Heart Attack Risk Factors

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Heart attack is most often caused by narrowing of the arteries by cholesterol plaque and their subsequent rupture. This is known as atherosclerotic heart disease (AHSD) or coronary artery disease (CAD).
The risk factors for ASHD are the same as those for stroke (cerebrovascular disease) or peripheral vascular disease. These risk factors include:
  • a family history or heredity,

  • cigarette smoking,

  • high blood pressure,

  • high cholesterol, and

  • diabetes.
While heredity is beyond a person's control, all the other risk factors can be minimized to try to prevent coronary artery disease from developing. If atherosclerosis (atheroma=fatty plaque + sclerosis=hardening) is already present, minimizing these risk factors can decrease further narrowing.
Non-coronary artery disease causes of heart attack may also occur. Examples include:
  • Cocaine use. This drug can cause the coronary arteries to go into enough spasm to cause a heart attack. Because of the irritant effect on the heart's electrical system, cocaine can also cause fatal heart rhythms.

  • Prinzmetal angina or coronary artery vasospasm. Coronary arteries can go into spasm and cause angina without a specific cause, this is known as Prinzmetal angina. There can be EKG changes associated with this situation, and the diagnosis is made by heart catheterization showing normal coronary arteries that go into spasm when challenged with a medication injected in the cath lab. Approximately 2% to 3% of patients with heart disease have coronary artery vasospasm.

  • Anomalous coronary artery. In their normal position, the coronary arteries lie on the surface of the heart. On occasion, the course of part the artery can dive into the heart muscle itself. When the heart muscle contracts, it can temporarily kink the artery and cause angina. Again, diagnosis is made by heart catheterization.

  • Inadequate oxygenation. Just like any other muscle, heart muscle requires adequate oxygen supply for it to work. If there isn't adequate oxygen delivery, angina and heart attack can occur. There needs to be enough red blood cells circulating in the body and enough lung function to deliver oxygen from the air, so that heart cells can be supplied with the nutrients that they need. Profound anemia from bleeding or failure of the body to make enough red blood cells can precipitate angina symptoms. Lack of oxygen in the bloodstream can occur due to a variety of causes including respiratory failure, carbon monoxide poisoning or cyanide poisoning.

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