Understand Your Risks to Prevent a Heart Attack

The First 90 Days After a Heart Attack: Understanding Your Risk of a Second Heart Attack

Knowledge is power. If you understand the risks for heart attack, you can take steps to improve your health.

Risk factors are traits and lifestyle habits that can increase your chance of having a heart attack. So, it’s important to know them. You can change some risk factors, some you can’t.

The first step is to talk to your health care professional, who can help you reduce, control or prevent as many risk factors as you can. They may recommend healthy changes to your daily habits, prescribe medication, or both.

If you don’t have a primary care physician, you may be able to see someone at a clinic in your community.

Know Your Risk

Your health care team will review your medical and family history. They will also want to know:

  • Whether you’ve ever had a heart attack or stroke, or blockages in the arteries of your heart, neck or legs.
  • Your risk factors, including age, sex, if you have diabetes, high blood pressure, high cholesterol, or are overweight or obese, and if you smoke.
  • About your lifestyle. They will ask about your diet and physical activity levels, alcohol intake and drugs or supplements you’ve been taking.

Your health care professional may use a risk calculator to estimate your chance for a heart attack. 

If you’re between 40 and 75 years old and have never had a heart attack, ask to have your risk of a cardiovascular event assessed in the next 10 years.

Traditional risk factors for heart attack include:

  • Smoking
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Overweight or obesity

Risk-enhancing factors include:

  • Family history of early atherosclerotic cardiovascular disease (men less than 55 years old, women less than 65 years old)
  • High cholesterol (LDL-C 160-189 mg/dL; non-HDL-C 190-219 mg/dL)
  • Metabolic syndrome
  • Chronic kidney disease
  • Chronic inflammatory conditions (e.g., rheumatoid arthritis, psoriasis, HIV/AIDS)
  • History of preeclampsia or early menopause
  • High-risk ethnicity (e.g., South Asian ancestry)
  • Higher than normal triglycerides (175 mg/dL or higher), ankle-brachial index (ABI) and other lab tests

Can risk factors be changed?

Some risk factors can be changed and some can’t. You may be born with certain risk factors that can’t be changed. Since you can’t do anything about these risk factors, it’s even more important to manage your risk factors that can be changed.

Risk factors that can't be changed

Increasing age
The majority of people who die of coronary heart disease are 65 or older. While heart attacks can strike people of both sexes in old age, women are at greater risk of dying (within a few weeks).
Male gender
Men have a greater risk of heart attack than women do, and men have attacks earlier in life.

Even after women reach menopause, when women’s death rate from heart disease increases, women’s risk for heart attack is less than that for men.
Heredity (including race)
Children of parents with heart disease are more likely to develop heart disease.

Black people have disproportionately high rates of more severe high blood pressure and it develops earlier in life. Heart disease risk is also higher among Mexican American, American Indian, native Hawaiian and some Asian American people. This may be partly due to higher rates of obesity and diabetes.

Historical and systemic factors play a major role in these statistics. Among them are adverse social determinants of health, the conditions in which a person is born and lives. The determinants include lack of access to health care and healthy foods, and other societal issues. 

Risk factors you can change

Tobacco smoke and vaping
Tobacco use is a major risk factor for heart attack and stroke. Nicotine, one of the chemicals in cigarettes and e-cigarettes, causes your heart to beat faster and blood pressure to rise. Smoking makes clots more likely to form. It can also promote the buildup of plaque in arteries.

Exposure to other people’s smoke also increases the risk of heart disease even for nonsmokers.

If you smoke, get help to quit. Many effective tools are available. These include behavior modification programs, nicotine replacement medicines and other medications.

Learn about smoking and cardiovascular disease

High blood cholesterol
If you’re over age 20, you should have your cholesterol checked every four to six years as part of a cardiovascular risk assessment. If certain factors put you at higher risk, or if you already have heart disease, you may need to check it more often.

Your health care professional will test your blood to measure your cholesterol levels. This may be a fasting or non-fasting lipoprotein profile. It assesses several types of fat in the blood. It’s measured in milligrams per deciliter (mg/dL). The test gives you four results: total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides (blood fats).  

Learn more about managing your cholesterol.

High blood pressure
High blood pressure increases the heart’s workload, causing the heart muscle to thicken and become stiffer. This stiffening of the heart muscle is not normal and causes the heart to function abnormally. It also increases your risk of stroke, heart attack, kidney failure and congestive heart failure.

When high blood pressure is present alongside obesity, smoking, high blood cholesterol or diabetes, the risk of heart attack or stroke increases even more.

Normal blood pressure is below 120/80 mm Hg.

Learn more about managing your blood pressure.

