Heart disease is the cause of death for 700,000 Americans1 and nearly 17.9 million people worldwide every year.2 While some of these individuals likely had indicators for higher risk, such as high cholesterol or high blood pressure, studies show that up to 70% of people who die from a heart attack do not have any of these traditional markers.3 Even young, seemingly healthy individuals can experience a sudden cardiac event. Almost a quarter of heart-disease related deaths happen in men between the ages of 35 and 65.4
While the prevalence of heart disease has gradually decreased over the past decade due to improved screening and education,5 why is it that so many heart attacks still happen without warning? One key factor is an over-reliance on using secondary risk factors and symptoms as signs of heart disease, which don’t fully measure what’s happening inside the heart.
To proactively understand your risk, it is essential to know the root cause of heart disease and what may put you at a higher likelihood of a heart attack.
What is atherosclerosis and how does it cause heart attacks?
Atherosclerosis is the build-up of plaque, usually made up of fat, cholesterol and other substances, in the heart’s arteries. Coronary artery disease, the most common type of heart disease, is when the heart doesn’t get enough oxygen, blood and nutrients due to atherosclerosis.
Different types of plaque put individuals at higher risk of heart attack and stroke. The most dangerous kind of plaque is low density noncalcified plaque, which is soft and has a fatty or liquid center. This plaque is unstable and has a high chance of rupturing. When plaque ruptures, it causes a blood clot that blocks blood flow to the heart muscle. This sudden loss of blood flow and oxygen delivery to the heart then causes a heart attack.6
What contributes to atherosclerosis and heart disease risk?
A person’s risk for developing atherosclerosis can vary depending on their lifestyle, genetics, gender, age and past medical history.
Controllable risk factors for heart disease may include:
- Tobacco use and exposure to secondhand smoke
- Excessive alcohol consumption
- Diets high in trans fats, saturated fats, salt and cholesterol
- Limited physical activity
- Sleeping less than 7 hours a night
- Obesity (having a body mass index of 30 or higher)
- Type 2 Diabetes, especially when not well-regulated
Non-modifiable risk factors for heart disease can include:
- Age: Men’s risk increases around the age of 55, and women’s risk increases around 65
- Family history: Those with a family history of heart attack at a young age, high cholesterol or high blood pressure
- Menopause: Women have a higher risk of heart disease after menopause or after undergoing hysterectomy
- Type 1 diabetes
Environmental factors can also influence a person’s likelihood of developing atherosclerosis. For example, heart disease is more common in lower socio-economic groups, compared with higher income individuals, due to increased stress, limited access to health care and fewer resources that may make a healthy lifestyle easier.7 Chronic stress can also increase risk, as it can contribute to high blood pressure, high cholesterol and general inflammation.8
How can you know your personal heart disease risk?
While the above guidelines can be a great starting point for evaluating heart disease risk, if you are looking for a more concrete analysis of your heart health, it is essential to speak to a clinician about your unique history and lifestyle.
If your doctor believes you have one or more risk factors for heart disease, a Coronary CT angiography (CCTA) with Cleerly analysis can show you any atherosclerosis present in your arteries. A CCTA is an imaging test that produces 3D renderings of your heart. Cleerly uses AI-enabled technology to identify the volume and types of plaque shown in your CCTA. Cleerly then presents findings in an easy-to-read report and evaluates your level of heart disease from normal, mild, moderate to severe plaque. Depending on your level of atherosclerosis, your physician can then help you determine the best next course of action, such as medical treatment, ongoing monitoring and lifestyle changes.
How to reduce your risk of heart attack
For many individuals, healthy lifestyle choices can go a long way to help reduce heart disease risk. Some studies show that 80% of heart attacks are preventable by avoiding tobacco use, getting regular physical activity, maintaining a healthy diet, and monitoring your cholesterol and blood pressure.9
The American Heart Association recommends the following practices for a healthy lifestyle:
- Eating a diet rich in whole foods, including vegetables, fruits, lean proteins and nuts or seeds.
- Getting 2 ½ hours of moderate or 75 minutes of vigorous physical activity per week.
- Quitting the use of tobacco products, including cigarettes, e-cigarettes and vaping.
- Sleeping 7-9 hours every night.
- Managing your weight or losing weight if you are obese or overweight.
- Working with a doctor to manage your cholesterol, blood sugar and blood pressure level so they fall within healthy ranges.
If you have atherosclerosis, your doctor may recommend medical therapies including:10
- Medications that lower cholesterol, such as statins.
- Medications that lower blood pressure, such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs).
- Medications that lower heart rate, such as beta blockers or calcium channel blockers.
- Surgery, such as stent placement, which helps keep the heart’s arteries open. This is used in more severe cases of heart disease.
Taking a proactive approach to your heart health is the best prevention for disease. While taking the first step to ask your doctor about heart health can be intimidating, it may be critical to prevent a future heart attack.
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1. Leading Causes of Death. National Center for Health Statistics. Last reviewed Jan.13, 2022.
2. Cardiovascular diseases. World Health Organization.
3. Akosah KO et al. J Am Coll Cardiol. 2003.
4. Top 10 Causes of Death in Men. Illinois Department of Public Health.
5. Heart Disease Prevalence. Center for Disease Control.
6. Heart Attack. Johns Hopkins Medicine.
7. Stress-Associated Neurobiological Pathway Linking Socioeconomic Disparities to Cardiovascular Disease. Tawakol, A., et al. 2019.
8. Stress and Heart Health. American Heart Association. Last Reviewed: Jun 21, 2021.
9. ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Arnett, D.K. et al. 2019.
10. Atherosclerosis. Mayo Clinic.