Heart attack is the leading cause of death in the United States and the world. In fact, every 37 seconds one person dies from cardiovascular disease in the Unites States.
Why do you get a heart attack? What causes a heart attack and what are the possible factors that increase your risk of getting a heart attack?
Knowing the reasons for a heart attack and the answers to these questions attain paramount importance, because of the alarming statistics.
Although the established causes of heart attack are the same in men, women, and young adults in their 20s and 30s, there are certain risk factors that make women more prone than men in developing a heart attack. Similarly, some factors make young adults more prone to a heart disease.
There are various reasons why you get chest pain, particularly the left-sided chest pain. Some of them are serious while some are not. We are particularly concerned about the heart pain or the cardiac pain that is caused by a heart attack.
Heart Attack Causes
What happens in the body to cause a heart attack?
The cause of heart attack or myocardial infarction (as a heart attack is also called) is the blockage of the coronary artery. The coronary arteries run on the surface of the heart and are relatively narrow, thereby being more prone to blockage.
Blockage of the artery deprives the concerned part of the heart muscle wall of oxygen. This causes death of the heart muscle tissue affected and you suffer from a heart attack and its symptoms such as chest pain.
What can cause the blockage of the coronary arteries?
Atherosclerosis is the main cause of the blockage of the coronary artery, which is responsible for a heart attack. In patients with higher blood cholesterol levels, there is a tendency for the cholesterol to be deposited on the inner walls of the arteries.
Firstly, the interior smooth surface of the coronary arteries becomes damaged, making it easier for the cholesterol to stick to it. This damage is caused by factors such as high blood pressure, diabetes, elevated blood cholesterol levels, smoking, etc.
Cholesterol is a wax-like substance and begins to stick to the damaged inner wall of the arteries, forming a plaque. A plaque is a flat plate-like or flat tablet-like substance. This is called coronary artery disease (CAD).
This plaque formation increases gradually over the years and subsequently decreases the lumen of the artery. This causes decreased blood flow to the part supplied by the affected artery.
The outer surface of the plaque is hard, which later cracks and breaks, forming in the process, a clot. This clot, if large enough, can occlude the lumen of the coronary artery and block the blood flow. The affected part of heart muscle begins to die and ultimately forms an infarct.
Coronary artery disease is responsible for about 80% of heart attacks and strokes.
Spasm of the coronary artery can cause a heart attack
Coronary artery spasm is a localized squeezing of the smooth muscle in the wall of the coronary artery. It is more often seen in people who smoke or in people with high cholesterol or in people with high blood pressure. It is usually triggered by:
- Alcohol withdrawal
- Cold weather
- Drugs that cause vasoconstriction (narrowing of blood vessels)
- Stimulant drugs also referred to as psychostimulants or psychoactive drugs such as amphetamines or cocaine
Coronary artery spasm is the reason you get a heart attack even if you do not have blockages in your coronary arteries.
Heart Attack Risk Factors
There are certain factors that increase your risk of getting a heart attack.
Advancing age increases not only your risk of a heart attack but also increases your chances of death due to coronary artery disease. The average age of the first heart attack in men is 66 years. About 85% of the people (men and women) die of a heart attack after the age of 65 years.
Women are less prone than men to suffer from a heart attack, but after menopause, their risk increases and equals that of men.
However, according to the stats for the last 32 years, more women die of a heart attack each year than men do.
Genetic factors and family history
Your genes play a big role in your risk of getting a heart attack. If your first-degree relative (parents, brother, sister) has had a heart disease, then you are twice as likely to suffer from similar problems compared to the general population.
Similarly, a positive family history also makes you more prone to develop diabetes, high blood pressure, and increased cholesterol levels. These factors potentially increase your risk of developing a heart attack.
Race and Ethnicity
People of African and African-Caribbean descent have the highest risk of heart disease due to the increased prevalence of obesity, high blood pressure and diabetes in them.
Again, a high incidence of diabetes in people of South-Asian descent (Indians, Sri Lankans, Pakistanis, and Bangladeshis) makes these people more prone to get a heart attack.
Smoking is the second most dangerous risk factor that can cause a heart attack. Whether you are a heavy smoker, a light smoker or are regularly exposed to secondhand smoke (passive smoking), you run a high risk of developing a heart attack.
Your risk increases with the number of cigarettes you smoke. Smoking also increases your blood pressure, worsens your lipid profile and increases platelet aggregation thereby increasing the risk of clot formation.
Secondly, the toxic substances absorbed in the blood from cigarette smoke damage the inner smooth lining of the arteries, which get inflamed and stiff.
This makes it easier for the cholesterol to stick to the walls of the arteries and accelerate atherosclerosis. Even a good and regular exercise regimen will not counter the bad effects of smoking nor reduce your risk if you continue to smoke.
