Scientists now know far more about the major controllable risk factors for coronary artery disease (CAD) than for most other diseases. A risk factor merely increases the probability that you will develop CAD; it doesn't guarantee that you will develop it, nor does its absence (or even the absence of all risk factors) guarantee that you won't have a heart attack.
For healthy people, the following steps have been shown to help reduce the risk factors for CAD. Keep in mind that reducing one risk factor may help reduce others. Exercising, for example, can help you control your weight, as can efforts to lower your cholesterol level through a low-fat diet.
1. Quit smoking. This is perhaps the single most effective step you can take. Anywhere from 20 to 40 percent (100,000 to 200,000 every year) of all CAD deaths in the U.S. are directly attributable to smoking. It more than doubles your chance of eventually having a heart attack and increases the chance of dying from it by 70 percent; it is also the leading cause of sudden cardiac death. The good news: Quitting smoking quickly reduces your CAD risk; within five to 10 years of quitting, your risk of heart attack declines to a level similar to that of people who never smoked, regardless of how long you smoked.
2. Reduce your blood cholesterol. For every 1 percent reduction in high blood cholesterol, there's a 2 to 3 percent decline in the risk of heart attack.
3. Avoid or control hypertension. High blood pressure is a risk factor for stroke and heart attack. For every one-point reduction in diastolic blood pressure, there's a 2 to 3 percent decline in the risk of heart attack. If you can reduce your blood pressure by making the appropriate lifestyle changes--including limiting intake of sodium, calories, and alcohol--the coronary benefits are likely to be particularly great.
4. Stay active. Exercise protects against CAD by helping the heart work more efficiently, reducing blood pressure, raising HDL cholesterol, decreasing the tendency of blood to form clots, moderating stress, helping the body use insulin, and helping people maintain a healthy weight. Sedentary people who begin a regular program of exercise reduce their risk of a heart attack by 35 to 55 percent. Low-intensity activities, such as gardening or walking, if done regularly and over the long term, can decrease the risk of heart attack.
5. Maintain a healthy weight. About one in three American adults is obese (weighing at least 20 percent above the "suggested" weight for their height), which doubles their risk for CAD at a given age. Obesity also increases the risk for diabetes, hypertension, and high blood cholesterol, which further worsen the risk for CAD.
6. Avoid or control diabetes. Type 2 diabetes (non-insulin-dependent), which affects more than 14 million Americans, is an important risk factor for both CAD and hypertension. Diabetic men have two to three times the risk of having coronary heart disease than those without diabetes. Weight control and exercise can improve the utilization of blood sugar and prevent or slow down the onset of diabetes--and reduce the incidence of heart disease.
7. Consider a drink a day. There's a growing consensus that light to moderate alcohol consumption--that is, two drinks or less a day for a man, one drink for a woman (a drink is defined as 12 oz.of beer, 4 oz. of wine, or 1.5 oz. of 80-proof spirits) can help prevent heart attacks. However, drinking more than that can increase the risk of heart attack and stroke, as well as cirrhosis, cancer, and accidents.
8. Consider low-dose aspirin. The recommended regimen--a baby aspirin (81 milligrams) daily or half a regular aspirin (160 milligrams) very other day--can lower the risk of heart attack by about one-third by reducing the ability of platelets in the blood to stick together and thus form a clot. It is particularly advisable if you have an elevated risk of CAD. Aspirin can have side effects and isn't right for everyone, so be sure to consult with your physician first.