a relatively lower risk of having a heart attack as compared with men. After the menopause, the risk for women becomes closer to that suffered by men. If a woman has her menopause early, she must look at ways to reduce other risk factors. However, if a woman has a naturally occurring menopause at an appropriate age, hormone replacement therapy (HRT) actually increases the risk of IHD so women considering HRT should discuss this carefully with their doctors.

Family history is another factor that one cannot control. Having a father who suffered a heart attack before the age of 55, and/or having a mother who had a heart attack before the age of 65, indicates that you are at greater risk. If you have a family history of heart attack, visit your GP for a heart attack risk assessment. They will be more than happy to work with you to minimise your risks.

Sources:

1. NICE, Guidance on the use of drugs for early thrombolysis in the treatment of acute myocardial infarction, 2002. Available at http://www.nice.org.uk/nicemedia/pdf/52_Thrombolysis_full_guidance.pdf (Accessed on 04/01/2010)

2. NICE, Type 2 Diabetes National clinical guideline for management in primary and secondary care (update), 2008. Available at http://www.nice.org.uk/nicemedia/pdf/CG66FullGuideline0509.pdf (Accessed on 04/01/2010)

3. Gerstein, H.C, et al. Effects of intensive glucose lowering in type 2 diabetes. The New England Journal of Medicine. 358(24), 2008 pp.2545– 2559

4. Patel A, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. The New England Journal of Medicine, 358(24), 2008, pp. 2560– 2572

5. Nathan, D.M, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. The New England Journal of Medicine, 353(25), 2005, pp. 2643-2653

6. Ridker, P.M, et al. Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. The New England Journal of Medicine, 359(21), 2008, pp. 2195-2207

Author: Dr Shazan Chughtai MB BS
Editor: Dr Hanny Anwar BMedSci, MB BS, MRCS

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This page was created on 07/01/2010 and last updated on 15/02/2010