Alcohol consumption in moderation actually helps to increase your HDL cholesterol, which is the good and healthy cholesterol. It also prevents the formation of blood clots and inflammation.
However, excessive alcohol drinking increases your risk of heart attack significantly. It raises the bad cholesterol levels and blood pressure.
Alcoholics also tend to have wrong lifestyle habits such as wrong dieting and a sedentary lifestyle without much physical activity. In fact, heart disease is the leading cause of the death amongst the alcoholics.
The general population grossly underestimates the wrong dietary habits as a heart attack risk factor. We see a lot of people, even those who have suffered a heart attack, not adhering to the advised diet.
You must reduce the sources of trans fats and saturated fats in your diet. You must also restrict salt intake because sodium present in salt can raise your blood pressure.
Unsaturated fats, polyunsaturated and monounsaturated present in fish, nuts, vegetables and seeds improve the health of the heart. You should also consume whole grain cereals and fruits for their fiber content.
A sedentary lifestyle
A sedentary lifestyle, which is the lifestyle without physical activity greatly increases your risk of diabetes, high blood pressure, obesity and high blood cholesterol levels.
All these are potential risk factors, which contribute to a heart attack. Exercise benefits can never be over-stressed. A regular exercise program improves blood circulation and the health of the heart.
You double the risk of a heart attack with a physically inactive lifestyle when compared with people who exercise regularly.
High blood pressure (Hypertension)
High blood pressure is the number one risk factor, which contributes to developing a heart attack and coronary artery disease. It damages your arteries and increases chances of atherosclerosis.
It also increases the load on the heart because the heart has to pump against increased pressure in the arteries. Both these factors potentially increase the chances of getting a heart attack.
Diabetes, especially in people who do not stabilize their blood sugar levels within the normal limits, poses a significant risk of developing a heart attack.
It is also the reason for high cholesterol levels, hypertension, blood clotting problems, kidney problems, and peripheral neuropathy (nerve dysfunction), all of which are potential risk factors for a heart disease by themselves.
Diabetics are up to five times more likely to develop coronary heart disease. In fact, heart disease is the leading cause of death amongst the diabetics.
Unhealthy Cholesterol Levels
High LDL cholesterol (the bad cholesterol) and triglyceride levels in the blood contribute significantly to the development of a heart attack. These high lipid levels result in deposits of plaques on the inner walls of the arteries.
Cholesterol is a wax-like substance and easily sticks to the inner walls of the arteries. The coronary arteries are relatively narrow and more prone to being blocked.
Reduced blood supply causes a deprivation of blood and oxygen to the affected part of the heart wall, causing the death of the tissue (called an infarct) and subsequently a heart attack.
Obesity (especially the “apple type” with more fat around the waist) is a major cause for the development of high blood pressure, high LDL cholesterol levels, low HDL levels and type 2 diabetes. All these are potential risk factors by themselves, which cumulate the risks of a heart attack.
Due the increased body mass, the heart has to pump with that much more force to ensure blood supply to all parts of the body.
This puts a continuous strain on the heart and adds to the increased risk of atherosclerosis, which can make an obese person that much more prone to suffer an attack.
Obesity is now considered an inflammatory condition, which is a strong contributing factor for cardiopulmonary disease.
According to WebMD, obese middle-aged men have a 60 % more risk of dying of a heart attack than non-obese middle-aged men, without taking into account the risk increased by high blood pressure, high LDL cholesterol levels, low HDL levels and type-2 diabetes. This just goes to show that obesity by itself is also a potential risk for the development of heart attack.
Autoimmune diseases such as rheumatoid arthritis or lupus increase your risk of coronary artery disease. This may be because these autoimmune conditions increase the risk of the patient to develop hypertension, diabetes type-2, high blood cholesterol levels and a sedentary lifestyle.
Vascular diseases such as aneurysm of the aorta, renal artery stenosis, and stroke increase the risk of a heart attack.
All nonsteroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors aspirin excluded, increase the risk of a heart attack by two to fourfold. That is a considerable risk.
COX-2 inhibitors are the new type of NSAIDs, which are considered relatively safe, but they do carry the risk of heart attack, especially when used over a prolonged period. Celecoxib (Celebrex) is an example of a COX-2 inhibitor.
Examples of NSAIDs include nonprescription drugs like ibuprofen (Advil, Motrin) and prescription drugs like diclofenac (Cataflam, Voltaren).
The American Heart Association recommends that patients who have a heart problem or are at risk for heart disease should try non-drug therapies for pain (say of osteoarthritis) such as physiotherapy, exercise or weight loss to reduce stress on the joints and hot and cold therapy.
If required, they should take the lowest possible dose of acetaminophen (Tylenol) or aspirin. COX-2 inhibitors should be reserved as a last resort.