Heart attacks don’t just happen out of nowhere—they’re often the result of a combination of risk factors that build up over time. Fortunately, up to 90% of heart attacks are preventable through lifestyle choices, including what you eat, whether you smoke, how you manage stress, and how active you are.  

Understanding your risk factors, recognizing early warning signs, and knowing what to do if a heart attack occurs can save your life or the life of someone you love.  

Let’s look at the most common heart attack risk factors, treatment options, and science-backed prevention tips that can help you protect your heart.

Heart Attack Risk Factors  

Genetic and lifestyle factors are key drivers of coronary artery disease and can lead to heart attacks. While we can’t control every risk factor, we can control many.

Family History 

Are heart attacks genetic? If you have heart disease in your family, you may be especially concerned about your own risk. You may have inherited certain genes that influence your cholesterol levels, blood pressure, and your response to inflammation.

Heart disease risk can skip generations, so either way, get your Lipoprotein(a) blood levels checked. If this is high and you have heart disease in your family, this combination further increases your chances of a heart attack. (Read my Lp(a) story). 

But while genetics certainly plays a role, this doesn’t mean having a heart attack is inevitable. Early detection and consultation with a cardiac dietitian and medical team are key. 

Medical Conditions

Certain medical conditions are associated with a higher risk of a heart attack: 

• High blood pressure
• High cholesterol
• High blood sugar
• High triglycerides
• Excess fat distributed around the waist (called visceral fat)
• Rheumatoid arthritis
• Arthritis
• Psoriasis
• Pre-eclampsia
• Gestational diabetes
• Osteoporosis 

All of these conditions are associated with inflammation in the body, which is associated with heart damage.

Gut Health 

The gut-brain axis is a complex communication network linking the gut and the brain, with your gut microbiome (the community of microbes in your digestive tract) at the center. There’s also evidence of a gut-heart axis.

Research suggests that an imbalanced gut microbiome, called dysbiosis, can trigger chronic inflammation, increase harmful metabolites, and disrupt the body’s ability to regulate blood pressure and cholesterol, risk factors for heart disease and heart attacks. 

Certain gut bacteria can even produce substances like trimethylamine (TMA), which the liver converts to trimethylamine N-oxide (TMAO). High levels of TMAO have been linked to a higher risk of atherosclerosis. Maintaining a healthy, diverse gut microbiome through a high-fiber, plant-forward diet and limiting ultra-processed foods is important for reducing heart attack risk.

Menopause 

Menopause is a hormonal shift that affects your cardiovascular wellness. Decreased estrogen levels are one of the biggest hallmarks of menopause, but estrogen has a protective effect on your heart. 

One of the key changes during menopause is reduced activity of LDL receptors, which results in higher LDL cholesterol levels. Nitric oxide levels will also decline, compromising blood vessel health, flexibility, and function. 

However, this doesn’t automatically mean you need hormone replacement therapy. It means we need to make adjustments to our diet and lifestyle habits. Cutting saturated fat intake and prioritizing food sources of calcium, magnesium, folate, potassium, manganese, omega-3s, and zinc are important to support cholesterol balance and vascular health. 

Lifestyle Habits 

While not all heart attacks can be prevented, there are many modifiable risk factors that you can control. Even if you cannot control your genetics, you can control your daily diet and lifestyle habits. 

A 2022 study published in Circulation showed that addressing risk factors for heart attacks had a more significant protective effect among people without genetic predisposition who had other risk factors than people with a genetic predisposition to cardiovascular problems.

These are the things we work on together in my 1:1 nutrition counseling program. As your cardiology dietitian, I conduct a full heart attack risk assessment from a nutrition and lifestyle perspective and work as part of your cardiology care team to help determine and mitigate your level of risk and address any underlying root causes. 

We’ll get into more details about lifestyle habits below. 

Treatment and Prevention 

There are several ways to prevent a first heart attack if you have a family history or other risk factors (known as primary prevention) or to prevent and treat a recurrent heart attack (known as secondary prevention). 

Medical research shows you are at a higher risk of another heart attack after your first one. This is where addressing the underlying root cause of your first heart attack is incredibly valuable.

Medical

 Three classes of medications are commonly prescribed if you’ve had a heart attack, intended to reduce your future risk:

• Beta-blockers: Cardiac medications that slow heart rate and reduce blood pressure.
• Statins: Medications that block cholesterol production, thereby helping lower cholesterol levels, a risk factor for a heart attack.
• Anticoagulants: Blood thinners that reduce the risk of blood clots. 

While these meds can be life-saving, they aren’t necessarily meant to be taken for life or to be a single-line treatment. Many of my clients come to me after being on statins and/or various medications for years, but still had a heart attack.

Surgical 

If medical (and lifestyle) interventions aren’t enough to treat and prevent a future heart attack, there are a few common surgical procedures that may be needed. 

