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 United 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? This post describes the various reasons that cause a heart attack in old people, the young, and in women.
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.
There are various reasons why you get chest pain, particularly left-sided chest pain. Some of them are serious while some are not. We are particularly concerned about heart pain or cardiac pain, which is one of the main symptoms of a heart attack.
Heart Attack Causes
To pump blood 24×7 throughout the body, your heart muscle requires a continuous supply of oxygen-rich blood. This requirement is supplied by the network of coronary arteries.
The coronary arteries run on the surface of the heart and are relatively narrow, thereby being more prone to blockage. The cause of heart attack is the blockage of one or more of the coronary arteries or their branches.
Blockage of the artery deprives the concerned part of the heart muscle wall of oxygen. This causes the death of the heart muscle tissue affected and you suffer from a heart attack and its symptoms such as chest pain.
Thee are two reasons why an artery can get blocked and cause a heart attack:
- Coronary artery spasm
Atherosclerosis is the main cause of heart attack caused by the blockage of a coronary artery. In patients with higher blood cholesterol and triglyceride 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 that 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 made of cholesterol. This leads to 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 the 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
A 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 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.
A lot of research has been done and certain factors have been identified that increase a person’s risk for coronary heart disease in general and heart attack in particular.
The more the risk factors you have and the greater the severity of each risk in you, increases your risk significantly. It is necessary to identify your risk factors for CAD and take steps to reduce your chances.
Formerly, it was believed that a heart attack was an old man’s disease. Not any more. Today, the risk is shared by young and old, men and women though not equally.
Advancing age increases not only your risk of a heart attack but also increases your chances of death due to it.
About 85% of the people (men and women) die of a heart attack after the age of 65 years. However, according to a study, the average age of heart attack is coming down.
The increased risk with increasing old age is due to:
- Hardening of the arterial walls
- Over time, fatty deposits can build up on the arterial walls
- The walls of the heart may thicken
- Electric impulses within the heart can change
Women are less prone than men to suffer from a heart attack, but after menopause, their risk increases and equals that of men.
The average age of the first heart attack in men is 66 years. For women, the average age of a first heart attack is 72 years.
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 increasing or decreasing your risk of getting a heart attack. If your first-degree relative (parents, brother, sister) has had heart disease, then you are twice as likely to suffer from similar problems compared to the general population.
Similarly, 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.
Alcoholics also tend to have wrong lifestyle habits such as wrong dietary habits and a sedentary lifestyle without much physical activity. In fact, heart disease is the leading cause of death amongst 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.
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 a 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
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 the 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 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 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 that 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 a heart attack.
Obesity (especially the “apple type” with more fat around the waist) is a major cause of 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 to 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 to 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 independent risk for the development of heart attacks.
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 developing 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.