Increase Your Chances of Avoiding a Heart Attack

Last month, a report by the American Heart Association and American College of Cardiology recommended extending statin drugs to a wider pool of people to prevent heart attacks as well as strokes. Previously, a high cholesterol level was the main criterion, but the new guidelines encourage people with normal cholesterol levels but higher risk factors related to age, gender and race to consider the cholesterol-lowering drugs.

The guidelines also promote more traditional preventive measures: 40 minutes of moderate to vigorous exercise four times a week and a diet focused on vegetables, fruits and whole grains.

Reinforcing the need for exercise to prevent heart attacks, new research from the Swedish School of Sport and Health Sciences suggests simple activities can reduce the risk of a heart attack (as reported in the online British Journal of Sports Medicine, October 28, 2013). Researchers found that those who were most physically active reduced their risk of heart attack and stroke by 27 percent and decreased their risk of all-cause mortality by 30 percent, when compared with the least active participants in the study.

Aging Factors for Heart Disease As we age, our bodies undergo changes that can lead to heart disease and heart attacks.

  • The heart’s natural pacemaker system, which controls the heartbeat, may develop fibrous tissue and fat deposits and lose some of its cells, resulting in a slightly slower heart rate.
  • The heart may fill more slowly, as the heart wall thickens, so the amount of blood that the chamber can hold may decrease.
  • Abnormal rhythms (arrhythmias) such as atrial fibrillation are more common in older people and may be a result of heart disease.
  • Deposits of the “aging pigment” lipofuscin can cause the heart-muscle cells to degenerate slightly and cause the valves inside the heart, which control blood flow direction, to thicken and stiffen.
  • Receptors, which maintain blood pressure by adapting to a person’s changing positions and activities, become less sensitive with aging. This may explain why, when a person stands, their blood pressure falls and less blood flows to the brain, causing dizziness, especially in the elderly.
  • The minor thickening of the capillary walls slightly slows the rate of our heart’s nutrient and waste exchange.
  • The main artery from the heart (aorta) becomes thicker and less flexible, increasing blood pressure and how hard the heart has to work, which may lead to thickening of the heart muscle (hypertrophy).

Aging Factor for Heart Attack Risk

Taking preventive measures becomes more important as we get older, because aging increases our risk factors. In fact, the number one cause of death in adults over the age of 60 is heart disease, including heart attacks. Heart disease can strike anyone, but older adults are hit the hardest for several reasons. For one, people who smoke or have a history of smoking have a much higher risk. Smoking is the leading cause of heart disease. (For help quitting smoking, you can call 1-800-QuitNow.)

The medical term for a heart attack is myocardial infarction, in which the supply of blood to the heart is suddenly and severely reduced or cut off, causing the muscle to die from lack of oxygen. This often happens as plaque, a fatty material, builds up over the years on the inside walls of the coronary arteries, which supply blood and oxygen to your heart; this build-up is often due to smoking. Eventually, an area of plaque can rupture, causing a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block the flow of oxygen-rich blood to the part of the heart muscle fed by the artery. If the flow of blood isn’t restored quickly, the section of heart muscle becomes damaged from lack of oxygen and begins to die.

As we age, changes normally occur in the heart and blood vessels, which can lead to heart disease, including heart attacks. The heart becomes more vulnerable to various injuries, and its “pump” capabilities begin to deteriorate.

The heart’s decrease in elasticity and ability to respond to changes in arterial-system pressure means escalating resistance to its pumping action. This increases the effort needed to drive blood to various organs. In addition, as the arterial wall thickens, the arteries stiffen. Rigid arteries lead to high blood pressure, which is especially dangerous for the elderly. (See the sidebar for other heart disease factors associated with aging.)

Heart Attack Symptoms Vary

People experience the symptoms of an oncoming heart attack differently. Women and those older than 75, especially, are less likely to feel any chest pain and more likely to suffer what is known as a silent heart attack. The problem is that silent heart attacks don’t exhibit the traditional warning signs but are equally deadly. In fact, they are even more common in older adults than heart attacks that immediately come to the attention of doctors and patients, according to a recent study in The Journal of the American Medical Association (as reported in “The Deadly Threat of Silent Heart Attacks,” New Old Age blog, New York Times). Silent heart attacks are hard to diagnose because the symptoms can be vague: prolonged fatigue, confusion, shortness of breath.

In general, common symptoms of a traditional heart attack include:

  • Chest pain and pain that originates in the chest and spreads to the back, jaw or arms. People may also feel pain in all of these places and not the chest, or they may feel pain in the stomach area and mistake it for indigestion. The pain is like that of angina but usually more severe and longer lasting, and it does not get better by resting or taking a nitroglycerin pill.
  • Faintness
  • Sudden sweating
  • Nausea
  • Heavy pounding of the heart
  • Abnormal heart rhythms (arrhythmias), which occur in more than 90 percent of people who have had a heart attack
  • Loss of consciousness, which sometimes is the first symptom of a heart attack
  • Feelings of restlessness, sweatiness, anxiety and a sense of impending doom
  • Bluishness of the lips, hands or feet

Certain symptoms are mostly seen in older adults:

  • Shortness of breath
  • Progressive fatigue
  • Heartbeats that are too fast, too slow or irregular
  • Dizziness
  • Pain in the left chest, or more commonly, “chest tightness,” especially if brought about by physical or emotional stress
  • Symptoms that resemble a stroke, such as feeling disoriented

Because half the deaths from a heart attack occur in the first three or four hours after symptoms begin, it’s important to take these symptoms seriously and get medical treatment as soon as possible.

Preventive Measures Can Help

It may be too late to change lifelong patterns (such as smoking and eating fat-rich foods), but you can still take measures to help your chances of preventing a heart attack.

The general advice for staying healthy also pertains to avoiding a heart attack, whether you are young or old. Controllable heart disease risk factors include high blood pressure, cholesterol levels, diabetes, obesity and smoking.

  • Eat a heart-healthy diet with reduced amounts of saturated fat and cholesterol.
  • Lose weight.
  • Follow your health care provider’s recommendations for treating high blood pressure, high cholesterol or diabetes.
  • Reduce or stop smoking.
  • Exercise moderately and regularly, which will reduce blood pressure and help you lose weight. Consult with your health care provider before beginning a new exercise program.
  • Have your blood pressure checked every year. If you have diabetes, heart disease, kidney problems or certain other conditions, your blood pressure may need to be monitored more closely.
  • Recheck your cholesterol level every five years, if it’s normal. If you have diabetes, heart disease, kidney problems or certain other conditions, your cholesterol may need to be monitored more closely.

(From “Aging changes in the heart and blood vessels,” Medline Plus, a service of the U.S. National Library of Medicine and National Institutes of Health).


“Aging changes in the heart and blood vessels,” Medline Plus, a service of the U.S. National Library of Medicine and National Institutes of Health.

“Aging and Diseases of the Heart,” American Heart Association Cardiology Patient Page.

“The Deadly Threat of Silent Heart Attacks,” New Old Age blog, New York Times.

“Heart Attack: Myocardial Infarction,” Cedars-Sinai.

“Heart Attack: Warning signs and risk factors,” National Heart, Blood and Lung Institute, National Institutes of Health


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