6 Preventable Risk Factors Associated With Heart Attacks

Heart disease remains a leading cause of health concerns in America. Every year over 800,000 people experience a heart attack. Of these, 605,000 are a first heart attack, and 200,000 happen to people who have already had at least one heart attack. Experiencing a heart attack can increase the likelihood of having another heart attack and may also contribute to other heart-related issues like atrial fibrillation or heart failure.

This article will highlight 5 important areas to focus on after a heart attack, such as measures that may help reduce the risk of future heart attacks and specialty labs commonly used in Functional Medicine to assess heart health.

[signup]

What Causes Heart Attacks?

Heart attacks often occur when there is a blockage in one or more of the coronary arteries. The coronary arteries supply blood to the heart muscle itself. These arteries can become filled with plaque, a sticky substance that lines the walls of the arteries and can lead to blockages.

Blockages can develop over time due to factors such as aging, diet, lifestyle, and genetics. Stress can sometimes cause plaque to rupture, leading to a blood clot that blocks blood flow through the artery to the heart muscle. This type of heart attack may require treatment with a coronary stent or, in severe cases, coronary artery bypass surgery.

It is also possible to have a heart attack without significant blockage in the artery. This is rare but can occur when there is significant demand on the heart. It can result from severe spasms of the coronary arteries, prolonged rapid heart arrhythmias, heart failure, or stress from surgery, which can temporarily decrease blood flow to the heart muscle, resulting in ischemia or heart attack. This type of heart attack is often managed with medications and may not require surgery or coronary stents.

Risk Factors That May Contribute to Heart Attacks

Tobacco use, in any amount
Obesity
High blood pressure
Diabetes or prediabetes
Insulin resistance
High cholesterol
Sedentary lifestyle
A diet full of processed foods
Excessive alcohol

Functional Medicine Labs to Test for Heart Health

Heart health-specific Functional Medicine labs can help assess a person's risk of developing cardiovascular issues.

APoB

APO-B and LP(a) are associated with cardiovascular risk. There is a growing consensus that the number of ApoB-containing lipoproteins (ApoB) is a reliable blood marker of lipid burden and cardiovascular risk. In a recent study, ApoB levels were found to be predictive of heart health concerns when compared to other lipid metrics.

Lp(a)

Lp(a) is a subtype of an LDL molecule with a unique lipoprotein, known as apolipoprotein(a), attached to its surface. There is increasing recognition that the number of Lp(a) particles is a factor to consider for cardiovascular health.

Inflammatory Markers

High sensitivity C reactive protein (hs-CRP) and homocysteine have been shown to correlate with heart inflammation and may indicate increased risk of heart health issues. These markers may be elevated initially after a heart attack but can normalize with healing and a healthy lifestyle.

Omega-3 Index

Omega-3 Index is a 3-month average of omega-3 levels in the body. A higher omega-3 index level is associated with a decreased risk of heart health concerns. Studies have shown that in places with a high Omega 3 Index (>8%), like in Japan, people have a lower incidence of heart health issues and increased longevity. A low Omega 3 index (<4%) is associated with an increased risk of heart health concerns.

HbA1c

Research shows that higher HbA1c levels are generally linked with a higher risk of heart health issues. High blood glucose can affect your blood vessels and the nerves that control your heart and blood vessels. Over time, this can contribute to heart health concerns.

Common Heart Health Risk Panels

Other Lab Tests to Consider

Sleep apnea is a common condition in people who have heart health concerns. Sleep apnea causes temporary decreases in oxygenation levels in the body during sleep due to periodic episodes of not breathing fully. Over time, this can affect the heart and may lead to heart arrhythmias, heart failure, and high blood pressure. If you wake up tired or have morning headaches, snore, or have been told that you stop breathing in your sleep, it may be helpful to get tested. Home sleep apnea tests are available.

Liver function tests are especially important if you take statins or blood thinner medications. Like most medications, statins are processed through the liver and, in rare cases, can affect liver function. The liver is also responsible for producing blood clotting factors for the body. If liver function is not optimal, it could increase bleeding risk with antiplatelet or aspirin use. This should be checked at least annually.

5 Things to Consider After a Heart Attack

A preventive lifestyle is important to consider after a heart attack to help reduce the risk of another heart attack. Key areas to focus on include nutrition, activity, stress management, and optimizing inflammatory biomarkers such as hs-CRP, homocysteine, and omega-3 index status.

1. Focus on Nutrition

Good nutrition is a cornerstone to supporting heart health. The Mediterranean diet is well-studied and researched in relation to cardiovascular health. In clinical trials, it has demonstrated the potential to support healthy cholesterol levels and cardiovascular health by promoting a balanced inflammation response in the body. The Mediterranean diet focuses on foods that may help reduce inflammation by incorporating whole foods that support the body's ability to manage stress. It differs from the standard American diet (SAD), which is often high in processed, calorie-rich, and pro-inflammatory processed oils. The SAD diet may contribute to inflammation in the body, which can affect cardiovascular health.

One often overlooked component of the Mediterranean diet is the lifestyle associated with the food eaten. It is eaten slowly and purposefully in a relaxed setting over conversation. In comparison, at least 20% of Americans eat at least one meal per day in the car. Stressed and mindless eating can lead to excess calorie consumption and may increase cortisol levels. Mindful eating habits can support digestion and help manage cortisol levels. High cortisol levels are associated with obesity and cardiovascular health concerns.

2. Lifestyle Changes

Your everyday lifestyle is an important component to supporting heart health after a heart attack.

