top of page
  • By Dr Satish Madiraju 

How to prevent heart attack: A Cardiologist’s Guide

Updated: May 23



Table of contents

  1. Introduction

  2. Preventive measures of heart attack

  3. FAQs

  4. Conclusion


How to prevent heart attack: A cardiologist’s guide


Key takeaways

  • Get regular check-ups for blood pressure, blood sugar, and cholesterol.

  • Use ethnicity-specific obesity assessments to predict heart risks accurately.

  • Consider advanced blood tests for a comprehensive heart risk evaluation.

  • CT angiography and CT coronary calcium scoring are vital for predicting the risk of coronary artery disease.

  • Adopt a healthy lifestyle.


Introduction

Heart attacks are becoming alarmingly common among young people in India, largely due to a condition called atherosclerosis, which blocks blood flow to the heart. Almost half of the deaths in the 40-69 age group are due to heart attacks. 



According to a recent report, over 32,000 people died from heart attacks in 2022, a 12.5% jump from the year before. But why? 


  • It turns out, we're facing a perfect storm of risk factors, including our genetics, rising rates of obesity, diabetes, high blood pressure, high cholesterol, being stressed, not exercising enough, smoking, and drinking too much alcohol. 



  • Adding to this is the "thin-fat" phenotype, which is more prevalent among Indians compared to Caucasians. Thin-fat Indians have a normal BMI but a high body fat percentage, particularly increased visceral obesity and decreased lean mass. This leads to a higher risk of diabetes, hypertension, and cholesterol issues compared to those without obesity.  



Given the heightened risk of atherosclerosis and coronary artery disease among Indians, coupled with the absence of clear patient guidelines, here are evidence-based recommendations from a cardiologist's standpoint on preventing heart attacks and maintaining heart health.


Preventive measures of heart attack 


1. Routinely check your blood pressure, blood sugar, and cholesterol levels. 

Diabetes, hyperlipidemia, and hypertension are modifiable risk factors for coronary artery disease. The impact of these factors on heart issues grows with higher levels of glucose, bad cholesterol, and blood pressure. Preventing heart disease begins with knowing your target numbers. 


2. Assess obesity using recommended cut-offs for Indian patients

Visceral obesity poses a significant risk for coronary artery disease. Over the years, there's been a noticeable shift in how we assess obesity, with a focus on ethnicity-specific criteria. This shift acknowledges the diverse body compositions and health risks among different populations, leading to more personalized evaluations. For Indians, it's imperative to consider obesity indicators with cut-offs specific to their ethnicity for accurate assessments.


Visceral fat estimation has emerged as the most reliable obesity indicator, providing valuable insights into underlying cardiometabolic risk factors. Dual Energy X-ray Absorptiometry (DXA) is instrumental in this regard, as it accurately measures visceral adiposity and offers precise estimates of lean mass and fat distribution. 



3. Consider advanced lipid profile testing

An advanced lipid profile is a comprehensive blood test that provides detailed information beyond traditional cholesterol levels. It includes measurements of various lipoproteins such as Apolipoprotein A (ApoA), Apolipoprotein B (ApoB), and particle size testing. By measuring these proteins, your doctor can determine if you're at increased risk of atherosclerosis, even if your standard cholesterol levels appear normal.


Additionally, particle size testing looks at the size of your cholesterol particles. Smaller, denser particles are more likely to build up in your arteries and cause heart problems compared to larger, less dense particles. 


Evidence suggests that the ApoB/ApoA1 ratio is an effective predictor of coronary heart disease risk, particularly in overweight and obese individuals.

4. Predict diabetes risk with HOMA IR

Homeostatic Model Assessment of Insulin Resistance (HOMA IR) is a calculation based on fasting blood glucose and fasting insulin levels, used to assess insulin resistance in the body. Insulin resistance is a condition where the body's cells become less responsive to insulin, leading to impaired glucose metabolism and an increased risk of developing diabetes.


Consider the HOMA IR test as it can detect early signs of insulin resistance, allowing you to take preventive measures to avoid developing diabetes. A low HOMA-IR indicates insulin sensitivity, while higher levels suggest insulin resistance and increased risk of diabetes.


5. Reduce your risk with hsCRP biomarker testing

Traditionally, we've relied on standard cholesterol tests to gauge your heart disease risk. However, many of you with normal cholesterol levels could still be at risk. Surprisingly, nearly half of heart attack and stroke patients fall into this category.


Recent research suggests that adopting a high-sensitivity C-reactive protein (hsCRP) test, a marker of inflammation could prevent thousands of heart attacks and strokes. Elevated hs-CRP levels can indicate up to four times higher risk of heart disease. This simple blood test can identify 37 to 43 percent more at-risk patients than just checking bad cholesterol levels alone. Medical management of patients with high CRP levels, regardless of their cholesterol levels, can significantly slash their risk of heart attack, stroke, and heart-related deaths.


6. Understand your coronary CT scan

A Coronary CT scan is usually ordered by your doctor to assess the health of your coronary arteries, especially if you're experiencing symptoms like chest pain or shortness of breath, or if you have risk factors such as high cholesterol, diabetes, or a family history of heart disease. It may also be ordered to evaluate the effectiveness of previous interventions such as stent placement or bypass surgery, or to monitor the progression of coronary artery disease over time.


It provides precise images of the coronary arteries, allowing for early detection of plaque buildup or blockages. It uses multiple X-ray beams to create detailed, 3D images of your heart, its blood vessels, and surrounding structures. Sometimes, an IV contrast dye may be administered to improve the visualization. 


