Charles A. Bertrand, M.D., FACP, DIM-CD (Ret.)
Associate Clinical Professor of Medicine at New York Medical College
and at the Medical University of South Carolina


Coronary heart disease is the number one cause of death in the industrialized nations. In the United States, approximately 40% of all deaths are due to disease of the coronary arteries.

If youíd like to have a heart attack, then read on. Iím going to tell you exactly how to do it.

First, however, a note about heart disease.

The coronary arteries are located on the surface of the heart and send branches to the heart muscle in order to provide oxygen and nutriments. Over a period of time, these arteries may develop areas of narrowing -- caused by deposits of fatty material, fibrin, calcium, and other substances. These deposits narrow the arteries of the heart. (The condition is commonly known as "hardening of the arteries.") When your arteries are clogged, all sorts of problems may arise.

Now, letís get on with the planning of your heart attack.

First, it helps to have the right genes. Heredity is important. If one or both of your parents had heart attacks, you may be ahead of the game.

Before you get too excited, however, a note of caution: It depends in part on the age of your parents at the onset of their heart trouble. In the past, I often gave medical students this hypothetical case: "Both parents died of heart attacks. Is this patient (we now see) in danger of the same fate?"

They rise to the bait.

"No question about it. Heís in real danger."

Then Iíd say, "One parent died at the age of 98 and the other died at age 104. Now what do you think?"

"O.K., heís not in danger" -- they laugh.

So your parents have to have suffered an early heart attack -- while in their 30's, 40's or 50's -- otherwise the heredity factor is less relevant. Unfortunately, thereís no way to undo your genes, so if your parents lived long healthy lives with strong hearts, your chances of a heart attack are substantially diminished. (Sorry about that).

Second, if you want to have a heart attack, try to lead a stressful life. Itís difficult to measure objectively the relationship between stress and heart attacks, but anecdotal evidence suggests a connection. However, it helps to add another risk factor, otherwise stress alone may not do the job.

But that doesnít mean you should ignore stress. Pick fights with your fellow workers. Hold grudges. Worry excessively about money matters. Get into shouting matches with your family members. Every little bit helps -- if you wish to have a heart attack. A Type A personality laced with hostility helps even more.

Third, to bring on your heart attack, be sure to eat a lot of the wrong foods to ensure that youíre overweight, even obese. Obesity itself is not as important a factor as many believe, but fat people often have high cholesterol levels -- and bad cholesterol makes a difference. So if you want to have a heart attack, donít lose weight. Some people who go on diets reduce the level of their cholesterol substantially, though not in every case, since the liver manufactures cholesterol at its own rate. I know a man who recently reduced his weight from 185 pounds to 160 pounds and his cholesterol level dropped from 330 milligrams to 210 milligrams. So be careful. If you lose weight, you may substantially reduce your opportunity to have a heart attack.

Of course, there are two kinds of cholesterol. One kind -- HDL -- will help prevent heart attacks, particularly if the level is well above 40. On the other hand, if your LDL level is below 120, your chances of a heart attack may be substantially diminished.

So if youíre interested in having a coronary, eat lots of fatty foods, preferably fried. Pile extra butter on your bread. And always go back for seconds.

Fourth, to hasten your heart attack, Iíd advise you to stop exercising. Lack of exercise is a major risk factor in heart disease. The minimum amount of exercise necessary to sustain a healthy heart is probably three to four times a week for at least 20-30 minutes -- and this exercise program should involve a significant increase in heart rate.

So, if youíre exercising now, you may be staving off a heart attack for years. Stop it. Get rid of the exercise machines. Donít listen to your doctor. Quit jogging. Donít walk when you can ride. Instead of climbing the stairs, take the elevator. Spend as much time as you can either sitting or lying down.

Fifth, if your blood pressure is high, thatís a good sign youíre a candidate for a heart attack. To avoid a coronary, you should keep your blood pressure below 140/90. In fact, recent studies have shown the dangers of even mildly elevated blood pressure. Reducing the blood pressure to normal limits not only lessens the incidence of heart attacks, but also has a major effect in protecting you against a stroke.

So if you want to hasten your coronary, avoid a normal blood pressure at all costs. Donít go to the doctor. Donít take any of the several medications that will reduce blood pressure. Better yet, donít ever have it checked. People who have their blood pressure checked once or twice a year are often diagnosed early and treated before they run into serious trouble. You wouldnít want that to happen, would you? Sixth, if you donít smoke cigarettes, start immediately. If you only smoke half a pack a day, work up to two or three packs. You can gauge the effect of cigarettes by calculating your smoking in terms of "pack years." For example, if a patient smokes a pack a day for 50 years, he would log 50 pack years. Three packs a day for 25 years would amount to 75 pack years. The greater the number of pack years, the greater the chance of developing coronary artery disease and heart attacks. Smoking is also associated with some forms of cancer as well, so you might be lucky enough to get cancer before you have your heart attack. Many people have.

To summarize: The four biggest risk factors for heart attacks are: high blood pressure, elevated cholesterol levels, a sedentary lifestyle, and smoking. If you have one or more of these, you are a candidate for a heart attack. If you have several -- congratulations. Youíre on your way.

Of course, if you donít want a heart attack, you can do something about all four "lifestyle factors" -- things you can alter simply by choosing to restructure your habits. You can control your blood pressure with medication. You can lower your cholesterol by dieting, eating fish, and taking certain prescription drugs. You can maintain a program of regular exercise. And you can stop smoking.

In addition, there are other things one can do to prevent coronary artery disease. You can take antioxidants such as vitamins A and C. You can have one drink a day, though no more. You can take aspirin on a regular basis. All of these seem to help.

the best possible advice. I hope you have enough sense to ignore it.

The advice provided on this website is intended to be general in nature and should not be relied upon for specific treatment. If you need personal medical attention please contact your physician.

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