Smoking Cessation

Tobacco use continues to be a significant factor in the development of heart health concerns worldwide. Even small amounts of tobacco can contribute to inflammation and affect the body and heart. There are many different ways to achieve smoking cessation other than going 'cold turkey' or taking a pharmaceutical medication or patch. Auricular acupuncture, hypnotherapy, transcranial stimulation, yoga, and app-based cognitive behavior therapy have all been explored as options to help with smoking cessation.

Movement

Daily physical activity is important for health and longevity. Our body benefits from daily movement to keep muscles and bones strong. Exercise can aid in weight, blood pressure, and blood sugar management and is also an important component in stress reduction. Physical activity has been associated with reduced risk factors for various health concerns, including arterial hypertension, diabetes mellitus type 2, dyslipidemia, coronary heart disease, stroke, and cancer.

While it is suggested for adults to aim for 150 minutes of vigorous activity per week, movement throughout the day can add up. Try breaking the walking into 10-minute increments throughout the day if you cannot fit a full 30-minute walk in your day. Cardiac rehabilitation programs offered at most cardiovascular centers are also a great way to get into an exercise routine if you are not already in one.

Stress Reduction

There are many ways to incorporate stress reduction into a daily routine. Meditation, mindfulness, yoga, talk therapy, journaling, singing, and dancing can help manage stress in the body. The key is finding what works best for you and incorporating it into your daily routine.

3. Support Healthy Cholesterol and Blood Pressure Levels

Cholesterol and blood pressure management are important physiologic markers to focus on after a heart attack.

While there is significant data on the benefits of statin use in supporting cardiovascular health, there are other ways to support healthy cholesterol levels.

Focusing on an anti-inflammatory diet, like the Mediterranean diet, avoiding highly processed foods and sugars, incorporating daily activity into your routine, and managing blood sugars can support healthy cholesterol levels.

Supporting healthy blood pressure makes it easier for the heart to function. A goal blood pressure is below 120/80 at rest. Several factors can influence blood pressure, but diet and exercise capacity are important considerations.

4. Manage Diabetes

Diabetes affects over 37 million Americans and is closely associated with heart health concerns. Persistently high blood sugar levels can affect the lining of the artery's wall, making it more vulnerable to plaque formation leading to blocked arteries. It can also affect nerves, called neuropathy, which can also impact the heart. This increases the risk of someone having a "silent heart attack," a heart attack without any symptoms.

5. Aim for a Healthy Weight

Maintaining a healthy weight can support heart health. Studies that have examined the relationship between abdominal fat and cardiovascular outcomes suggest that people with excess visceral fat around their midsections and vital organs may have an increased risk for heart health concerns.

Experts recommend that both waist-to-hip ratio and BMI be considered during regular health care visits due to the correlation between excess visceral fat and heart health.

Abdominal obesity is also linked to fat accumulation around the liver. That often leads to non-alcoholic fatty liver disease, which may affect cardiovascular health.

Having a waist-to-hip ratio higher than 1.0 may indicate an increased risk of heart health concerns.

Optimal Measurements:

For women:

Waist circumference <35 inches
waist to hip ratio: <0.8

For men:

waist circumference <40 inches
waist to hip ratio: < 0.9

Conventional Treatment Post Heart Attack

After a heart attack, current cardiovascular guidelines recommend starting several medications to help reduce the chance of having another heart attack and support the heart's recovery.

Aspirin daily - this thins the blood to help reduce the risk of another heart attack
Antiplatelet agents, like Plavix or Efficient. This typically continues for a year or longer. This is especially important if a coronary artery stent is placed.
Beta-blocker and ACE inhibitors are both added to support heart health and blood pressure management.
Statins for cholesterol management and anti-inflammatory benefits
Nitroglycerin to take if needed for future episodes of chest discomfort.
Diabetes medications, if diabetes is newly diagnosed.

Functional Medicine Considerations Post Heart Attack

A functional medicine approach post-heart attack emphasizes optimizing the above lifestyle changes and addressing underlying factors that may contribute to heart health concerns. Following the above guideline-directed medical therapy after a heart attack is recommended under the supervision of a licensed practitioner. However, there are nutraceutical supplements that some people find beneficial in supporting the heart's recovery after a heart attack.

Coenzyme Q 10:

CoQ 10 levels in the heart can be affected by beta-blockers, statins, and sulfonylurea drugs like metformin. CO-Q 10 may help support heart health and manage inflammation.

Omega 3 Fish Oil:

Omega 3 Fish Oil is considered heart-supportive and has anti-inflammatory and antioxidant properties. It may help manage triglyceride levels in the blood. It should be used with caution while taking other blood thinner medications, such as aspirin and antiplatelet agents.

Red Yeast Rice

Red Yeast Rice - has properties that may support cholesterol management and is used by some statin-intolerant people.

N-Acetyl Cysteine (NAC)

NAC has been shown to support lipid profile, fasting blood sugar, and blood insulin levels.

Follow Up Labs

Follow-up laboratory testing should be completed at least annually. This should include blood cholesterol levels, CRP, metabolic, liver and kidney function markers, and hemoglobin A1c.

[signup]

Summary:

While heart disease remains a significant health concern in America, there are many ways to support your overall heart health after a heart attack. Focusing on optimizing physiologic factors like weight, blood pressure, and cholesterol levels and prioritizing exercise and a healthful diet can help reduce the risk of having a second heart attack and support heart health.

Functional medicine laboratory testing annually can help ensure heart biomarkers are optimized, and your heart is healthy. Be sure to talk with your practitioner before starting or stopping any medication or supplement.

6 Preventable Risk Factors Associated With Heart Attacks

What Causes Heart Attacks?

Risk Factors That May Contribute to Heart Attacks

Functional Medicine Labs to Test for Heart Health