Mary Pickett, MD

Q: I take so many medications and still had a heart attack. How much of a role do obesity, physical fitness and nutrition play in causing a heart attack?

A: Obesity, physical fitness and nutrition each play a large role in causing a heart attack (myocardial infarction).

Obesity. Heart attacks are more likely to occur in obese people. This is partly due to the way obesity contributes to high blood pressure and makes diabetes and cholesterol problems more likely.

Obesity also increases heart attack risk by causing a thickening (hypertrophy) of the heart muscle and by increasing the chance that you will have sleep apnea. People with sleep apnea are more likely to develop heart disease.

Several studies have estimated the risk for obese people compared with people of normal weight. One example is the Nurses' Health Study. It found that non-smoking women who had a body mass index (BMI) at or above 32 had a quadrupled risk for dying of a heart attack compared to thin women with a BMI below 19.

Physical fitness. Exercise improves blood pressure, cholesterol, and weight. Even in modest amounts, exercise protects against heart attacks. Experts have blamed poor exercise for about 12 percent of the total risk for heart attack across the world.

Physical fitness, as determined by the degree of peak exercise you can perform, has a direct relationship to heart attack risk. The measurement of fitness most commonly used is called metabolic equivalents (METs). According to one study, every increase of one MET in exercise capacity was linked to a 12 percent improvement in longevity.

Nutrition. A diet low in salt and high in fruits and vegetables can reduce your risk for a heart attack.

The amount of salt in the diet may play a bigger than expected role in heart attack and stroke risk than we expected. Most Americans eat about two teaspoons of salt in a day. If all American adults over age 35 cut their salt intake in half, a computer simulation predicts that during the next decade we would see 54,000 to 99,000 fewer heart attacks per year, and 32,000 to 66,000 fewer strokes per year.

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