Heart Attack?

Heart Attack?

Ways to Reduce Your Risk
By Wayne N. Leimbach, MD, FACC, FSCAI, FCCP, FAHA

The disease that kills the most Americans each year is actually preventable in the majority of cases. It’s heart disease, and it causes heart attacks in about 1.2 million people in the United States each year. If heart disease is treatable for most people and can be diagnosed early, why are so many of us having heart attacks?

Many people don’t know they are at risk. Others who actually know their risk factors don’t treat them. Still others who know their risk factors do not seek testing to assess whether or not they already have significant heart disease that needs treating.


Heart attacks can be prevented by treating the known risk factors that lead to your having one.

First, you should know your blood cholesterol and triglyceride levels (lipids).

Second, you should know your blood pressures and blood sugar. If these levels are elevated, blockages are probably being made in the blood vessels that provide blood supply to the heart. We now know blockage formation can start as early as in the teenage years. The formation of blockages in the blood vessels to the heart can also be caused by smoking, chronic inflammation as measured by a blood test called the high sensitivity–CRP (hs-CRP), and a sedentary lifestyle.

Your risk of having a heart attack increases as blockages continue to develop in the blood vessels supplying the heart muscle. In most cases, blockage material (plaque) in the blood vessels to the heart muscle ruptures, and a blood clot forms on the ruptured plaque, causing the blood vessel to become completely blocked. This causes heart muscle to die. If a large amount of heart muscle dies, the person will die.


Preventative cardiology is important. Here’s why. If blockages in the blood vessels to the heart are never made, then blockages cannot rupture, and a blood clot cannot form on the ruptured plaque to block the blood supply to the heart muscle. Thus, a heart attack is prevented.

The goal, then, to preventing heart attacks is preventing blockage formation in the blood vessels to the heart.

You can do this by treating your major risk factors: high lipids (cholesterol and triglycerides), high blood pressures, high blood sugars, cigarette smoking, high hs-CRP (marker of inflammation) and sedentary lifestyle.


What are good cholesterol levels? For people at mild risk, LDL cholesterol (the bad cholesterol) should ideally be less than 130. For people with known blockages of the blood vessels and/or with diabetes, the LDL cholesterol levels should be definitely less than 100 and, if possible, less than 70.

What should your blood pressure be? Ideal blood pressures are less than 120/80. The goal for most people is blood pressures at rest consistently to be less than 140/90.

What should your blood sugars be? For most people fasting blood sugars should be less than 110, and ideally less than 100. The blood test called a high sensitivity-CRP is a marker of inflammation. It also indicates increased risk of blockage formation. The hs-CRP should be less than 2, and ideally less than 1.

Almost everyone’s blood pressure, cholesterol levels and blood sugars can be normalized today.


You should also follow a low-cholesterol, low-saturated fat diet to reduce cholesterol levels. A low-sodium diet will help reduce blood pressures. A low simple carbohydrate diet helps reduce the risk of diabetes and lowers triglycerides. Weight loss in overweight patients significantly reduces the risk of diabetes. If your risk factors cannot be normalized with dietary changes and lifestyle modification, then medications should be used.

Studies have shown that if risk factors are normalized, not only can blockage formation be stopped, but also reversal of already existing blockages can occur.


For people who are having symptoms suggestive of heart disease or for people with multiple untreated risk factors, tests should be considered that screen for the presence of already severe blockages in the blood vessels to the heart. These include stress tests, calcium CT scans or CT angiograms. If severe blockages are present, they can be treated before a heart attack occurs.


Finally, if you are having symptoms that may be those of a heart attack, call 911, so you can be taken immediately to the hospital.

If the diagnosis is confirmed at the hospital, the heart attack can be interrupted by emergency cardiac catheterization and balloon angioplasty and/or stenting. Most heart attacks can be interrupted, if the patient gets to the hospital early enough. This not only prevents death, but also minimizes the amount of damage done to the heart, so that the person can return to their normal lifestyle.


It is important that we take an active role in our healthcare by knowing our risk factors for heart attacks, aggressively treating those risk factors and making sure symptoms suggestive of heart disease are evaluated.

Only in this way can you reduce your personal risks, thus reducing the number one cause of death in the United States.


Resource Type: 
Wayne N. Leimbach, Jr., M.D.