Physical inactivity
An inactive lifestyle is a risk factor for coronary heart disease. Regular moderate to vigorous physical activities can reduce the risk of cardiovascular disease. Physical activity can help control blood cholesterol, diabetes and obesity. It can also help lower blood pressure in some people.

Adults should aim for at least 150 minutes a week of moderate-intensity physical activity (such as brisk walking) or 75 minutes of vigorous-intensity physical activity (such as jogging), or a combination of the two.

Learn more about getting active.

Obesity and being overweight
People who have excess body fat – especially if a lot of it is at the waist – are more likely to develop heart disease and stroke, even if they have no other risk factors.

Overweight and obese adults with risk factors for cardiovascular disease such as high blood pressure, high cholesterol or high blood sugar can make lifestyle changes to lose weight and reduce risk factors such as high triglycerides, blood glucose, HbA1c and Type 2 diabetes.

Many people may have difficulty losing weight. But for those above a healthy weight, a sustained weight loss of 3% to 5% may lead to significant reductions in some risk factors. Greater sustained weight losses can improve blood pressure, cholesterol and blood glucose.

Learn more about managing your weight.

Diabetes seriously increases your risk of developing cardiovascular disease.

Even when glucose levels are under control, diabetes increases the risk of heart disease and stroke. The risks are even greater if blood sugar is not controlled.

If you have diabetes, regular checkups are critical to help keep your blood sugar under control. Work with your health care team to develop healthy eating habits, control your weight and get regular physical activity. You also may need medicines to help control your blood sugar or insulin levels.

Learn more about managing your diabetes.

Other factors to consider

Everyone feels stress, but people react differently. Individual response to stress may be a contributing factor for heart attacks.

Some research has noted a relationship between coronary heart disease risk and stress in a person’s life, along with their health behaviors and socioeconomic status. These factors may affect established risk factors.

Over time, unhealthy responses to stress may create health problems. For example, people under stress may overeat, start smoking or smoke more than they otherwise would.

Find ways to address the causes of your stress and make time for things you enjoy.  

Get stress management tips and tools.

Getting a good night’s sleep regularly is vital to cardiovascular health. Good sleep benefits your whole body, including your heart and brain, and can improve mood, memory and reasoning.

The amount and quality of sleep you get can influence your eating habits, mood, memory, internal organs and more. Too much or too little can be harmful.

Adults should aim for an average 7-9 hours a night, and babies and kids need more depending on their age.

Get tips for getting good sleep.

Drinking too much alcohol can raise blood pressure, and increase your risk for cardiomyopathy, stroke, cancer and other diseases. It can also contribute to high triglycerides and cause irregular heartbeats. Excessive alcohol consumption also contributes to obesity, alcoholism, suicide and accidents.

If you don’t drink, don’t start. If you drink, limit your alcohol consumption to no more than two drinks per day for men and no more than one drink per day for women. The National Institute on Alcohol Abuse and Alcoholism defines one drink as 1 1/2 fluid ounces (fl. oz.) of 80-proof spirits (such as bourbon, scotch, vodka, gin, etc.), 5 fl. oz. of wine or 12 fl. oz. of regular beer.

Read our recommendation on alcohol and heart health.

Diet and nutrition
A healthy diet is one of the best ways to fight cardiovascular disease. What you eat (and how much) can affect other controllable risk factors, such as cholesterol, blood pressure, diabetes and weight.

Choose nutrient-rich foods, which have vitamins, minerals, fiber and other nutrients, but are lower in calories than nutrient-poor foods. Choose a diet that emphasizes vegetables, fruits and whole grains. A heart-healthy diet also includes low-fat dairy products, poultry, fish, legumes, nuts and nontropical vegetable oils. Be sure to limit your intake of saturated and trans fats, sodium, sweets, sugar-sweetened beverages and red meats.

To maintain a healthy weight, coordinate your diet with your physical activity level so you’re using up as many calories as you consume.

Learn more about healthy eating. 

Be a Team Player and Ask for Support

A heart attack can occur at any age. You’re never too young to start living healthier. If you’re over 40, or if you have multiple risk factors, work closely with your health care team to address your risk of developing cardiovascular disease. A team-based approach is the best way to prevent heart disease and stroke. You and your health care team can build a prevention plan that works for you.

If you’re prescribed medications to manage blood sugar, cholesterol, blood pressure or other conditions, take them as directed.

Talk about challenges in your life that may affect your health and ask for support. If you have concerns about accessing care, affording your medications or finding transportation to and from medical appointments, ask your health care team about finding resources.

You’re the most important member of your health care team. And they depend on you to tell them how you feel and what help you need. So ask questions and make decisions together.

Together, you can reduce your risk of heart attack.