11 Surprising Heart Attack Triggers
En español | When it comes to heart attacks, many of us know the causes most likely to trigger a problem: Obesity, not enough exercise, high blood pressure, stress and smoking. But new research is finding other, less common factors can also put your heart at risk.
1. Asthma that requires daily medication
Persistent asthma, which is asthma severe enough to require daily controller medications, is associated with a 60 percent higher risk of a heart attack, stroke or death from cardiovascular disease, according to new research published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology.
"Both asthma and cardiovascular disease are caused by high levels of inflammation," explains lead researcher Matthew Tattersall, assistant professor of medicine at the University of Wisconsin School of Medicine and Public Health.
New research published in the Journal of the American Heart Association found that being diagnosed with asthma as an adult (defined as late onset asthma) also increases the risk of developing heart disease.
In addition, because chest tightness is often a symptom of asthma, asthmatics could miss the signs of a heart attack, delaying treatment. To reduce the long-term cardiovascular risk, Tattersall believes close monitoring is essential. "If you have persistent asthma, you may need stronger and more aggressive preventative care," he says.
2. Taking certain heartburn drugs
For those with acid reflux, taking proton pump inhibitors (PPIs) — including Prilosec, Nexium and Prevacid — was associated with a 16 to 21 percent higher heart attack risk, according to a large new Stanford University study that looked at data from nearly 3 million patients.
The study found no link, however, between heart attacks and another well-known type of heartburn drug, H2 blockers, such as Tagamet, Pepcid and Zantac.
So why are PPIs different? Previous research suggests that they may reduce the production of nitric oxide, an important molecule that helps maintain the health of the inner linings of blood vessels. Too little nitric oxide could accelerate heart disease.
Over-the-counter heartburn medications could also be cause for concern. A 2016 study published in Circulation Research found that drugs like Nexium, which treats gastroesophageal reflux disease, could cause faster aging of blood vessel cells, making it more difficult for them to prevent heart attacks.
3. Having migraines with aura
Middle-aged and older women who have migraines with aura, meaning the headaches are often preceded by visual symptoms like flashing lights or blind spots, have an increased risk of heart attack, according to a 2013 analysis of 28,000 women enrolled in the ongoing national Women's Health Study.
In fact, having migraine with aura was found to be the second-strongest contributor to heart attack and stroke risk after high blood pressure, according to researcher Tobias Kurth, M.D., of Brigham and Women's Hospital in Boston.
This does not mean everyone with this type of migraine will have a heart attack or stroke, Kurth noted, but that these migraine sufferers should try to reduce their risk in other ways, including not smoking, staying active and keeping blood pressure under control.
4. Skipping the flu vaccine
A flu vaccine doesn't just protect you against that nasty virus. Recent research has shown it also helps your heart, decreasing your odds of having a heart attack by 50 percent in the year following the shot compared with those who don't get the vaccine. Now a study published in the journal Vaccine shows why.
"We discovered that antibodies that are produced after the vaccination activate molecular processes, which protect and strengthen the cardiovascular system," explains study coauthor Veljko Veljkovic of the Vinca Institute of Nuclear Sciences at the University of Belgrade in Serbia.
By getting the flu vaccine, Velijkovic says, you're getting a double benefit: protection against both the flu and a heart attack.
It’s especially important for those with type 2 diabetes to get the flu vaccine. The Canadian Medical Association Journal found it lowers hospital admissions for stroke and heart failure among this high risk group.
5. Weak grip strength
What does your handshake have to do with heart health? More than you think, according to research published online in May 2015 by The Lancet.
Researchers found that grip strength, or the force you exert when you squeeze something as firmly as possible in your hand, is a predictor of heart attack risk. By measuring patients' grip strength with a special device called a handgrip dynamometer, the scientists found that for every 5-kilogram (11-pound) decline, there was a 17 percent greater risk of cardiovascular death and a 7 percent higher risk of having a heart attack.
"Grip strength is as strong a predictor of cardiac death as blood pressure," notes Darryl Leong, assistant professor of cardiology at McMaster University in Canada and lead author.
While the cause of the link is unknown, Leong suspects there could be a connection between muscle strength and improved vascular function.
6. Daylight Saving Time
Adjusting the clocks forward (or back) an hour does more than just mess up your sleep.
