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A risk factor is something that increases your likelihood of getting a disease or condition.

It is possible to develop a heart attack with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of having a heart attack. If you have a number of risk factors, ask your doctor what you can do to reduce your risk.

Some risk factors are lifestyle habits that you can modify. Other factors, like family history, are out of your control.

Cigarette smokers are twice as likely as nonsmokers to have a heart attack and are more likely to die from a heart attack than nonsmokers. Patients who continue to smoke in the presence of already established coronary heart disease are at increased risk for repeated myocardial infarction and sudden cardiac death.

While the risk is not as great as with smoking cigarettes, smoking other products or inhaling second-hand smoke increases the risk of heart disease and heart attack. Each year in America almost 40,000 deaths from heart disease are caused by passive smoking.

Regular moderate to intense exercise improves heart function and promotes healthy arteries. It also helps to reduce high blood pressure, helps to lower cholesterol, as well as may help to prevent the development of diabetes. Also, there is strong evidence to suggest that regular physical exercise has beneficial effects for patients with already established heart disease.

Physical inactivity is at least responsible for a twofold increase in the risk of coronary events.

People who are usually inactive and then suddenly increase their physical activity are also at risk for having a heart attack.

Drinking too much alcohol can increase blood pressure and lead to other heart problems. But drinking moderate amounts of alcohol seems to lower the risk of heart disease. Moderate means an average of one drink per day for women or two drinks per day for men.

It is important to remember, however, that moderate ingestion of alcohol poses several health risks. Based on currently available data, taking up regular consumption of alcohol is not encouraged for middle-aged men who do not drink or drink sporadically.

Cocaine abuse can lead to various health complications. Myocardial infarction (heart attack) is, however, one of the most frequently encountered. Cocaine is a very strong stimulant that causes rapid increase in blood pressure and heart rate; therefore, the drug places strong stress on the heart.

Cholesterol is a waxy substance crucial to many body processes. But, cholesterol problems can lead to plaque buildup in the arteries. This, in turn, makes it more difficult for blood to flow to your heart. High levels of LDL (or "bad") cholesterol and low levels of HDL (or "good") cholesterol increase your risk of heart disease.

When your blood pressure is high, your heart has to work harder than normal to pump blood through your body. This causes the heart to grow larger and weaker.

Even if you have no other risk factors, being obese or overweight will increase your risk of heart disease. It also adds to your chances of developing high blood pressure, high cholesterol, and type 2 diabetes, which are also risk factors for heart disease. Even losing as few as 10 or 20 pounds will lower your risk of heart disease.

Diabetes mellitus is a metabolic disease in which the body does not produce or effectively use insulin. Even if you maintain good control of your blood sugar, your risk of heart disease is higher than someone who does not have diabetes. About 60% of patients with diabetes die of heart disease and/or stroke.

Even if you do not have diabetes, having high blood sugar levels can put you at an increased risk for heart attack and stroke.

Metabolic syndrome is a cluster of conditions (elevated blood pressure, increased insulin levels, excess body fat around the waist or increased cholesterol levels) that occur together and significantly increase the risk of heart disease.

Older adults are more likely to die of heart disease. About 80% of heart disease deaths occur in people age 65 or older.

Men tend to have heart attacks earlier in life than women. Women’s rate of heart attack increases after menopause but does not equal men’s rate. Even so, heart disease is the leading cause of death for both men and women.

You are more likely to develop heart disease if your parents have heart disease.

African Americans, Mexican Americans, American Indians, Native Hawaiians, and some Asian Americans are more likely than Caucasians to develop heart disease. African Americans are more likely to have severe high blood pressure, which is associated with heart disease. The other ethnic groups at increased risk have higher rates of obesity and diabetes, which are associated with heart disease.

References:

Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol. 2004;43:1731.

American Heart Association website. Available at: http://www.americanheart.org. August 14, 2008.

Goldfrank, LR, Hoffman, RS. The cardiovascular effects of cocaine. Ann Emerg Med. 1991;20:165.

Harrison's Principles of Internal Medicine. 16th ed. McGraw-Hill; 2004.

Lemaitre RN, Siscovick DS, Raghunathan TE, et al. Leisure-time physical activity and the risk of primary cardiac arrest. Arch Intern Med. 1999;159:686.

Njolstad, I, Arnesen, E, Lund-Larsen, PG. Smoking, serum lipids, blood pressure, and sex differences in myocardial infarction. A 12-year follow-up of the Finnmark Study. Circulation. 1996;93:450.

Powell KE, Thompson PD, Cespersen CJ, Kendrick JS. Physical activity and the incidence of coronary heart disease. Annu Rev Public Health. 1987;8:253.

Prescott, E, Hippe, M, Schnohr, P, et al. Smoking and the risk of myocardial infarction in women and men: longitudinal population study. BMJ. 1998;316:1043

Shephard RJ, Balady GJ. Exercise as cardiovascular therapy. Circulation. 1999;99:963.

Sesso, HD, Stampfer, MJ, Rosner, B, et al. Seven-year changes in alcohol consumption and subsequent risk of cardiovascular disease in men. Arch Intern Med. 2000;160:2605

10/23/2009 DynaMed Systematic Literature Surveillance http://www.dynamicmedical.com/what.php: Lin HJ, Lee BC, Ho YL, et al. Postprandial glucose improves the risk prediction of cardiovascular death beyond the metabolic syndrome in the nondiabetic population. Diabetes Care. 2009;32:1721-1726.

4/15/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/: Dahabreh IJ, Paulus JK. Association of episodic physical and sexual activity with triggering of acute cardiac events: systematic review and meta-analysis. JAMA. 2011;305(12):1225-1233.

1/12/2012 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/: Mora S, Buring JE, Ridker PM, Cui Y. Association of high-density lipoprotein cholesterol with incident cardiovascular events in women, by low-density lipoprotein cholesterol and apolipoprotein b100 levels: a cohort study. Ann Intern Med. 2011;155(11):742-750.

Last reviewed September 2013 by Michael J. Fucci, DO

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.