How to Prevent Heart Attacks

Most people know that heart health requires a good diet, regular exercise, and no smoking. But unless you partner with your doctor, you’re only doing part of the work.

“Many people assume that heart attacks happen to a certain type of person — for example older, overweight men — and that it happens to them because of what they’ve done to their bodies,” says Sohah Iqbal, MD, a Mass General Brigham cardiologist who serves as chief of cardiology at Salem Hospital.

Lifestyle choices are important. But even if you feel healthy and think you’re doing all the right things, don’t overlook the importance of regular checkups.

“Make sure you partner with your doctors so that you understand your risk factors and know your numbers, including cholesterol, blood pressure, and blood sugar,” Dr. Iqbal says. “And then you can work with your doctor to make sure that those are in a good range, either with lifestyle changes or medications.”

Risk factors for heart attack

Your doctor can help you understand your individual risk for heart attack, including these five classic risk factors:

1. Family history of heart problems: If someone in your family had a heart attack at an early age, you have a family history of heart disease. The guideline is a male relative who had a heart attack before age 55 or a female relative before age 65. Your doctor may recommend testing or regular follow-up appointments to keep a closer eye on your heart.


2. High blood pressure: High blood pressure, also known as hypertension, can put strain on your cardiovascular system and lead to heart attack. You should have blood pressure measured at least once a year, more often if you have high blood pressure (140/90 mmHg or higher). As with cholesterol, lifestyle changes and medications can help control hypertension.


3. High cholesterol: High cholesterol can boost the chances of a heart attack by clogging your arteries and limiting blood flow to the heart. Your doctor can check your cholesterol levels with a simple blood test. People should have one fasting cholesterol test in their 30s. If it’s normal, then you can wait until your 40s for additional screening. If your cholesterol is high, then lifestyle changes and medications can help control it and therefore reduce the chances of heart attack.


4. Diabetes: High blood sugar levels can damage blood vessels and the heart over time. Therefore, people with diabetes are more likely to have a heart attack. With checkups and blood tests, your doctor can help you detect diabetes as early as possible. If you have prediabetes or diabetes, your doctor can help you control it with lifestyle changes and/or medication.


5. Smoking: Smoking accelerates how your body ages, including heart muscle and arteries. It stiffens the blood vessels and raises your heart rate and blood pressure, putting extra strain on your heart. “It’s relatively rare for someone to come in with a classic heart attack in their 30s. But when that happens, it’s usually someone who’s smoking and has an underlying risk factor like family history or genetics,” Dr. Iqbal says.

Talking with your doctor about how you feel doing daily activities is also important to understand your heart health. “Come to your doctor with specifics, such as, ‘I do 30 minutes of exercise a day. But whenever I get to the top of the hill, I feel like I just can’t get past that, and I’ve been working on it for a few weeks,’” Dr. Iqbal says. “Your doctor can identify whether that is simply a conditioning or fitness issue versus a reason to be concerned.”

Heart-healthy foods

Dr. Iqbal recommends a low-cholesterol, heart-healthy diet to prevent heart attack. This includes minimizing animal fats, red meat, fried foods, creams, and cheeses.

“You don’t want to add to the cholesterol that your body is already making,” she says. “Data suggest that a vegan diet is the only diet that can definitively lower your risk, but that can be difficult for people to maintain. The Mediterranean diet and the American Heart Association diet have some benefit as well.”

A heart-healthy diet also includes good fats that can help increase good cholesterol. Make a heart-healthy grocery list with foods including nuts, vegetables, avocados, and fish. She encourages people to avoid fad diets, as they are often found to be unhelpful or even harmful. 

Exercise for heart health

Research shows that at least 150 minutes of moderate-intensity activity a week can improve heart health. But something is better than nothing, Dr. Iqbal says. So she encourages people to do what they can. If you’re inactive, start out slow. Even a few minutes at a time may offer some health benefits.

Exercise protects the heart in several ways. “Exercise boosts the metabolism of whatever foods we are putting into our bodies, including fats and cholesterol. And when we exercise, our bodies secrete hormones that allow our arteries to dilate appropriately so that we have good blood flow around our heart,” she explains. “It also helps arteries throughout the body stay elastic, which minimizes the risk of developing hypertension.”

Dr. Iqbal also emphasizes that people who exercise are more in tune with their bodies and heart health. “In people who are active, we can get early signals that there may be something wrong because their body’s telling them, ‘I can’t do as much as I normally can,’” she says. “The more you’re active, the more you know your body, and the more you’ll realize any changes happening that you should talk to your doctor about.”

Does stress cause heart attacks?

Although stress doesn’t cause heart attacks directly, Dr. Iqbal says it’s a non-traditional risk factor for developing heart disease. It increases inflammation in the body, which can contribute to hypertension and high levels of bad cholesterol. Plus, stress can contribute to unhealthy behaviors, such as smoking and overeating. She recommends managing stress in the following ways:

• Exercise for stress reduction.

• Get enough sleep.

• Limit stress.

• Practice mindfulness and other relaxation techniques.

• Spend time with friends and family and doing things you enjoy.

Make a habit of heart health

“Changing to a heart-healthy lifestyle is not rocket science — it’s actually harder than rocket science. Changing habits and staying motivated are much harder than just taking a pill or reading something online,” she says.

Dr. Iqbal also suggests that you write down your goals and have an accountability partner, someone who will help you stay on track. She also recommends that heart-healthy changes fit into your life. Choose healthy foods and activities that you actually enjoy.

“It takes time to develop habits. The biggest hurdle is just taking that first step.”