• Coronary angioplasty: A minimally invasive procedure that opens clogged arteries.
• Stenting: A small metal or plastic tube is inserted into the blocked artery to dilate and open it up.
• Coronary artery bypass graft (CABG): This is one of the most invasive surgical procedures to treat heart disease. During this surgery, you will be given general anesthesia.

The surgeon makes an 8-10 inch cut to the chest to expose the heart. Once your heart is visible, you may be hooked up to a heart-lung bypass machine to direct blood flow away from the heart, so the surgeon can perform the procedure more easily. 

A healthy blood vessel is used from another part of the body and is attached to the blocked area. This creates a “graft” vessel where the blood can flow more freely, reducing the risk of future blockages. 

Prevention Through Lifestyle 

While surgery may seem permanent, and medications can be used long-term, these aren’t “cures” for a heart attack. Without healthy lifestyle changes, your arteries will eventually become hardened and narrowed again. 

This will be your biggest opportunity to reduce future heart attack risk. Here are the top factors you can work on.

Transition to a Heart-Healthy Diet 

Your diet can make or break your heart health. I see this every day with my clients and see a vast difference between those who practice heart-healthy eating and those who don’t.  

Several studies show the connection between heart attacks and the presence of oxidative stress, insulin resistance, inflammation, and high blood pressure—all of which are affected by your diet. 

True heart health comes from nutrient sufficiency—giving your body what it needs in the right balance to stabilize plaque, support blood flow, and reduce inflammation.⁠ 

To start, you can move towards plant-based eating and increasing fiber intake while reducing saturated fat and sodium. I’ll help you focus on what to eat more, first and foremost, versus restriction.  

This way of eating is a more sustainable, long-term approach to longevity. And when it comes down to it, your diet habits need to be realistic for you in the long term.

Achieve a Healthy Weight 

Losing weight if you’re considered overweight may help lower your heart attack risk. However, your waist circumference is the most important factor.

If you have excess weight distributed around your waist rather than your hips, this is associated with an increased heart attack risk. Even a modest weight loss of 5-10% of your weight can make a difference.  

The recommendation for waist circumference to reduce risk is less than 35 inches for women and less than 40 inches for men. As for how to measure waist circumference​, do it at the height of your belly button (it is not based on your pants size). 

Even athletes experience heart attacks with a healthy waist circumference and have to learn how to reduce their future risks by addressing other root causes.

Physical Activity 

Your heart is a muscle, and it needs exercise to stay strong and healthy. If you have a favorite form of exercise, start with this as it will likely keep you coming back for more. 

If you suffered a heart attack, you’ll want to get back into exercise gradually. Consult with your doctor for the safest way to start. It’s also essential to couple your exercise routine with good nutrition to balance out the oxidative stress created during exercise. 

Stress Management 

Chronic, unresolved stress can increase the risk of heart attacks in several ways. It can increase blood pressure, trigger inflammation, and increase the risk of blood clots. 

It can also increase the stress hormones cortisol and adrenaline, which increase blood pressure and heart rate if chronically elevated.  

Stress can also affect your habits. When you’re in a constant state of stress, you’re more likely to smoke, drink alcohol, or overeat as a coping mechanism, all risk factors for a heart attack.  

If you have underlying stress, it’s essential to find ways to manage it, such as daily meditation, deep breathing practice, nature walks, and/or working with a therapist.

Quitting Smoking

Even if you’ve been smoking for years, it’s never too late to quit. Speak to your doctor for guidance on how to start the process and get support. 

All of these prevention techniques matter, no matter your age, weight, or fitness level.

Let’s Optimize

No matter where you are in your health journey, there are many heart attack risk factors you can control, such as transitioning to a heart-healthy diet, exercising regularly, managing stress, and quitting smoking. 

⁠As a cardiovascular dietitian with 13+ years of experience, I’ve helped thousands optimize their heart health using science-based, practical strategies—and now I teach all of this in my 6-week group coaching program, Optimize.⁠

Inside Optimize, I’ll show you exactly how to:⁠

• Normalize blood sugar and insulin levels⁠
• Lower LDL, apoB, and triglycerides
• Decrease inflammation and oxidative stress⁠
• Improve blood vessel health and reduce heart strain⁠
• Reduce risk for heart attack, stroke, and heart failure⁠

We go deep, addressing the biological pathways that contribute to plaque development and showing you how to mitigate them at every step using targeted, science-backed nutrition.⁠⁠

And most importantly, I’ll teach you how to actually implement these strategies in your daily life so you can finally see real, lasting results.⁠⁠ 

Learn more about my 6-week heart optimization group program.

