Death rate from first heart attack higher in those without the usual risk factors

Most of us know about the factors that raise our risk for heart attack: high blood pressure, bad blood lipids, diabetes, smoking, family history of heart attacks. Either that, or we’ve been living in a cave.

Though a study of more than 500,000 patients just reported in the Journal of the American Medical Assn. doesn’t change any of that, it did find something odd: Among a large group of people admitted to the hospital for their first heart attack, those who had those traditional risk factors were less likely to die of the heart attack than those who arrived at the hospital without any of them.

What could this mean? The authors don’t really know. But they do have several ideas.

One idea is: People who already have risk factors for heart disease are likely to be on medications such as aspirin, statins, beta blockers and so on, so even if they have a heart attack, the attack may be less serious than those experienced by people who were on no meds.


And once they get to the hospital? The study data show that those without the traditional risk factors were less likely to quickly receive the right kind of medications or procedures such as angiograms and bypass surgery within the first 24 hours.

It’s also possible that the kind of heart attack experienced by those who don’t have the traditional risk factors may be biologically somewhat different than those that go along with high blood pressure, bad cholesterol, etc. – and also more deadly. For example, those in the zero-risk-factor group tended to be older.

And here’s another interesting possibility: There is a thing called the “obesity paradox,” in which, under some circumstances, you’re actually better off, healthwise, if you’re carrying extra pounds. For example, overweight people with congestive heart failure live longer than those with congestive heart failure who are skinny.

It’s also possible that the finding may be more apparent than real, in the sense that the group without risk factors really did have them, they just weren’t properly noted in their records. They also tended to be older, so maybe the folks with the traditional risk factors had already had first heart attacks, or died, at a younger age.


Regardless -- before anyone starts thinking that smoking and eating terribly and getting stressed out is some kind of insurance should they ever end up in the ER with a heart attack -- it’s worth remembering that 86% of the group in the study population had at least one of the risk factors and only 14% had none.

You can gauge your risk of a heart attack using a tool at the Mayo Clinic website.

Read more health news at The Times’ Booster Shots blog.