Almost half of Americans have at least one major risk factor for heart disease. While you can’t always eliminate your risk for a heart attack, as some genetic factors are at play, there are steps you can take to minimize your risk in many instances, health experts say.  “Every year, roughly 800,000 people in the U.S. have a heart attack,” says Dr. Nicholas Ruthmann, MD, MPH, cardiologist at Cleveland Clinic. “You probably know more than one person who has had one. Don’t wait for symptoms or assume it couldn’t happen to you.”  Knowledge is power, after all, so understanding your risk factors for a heart attack is the best way to take control of your health. Here’s an overview of the top risks for a heart attack (and some lesser-known ones) and how you can eliminate them. 

Top risk factors for a heart attack

Smoking

Smoking is one of the biggest risk factors for having a heart attack. “Smoking increases inflammation in the body and plaque buildup in the heart’s blood vessels,” Dr. Ruthmann says. “Smoking thickens the blood, which can lead to clots inside veins and arteries. These clots can lead to heart attacks and stroke.”  Exposure to secondhand smoke can also raise your risk, says Dr. Linda Anegawa, MD, a double board-certified physician in internal medicine and obesity medicine and medical director with PlushCare. “Chemicals in tobacco smoke can cause inflammation in the bloodstream, which can increase the risk of blood clotting in the heart arteries,” she explains.  Quitting smoking can improve both your heart health and overall health. Dr. Anegawa says damage to your heart’s blood vessels can start to reverse after 14 days and it can cut your risk of a heart attack in half. “While it is not an easy task, people who are most successful with quitting work with their doctor and often receive counseling to help reinforce abstinence,” she explains. 

 Poor diet and lack of exercise

Having a poor diet and not getting enough exercise can lead to a number of health issues that could up your risk for a heart attack. High cholesterol is one such condition, Dr. Ruthmann says, “Cholesterol directly leads to increase in plaque formation in the coronary arteries that directly supply blood to the heart and if significantly blocked can lead to symptoms including chest pain and heart muscle death.”  High blood pressure, also linked to an unhealthy diet, can strain the heart and put you at risk for a heart attack.  Diet and exercise also help you maintain a healthy weight. Dr. Anegawa says obesity increases your risk for abnormal cholesterol and type 2 diabetes, which in turn increases your risk for a heart attack. “You don’t have to be skinny—even a 5% to 10% weight loss can drop your risk of cardiac events,” she explains.    Following a healthy diet, such as the Mediterranean diet, and eating and drinking alcohol in moderation can lower your risk for a heart event, Dr. Ruthmann says. Stay active, as well, he says. “Try to break a sweat most days and try to find ways to do activities that you really enjoy.”

Stress and anxiety

Stress and how we respond to it can also increase your risk for a heart attack, Dr. Anegawa says. Your body releases the hormone cortisol when you encounter stress, and research suggests prolonged high cortisol levels can increase blood cholesterol, triglycerides, blood sugar and blood pressure—all risk factors for heart disease.  Stress might also cause changes in the body that can encourage plaque buildup in the heart’s arteries. Instances of stress can interfere with blood flow to the heart and affect how blood clots, which can be damaging to the heart.  Exercising, leaning on your support system of family and friends, embracing self-care, reducing stress, and seeking treatment for anxiety or other mental health conditions can help reduce the strain on your heart. 

Diabetes and prediabetes

Type 2 diabetes is another risk factor for a heart attack. High blood sure can damage the blood vessels and nerves that help regulate the heart’s normal functioning, says Dr. Anegawa. People with prediabetes are also at an increased risk for a heart attack since they’re often likely to develop diabetes over the following decade, Dr. Ruthmann adds.  Maintaining a healthy weight, eating a healthy diet and being more physically active can help reverse prediabetes. 

Inflammation

Heart disease has also been linked with inflammation. “Elevated levels of inflammation throughout the body can be measured by blood work and have been found to be less common but important markers for possible increased cardiovascular risk,” Dr. Ruthmann explains.  Autoimmune conditions like rheumatoid arthritis or lupus can also cause chronic inflammation of the heart artery walls, which is a risk factor for a heart attack, Dr. Anegawa says. 

Other medical conditions

Many other medical conditions can increase your risk for a heart attack, for example: 

Peripheral vascular disease, where arteries in the hands and feet are narrowed, can make a heart blockage more likely.Sleep apnea Breast cancer on the left side that involves radiation to the chest can cause damage to the heart. Preeclampsia can raise your blood pressure. 

Family history

Family history is an important risk factor for heart attacks that Dr. Ruthmann says often isn’t fully addressed. “Having a primary relative who had a heart attack at an early age in life is a risk factor having heart disease as well and deserves close attention and evaluation by a doctor,” he adds. 

How to reduce your risk for a heart attack

You can’t fully eliminate risk, and some risk factors, like family history, are beyond your control, Dr. Anegawa says. But, you can often reduce your risk. If you have any risk factors for a heart attack, visit a cardiologist. “First, see a doctor to get your risk assessed and to come up with a concrete, sustainable improvement plan with defined goals,” she adds.  Adopting a healthier lifestyle, reducing stress and keeping your overall health in check can minimize your risk for a heart attack.  “People can significantly reduce their risk to have a heart attack though as we age and when factoring in our genetic backgrounds, most carry some underlying risk of developing cardiac disease in their lifetime,” Dr. Ruthmann says.  Next, read about how to keep your heart healthy. 

Sources: 

Dr. Linda Anegawa, MD, double board-certified physician in internal medicine and obesity medicine and medical director, PlushCareDr. Nicholas Ruthmann, MD, MPH, cardiologist, Cleveland ClinicCenters for Disease Control and Prevention (CDC): Know Your Risk for Heart Disease The Permanente Journal: Prediabetes and Lifestyle Modification: Time to Prevent a Preventable DiseaseUniversity of Rochester Medical Center: Stress Can Increase Your Risk for Heart DiseaseJohns Hopkins Medicine: Fight Inflammation to Prevent Heart Disease  Tops Risk Factors for a Heart Attack  from Diabetes to Stress - 85