Why Does One Man Have a Heart Attack and Another Doesn’t? Risks Worth Knowing
'One morning, a 45-year-old got up at his usual early hour, threw on his running gear, and went out for a quick jog'
I have a friend, an internist at one of the hospitals where I work, who is the epitome of physical health.
At 45, “Martin,” as I’ll call him, is very lean and plays high-level racquetball, runs, watches his diet, and has never smoked.
One morning, he got up at his usual early hour, threw on his running gear, and went out for a quick jog in a local park. He came back home, did a few stretches, and ate some breakfast. Then he started feeling like he had indigestion. That wasn’t unusual for him, so he popped a couple antacids.
After a few hours, the indigestion hadn’t gone away. Martin thought he might be having an issue with his gallbladder, so he drove himself to the ER at the hospital where he works and asked a colleague to run a few tests to check his gallbladder.
The tests showed that Martin’s gallbladder was fine. That was the good news. The bad news was that his EKG was highly abnormal, indicating ACS. More specifically, it meant Martin was having a heart attack. That’s when he was whisked into the cath lab. I performed a heart catheterization on him and discovered that Martin had several blockages in his arteries. I called in the cardiovascular surgeon, and the next day we performed a quadruple bypass on him.
That was 15 years ago. Today, Martin is back to his usual picture of health and still plays racquetball and runs.
After his heart attack, Martin wanted my help to figure out why it had happened. He thought he was doing everything right to protect his health, and he had no history of any heart problems, so he couldn’t understand why he fell victim to a heart attack.
We went through a list of risk factors — high blood pressure, diabetes, and more — and he didn’t have any of them. Then I asked him about his family history. That’s when he told me his brother had been diagnosed with coronary heart disease (CHD) at age 39.
I informed him that having a first-degree family member with premature heart disease is a major risk factor for CHD. I told him that if I had known about his brother, I would have insisted that Martin come to see me sooner to have his heart health tested. If he had, he might have avoided that heart attack and the bypass surgery.
If you’ve been told you have coronary heart disease or you’ve had a heart attack, you may wonder what put you at risk. Was it a genetic predisposition you inherited from your grandfather? Was it because you have high blood pressure? Was it because you have a very stressful job? Was it all that pizza you ate in college?
The medical community has been searching for the answers to these questions for decades. Although we cannot predict with 100 percent certainty who will have a heart attack and who will not, we have identified certain conditions and lifestyle choices that can make a person more likely to develop CHD. These are called risk factors.
In general, having more risk factors increases the likelihood of developing CHD. Based on thousands of research studies and decades of data, the American Heart Association and the American College of Cardiology have identified the following as the strongest predictors for 10-year risk of developing CHD: older age, male gender, race, elevated total cholesterol, low HDL “good” cholesterol, high blood pressure, blood pressure treatment status, diabetes, and smoking.
Although CHD and heart attack can strike at any age, your risk rises as you get older. In men, the risk begins to increase after reaching age 45. From age 35 to 44, some 25 men per 1,000 suffer a heart attack or die from CHD.
When assessing the risk of CHD, cardiologists also take into account a number of other factors.
Being aware of these factors and knowing your personal risk level is an important step in understanding the disease.
Controlling your risk factors may slow the growth of atherosclerotic plaques, reverse disease, or even prevent a heart attack.
Here are the top risk factors for CHD and heart attack:
- Older age
- Male gender
- Race and ethnicity
- Elevated levels of total cholesterol
- Low levels of good cholesterol
- High blood pressure
- Blood pressure treatment status
Most of us associate getting older with the appearance of a sprinkling of gray hairs, a few more lines on our faces, and an invitation to join AARP. But there’s another thing that comes with age: an increased risk of heart disease. Although CHD and heart attack can strike at any age, your risk rises as you get older. In men, the risk begins to increase after reaching age 45.
From age 35 to 44, some 25 men per 1,000 suffer a heart attack or die from CHD.
That number jumps to 75 per 1,000 in men between the ages of 45 and 54 and continues to skyrocket from age 55 to 74, when the rate reaches 125 men per 1,000.
In women, the risk goes up once they hit age 55 and especially after menopause.
Only 35 women per 1,000 suffer a heart attack or fatal CHD from age 45 to 54. Starting at age 55, however, that number hits 60 per 1,000 — and it continues to rise for the rest of a woman’s life, eventually outpacing men after age 85.
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Waqar Khan, M.D. has been in private practice and an affiliate faculty at Baylor College of Medicine in Houston, Texas, and has been providing state-of-the-art cardiology services to the Houston area for over 20 years. His new book is “Be Heart Smart: Understand, Treat, and Prevent Coronary Heart Disease,” from which this excerpt is used by permission. He is board certified in cardiology as well as interventional cardiology and is a fellow of the American College of Cardiology.