Who is Most at Risk of a Heart Attack?

The trends in heart attack may be headed the wrong way in the United States, but there are steps you can take to lower your chances.

Young man with obesity listening to a healthcare provider.

Updated on February 16, 2022.

Every year over three-quarters of a million Americans have a heart attack. That’s obviously bad news.

But the good news is that you do have some control over whether you’ll become one of them. To get started, take a look at your risk factors—the parts of your life that may make heart attack more likely.

These risk factors include:

  • Smoking and other tobacco use
  • Unhealthy diet
  • Drinking too much alcohol
  • Excess body weight
  • Lack of physical activity
  • High blood pressure
  • Unhealthy blood cholesterol levels
  • Diabetes
  • Older age
  • Family history of heart disease

Age and family history are two risk factors you can’t control. But others—like smoking, obesity, and inactivity—you can do something about.

“It’s hard to say a percentage, but I would say about half of all heart attacks are preventable as long as risk factors are identified,” says Vivek Sailam, MD, a cardiologist with Virtua Our Lady of Lourdes Medical Center in Camden, New Jersey.

Unfortunately, trends seem to be heading in the wrong direction over time, as research suggests many people are not getting the risk factors that are within their grasp under control. A 2017 study from Cleveland Clinic published in International Journal of Cardiology compared the characteristics of the average person suffering a heart attack in 2014 versus 1995. In 2014, the average heart-attack victim was younger, more obese, and had more risk factors than the average heart-attack victim was in 1995.

A changing patient profile

The study found that the average age for people having the most serious kind of heart attack—known as ST-elevation myocardial infarction, or STEMI—at Cleveland Clinic dropped from 64 at the beginning of the study period to 60 by the end. The percentage of people with diabetes jumped from 24 percent to 31 percent. In 2014, more than three-quarters of those studied had high blood pressure, as opposed to only 55 percent in 1995. And, though smoking rates among adults in the United States have fallen since the 60s, the hospital saw an increase in smoking rates among heart attack patients, from 28 percent to 46 percent.

Cleveland Clinic’s findings track with Dr. Sailam’s own observations.

“Unfortunately, in the past 10 years or so I’ve been seeing a steady increase in patients younger than 50 who have significant risk factors: morbid obesity, diabetes, high cholesterol, high blood pressure, and tobacco use,” he says.

The researchers also found that rates of diabetes, high blood pressure, smoking, and obesity were higher in people with low income levels. These differences could be related in part to difficulties in getting quality medical care. Many lower-income people lack health insurance or face other barriers to seeing a healthcare provider and paying for care.

It can also be harder for people living in low-income neighborhoods to buy and find time to prepare fresh fruits and vegetables, though there are workarounds that can make a healthy diet easier and more affordable. In addition, people with lower income are likelier to be smokers, but less likely to try quitting tobacco or to quit tobacco successfully. That’s in part because it can be harder to access truly effective treatment for nicotine dependence with a limited income.

Many risks are preventable

Sailam blames the increase in risk factors among people having heart attacks, in part, on poor lifestyle choices: smoking, eating too much, eating the wrong kinds of foods, and not exercising. “It’s absolutely lifestyle-mediated,” he says. “Consumption of food from chain restaurants has increased dramatically, and portion sizes are up exponentially. Patients are sedentary, not exercising.”

Diet and exercise changes can reduce the risk of heart attack, as well as helping you manage obesity, high blood pressure, high blood sugar, and high cholesterol.

The importance of being proactive

It’s good news that the risk factors for heart attack are partially preventable. The first step in heart attack prevention is identifying potential risk factors, says Sailam. “If you have risk factors, you want to get them evaluated and treated. You don’t want to wait until something happens,” he says. “Be proactive. A lot of folks ignore risk factors, and I meet them in the ER while they’re having a heart attack.”

Lifestyle management

Good places to start? Reduce food portions and get more exercise.

“Pretend it’s the 1980s and cut your portions in half,” Sailam says. “For a lot of people, a normal meal to them today would be normal for three people in the 80s.”

In fact, Sailam estimates many of his patients eat upward of 4,000 calories a day. That’s well above even the highest of the United States Department of Agriculture’s (USDA) daily estimates; most people need between 1,600 and 3,000 calories per day.

The Centers for Disease Control and Prevention (CDC) recommends 150 minutes per week of moderate-intensity exercise or 75 minutes per week of vigorous exercise. Walking 30 minutes a day is an excellent way to get your daily dose of moderate exercise. You can take three 10-minute walks a day if that suits your schedule better. In addition, you should get in two sessions a week of strength training.

Article sources open article sources

Centers for Disease Control and Prevention. Heart Disease Facts. Page last reviewed February 7, 2022.
Centers for Disease Control and Prevention. Know Your Risk for Heart Disease. Page last reviewed December 9, 2019.
Centers for Disease Control and Prevention. Why Walk? Why Not! Page last reviewed September 17, 2020.
Mentias A, Hill E, Barakat AF, et al. An alarming trend: Change in the risk profile of patients with ST elevation myocardial infarction over the last two decades. Int J Cardiol. 2017;248:69-72.
Liu J, Brighton E, Tam A, et al. Understanding health disparities affecting utilization of tobacco treatment in low-income patients in an urban health center in Southern California. Prev Med Rep. 2021;24:101541. Published 2021 Sep 2.
Christiansen B, Reeder K, Hill M, Baker TB, Fiore MC. Barriers to effective tobacco-dependence treatment for the very poor. J Stud Alcohol Drugs. 2012;73(6):874-884.
The Annie E. Casey Foundation. Food Deserts in the United States. Posted February 13, 2021.
Gans KM, Risica PM, Keita AD, et al. Multilevel approaches to increase fruit and vegetable intake in low-income housing communities: final results of the 'Live Well, Viva Bien' cluster-randomized trial. Int J Behav Nutr Phys Act. 2018;15(1):80. Published 2018 Aug 20.

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