Sources

1. Cleveland Clinic. (2021). 90 Percent of Heart Disease is Preventable through Healthier Diet, Regular Exercise, and Not Smoking. https://newsroom.clevelandclinic.org/2021/09/29/90-percent-of-heart-disease-is-preventable-through-healthier-diet-regular-exercise-and-not-smoking 
2. Khera A, et al. (2016). Genetic Risk, Adherence to a Healthy Lifestyle, and Coronary Disease. https://www.nejm.org/doi/full/10.1056/NEJMoa1605086 
3. American Heart Association. (2023). Lipoprotein (a) Meaning and How Does it Impact My Heart Health? https://www.heart.org/en/health-topics/cholesterol/genetic-conditions/lipoprotein-a-risks 
4. Centers for Disease Control and Prevention. (2024). Heart Disease Risk Factors. https://www.cdc.gov/heart-disease/risk-factors/index.html
5. Zaher A, Elsaygh J, Peterson SJ, Weisberg IS, Parikh MA, Frishman WH. The Interplay of Microbiome Dysbiosis and Cardiovascular Disease. Cardiol Rev. 2024 Apr 26. doi: 10.1097/CRD.0000000000000701. Epub ahead of print. PMID: 38666794. https://pubmed.ncbi.nlm.nih.gov/38666794/ 
6. Bui TVA, Hwangbo H, Lai Y, Hong SB, Choi YJ, Park HJ, Ban K. The Gut-Heart Axis: Updated Review for The Roles of Microbiome in Cardiovascular Health. Korean Circ J. 2023 Aug;53(8):499-518. doi: 10.4070/kcj.2023.0048. Epub 2023 Jun 23. PMID: 37525495; PMCID: PMC10435824.https://pmc.ncbi.nlm.nih.gov/articles/PMC10435824/ 
7. Singh A, Kishore PS, Khan S. From Microbes to Myocardium: A Comprehensive Review of the Impact of the Gut-Brain Axis on Cardiovascular Disease. Cureus. 2024 Oct 5;16(10):e70877. doi: 10.7759/cureus.70877. PMID: 39497887; PMCID: PMC11533101. https://pmc.ncbi.nlm.nih.gov/articles/PMC11533101/ 
8. Peters SAE, Colantonio LD, Dai Y, Zhao H, Bittner V, Farkouh ME, Dluzniewski P, Poudel B, Muntner P, Woodward M. Trends in Recurrent Coronary Heart Disease After Myocardial Infarction Among US Women and Men Between 2008 and 2017. Circulation. 2021 Feb 16;143(7):650-660. doi: 10.1161/CIRCULATIONAHA.120.047065. Epub 2020 Sep 21. PMID: 32951451. https://pubmed.ncbi.nlm.nih.gov/32951451/ 
9. Dubois-Deruy E, Peugnet V, Turkieh A, Pinet F. Oxidative Stress in Cardiovascular Diseases. Antioxidants (Basel). 2020 Sep 14;9(9):864. doi: 10.3390/antiox9090864. PMID: 32937950; PMCID: PMC7554855. https://pmc.ncbi.nlm.nih.gov/articles/PMC7554855/ 
10. Chen Q, Li L, Yi J, Huang K, Shen R, Wu R, Yao C. Waist circumference increases risk of coronary heart disease: Evidence from a Mendelian randomization study. Mol Genet Genomic Med. 2020 Apr;8(4):e1186. doi: 10.1002/mgg3.1186. Epub 2020 Feb 24. PMID: 32090477; PMCID: PMC7196469. https://pmc.ncbi.nlm.nih.gov/articles/PMC7196469/ 
11. Ross R, Neeland IJ, Yamashita S, Shai I, Seidell J, Magni P, Santos RD, Arsenault B, Cuevas A, Hu FB, Griffin BA, Zambon A, Barter P, Fruchart JC, Eckel RH, Matsuzawa Y, Després JP. Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nat Rev Endocrinol. 2020 Mar;16(3):177-189. doi: 10.1038/s41574-019-0310-7. Epub 2020 Feb 4. PMID: 32020062; PMCID: PMC7027970. https://pmc.ncbi.nlm.nih.gov/articles/PMC7027970/ 
12. Kawamura T, Muraoka I. Exercise-Induced Oxidative Stress and the Effects of Antioxidant Intake from a Physiological Viewpoint. Antioxidants (Basel). 2018 Sep 5;7(9):119. doi: 10.3390/antiox7090119. PMID: 30189660; PMCID: PMC6162669. https://pmc.ncbi.nlm.nih.gov/articles/PMC6162669/ 
13. Dar T, Radfar A, Abohashem S, Pitman RK, Tawakol A, Osborne MT. Psychosocial Stress and Cardiovascular Disease. Curr Treat Options Cardiovasc Med. 2019 Apr 26;21(5):23. doi: 10.1007/s11936-019-0724-5. PMID: 31028483; PMCID: PMC6568256. https://pmc.ncbi.nlm.nih.gov/articles/PMC6568256/ 
14. Hasbani NR, Ligthart S, Brown MR, et al. American Heart Association’s Life’s Simple 7: Lifestyle Recommendations, Polygenic Risk, and Lifetime Risk of Coronary Heart Disease. Circulation. 2022;145(11):808-818. doi:10.1161/CIRCULATIONAHA.121.053730 https://pmc.ncbi.nlm.nih.gov/articles/PMC8912968/