Heart Attack: Lowering the Risk

By Lynn Difley

The Risk of Heart Attacks: What We Can Do Before They Happen

We just read in the papers that Tim Russert, the host of NBC’s “Meet the Press” and the American network’s Washington bureau chief, died on Friday of a heart attack. Russert collapsed and died at work in NBC’s Washington bureau after returning from a trip to Italy with his family, and despite resuscitation efforts, died. His death is a sad reminder that cardiac arrest can strike anyone without warning—and that when it does, it is often fatal. The first warning of heart problems is often the heart attack itself.

Sudden cardiac arrest accounts for 310,000 deaths in America every year, or 850 a day—more than those caused by breast cancer, lung cancer, stroke, and AIDS combined. But despite how common the condition is, doctors know little about what predisposes one person to it and not another.

For one thing, the most important risk factor is previous history. Age and gender also play roles; the average age for cardiac death is 58-62. Other factors are family history, smoking, diabetes, and obesity–all can be red flags. Russert had been previously diagnosed with diabetes and coronary artery disease, and his autopsy on Friday showed an enlarged heart. But doctors do not know which of these factors is most important in causing a sudden heart attack, or why.

What is clear is that there are ways to lower one’s risk of sudden cardiac death: eat healthy, exercise, don’t smoke, and take aspirin or statins. The trouble, though, is that people often don’t think they’re at serious risk until they are actually experiencing an attack. The truth is that there isn’t really a lot of “science” connected with sudden cardiac arrest when it is caused by a problem with the heart’s circulatory system. We simply don’t know why a given piece of plaque blocks a given artery on a given day. We also don’t really understand why plaque develops in some but not others, or why it develops slowly in some and faster in others.

What we do know is that there are specific risk factors–type II diabetes, obesity, smoking, saturated fats in the diet in high numbers–and that there is some genetic risk as well. The best advice is still the oldest, and–surprise, surprise–the cheapest: stop smoking, lose weight, eat more fruits and vegetables, less saturated fats, and exercise.

The most important thing to do if you suspect a heart attack is get medical help promptly, minutes can make the difference between life and death.

The most common symptom of a heart attack is severe chest pain, although this sensation is not always present. Shortness of breath, dizziness, weakness or fainting, and abdominal pain are also symptoms of heart attack. Women, older adults, and people with diabetes are less likely to have chest pain during a heart attack and more likely to have other symptoms.

People who are having a heart attack often describe their chest pain in various ways. The pain:

• May feel like pressure, heaviness, weight, tightness, squeezing, discomfort, burning, a sharp ache (less common), or a dull ache. People often put their fist to their chest when describing the pain.
• May radiate from the chest down the left shoulder and arm (the most common site) and also to other areas, including the left shoulder, middle of the back, and upper portion of the abdomen, right arm, neck, and jaw. May be diffuse—the exact location of the pain is usually difficult to point out.
• Is not made worse by taking a deep breath or pressing on the chest.
• Usually begins at a low level, then gradually increases over several minutes to a peak. The discomfort may come and go. Women are more likely to have symptoms such as shortness of breath, heartburn, nausea, jaw pain, back pain, or fatigue.

Call 911 or your local emergency services if any of these conditions occur, or if you suspect heart attack. Remember that every minute counts, and as any doctor or EMT will tell you, better safe than sorry.