The disturbance to your circadian rhythm — or body clock — also appears to have an impact on your heart. Research presented at the American College of Cardiology's 63rd Annual Scientific Session noted a 25 percent increase in the number of heart attacks on the Monday after the clocks move ahead — or "spring forward" — and we lose an hour, compared with other Mondays during the year. By contrast, there is a 21 percent decrease in the number of heart attacks on the Tuesday in the fall after the clocks "fall back" and we gain an hour.
The sleep disruption from the spring time change is stressful to the body, which researcher Hitinder Gurm, M.D., an interventional cardiologist and associate professor at the University of Michigan, believes can trigger a heart attack in susceptible patients. "We live in a sleep-deprived society and these data indirectly suggest that even small disturbances in sleep can be deleterious for health," Gurm says.
7. The cocktail hour
When it comes to whether alcohol helps or hurts heart health, timing appears to be everything. Research published in the March 2015 issue of the journal Epidemiology found that the chances of having a heart attack increased 72 percent in the first hour after drinking alcohol. "Within the first hour after drinking, your heart rate and blood pressure increase, and your blood becomes more sticky, making it more likely to clot," explains lead author Elizabeth Mostofsky, with the Beth Israel Deaconess Medical Center and the Harvard School of Public Health. However, within 24 hours of imbibing, the overall risk of heart attack decreased by 14 percent.
While alcohol may have a protective effect over time, it may also cause a temporary spike in heart attack risk, Mostofsky says. For that reason, "alcohol consumption can be beneficial, but stick with small amounts — no more than one drink a day for women or two for men."
8. Anger issues
If you're blowing your top at every little thing, those outbursts are sending your heart attack risk skyrocketing.
A 2014 study published in the European Heart Journal found that patients who described their mood as "furious" or "enraged" had almost a five-fold increase in their risk of heart attack in the two hours after an intense bout of anger. "The key message is that even if you can't prevent anger entirely, lowering how often you get angry or lowering the intensity can be helpful for lowering your heart attack risk," says study coauthor Mostofsky.
Think twice before heading to the gym to burn off that anger. A study published in a 2016 issue of Circulation found that the risk of physical exertion, like exercise, while angry or upset tripled the risk of having a heart attack within an hour. Possible takeaway: It’s best to simmer down before working out.
9. Traumatic events
It's not an exaggeration to say that heartbreaking events really may break your heart — especially for women.
Research presented at the American Heart Association's 2015 Scientific Sessions found that traumatic life events like the death of a loved one or a life-threatening illness increased heart attack risk by nearly 70 percent among middle-aged and older women.
The research didn't examine the reasons some women are more vulnerable to the effects of deeply distressing life events, but coauthor Michelle A. Albert, M.D., professor of medicine at the University of California San Francisco, speculates that negative experiences might interfere with the body's response to stress, increasing inflammation and stress hormones, which are linked to susceptibility to heart attacks.
Physicians and patients should discuss ways to reduce psychological stress following a personal trauma, Albert adds, in order to reduce cardiovascular risk.
10. Taking common painkillers
You may not have noticed the fine print, but the widely used over-the-counter and prescription painkillers ibuprofen and naproxen (brands like Advil, Motrin and Aleve) come with a warning about possible heart attacks and stroke.
Up to now, the warning has said that these nonaspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) "may cause" an increased risk of heart problems, but new data has convinced the Food and Drug Administration to strengthen the wording to say these medications "cause" a higher risk, and the agency warned that Americans should use the drugs sparingly for a brief time, and at the lowest dose possible.
The FDA said several new studies show the risk of heart attack or stroke can increase even after using NSAIDs for a short time. The risk also appears greater at higher doses.
"Everyone may be at risk — even people without an underlying risk for cardiovascular disease," Judy Racoosin, M.D., deputy director of the FDA's Division of Anesthesia, Analgesia and Addiction Products, said in a written explanation of the new warning.
People who have heart disease, particularly those who recently had a heart attack or cardiac bypass surgery, are at the greatest risk and should discuss taking these drugs with their doctor.
11. Eating a late supper
When it comes to your nightly nosh, earlier is better.
Turkish researchers tracked 721 adults with high blood pressure and found that found that those who ate within two hours of going to bed were 2.8 times more likely to retain high blood pressure overnight.
Blood pressure that fails to drop overnight is called “non-dipper hypertension” and it increases cardiovascular risk, which includes heart attack.
Eating is believed to release stress hormones, causing your body to be on high alert at a time when it should be winding down. To avoid elevated overnight blood pressure, researchers suggest identifying healthy eating patterns in terms of ideal frequency and timing of the meals to improve cardiovascular health.
Jodi Helmer regularly contributes health stories to AARP.