Two very large studies have confirmed that smoking increases the risk of a first heart attack by more than 100% in some people.1, 2 Women were found to be at greater risk than men; "inhalers" were almost twice as susceptible as non-inhalers. Quitting smoking is critical for reversing this risk. According to one study, female ex-smokers who had not smoked for three or more years were "virtually indistinguishable" from women who had never smoked in terms of heart attack risk.3 Exposure to secondhand smoke, which increases infarct size in animals4 and impairs heart function and exercise tolerance in heart attack survivors,5 should also be avoided. For people who have already had a heart attack, quitting smoking is associated with a significant decrease in mortality.6
Routine, moderate exercise is preferred over excessive exertion for people at risk for heart attacks. Research indicates that heart attack risk rises six-fold for one hour immediately following heavy physical activity (compared to moderate or no activity), particularly among people who are sedentary.7 This risk is more than five times less in people who exercise four or more times per week.8 Most studies show that regular, moderate exercise reduces overall heart attack risk. Therefore, researchers and doctors recommend that susceptible individuals engage in an exercise program.9 Exercise recommendations for people who are at risk or who have a history of heart attack need to be custom tailored to the individual. Therefore, anyone with a heart condition or anyone over the age of 40 should consult a healthcare professional before beginning an exercise plan.
Although sexual activity can trigger a heart attack, the risk is very low and10 is no greater for people with a history of angina or heart disease. Doctors recommend regular, moderate exercise to further reduce this risk.
Obesity is associated with an increased risk for heart attack, particularly among younger people.11 One study found this relationship increased in women who also had a history of diabetes or high cholesterol.12 Doctors encourage overweight people who are at risk for heart attack to lose the extra weight.
Type A behavior is typically defined by time-conscious, impatient, and aggressive feelings and the behavior that arises from those feelings. Type A behavior has been linked to increased heart attack risk in some,13 but not all, studies.14 The link between personality and heart attack remains unclear.15 In the study with the most hopeful outcome, psychological intervention aimed at modifying type A behavior was reported to successfully change not only emotional state but also to significantly lower the risk of subsequent heart attacks.16 Some healthcare professionals recommend that people at high risk for heart attacks who also have frequent feelings of impatience, lack of time, and hostility, seek counseling as a way to feel better and potentially reduce their risk of heart disease.
Researchers suggest that negative emotional states, such as hostility, distrust, anger,17 worry,18 and stress,19 promote heart attacks. Results from the National Heart, Lung, and Blood Institute (NHLBI) Family Heart Study showed that hostility was significantly associated with an increased risk of having a heart attack (in women) and increased odds of having heart surgery (in men), when a family history of heart disease was also present.20, 21 According to another study, women with a history of heart disease who report stressful relationships with their husbands or partners have almost triple the risk of suffering a heart attack, dying from heart disease, or requiring bypass surgery or angioplasty, compared with women in positive relationships.22
Following a heart attack, bed rest is often recommended. However, a review of trials concluded that bed rest may actually worsen recovery from a heart attack.23