Feature | May 16, 2018 | Brian Kolski, M.D., FACC

Understanding How to Reduce the Risk for Heart Attack

How coronary artery plaque forms and becomes a vulnerable plaque leading to a heart attack.

Image courtesy of AstraZeneca

As a cardiologist practicing at the Orange County Heart Institute and St. Joseph Hospital in Orange, my mission is to positively impact heart health and quality of life for people, not only in my community, but around the globe. Nothing is more satisfying than helping a patient with education, prevention and treatment of complex heart problems. When patients learn about the intricacies of the heart, it helps them better understand how they can prevent heart attack, stroke and peripheral vascular disease, high cholesterol, high blood pressure, diabetes and blood clots.

Being informed of the pros and cons of procedures related to the heart, including coronary artery calcium scoring, angiogram, bypass heart surgery and pacemakers helps patients make more informed decisions.

This article is aimed at educating patients about myocardial infarctions (heart attacks). 


What is a Heart Attack?

A heart attack occurs when a blood clot blocks the flow of blood to the heart. But, how and when does this happen? 

A heart attack strikes someone about every 40 seconds.[1] It occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely. This happens because the arteries that supply the heart with blood can slowly narrow from a buildup of plaque in the coronary arteries caused by fat and cholesterol. Plaques can become vulnerable through a biological process of inflamation and rupture. Plaque rupture leads to the formation of blood clots made up of platelets and red blood cells that block the coronary arteries that supply the heart muscle with blood. If the heart does not get enough oxygen-rich blood, part of the heart will die in what is called an infarct.


Heart Attacks in Women vs. Men

As with men, the most common heart attack symptom for women is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain. When a man has a heart attack, he may gasp, clutch his chest, and fall to the ground because of the heavy chest pressure. However, women may instead experience shortness of breath, upper abdomen pain, dizziness, lightheadedness or fainting.

Read the article "Diagnostic Differences in Women’s Heart Health"

Watch the VIDEO: Sex Differences in Diagnosing Heart Disease in Women — and interview with Doreen DeFaria Yeh, M.D., Massachusetts General Hospital, Boston.


Modifiable Risk Factors to Prevent Heart Disease

Fortunately, there are steps that can be taken to reduce cardiovascular health risks. These are some of the risk factors that can be modified with a few guidelines and discipline:
   • Quit smoking. Avoid secondhand smoke too. Quitting smoking may be the best thing you can do for your health. It damages the lining of your arteries, leading to fatty buildup that narrows the artery. This can cause angina, a heart attack or a stroke.
   • Exercise. There are lots of ways that exercise boosts your heart health. It can improve cholesterol and blood pressure. It can also help you reach a healthy weight. Just walking 30 minutes a day can lower your risk for heart attack and stroke. Talk to your doctor before starting an exercise program to make sure that it is safe for you.
   • Eat a heart-healthy diet. Heart-healthy foods include fish, fruits, vegetables and whole-grains. Choose foods that are low in saturated fat, trans fat, cholesterol, and sodium. The therapeutic lifestyle changes (TLC) diet can help lower your risk of heart disease or stroke.[2] The formula is reduce intake to 25-35 percent of calories daily from fat, mainly unsaturated fats though like canola, olive, peanut, safflower, sunflower and corn oils. You are allowed only 7 percent of saturated fats such as butter, shortening and fat found in animal and dairy products. 
   • Do not eat more than 200 milligrams of cholesterol a day. Cholesterol is found in egg yolks, poultry, red meat, dairy products and shellfish. You must avoid trans fats, including some vegetable shortening, crackers, cookies and packaged snack foods. Changing what you eat helps lower cholesterol, reducing the risk for heart attack.
   • Stay at a healthy weight. According to a study by the Trust for America’s Health and the Robert Wood Johnson Foundation,[3] obesity is one of the biggest drivers of preventable chronic diseases and health care costs in the United States. Currently, estimates for these costs range from $147 billion to nearly $210 billion per year. In addition, obesity is associated with job absenteeism, costing approximately $4.3 billion annually and with lower productivity while at work, costing employers $506 per obese worker per year. It may sound simple, but being active and eating healthy foods can do wonders in helping you lose weight or stay at a healthy weight. 
   • Manage stress. Stress can hurt your heart. Try different ways to manage stress, such as exercise, deep breathing, meditation or yoga. Set goals that you can reach. Try to focus on one goal at a time. And reward yourself when you reach a goal.
   • Take medicines recommended by your doctor. This might include medications such as aspirin, cholesterol-lowering medications like statins and drugs to help lower high-blood pressure. Patient non-compliance with taking prescribed medications can put the patient as increased risk of heart disease and acute myocardial infarction (AMI).
   • Use of low-dose aspirin. Taking low-dose (81 mg) aspirin might lower your chance of having a heart attack. Aspirin is an anti platelet drug, which can help prevent clots the cause heart attacks. Talk with your doctor about it. To see if aspirin is right for you, you and your doctor will balance the benefits and the risks of taking a daily aspirin. Aspirin can reduce your risk of heart attack and stroke by one third. 
   • Manage other health problems that raise your risk of a heart attack. If you have high blood pressure, high cholesterol or diabetes, be sure you are doing everything you can to keep these conditions under control. 

