How to Know If You’re at Risk of a Heart Attack

Heart disease is the number one killer in the U.S. And heart attacks happen all the time. In fact, one happens every 40 seconds in the U.S.. 

There are many risk factors for heart disease. Some factors you can control, but others you can’t. The good news is that even if you’re at increased risk of a heart attack, there are actions you can take to reduce your risk.

What is a heart attack?

A heart attack happens when blood flow to the heart gets blocked. In a heart attack, this most often happens when plaque — a fatty cholesterol deposit in the arteries — breaks off and blocks a coronary artery. The coronary arteries are the blood vessels that surround the heart. These supply the heart with oxygen. And, if they get blocked, the heart muscle begins to die.

A heart attack may start with mild symptoms or discomfort. But it can also occur quickly and intensely. The most common heart attack symptoms to look out for are:

• Chest pain or tightness

• Pain in the jaw or neck or shoulders

• Shortness of breath

• Dizziness

• Nausea or vomiting

About 20% of heart attacks are silent. This means you have no known symptoms of a heart attack and don’t know that you’ve had one afterward.

What can put you at risk for a heart attack?

More than half of U.S. adults have a risk factor for heart disease and are at increased risk of a heart attack. You may be able to change some risk factors, such as smoking and your diet. But there are others that you can’t change — like your family history and your age.

There are tools and calculators to help determine how high your risk is of having a heart attack or stroke in the next 10 years. If you’re concerned, you can always talk with a healthcare professional about your personal risk.

Factors you can control

The most common risk factors for a heart attack that you may be able to do something about include:

• Smoking: Smoking damages the lining of your arteries and lowers your oxygen levels, forcing your heart to work harder than it should. Even smoking less than five cigarettes a day can lead to early signs of cardiovascular disease.

• High blood pressure: Often called the "silent killer," high blood pressure typically has no symptoms but significantly increases your risk for heart disease. Managing your blood pressure through lifestyle changes and medication is crucial to reducing your risk of a heart attack.

• High cholesterol: High levels of low-density lipoprotein (LDL) — the “bad” cholesterol — can lead to plaque formation in your arteries. And this can restrict blood flow to the heart. Keeping your cholesterol in check through a heart-healthy diet, exercise, and medication can help protect your heart.

• Overweight or obesity: Carrying excess weight — especially around the abdomen — can raise your risk for several conditions that contribute to heart attacks. Even modest weight loss can have a meaningful impact on heart health.

• Diabetes: High blood sugar levels can damage your blood vessels over time, increasing your risk of a heart attack. Managing diabetes with medication, diet, and exercise is key to protecting your heart. 

• A diet high in saturated or trans fats: Diets rich in unhealthy fats can raise cholesterol levels and promote plaque buildup in your arteries. Shifting to a diet with more fruits, vegetables, whole grains, and healthy fats can lower your risk of a heart attack.

• Lack of exercise: Being physically inactive can lead to weight gain and worsen other risk factors like blood pressure and cholesterol. Regular physical activity — even just walking — strengthens your heart and improves circulation. 

• Heavy alcohol use: Drinking too much alcohol can raise blood pressure and your risk of a heart attack. Limiting alcohol to less than 2 drinks for men and 1 drink for women can help lower your risk.

Factors you can’t control

There are also risk factors that you can’t control. These include:

• Family history of heart attacks: Having a close relative who had a heart attack at an early age puts you at higher risk for having one. While you can't change your genetics, knowing your family history can help you and your healthcare team stay proactive.

• Increasing age: Your risk of a heart attack goes up as you get older, especially after age 45. Aging causes changes in your blood vessels that make heart disease more likely.

• Race and ethnicity: Non-Hispanic Black and non-Hispanic white adults are at the highest risk for heart attacks. The precise reason for this is unclear. But it may be due to a combination of genetics, health disparities, and differences in access to care.

• Infections: Certain infections, especially those that cause inflammation throughout the body, can increase your risk of a heart attack. For example, respiratory infections like the flu or COVID-19 are known to temporarily raise your risk.

