To prevent myocardial infarction (heart attack), attention must be paid to reducing individual risk factors. Behavioral risk factors
- Diet
- Excessive caloric intake and high-fat diet (high intake of saturated fatty acids, trans fatty acids – found especially in convenience foods, frozen foods, fast foods, snacks).
- Increased homocysteine due to deficiency of vitamin B6, B12 and folic acid.
- Micronutrient deficiency (vital substances) – see Prevention with micronutrients.
- Consumption of stimulants
- Alcohol – (woman: > 20 g/day; man: > 30 g/day); immediately after moderate alcohol consumption, there is a higher cardiovascular risk (myocardial infarction, apoplexy), which falls off after 24 h as, subsequently, there is even a relative protection against myocardial infarction and hemorrhagic stroke (≈ 2-4 drinks: relative risk = 30% lower risk) and protection against ischemic stroke within 1 week (≈ 6 drinks: 19% lower risk).
- Tobacco (smoking, passive smoking); <50 yr 8-fold higher risk.
- Snus (oral tobacco: tobacco mixed with salts, which is put under the upper or lower lip).
- Drug use
- Cannabis (hashish and marijuana)
- Cocaine
- Methamphetamine (“crystal meth”)
- Physical activity
- Physical inactivity; the most important risk factor in women > 30 years of age.
- Effort while shoveling snow; one-third of all heart attacks are on days with heavier snowfall (Canada)
- Psycho-social situation
- Anxiety (10-fold increased risk)
- Lonely and socially isolated people (+42%).
- Stress (including work stress).
- Anger attack (trigger; in the first two hours, the risk increases by a factor of 4); 8.5-fold increased risk
- Anger and rage increases the risk of reinfarction (further heart attack).
- Long working hours (> 55 h / week)
- Sleep duration
- Sleep duration 9-10 hours – In a large-scale study, it was observed that people who slept 9-10 hours were 10% more likely to suffer cardiovascular events such as myocardial infarction (heart attack) than those who slept 6-8 hours. If the sleep duration was more than 10 hours, the risk increased to 28%.
- Poor dental hygiene – this can lead to gingivitis (inflammation of the gums) or periodontitis (inflammation of the dental bed) and, as a result, infectious agents can enter through the oral cavity, promoting atherosclerosis
- Overweight (BMI ≥ 25; obesity)? – Monozygotic (identical) twins have a similar risk of myocardial infarction even when the risk of the heavier twin is compared with that of the lighter twin.
- Android body fat distribution, that is, abdominal/visceral truncal central body fat (apple type) – high waist circumference or waist-to-hip ratio (THQ; waist-to-hip ratio (WHR)) is present When waist circumference is measured according to the International Diabetes Federation (IDF, 2005) guideline, the following standard values apply:
- Men < 94 cm
- Women < 80 cm
The German Obesity Society published somewhat more moderate figures for waist circumference in 2006: < 102 cm for men and < 88 cm for women.
Medication
- Clarithromycin – within 14 days of starting therapy, increased risk of myocardial infarction, among other things.
- Nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, diclofenac) incl. COX-2 inhibitors (synonyms: COX-2 inhibitors; commonly: coxibe; e.g., celecoxib, etoricoxib, parecoxib)No significant increased rate of vascular (“vessel-related”) deaths has been demonstrated for naproxen and acetylsalicylic acid. Both are inhibitors of cyclooxygenase COX-1.
- Proton pump inhibitors (PPIs; acid blockers):
- In patients taking them for heartburnNote that many PPIs are degraded via the liver enzyme CYP3A4, which is also required for the activation of clopidogrel (antiplatelet agent).Accordingly, one study demonstrated that concomitant use of, for example, omeprazole with clopidogrel lowers the plasma level of clopidogrel.
- Long-term PPI users were 16-21% more likely to develop myocardial infarctions
Environmental exposure – intoxications (poisonings).
- Heat
- Winter: Myocardial infarction frequency increased by 7% when daytime temperature dropped by 10°C
- Air pollutants
- “Asian dust” (sand particles, soil particles, chemical pollutants, and bacteria): acute myocardial infarctions were 45% more likely to occur one day after Asian-dust weather than on other days
- Particulate matter from wood burning – increased risk of myocardial infarction in those over 65 years of age; esp. during cold spells (< 6.4 °C three-day mean); neither NO2 nor air ozone levels significantly affected outcome
- Nitrogen dioxide and particulate matter pollution levels.
