5 Lesser-Known Risk Factors for Heart Attack

Steven Nissen, MD, Cleveland Clinic Expert

Medically reviewed by

on July 20, 2021

Many risk factors for heart attack are well known, among them smoking, diabetes, high blood pressure, obesity, and lack of exercise. These tend to be universal, meaning they can increase the risk in nearly anyone. But there are other risk factors that put certain people at risk—or put people at risk under certain conditions. Let’s talk about these lesser-known risk factors and who is likely to be affected.

Extreme Cold

Man shoveling snow — nautiluz56 / iStock

Cold temperatures cause the arteries to constrict which can cause a sudden increase in blood pressure. Combine this with physical exertion, such as shoveling snow, and the strain may be too much for some hearts to take. Every year, shoveling snow sends more than 11,000 people to the hospital—at least seven percent are with heart trouble.

Sudden Exertion

A bout of sudden, strenuous physical activity can lead to a heart attack in people who are not physically fit. It can happen from something as seemingly harmless as a pick-up game of basketball or from lifting and carrying something heavy, such as a shovel full of snow. People who are not used to exercising, or have traditional risk factors for heart disease, are at increased risk.

Heavy Meals

A heavy meal can occasionally trigger a heart attack. Researchers think it happens because eating raises levels of the hormone epinephrine which can increase blood pressure and heart rate.

Intense Emotions

Studies have shown that intense anger and grief can cause a heart attack. It probably occurs from a sudden increase in heart rate and blood pressure triggered by an element of surprise. Because many of us experience these emotions in our lifetime and live through them, they are probably more likely to negatively impact people who are already at increased risk for heart attack.

There is a condition called Takotsubo cardiomyopathy, which may imitate a heart attack, but is somewhat different. It tends to occur more often in women, at times of intense grief, and produces heart attack-like symptoms that cause sudden heart failure. It is thought to be the result of an arterial spasm. With treatment, heart failure often resolves after the grief subsides. Later testing generally shows no evidence of heart attack.

Related Conditions

When you are diagnosed with a serious medical condition that seems unrelated to your heart, the risk of a heart attack may not cross your mind. For this reason, the role of certain conditions in raising the risk of heart attack is often unappreciated. Conditions known to increase the risk of a heart attack include:

Rheumatoid arthritis, lupus, and any other inflammatory disease which can cause inflammation in the blood vessels
Preeclampsia (raises blood pressure)
Gestational diabetes (greatly increases the risk of heart attack)
Sleep apnea (causes aggressive heart disease that increases the risk of heart attack by 30 percent over five years)
Prior radiation to the chest (primarily for cancer of the left breast which can damage the heart)

Any person with one of these conditions should see a cardiologist in addition to their regular doctor.

Dr. Nissen is a cardiologist at Cleveland Clinic's Heart and Vascular Institute, the nation's No. 1 cardiology and heart surgery program as ranked by U.S. News & World Report.