By focusing on a few key risk factors, most people can significantly reduce their odds of ever having a heart attack. "There's a lot we can do," says Libby. The top six steps:
Keep your cholesterol in check
Excess cholesterol gets stuck in artery walls. The walls become inflamed with white blood cells of the immune system, and those cells release chemicals that cause plaque. The normal level of so-called bad cholesterol, or LDL cholesterol, is 60 to 130. But if you are at high risk of a heart attack—because you have diabetes, for example—your level should be below 100 and, ideally, no higher than 70. Diet and weight loss are the preferred way to control your cholesterol, say heart-disease experts. If that doesn't work, statins—a class of cholesterol-lowering drugs—can reduce your LDL enough to help prevent heart attacks. Two decades of large and rigorous studies have shown that statins are safe for almost everyone.
Lower your blood pressure
High blood pressure can damage artery walls, causing them to become stiff and narrow. Ideally your blood pressure should be below 120/80. If you can get it that low with diet and exercise, great; if not, medications may do the job. Studies have shown that blood-pressure medications can reduce heart attack risk by 27 percent.
Smokers are two to three times more likely to die from coronary heart disease than nonsmokers, notes the American Heart Association. In addition to raising blood pressure and lowering the level of HDL (good ) cholesterol, smoking injures blood vessels, boosting your risk of having a heart attack. Even if you've been smoking for years, kicking the habit will help your heart. Studies have found that within one year after you quit, your heart attack risk is cut almost in half; within 15 years, it's similar to that of a nonsmoker.
Control your blood sugar
High blood sugar can promote the growth of plaque. To be safe, your blood sugar level, tested after fasting, should be from 70 to 130 milligrams per deciliter of blood. Your doctor can order this test.
Control your weight
Obesity increases the likelihood that your cholesterol, blood pressure, and blood sugar will be too high; losing weight can often bring these numbers down. Being even slightly overweight also boosts your risk of heart attack, particularly if you tend to gain weight around your middle.
For optimal heart health, heart researchers recommend 30 minutes of moderate exercise—such as brisk walking—most days of the week. Exercise can help you control your weight, and it can also help you avoid diabetes if your blood sugar is inching up.
If you've already had a heart attack, the challenge is to control the risk factors even more stringently, heart researchers say. Yet few heart attack survivors do this.
"I witness the cholesterol story time and time again," says Elliott Antman, M.D., director of the cardiac-care unit at Brigham and Women's Hospital. "People come to me for a second opinion after having a heart attack and I ask them, 'Have you ever been told what your cholesterol levels were?' The person will say, ' Yes, I was told they were normal.' That's not good enough anymore," if you've already had a heart attack. If you can get your LDL cholesterol level below 70, Antman says, it is unlikely you will have another heart attack.
An LDL of less than 70 is also a good goal for people who have never had a heart attack, says Daniel Rader, M.D., head of preventive cardiovascular medicine at the University of Pennsylvania. Rader offers extra tests for his high-risk patients, including one for the blood protein CRP; if this protein is elevated, it indicates an increased heart-disease risk. Rader also offers heart scans to assess the extent of plaque in a person's arteries. If the tests reveal additional risk, he will suggest drugs to drive an LDL level down to 70. With an LDL level that low, Rader says, "your lifetime risk of heart disease will be reduced dramatically." It may not reach zero, he says, but it will be a lot lower.
Naomi Atrubin is counting on it. Her LDL cholesterol level, with medication, is currently 69; she's taking another drug to control her blood pressure, and she exercises religiously. "I feel good," she says, though she knows what's at stake: that only an aggressive approach on all fronts will help her avoid a third—and potentially fatal—heart attack.
Gina Kolata is a science writer for The New York Times.
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