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Drugs that increase your risk of heart attack

Many drugs for personal use can negatively affect the heart and increase your risk of a heart attack. Even in young, healthy people who have no other risk factors for heart disease, certain drugs can affect heart rate, heart rhythm, and blood pressure. This can increase your risk for a heart attack or stroke. These drugs include: 

• Cocaine

• Heroin

• Amphetamines

• LSD

• MDMA (Ecstasy or Molly)

• Cannabis

If you are at risk for a heart attack, what should you do?

If you’re at risk for a heart attack, there are steps you can take to reduce your risk. Arteries can start developing plaque in midlife, but you might not have any symptoms for decades. 

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It’s never too late to make healthy changes — no matter your age or if you have known heart disease. In fact, you can actually reverse heart disease with lifestyle changes. 

How can you lower your risk for a heart attack?

Here are some of the most important lifestyle changes you can make to reduce your heart attack risk:

• Avoid smoking (tobacco or cannabis).

• Maintain a comfortable weight.

• Follow a heart-healthy diet.

• Do regular physical exercise.

• Avoid excessive alcohol (limit to less than 1 to 2 drinks per day). 

• Try to get at least 7 hours of sleep per night.

Even if you have an increased genetic risk for heart disease, making lifestyle changes can decrease your risk of heart disease by almost 50%.

Best exercises for heart health

The best exercises for your heart health will be the ones you enjoy and can do regularly. Exercise is very important for heart health. It helps you reduce blood pressure, maintain a comfortable weight, and improve your cholesterol levels.

In order to reduce your heart attack risk, your exercise goal should be either:

• Moderate-intensity exercise, like walking or gardening, for 150 minutes per week (20 to 30 minutes per day) 

• Vigorous-intensity exercise, like running or swimming laps, for 75 minutes per week (10 to 20 minutes per day) 

Eating a heart-healthy diet

Your diet has a big impact on your heart health. A heart-healthy diet means eating a diet that’s high in:

• Fruits

• Vegetables

• Fiber

• Grains

• Healthy fats

Heart-healthy foods include: 

• Nuts

• Legumes, like beans and lentils

• Brown rice, quinoa, and oats

• Fruits and vegetables, fresh or frozen

• Fatty fish, like salmon or trout

• Soy products, like edamame, tempeh, and tofu

• Olive oil, canola oil, and flaxseed oil

There are certain foods you should avoid, including: 

• Red meat

• Processed meat

• Fried foods

• Trans fats

• Sugary foods with added sugar or high fructose corn syrup 

Monitoring your health to prevent heart attacks

Heart health can be optimized with regular monitoring and testing. If you’re at increased risk, you may need to be more proactive about your heart testing and monitoring. 

You may want to consider the following ways to check your risk for a heart attack:

• Check in with a healthcare professional. Have a checkup at least once per year to evaluate your blood pressure and do lab tests. If you have a health condition that increases your risk, such as diabetes, then check in more frequently.

• Find out your risk for a heart attack or stroke. If your risk is high, then ask a healthcare professional about ways to lower it, such as taking aspirin or a statin.

• Check blood tests to evaluate your heart health. These may include cholesterol, high-sensitivity C-reactive protein (hs-CRP), and homocysteine.

• Consider heart function tests. These might include an electrocardiogram, echocardiogram, stress test, coronary CT scan, or cardiac MRI. The best test for you will depend on your age, your risk factors, and whether you’re having any symptoms.

• Monitor your heart health. You can do this at home by using a home blood pressure monitor or heart rate monitor.

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Written by:

Christina Palmer, MD

Christina Palmer, MD, is a board-certified family physician with a focus on chronic care management, women’s health, and mental health. She’s the co-author of “Open Heart: When Open-Heart Surgery Becomes Your Best Option.”.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Farzon A. Nahvi, MD

Farzon Nahvi, MD, is an emergency medicine physician and author of “Code Gray: Death, Life, and Uncertainty in the ER.” He works at Concord Hospital in Concord, New Hampshire, and teaches at the Geisel School of Medicine at Dartmouth.

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