Heart attacks may strike without warning. In most cases they are the result of a lifetime buildup of plaque; damaging, scarring and eventually blocking the arteries supplying blood to the heart muscles. Knowing what causes plaque is the first step in learning how to reverse it.

Your clenched fist is roughly the size and shape of your heart. If you clench and relax your fist about 60 times a minute, you'll get an idea of what a beating heart looks like. By the time you've done this for a few minutes, you'll have a tired, possibly sore, fist. Imagine tripling the rate of clenching and relaxing to as much as 180 or more times a minute, which is what happens in your heart when you are exercising or running fast. The fist, unlike the heart, isn't made to do that kind of work, and soon you'd have a painful cramp in the muscles you're using, caused by the demand for blood to keep the muscles working which can't be met by the narrow blood vessels which supply them. Many other muscle cramps are caused by a similar shortage of blood.

The heart is basically muscle. Its constant demand for oxygenated blood is supplied by the two large arteries and their branches. When these coronary arteries are clear the heart muscles can do their job. When there is partial blockage, the supply may be sufficient to keep the heart muscles working when the activity level is low, but can't pass the increased flow needed when the demand is much higher, a condition called ischemia. Some people are fortunate enough to be given a warning when this happens, such as chest pain or other discomfort called angina. Many other people will never know that their heart muscle is about to be permanently damaged from lack of enough blood until they suffer a heart attack (technically a myocardial infarction). If the damage is only to a small portion of the heart muscle, that portion dies and some scarring occurs, but the heart may continue to function enough to sustain life. If the damage is to a large area, the heart may no longer be able to work as a pump and the person dies of heart failure.

If a person exercises regularly and eats enough food there's nothing to worry about, right? Wrong. The problem is in the foods we choose to eat and the kind of exercise we choose to do.

Americans - and most people in Western industrialized countries - eat a combination of foods that causes most of the health problems they have. The standard American diet (SAD) has more fat and more protein than needed. This diet starts us out on a path to cardiovascular disease before we ever get into our teens. Until the Korean and Vietnam wars, it wasn't realized how bad the situation was. Autopsies of soldiers who died in those wars revealed harmful blockages of the coronary arteries in a majority of these young men, even those younger than 20.

We know that when we eat more fat than we need we get fatter. But some people eat fatty foods and stay thin, or at least don't become overweight. This may be due to their physical activity level. Some of it is determined by the way their body metabolizes fuel, or can be influenced by the other foods they eat. In most cases, even if they don't get heavier, people who eat high fat foods are building a foundation for eventual heart disease.

Some fat is present in nearly all foods. Margarine, salad dressings, mayonnaise, nuts, seeds and avocados are very high in fat. All oils are 100% fat. When we consume high fat foods, we are adding more to our system than we usually need for a healthy life. Vegetables, whole grains, beans (legumes) and fruits supply all the fats an adult body needs. The standard American diet (SAD) has four times more fat than our body requires and is a major cause of many health problems, especially heart disease.

Most Americans also consume more protein than they need, more calcium than can be absorbed, and not enough of the foods that provide basic vitamins and minerals. We aren't very good choosers when it comes to eating. The difference between living a long and full life and being ill or disabled is most often determined by the lifestyle choices we make.

There are other reasons for heart disease besides what we eat. Abusing drugs (alcohol and tobacco are among those drugs), or burning the candle at both ends, not letting our body recover from the abuse we heap on it, also contribute to health problems and a shorter life. These are things we can control through the choices we make.

Many people believe there's nothing they can do about high levels of stress. Changing where we live or where we work is not often a reasonable option. Stressful situations may be difficult to avoid in many parts of our life, but we can learn how to deal with stress more effectively. It's possible to live in a stressful world and not be affected by much of it, if we learn how to master our reactions to stressful situations.

We can't do anything about our inherited genetic patterns, but we can be aware how to minimize our own risks. A knowledge of family illnesses can help us to make better choices in our lifestyles.

In the pages that follow, the mechanisms of heart disease and the choices one can make to prevent and reverse this often fatal condition are explained.

Heart disease can take many forms, but the most common - and the biggest killer of men and women in the U.S.A. - is the blockage of the arteries bringng blood to the heart's muscles.

Next: The Heart Risk Factor

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