There are well-known risk factors for heart disease, such as high blood pressure, diabetes, being overweight and a family history of early heart attacks. But some little-known risk factors are as threatening to your heart as those you're familiar with-in some cases, doubling your risk for disease.

Here Stephen Sinatra, MD, shares six of these "secret" risk factors, revealed by recent scientific studies-and how to reduce your risk…

Bisphenol-A (BPA)

BPA is a chemical frequently found in food and beverage containers, such as plastic bottles and the lining of metal cans. It can harm your arteries.

Recent research: In a study of 591 people published in PLOS One, those with the highest urinary levels of BPA were the most likely to have advanced coronary artery disease-severely narrowed arteries ripe for the blockage that triggers a heart attack.

What happens: BPA sparks the chronic inflammation that drives arterial damage and heart disease.

My recommendation: Reduce your exposure to BPA. Avoid canned foods as much as possible because cans may have an epoxy liner that leaches BPA into food. Or look for cans labeled BPA-free. Drink water out of glass or stainless steel bottles that don't have a plastic liner. Don't microwave food in plastic or use plastic containers for hot foods or liquids-the heat can cause BPA to leach out.

Exception: Soft or cloudy-colored plastics typically do not contain BPA-they usually are marked on the bottom with the recycling labels #1, #2 or #4.

Shift Work

Dozens of studies have linked shift work-an ongoing pattern of work that is not roughly 9 am to 5 pm-to higher heart disease risk, but the link has always been speculative. The latest study-a so-called "meta-analysis" of previous research-changes the shift work/heart disease hypothesis into scientific fact.

Recent research: The study, published in BMI, analyzed data from 34 studies involving more than two million people and found that shift work was linked to a 23% increased risk for heart attack. The researchers concluded that 7% of all heart attacks-about one out of every 14-are directly attributable to shift work.

Tasty Way to Lower Heart Attack Risk

In a recent study of 93,600 women, those who ate more than three servings of strawberries or blueberries each week had a 34% lower risk for heart attack compared with those who rarely ate these berries.

Theory: Berries are rich in antioxidant anthocyanins, which have been shown to help regulate blood pressure and improve blood vessel function.

For heart health: Eat a handful of fresh or frozen berries a few times a week.

What happens: Shift work disrupts the normal sleep-wake cycle, throwing every system in your body out of balance, including the autonomic nervous system, which regulates heartbeat. An irregular heartbeat (arrhythmia) can cause a type of heart attack.

My recommendation: A key way to balance your autonomic nervous system is to increase your intake of foods rich in omega-3 fatty acids, such as wild-caught fatty fish (salmon, sardines, mackerel, tuna), grass-fed red meats, free-range poultry, walnuts and flaxseed oil. Also, take a daily fish oil supplement that delivers one to two grams of the essential fatty acids EPA and DHA.

If your work schedule includes shift work, pay attention to other heart disease risk factors and go for regular screenings.

Diabetes Drugs

A generic, low-cost class of anti-diabetes drugs called sulfonylureas (glipizide, glyburide and glimepiride) help control type 2 diabetes by stimulating the pancreas to produce insulin, a hormone that regulates blood sugar levels, but these drugs can be dangerous to your heart.

Recent research: Researchers at the Cleveland Clinic analyzed data from nearly 24,000 patients who had taken either a sulfonylurea drug or metformin, another generic, low-cost drug used to control diabetes. Compared with metformin, the sulfonylureas were linked to a 50% greater risk for death.

What happens: It's likely that sulfonylurea drugs are toxic to the body's mitochondria, the energy-generating structures in every cell that are crucial to health and longevity.

My recommendation: If you're taking a sulfonylurea drug, ask your doctor to switch you to metformin.

Even better: In a major, multiyear study, losing weight and exercising outperformed metformin in regulating blood sugar.

Fatty Deposits Around The Eyes

Recent research: In a 35-year study involving nearly 11,000 people, researchers found that those with three out of four signs of visible aging had a 39% increased risk for heart disease and a 57% increased risk for heart attack. The four signs in both men and women) are receding hairline at the top baldness...earlobe creases...and fatty deposits around the eyes.