- Days with heavy pollen count (> 95 pollen grains per m3 air) (+ 5%).
- Weather factors:
- Low outdoor temperatures (four more heart attacks when the average temperature fell below 0°C than when it was above 10°C).
- High wind speed
- Little sunlight
- High humidity
Prevention factors (protective factors)
- High-fiber diet was associated with significantly reduced mortality risk (risk of death).
- “Life’s Simple 7” – seven lifestyle factors, such as optimal blood pressure, low cholesterol and blood sugar levels, physical activity, a balanced diet, not smoking and not being overweight – not only significantly reduce the risk of heart attack, but also help improve prognosis after a heart attack.
- Good physical training before a heart attack was associated with a significantly reduced risk of dying from the effects of the attack within a year. Fitness influenced postinfarction mortality rates more than the traditional parameters of age, smoking, obesity, diabetes mellitus, hyperlipidemia (dyslipidemia), and hypertension (high blood pressure).
- Exercise at least once a week, pay attention to a healthy diet, refrain from smoking and avoid obesity, can significantly reduce the risk of myocardial infarction even in patients genetically predisposed to CHD: in participants with a high genetic risk, the coronary risk decreased by 46% (hazard ratio 0.54; 0.47 to 0.63)
- Acetylsalicylic acid (ASA); recommendations in professional society guidelines on this vary:
- European Society of Cardiology (ESC) makes no recommendation in individuals without cardiovascular or cerebrovascular disease.
- U.S. Preventive Services Task Force (USPSTF) advocates ASA use for primary prevention for both men and women:
- Between 50 and 59 years of age with a life expectancy of at least 10 years whose estimated risk of having a myocardial infarction or apoplexy (stroke) in the next 10 years is >10%; there should be no increased risk of bleeding; and patients should be willing to take ASA for at least 10 years (B recommendation)
- Between 60 and 69 years of age with an appropriate profile, this recommendation is optional and should be made on an individual basis (C recommendation)
- American College of Chest Physicians (ACCP) makes a blanket recommendation for low-dose ASA for patients aged 50 years, regardless of individual risk.
- The cardiology professional society ESC recommends determining that threshold of cardiovascular risk above which the benefits of primary prevention with ASA exceed their risks regarding gastrointestinal bleeding. According to the ESC, the threshold thereby specified, above which ASA prophylaxis appears justified, is reached when the ten-year risk of a cardiovascular event (myocardial infarction, apoplexy (stroke), death) is at least 20% or when at least two events per 100 person-years are to be expected.
- A meta-analysis of ASA in the primary prevention of cardiovascular events concludes that the benefit is bought with a harm of about the same magnitude in the form of the risk of major bleeding.This result is all the more remarkable because data on high-risk patients (ten-year risk of cardiovascular death 5% or more or cardiovascular disease 20% or more) were used here.
- Whether taking ASA decreases or increases the risk of a cardiac event depends on the allele constellation in the gene GUCY1A3: see below Coronary artery disease/Prevention/Prevention factors.
- ASCEND study (“A Study of Cardiovascular Events in Diabetes“): diabetic patients (94% type 2) received 100 mg ASA. During the follow-up period of 7.4 years, a vascular event occurred in 658 participants (8.5%) in the ASA group compared with 743 participants (9.6%) in the placebo group, i.e., there was a 12% risk reduction for vascular events. At the same time, however, 314 participants (4.1%) in the ASA group experienced a major bleeding event compared with 245 participants (3.2%) in the control group, i.e., there was a 25% increase in major bleeding.
- HOPE-3 trial showed a preventive effect for myocardial infarction by lipid lowering with a statin (3.7% vs. 4.8%). Subjects were required to have at least one risk factor such as positive family history of CHD, smoking, or abdominal obesity.
- Pretreatment with acetylsalicylic acid and statins had a beneficial effect on disease signs and symptoms, infarct size, cardiac function, and extent of inflammation in patients experiencing first-time myocardial infarction or stable angina (“chest tightness”; sudden onset of pain in the cardiac region; reversible discomfort on exertion or exposure to cold): Patients showed lower creatinine kinase and troponin levels and higher left ventricular ejection fraction (ejection fraction of the left ventricle) compared with the group without any drug.
