Heart Attack Risk Factors

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:

• Family history or heredity
  
  
• Smoking
  
  
• High blood pressure
  
  
• High cholesterol
  
  
• Diabetes

While heredity is beyond a patient's control, all other risk factors can be addressed to minimize the risk of developing coronary artery disease or decreasing its progression if already present.

Non-coronary artery disease causes of heart attack may also occur, these include:

• Cocaine use. This drug can cause the coronary arteries to go into enough spasm to cause a heart attack. As well, 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 specific cause 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%-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. This means that an adequate number of red blood cells and normal lung function are required to deliver oxygen to the cells of the heart. Profound anemia from bleeding or bone marrow failure can lead to lack of red blood cells. Lack of oxygen in the bloodstream can occur due to a variety of causes including respiratory failure or carbon monoxide poisoning.