Important: Of these four signs, fatty deposits around the eyes were the strongest predictor of heart attack and heart disease.

My recommendation: If your doctor finds at least three of these risk factors or just fatty deposits around your eyes-he/she should schedule you for regular screenings for heart disease.

Early Menopause

Menopause, and its accompanying drop in heart-protecting estrogen, increases the risk for heart disease. So it's no surprise that early menopause (starting at age 46 or younger) is a risk factor.

Recent research: In an eight-year study published in Menopause, researchers found that women who enter menopause early are twice as likely to suffer from heart disease and stroke.

My recommendation: There are several ways menopausal women can lower their risk for heart disease…

  • Eat more noninflammatory foods, such as fresh, organic vegetables and fruits and wild-caught fatty fish.
  • Minimize your intake of inflammatory simple sugars (white bread, pastries, cookies, pastas, candies, etc.).
  • Exercise regularly, such as a daily 30-to60-minute walk.
  • In addition to a multivitamin, take daily supplements that strengthen the heart and circulatory system, including CoQ10 (60 mg to 100 mg) oil (one to two grams)...vitamin C (1,000 mg)...and magnesium (400 mg to 800 mg).
  • Reduce stress with meditation, yoga and/or tai chi. Other ways to reduce stress include socializing with friends and doing hobbies you enjoy.


The chronic inflammatory disease of psoriasis causes patches of dry, itchy skin. A recent study shows that it also damages arteries.

Recent research: In a study in Journal of Investigative Dermatology, researchers found that chronic inflammation of the skin is accompanied by chronic inflammation in blood vessels. And in a study published in Circulation: Cardiovascular Imaging researchers found that treating psoriasis patients with the anti-inflammatory drug adalimumab decreased inflammation in the arteries (carotid and ascending aorta) often involved in heart attack and stroke.

My recommendation: All psoriasis patients should go on a gluten-free diet, eliminating inflammation-sparking grains such as wheat, rye and barley. They also should take inflammation-reducing omega-3 fatty acids (three to four grams daily). In addition, people with psoriasis should be screened regularly for heart disease.

When a Brother or Sister Dies…

When a brother or sister dies, heart attack risk rises. In an 18-year study of more than 1.6 million middle-aged people, those whose adult siblings had died of any cause were 20% more likely to have a fatal heart attack a few years after the event than peers who had not lost a sibling.

Interesting: Heart attack risk was not highest immediately after the sibling's death-but two to six years later.

Theory: Chronic stress and grieving, as well as family risk factors, could lead to heart attack.

If your adult sibling has died: Talk with your doctor about your heart attack risk, which also has been shown to increase after the death of a spouse or child.

Don't Miss These Risk Factors For Heart Attack

When determining one's odds of having a heart attack, two factors often are overlooked…

  • Periodontal disease. Many doctors have been slow to recognize how poor dental hygiene can increase a person's heart attack risk.

Here's what happens: If you don't brush and floss regularly, small particles of food get trapped between your teeth and gums, which promotes the buildup of plaque as well as inflammation and infection. Periodontal disease, in turn, causes a generalized inflammatory response that can increase heart attack risk.

In fact, a recent seven-year study of more than 100,000 people with no history of heart attack or stroke showed that those who had their teeth cleaned by a dentist or hygienist at least twice a year over a two-year period had a 24% lower risk for heart attack compared with people who did not go to the dentist or went only once in a two-year period.

My approach: Brush and floss regularly... and see your dentist at least every six months.

  • Sleep apnea. Recent research shows that this nighttime breathing disorder increases a person's risk for heart attack and stroke.

What's the connection? With sleep apnea, the upper airway narrows or collapses during sleep, often disrupting sleep hundreds of times each night. This sleep disturbance decreases oxygen saturation in the bloodstream. Sleep apnea also raises adrenaline and inflammation-both of which increase risk for heart attack.

My approach: Patients who have signs or symptoms of sleep apnea-such as snoring. periods of breathing cessation during sleep daytime fatigue and/or morning headaches–should see a doctor. There is some evidence that treating sleep apnea can lower heart attack risk.

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