Recently identified risk factors for a heart attack include anger, anxiety, air pollution, influenza, erectile dysfunction, rheumatoid arthritis, and lupus.

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If you are prone to feeling angry, you might be more susceptible to a heart attack. Repeated episodes of anger can trigger inflammatory responses within the arteries, raise blood pressure, and constrict coronary arteries —events that contribute to heart attacks. Regular aerobic exercise helps many people keep their anger under control.


If you have an anxiety problem, such as panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, or post-traumatic stress disorder, you may be at increased risk for a heart attack. In fact, in a recent study, anxiety was a better predictor of heart attacks than depression or anger. Anxiety activates the autonomic nervous system, which can increase inflammation and blood clotting and impair heart rate regulation. Treatment options for anxiety include cognitive-behavioral therapy, relaxation techniques, and medication.

Air Pollution

Inhaling polluted air may increase your likelihood of having a heart attack, and a recent review of research by the American Heart Association suggests that the link is stronger than previously thought. Air pollution can impair the function of blood vessels, increase blood clotting, elevate blood pressure, and disrupt the heart’s electrical activity, potentially leading to a heart attack or stroke. If you are at risk for a heart attack, you should limit your time outside and avoid strenuous exercise when the Air Quality Index is in the unhealthy range (151 to 200) and reduce your exposure to car traffic as much as possible. In addition, air conditioners and air cleaners should be used indoors on days when the Air Quality Index is high.

Influenza (Flu)

The flu can exacerbate coronary heart disease and trigger a heart attack. The Centers for Disease Control and Prevention (CDC) recommends annual vaccination against the influenza virus for everyone over age 50 and for anyone with a chronic disease such as heart disease. In addition, the American Heart Association now says that an annual flu shot is just as important for preventing heart attacks as lowering your LDL cholesterol and blood pressure.

Erectile Dysfunction

Men with erectile dysfunction (ED) have the same risk of heart attacks as people who smoke or have a family history of heart disease. If you have ED, you should ask your doctor for a detailed assessment of your heart health —even if you have arteries that carry blood to the penis, and if this process is occurring there, it is likely occurring throughout your body, including in the arteries that lead to your heart.

Rheumatoid Arthritis and Lupus

People with rheumatoid arthritis or lupus are at increased risk for heart attacks, because the same inflammatory processes that cause swollen joints also play a role in atherosclerosis. It is unknown whether treating rheumatoid arthritis and lupus decreases the risk of heart attacks, but people with either of these conditions should be especially attentive to controlling their other heart attack risk factors.

Publication Review By: Roger S. Blumenthal, M.D. and Simeon Margolis, M.D., Ph.D.

Published: 08 Mar 2011

Last Modified: 15 Jan 2015