Some say it’s like an elephant walking on your chest. Others report shortness of breath, extreme fatigue or symptoms similar to heartburn. In some cases, a heart attack comes on silently, with no symptoms. After about age 40 for men and 55 for women, most Americans carry in their minds an image of what a heart attack–their heart attack–might be like. Heart disease remains the number one killer of both men and women in the United States, and despite advances in treatment, 38 percent of heart attack victims die, many on their way to the emergency room. Unfortunately, there’s no way to predict a heart attack. Most Americans think in terms of the old plumbing analogy: fatty deposits clog your arteries, and when the blood vessels become too narrow to deliver blood to the heart, you have a heart attack. But the process is far more complex than that. Heart attacks frequently occur in persons whose arteries are functioning relatively well until a piece of plaque breaks loose somewhere in the body, travels to the heart and forms a clot in a coronary artery. As a health-conscious person, the best you can do is know your risks so you can make the lifestyle changes necessary to control them.

AGE and GENDER are major risk factors over which you have no control. An elevated risk for men starts by age 45 while women are offered some protection by virtue of their hormones until about age 55.
A healthy 68-year-old male with normal blood pressure and cholesterol and no additional risk factors has an 11 to 13 percent risk of having a heart attack within the next 10 years–simply by virtue of age and gender. A female the same age with a similar health profile has only a 5 percent risk, and the woman’s risk doesn’t catch up until about age 75.
If you have a close family member, male or female, who developed heart disease at an earlier than average age, you have a higher risk.

BLOOD PRESSURE, CHOLESTEROL, HDL: These three risk factors are usually linked, and all can be controlled by lifestyle. High blood pressure may develop during middle age, or even sooner, in otherwise healthy persons who are salt sensitive, basically an inherited condition. It can also develop because of high blood cholesterol, kidney problems, excess weight or other disorders.
When high blood pressure is undetected or uncontrolled, it can quickly lead to other problems such as atherosclerosis, kidney damage and a weakened heart muscle–all of which can cause even higher blood pressure. When BP is kept under control, it generally causes little harm–although treatment must usually continue throughout life.
Systolic blood pressure, or the first number, is considered most important in terms of heart disease because it indicates how hard the heart is working to pump blood through the body. Normal systolic pressure is under 120, with readings between 120 and 130 considered prehypertension.
To prevent high blood pressure, get regular exercise, control your weight and limit your intake of saturated fat, trans fat and sodium. If your blood pressure starts to creep into the prehypertension range, see a doctor and follow carefully all treatment recommendations. Early hypertension can usually be managed with medications such as diuretics which are inexpensive and have a strong safety record.
Like high blood pressure, high cholesterol comes on silently. Most Americans today know their cholesterol numbers. It’s equally important to do something about them should they become too high.
Of the numbers in a total cholesterol profile, the HDL, or good cholesterol, is probably the most important in terms of preventing a heart attack. While total cholesterol under 200 mg/dL is considered normal, it may not be low enough if your HDL is less than 40. On the other hand, an HDL over 60 will cancel out high total cholesterol or another risk factor.
Diet, exercise and weight control–as well as heredity–influence cholesterol. HDL is particularly sensitive to exercise.
Probably the ideal eating plan for HDL is the Mediterranean diet, stressing moderate use of monounsaturated fats such as olive oil and nuts along with fruits, vegetables and whole grains.
For the 68-year-old male mentioned above, the risk of a heart attack increases from 11 to 21 percent with only modest changes in blood pressure (from 118 to 130), cholesterol (from 197 to 205) and HDL (from 57 to 37). For a female with the same blood pressure and cholesterol readings, the risk would increase from 5 to 12 percent.

SMOKING: As important as all the other risk factors are, smoking usually ranks at or near the top of any list. The 68-year-old female with normal cholesterol and blood pressure will nearly double her risk simply by smoking. But, of course, smokers rarely have normal cholesterol or blood pressure so the problems multiply.
Even persons exposed to second hand smoke exhibit damage to arteries and an increased vulnerability to blood clotting with just 30 minutes of exposure. If you smoke, quit–for the sake of yourself and everyone around you

DIABETES is another major risk factor. In addition to the effect of blood sugar and insulin on blood vessels, diabetes tends to raise cholesterol and blood pressure while lowering HDL.
Type 1 diabetes can’t be prevented, but you can minimize your cardiovascular risks by keeping your blood sugar under tight control.
Type 2 diabetes often occurs in individuals who are overweight and/or physically inactive. Exercise and weight loss are considered the best ways to prevent or delay the onset of disease and keep blood sugar under control in the early stages. Diabetics–like heart patients–are advised to eat a diet that’s low in saturated and trans fats and high in fruits, vegetables and whole grains.
There are other heart attack risk factors such as kidney disease; high levels of inflammatory markers such as C-reactive protein (CRP); uncontrolled stress or anger; depression; and obstructive sleep apnea. The biggest risk of all is having a previous heart attack.
While there’s no way to prevent a heart attack, there is much you can do to improve your odds. In one way
or another, these strategies all involve healthy eating, regular exercise and careful monitoring of chronic medical conditions