The Guide to Beating a Heart Attack

First Line of Defense Is Lowering Risk, Even When Genetics Isn't on Your Side

Here's the good news: Heart disease and its consequences are largely preventable. The bad news is that nearly one million Americans will suffer a heart attack this year.

Deaths from coronary heart disease in the U.S. have been cut by 75% during the past 40 years. Hospital admissions for heart attack among the elderly fell by nearly 25% in a five-year period during the last decade, a remarkable feat when many experts had expected the aging population to cause an increase in the problem.

Still, cardiovascular disease remains the leading killer of both men and women. Doctors worry that the steady progress from an intense public-health campaign beginning in the 1960s is in jeopardy thanks to the obesity epidemic and rising prevalence of diabetes. Only a relative handful of people are fully compliant with recommendations for diet, exercise and other personal habits well proven to help keep hearts healthy.

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Particularly troubling are increasingly common reports of heart attacks among younger people, even those in their 20s and 30s, says Donald M. Lloyd-Jones, a cardiologist and chief of preventive medicine at Northwestern University's Feinberg School of Medicine in Chicago.

There is a lot a person can do to help prevent a heart attack. One international study found that about 90% of the risk associated with such factors as high cholesterol and blood pressure, physical activity, smoking and diet, are within a person's ability to control. The study, called Interheart, compared 15,000 people from every continent who suffered a heart attack with a similar number of relatives or close associates who didn't.

While genetics plays a role in up to one-half of heart attacks, "You can trump an awful lot of your genetics with choices you make and with medicines if you need them," says Dr. Lloyd-Jones.

The Basics

Knowing your cholesterol and blood pressure numbers is as fundamental to heart health as knowing the alphabet is to reading. Yet surveys show about one third of people with problem levels don't know it. For most people, optimal LDL, or bad cholesterol, is under 100; HDL, or good cholesterol, is over 60; and blood pressure is less than 120/80.

Tests for such readings aren't only important to understanding your risk, doctors say, but to measuring your progress toward reducing it. Healthy diet and exercise habits comprise the first line of offense toward improving or managing these numbers and toward controlling weight and blood-sugar levels as well. Drugs to lower cholesterol and blood pressure are effective weapons when needed.

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Quitting smoking also yields big benefits. Within a year, a former smoker's heart-attack risk is reduced by 50%.

A 10-minute Workout

Guidelines urge three hours a week of brisk exercise to maintain heart health, but many people who can't find the time to work up a sweat for 30 minutes most days don't bother. "It's the all or nothing phenomenon," says Martha Grogan, a cardiologist at Mayo Clinic.

But how about 10 minutes a day? While the 30-minute target is associated with a 70% reduction in heart-attack risk over a year, Mayo researchers analyzed the data and noticed that a brisk 10-minute walk a day results in a nearly 50% reduction compared with people who get hardly any exercise.

The actual benefit varies depending on age, gender, weight and base line physical condition, and those at highest risk have the most to gain. "If you can do more, then you're better off," says Dr. Grogan. "But small amounts of exercise aren't nothing." Still, cardiologists say a 30-minute daily workout should be the goal.

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Keep Moving

Even regular exercise isn't sufficient if you're confined to a desk or a couch for the rest of the day.

A study from Australian researchers published two years ago found that spending more than four hours a day in front of a computer or television was associated with a doubling of serious heart problems, even among people who exercised regularly. The researchers tracked 4,512 men and women, mostly in their late 50s, for four years and compared them against those spending less than two hours in front a screen.

Prolonged sitting was associated with higher levels of inflammatory markers in the blood, higher body weight and lower levels of HDL, or good cholesterol, indicating that sedentary behavior has its own bad biology apart from whether you're physically active.

"For people who sit most of the day, their risk of a heart attack is about the same as smoking," Dr. Grogan says.

Possible remedies: getting up from your desk every 30 minutes or even working at your computer while standing up. Take a walk to talk to a colleague instead of sending an email. Or, "when the 2:30 p.m. doldrums hit," says Dr. Lloyd-Jones, "rather than going for a Snickers, go for a 10-minute walk. The benefit starts to occur as soon as you get up."

Build steps into your day. Take the stairs instead of the escalator; park at the edge of the parking lot at work or the mall instead of jockeying for a space near the entrance.

Don't Worry, Be Happy

In their new heart-health book "Heart 411," Cleveland Clinic doctors Marc Gillinov and Steven Nissen describe a study by Wayne State University researchers who rated the smiles of 230 baseball players who played before 1950 based on pictures in the Baseball Register. Then they looked to see how long the players lived on average: No smile, age 73; partial smile, 75. Those with a full smile made it to 80.

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While not the most robust science, it is consistent with other research linking emotional health to lower risk of cardiovascular disease. In contrast, depression, anger and hostility have a deleterious effect. A Duke University study of 255 doctors from several years ago found that 14% of those rated above average for hostility based on a personality test had died 25 years later—most from heart disease—compared with 2% of those who tested below the average.

Eat your veggies

Complying with nutritional guidelines is the toughest challenge for most Americans, data from the American Heart Association indicate. Shopping the perimeter aisles of the grocery store is one possible remedy. It's where fresh produce and other unprocessed foods are typically found—generally considered more heart-healthy than the calorie-dense, salt-heavy foods found principally in the interior sections of the store, says Amparo Villablanca, a cardiologist at University of California, Davis.

She advises patients to "not put mud in your engines. You have to get people to think of their bodies as a finely tuned machine."

Adds Sharonne Hayes, a Mayo Clinic cardiologist: "Don't skip breakfast." If you don't eat in the morning, you trigger metabolic processes "that lead you to eat more during the day."

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Get a Good Night's Sleep

Sleep's role in protecting the heart is underestimated, says Mayo's Dr. Grogan. "If you get one less hour of sleep than you need each night, you've basically pulled an all-nighter a week," she says. Chronic sleep deprivation can lead to high blood pressure, weight gain and increase your risk of diabetes, she says.

Healthy Heart Resources

Some books and websites for more information

  • 'Heart 411' A comprehensive heart-health guidebook covering preventive strategies and treatment options by Drs. Marc Gillinov and Steven Nissen of the Cleveland Clinic

  • 'Mayo Clinic Healthy Heart for Life!' A book designed to help readers start and maintain a life-long plan for heart health

  • An American Heart Association-sponsored website geared to helping people set up a plan to achieve targets on seven different risk factors for cardiovascular disease

  • An educational website for patients sponsored by the American College of Cardiology

  • An educational and support-group website focusing on prevention and treatment of women affected by heart disease