Why Healthy People Have Heart Attacks

Featured Article, Healthy Heart, Heart attack
on February 1, 2014
angina in women

How could somebody with a clean bill of cardiac health end up in the ER clutching his or her chest? While it’s true that most heart attacks (and strokes) are preventable, many people don’t understand what really causes heart disease, and standard risk assessments routinely miss crucial warning signs.

For example, most heart attacks don’t strike in the severely blocked arteries surgeons target for bypasses and stents. Indeed, nearly 20 years ago, a study found that 86 percent of heart attacks occurred in people whose coronary arteries are less than 70 percent obstructed; 68 percent in people with less than 50 percent obstruction. Yet patients are often told not to worry unless major arteries are 70 percent blocked. A more critical cause of cardiovascular disease (CVD) is inflammation of the arterial walls, which can cause plaque to rupture and tear the blood vessel lining, creating a clot.

Despite misconceptions like this, there are simple ways to identify the early signs of CVD. Here are the five main reasons why people who appear to be in the clear could actually be at risk—and action items to help you protect your heart health.

They have the “heart attack gene.”

More than 50 percent of Americans carry one or more of the four gene variants that dramatically increase heart attacks and stroke risk. Most notorious is the 9P21 “heart attack gene,” but others include the Apo E, KIF6 and IL-1 genes.

Action item: Ask your doctor about genetic testing, which typically costs about $100 per gene. Even if you have high-risk genes, heart problems are not inevitable: For instance, if you have the Apo E 2 or 3 genotype, eating a Mediterranean diet rich in fruits and vegetables, nuts, whole grains and omega-3 fats can help; people with Apo E 4 genotypes respond better to low-fat diets.

They have gum disease (and probably don’t know it).

Almost 75 percent of Americans have some degree of gum disease—which, in the early stages, is painless and almost invisible. Nonetheless, it can double or even triple the risk of a heart attack or stroke.

Action item: Get screened by your dentist or dental hygienist. If you have gum disease, improve your brushing and flossing habits, and undergo a complete physical exam including checks for diabetes and high cholesterol.

They have insulin resistance.

This condition, in which the body doesn’t use insulin properly, is the leading cause of vascular blockages and chronic inflammation, the “fire” in arteries that ignites cardiovascular events.

Action item: Make sure your doctor administers the oral glucose tolerance test, the “gold standard” of blood sugar testing, to be sure you are being most effectively evaluated. Exercise daily for at least 30 minutes, and watch sugars and simple carbohydrates to help lower blood sugar.

They have plaque in their arteries.

We call plaque “kryptonite,” because it can even bring down Superman. But 99 percent of plaque does not obstruct blood flow, and therefore can’t be detected with common screenings like stress tests.

Action item: Consider the Carotid intima-media thickness (cIMT) test, a painless, noninvasive ultrasound that directly examines the arterial wall. A cIMT scan can reveal how “old” your arteries are—it’s possible for a fit-looking forty-something to have the arteries of someone three decades older! If you do have plaque, it’s critical to identify its root cause (gum disease, insulin resistance or elevated cholesterol, for instance). Treatments may include some combination of statins, aspirin therapy, blood-pressure drugs and omega 3s, along with a healthy lifestyle.

They have ample waists.

Waist circumference is a more accurate predictor of heart attack and stroke risk than your weight or body mass index (BMI).

Action item: Wrap a tape measure around the top of your pelvic bones to measure your waist—a number above 35 inches for a woman, or above 40 inches for a man, is one “strike” for Caucasians, African Americans and Hispanics. For people of Asian descent, abnormal numbers are over 31 inches for women and 35 inches for men. While it’s hard to target your waistline alone, do your best by exercising daily, boosting core strength and watching your intake of sugars, simple carbohydrates and saturated fats.

Education and early detection are the keys to wellness. Go to your doctor armed with information about the kinds of tests you want, and why. It’s never too late to take control of your heart health, no matter what your symptoms—or lack thereof.

Bradley Bale, MD, and Amy Doneen, ARNP, are co-authors (with Lisa Collier Cool) of BEAT THE HEART ATTACK GENE: The Revolutionary Plan to Prevent Heart Disease, Stroke, and Diabetes (Wiley General Trade; February 2014). They are also the founders of the Heart Attack & Stroke Prevention Center in Spokane, Wash.