One in four people can have a heart attack without risk factors, says study. Find out what else is causing them

“People would think that mortality should be less in those without any of the standard risk factors, but we found that is not the case. In fact, some of the studies from the West has shown that the risk of dying is actually higher in those without the risk factors. This could be because the people with risk factors are much more likely to seek medical advice and try to make lifestyle changes,” says Dr G Justin Paul, lead author of the study and professor at the Institute of Cardiology at Madras Medical College.

The study also found that more women than men suffered heart attacks without the four risk factors – 27.1 per cent women as compared to 22.1 per cent men. “The reason why more women were enrolled without standard risk factors could be because women tend to give lesser importance to themselves and prioritise the needs of others. They are less likely to undergo preventive health check-ups identify their cardiac risk status,” adds Dr Paul” adds Dr Paul.

Those without the risk factors also tended to be older and former smokers. The mean age of those who had a heart attack without the risk factors was 57.4 as compared to 55.7 for those who had the risk factors. The study also found that 10.4 per cent of those who did not have the four risk factors at the time of heart attack were former tobacco users, while only 5 per cent of those with the risk factors were.

So, what do the findings mean for your heart care?

What this means, Dr Paul says, is that it is equally important to address the non-quantifiable risk factors as well. “If a fourth of people are getting heart attacks without the four standard risk factors – which can be easily measured with simple tests – it means that there are other risk factors also at play. There is sufficient data to show that feelings of guilt, bitterness, worthlessness, anger, lack of support system, domestic stress, workplace stress also contribute to heart diseases,” he said.

Lifestyle management to reduce the impact of the risk factors should envelop the three Es – eating habits, exercise and emotional stability. “Everyone should work on these three areas to keep their heart healthy whether they have the risk factors or not. Having a family history of heart disease puts us at a greater risk, however practicing a healthy lifestyle can modify the expression of inherited bad genes,” said Paul.

These findings also suggest that even individuals who do not have known risk factors, should still prioritize the evaluation of their symptoms and seek medical attention

The findings of the study also mean, he feels, that even those without these known risk factors should take their symptoms seriously and seek medical advice.

Does this mean that screening for heart health should not focus on these risk factors?

Dr Paul says that while these risk factors continue to remain important – and people must work on lifestyle modifications – screening does not always help one avoid heart attacks. “I get patients who request that I get a treadmill test or Echo done for their peace of mind till their next consultation but what people do not understand is that a person can have normal tests today and still have a heart attack a few days later,” he explains.

This is because most heart attacks are caused by smaller non critical blocks that do not always show up on the tests, he elaborates.

The larger, critical clots, which make up for more than 70% of all blocks and can be detected on tests like TMT, Echo or angiogram, are responsible for only a third of the heart attacks. “Most heart attacks are caused by smaller, unstable blocks that cannot be detected on these tests. These unstable blocks are riskier because they have a thinner covering, are fat-laden, and can rupture more easily leading to a heart attack. The stable blocks are more fibrous, have a thicker covering, but are less risky even if they are larger” he says.

“As doctors, we should not be focussing on treating the blocks; we should focus on treating the patient as a whole. What can cause a stable block to become unstable? Emotional distress can do it and lifestyle can do it. So, lifestyle modification can help everyone avoid heart attacks whether they have the risk factors or not,” he says.