Second of three parts

A blood clot in a narrowed coronary artery is the usual cause of a heart attack. The clogged artery prevents oxygenated blood from nourishing the heart. This can lead to pain, the death of heart cells, scar tissue and fatal arrythmias. A variety of causes leads to the narrowing of arteries, which is called “atherosclerosis.” This, in turn, increases the likelihood of a heart attack. Here are some of the leading causes of heart attacks:

Genetics. If early heart attacks run in your family, you may be at risk to have one. You may have inherited the tendencies to have high blood cholesterol and high blood pressure.

Cholesterol and triglycerides. These can lead to deposit build-up in the arteries, which constricts the flow of blood. High levels of these substances are dangerous to the heart.

Smoking. This habit damages the inside walls of arteries allowing cholesterol to collect on them. Smoking can increase the risk of clots forming. The risk of getting coronary artery disease is two to four times greater if you smoke.

High blood pressure. Also known as hypertension, this can damage arteries and speed up atherosclerosis. High blood pressure makes the heart work harder. The added effort makes the heart thicken and become stiffer. The risk of high blood pressure increases as you age.

A sedentary lifestyle. Insufficient exercise contributes to high blood cholesterol levels. Exercise also prevents obesity and lowers blood pressure. The more vigorous the activity, the greater your benefits, but any exercise can benefit your health.

Obesity. Obesity is associated with high cholesterol levels, high blood pressure and diabetes. In addition, excess weight forces the heart to work harder.

Diabetes. This disease accelerates atherosclerosis. Diabetes strikes more often in middle age. It is also more common in people who are overweight. About three-quarters of people with diabetes die of heart or blood-vessel disease.

Stress. This can elevate your blood pressure. It may also lead you to gain weight from overeating, and make you smoke to relieve tension.

Alcohol. Too much drinking can raise blood pressure and triglyceride levels. However, the risk of heart disease in people who drink moderately is lower than in nondrinkers Moderate drinking means one to two drinks a day for a man, and one drink daily for a woman. A drink is equivalent to 12 ounces of beer, 4 ounces of wine or 1.5 ounces of an 80-proof liquor.

Diet. Too much saturated fat and cholesterol in your diet can narrow the arteries to your heart.

Age. More than eight out of 10 people who die of coronary heart disease are 65 or older.

Gender. Men are at greater risk than women of having a heart attack.

Race. African-Americans suffer from higher blood pressure and a higher risk of heart disease than Caucasians. Heart-disease risk is also higher among Mexican-Americans and Native Americans.

Next week: treatment for heart attacks

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