Maintaining the heart is a complex, yet essential process that involves nutrition, exercise and emotional wellbeing. All these contribute to nurturing of the heart and prevention of coronary artery disease (CAD). 

Knowing that weight loss significantly mitigates the risk for CAD, my personal mission is to help patients take control of their heart health by helping them understand the healthiest methods, including holistic medicine, and keeping them out of the surgical suite. My passion for saving lives and my belief in using the most natural and least invasive solutions first, has led me to innovate and learn about alternatives that promote heart health. 

A regimen of B vitamins, magnesium supplements, CoQ10 and omega-3 fatty acids, soy protein, soluble fiber and even certain natural herbs, can strengthen the heart, while promoting weight loss and reducing the risk of an acute coronary event. 

Often, patients who are obese also have high cholesterol. Again, diet and exercise cannot be emphasized more in preventing stroke or cardiac arrest. Unhealthy fats (trans and saturated) must be replaced with healthy fats (monounsaturated and polyunsaturated). In addition, the National Institutes of Health recommends the use of 2 grams a day of plant sterols or stanols for enhancing LDL-lowering treatment plans.[2] Plant sterols and stanols (also referred to as phytosterols) are found in fruits, vegetables, whole grains, legumes, nuts and seeds. These can help bring cholesterol levels down by reducing intestinal absorption of cholesterol. Because phytosterols are structurally similar to the body’s cholesterol, when they are consumed they compete with cholesterol for absorption in the digestive system. As a result, cholesterol absorption is blocked and blood cholesterol levels are reduced.

Nutrition is a smart path that is often neglected as a sound treatment for the heart, the center of harmony in the body. I encourage everyone to take the time to understand this incredible organ, which deserves the proper nutrients and care required to keep a body and soul healthy. Please, of course, consult with your cardiologist before you seek out a quick weight loss solution that may compromise your most vital organ.

About the Author: Brian Kolski, M.D., FACC, director, Orange County Heart Institute (OCHI) noninvasive vascular lab, is board certified in interventional cardiology and cardiovascular diseases. Kolski is a nationally recognized faculty member of the Society for Cardiac Angiography and Interventions (SCAI). He is the director of structural heart disease at St. Joseph Hospital in Orange County, where he helped start the transcatheter valve program and participates in every case. Previously, Kolski started a very busy and successful vascular and limb salvage program in his previous position in Salt Lake City, Utah. He travels throughout the United States in educating physicians on vascular techniques, as well as complex high-risk (and indicated) patients (CHIP). Kolski is also involved as team cardiologist for the Anaheim Ducks professional hockey organization. 



1. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association. 2017; 135:e1–e458. DOI: 10.1161/CIR.0000000000000485.

2. National Institutes of Health (NIH).  Your Guide to Lowering Your Cholesterol With TLC. NIH Publication No. 06–5235. December 2005. 

3. 14th annual State of Obesity: Better Policies for a Healthier America. Report from the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF). 2004-2018. https://stateofobesity.org/. Accessed May 10, 2018.

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