7. Role of CT coronary angiogram vs coronary angiogram in detecting plaque deposition

In clinical practice, coronary angiograms are ordered by cardiologists when patients present with symptoms indicative of coronary artery disease or in cases of abnormal stress test results. Additionally, cardiologists may order coronary angiograms to assess the extent and severity of known coronary artery disease.


The traditional coronary angiogram utilizes X-rays to examine the coronary arteries. During the procedure, the doctor will make a small incision, either in your leg or wrist, to access an artery. A flexible tube, called a catheter, is then gently inserted through this incision and guided to your heart. Once in position, a dye is injected through the catheter into your heart's blood vessels, while X-ray images, known as angiograms, are taken to observe how the dye flows. These images help cardiologists assess the size, shape, and condition of the arteries, identify blockages, and guide treatment decisions to reduce your risk of heart attacks and stroke. 


Unlike a coronary angiogram, the CT coronary angiogram procedure does not involve any invasive procedures. During the procedure, a special contrast dye is injected into a vein in the arm to highlight the coronary arteries. A CT scanner takes multiple X-ray images of the heart from different angles, which are reconstructed into detailed 3D images of the coronary arteries.  


Mounting evidence suggests that this advanced diagnostic tool can enhance the accuracy of diagnosis, potentially lowering the risk of future heart attacks. It offers detailed insights into plaque buildup and helps tailor treatments. Additionally, it assists in assessing medication effectiveness and determines if a trip to the cardiac catheterization lab is necessary.



The importance of CT coronary calcium score test

The CT coronary calcium scoring is a non-invasive, cost-effective way to detect coronary artery disease. Evidence suggests that it is reliable and effective in predicting major heart events. This test is particularly useful for people without symptoms who are considering preventive measures like aspirin and statins. 


This test measures the amount of calcium in the arteries using a CT scan, specifically known as the Agatston score. This score helps assess the amount of plaque in the coronary arteries, which is directly linked to atherosclerosis. The higher the score, the higher the risk of heart disease. 


During the test, a CT machine scans your heart to detect areas of calcification in your coronary arteries. These calcified areas appear on the scan. 



8. Take your heart medications diligently 

Taking prescribed medications as advised by your physician is crucial for reducing the risk of heart attacks. If you experience side effects, don't stop or skip doses without consulting your physician. 


9. Embrace healthy lifestyle habits

Last but not least, to promote heart health and prevent heart attacks or strokes, consider implementing the following lifestyle changes:


  • Quit smoking and limit alcohol intake.

  • Stay physically active throughout the day.

  • Include 150 minutes per week of moderate-intensity aerobic exercise or 75 minutes per week of vigorous aerobic exercise.

  • Manage stress with techniques like meditation, deep breathing exercises or yoga.

  • Get 7-9 hours of quality sleep each night.

  • Limit your intake of salt, sugar, trans fat, saturated fats, and processed foods. Include plenty of whole grains, fruits, vegetables, and lean proteins in your diet.


FAQs


Q1. Who should get a CT calcium score test?

If you're between 40 and 70 and have risk factors like a family history of heart disease, tobacco use, high cholesterol, diabetes, high blood pressure, overweight or obesity, inactive lifestyle, or other risk factors, a calcium score test could be beneficial, even if you don't have symptoms. 


Younger individuals with a family history of high cholesterol may also consider this test. While the test can't detect all forms of coronary disease, it helps assess the extent of calcium buildup in your arteries, aiding in risk assessment. 


If your first calcium score test is normal and you want to check if your risk is still low, you might consider having the test every three to five years, as studies suggest. But if your earlier results showed a problem, doing the test again won't provide useful information.


Q2. What is the difference between a CT coronary angiogram and a coronary angiogram?

While both tests serve similar purposes, a CT coronary angiogram is non-invasive and relies on CT imaging technology, whereas a coronary angiogram is invasive and involves catheterization. Your healthcare provider will determine the most appropriate test based on your circumstances and medical history.


Q3. Should I take aspirin to prevent heart attack?

Aspirin can be beneficial for some individuals in preventing heart attacks, but it's not suitable for everyone. The decision to take aspirin for heart attack prevention should be made in consultation with your healthcare provider, based on your risk factors and medical history.


Q4. Do statins prevent heart attacks?

Yes, statins are commonly prescribed medications that can help prevent heart attacks by lowering cholesterol levels in the blood. Lowering LDL cholesterol with statins has been shown to decrease the risk of cardiovascular events, including heart attacks, strokes, and coronary artery disease. 


Conclusion 

In conclusion, prioritizing preventive measures for heart attack is paramount for safeguarding heart health and reducing the risk of cardiovascular events. Understanding your risk factors is crucial for early detection and intervention. Advanced diagnostic tools like coronary CT angiography and CT coronary calcium scoring offer valuable insights into heart health, allowing for personalized care and targeted treatments. Alongside medical interventions, adopting a healthy lifestyle plays a pivotal role in reducing the risk of heart attacks.


To further empower yourself in safeguarding your heart health, consider downloading the Aware Health Rewards app. With this app, you can access valuable resources, including a FREE Heart Attack Risk Assessment, to better understand your risk factors and take proactive steps towards prevention. Don't wait until it's too late – take control of your heart health today with the Aware Health Rewards app.



46 views0 comments

Comments

Rated 0 out of 5 stars.
No ratings yet

Add a rating
bottom of page