Over 800,000 people experience heart attacks every year in the United States. That’s about one every 40 seconds. It’s important to recognize the signs of a heart attack—and equally important to take steps to prevent one in the first place.
Blocked Blood Flow. When the heart contracts, it pushes blood into the circulatory system to deliver oxygen and nutrients to every part of the body. Like every other tissue, the heart, which is a muscle, needs fuel and nourishment.
“Oxygen is carried to the heart muscle in blood through the coronary arteries,” says Samuel Stone, MD, cardiology fellow at Tufts Medical Center. “When the flow of blood and oxygen is limited, damage to the heart muscle occurs. If oxygen is unable to reach the heart muscle for significant periods of time, muscle cells die.”
Atherosclerosis (the buildup of cholesterol-laden plaque lining the walls of arteries) is the main culprit behind heart attacks. “If plaque ruptures, it can cause a clot to form,” says Stone. “If this happens in a coronary artery, it cuts off oxygen from a portion of the heart muscle, leading to a myocardial infarction (heart attack).” If the clot is in an artery in the brain, the resulting death of brain cells is called a stroke.
➧ Eat well. Follow a healthy dietary pattern that emphasizes plant foods (see page 4), limits sodium (salt) and added sugars, and focuses on unsaturated fats from fish and plant oils over saturated fats from animal sources (meat and dairy).
➧ Be physically active. Aim for least 150 minutes of moderate-intensity physical activity a week.
➧ Weigh in. Work to reach and maintain a healthy weight.
➧ Get enough sleep. Aim for an average of 7 to 9 hours of sleep a night.
➧ Avoid tobacco. Don’t smoke or vape and avoid second-hand smoke.
➧ Manage stress. Make lifestyle changes to lessen stress when possible, and find outlets (like socializing, exercising, or meditating) to help manage stress.
➧ Get regular medical check-ups. Have a healthcare provider monitor your blood sugar (fasting blood sugar less than 100 mg/dL and/or A1C less than 5.7 percent), blood pressure (best below 120/80 mm Hg), and LDL cholesterol levels at or below 100 mg/dL).
➧ Respect the Rx. Take any medications as prescribed.
Risk Factors. “There are two categories of risk factors for a heart attack,” says Stone, “non-modifiable and modifiable. Non-modifiable risk factors are things we cannot control, such as age, sex, and family history. For example, men over the age of 45 and women over the age of 55 are more likely than younger men and women to have heart disease. Having close relatives who had heart attacks at a young age is also a risk factor.” Black and Mexican Americans, American Indians, native Hawaiians, and some Asian Americans are at higher risk, although this may be due at least in part to modifiable societal disparities that impact their overall health, rather than genetics.
“Modifiable risk factors are things that individuals can control or that can be treated,” Stone explains, “including tobacco use, high blood pressure, high cholesterol, diabetes, obesity, metabolic syndrome, poor diet, lack of exercise, and chronic stress.” Additionally, you may be at increased risk if you have chronic kidney disease, blood triglyceride levels of 175 mg/dL or higher, chronic inflammatory conditions like rheumatoid arthritis or psoriasis, or a history of preeclampsia or early menopause. Regularly getting less than seven hours of quality sleep a night and excessive alcohol use also play a role in the development of heart disease and can increase heart attack risk.
Prevention. You can protect your heart by taking control of the modifiable risk factors mentioned above. A healthy dietary pattern is key. Replace most animal fats (especially red meats, full fat dairy products, and butter) with sources of unsaturated fatty acids (like fish and non-tropical plant oils); cut back on sweet or salty packaged (usually ultraprocessed) foods and beverages; lower sodium intake; and choose whole grain over refined grain products.
“Follow up routinely with primary care for blood pressure and cholesterol screening, as well as clinical evaluation for other risk factors and symptoms of heart disease,” says Stone. “This is particularly essential for those with family history or other risk factors for heart disease. For those with elevated blood pressure or high LDL cholesterol levels, we recommend treatment with lifestyle modifications and medication when needed.”
During…and After. It’s important to know the warning signs of a heart attack and seek help immediately for yourself or someone else. Getting treatment quickly can save a life and may limit long-term damage. If you suspect you or someone around you is experiencing a heart attack, don’t wait to see if the symptoms improve—call 911. Not all heart attacks present as chest pain. See “Heart Attack Warning Signs” to learn what to look for.
About 25 percent of heart attacks in the U.S. occur in people who have suffered a previous attack. Individuals who have had a heart attack should follow their healthcare providers’ recommendations for medications, rehabilitation, and lifestyle changes to maximize their recovery and minimize their risk for another attack in the future.
Whether you have had a heart attack or not, do what you can to protect your heart. “A healthy lifestyle, along with detection and treatment of modifiable risk factors, can greatly decrease your risk for heart disease and a heart attack,” says Stone.