Could having pneumonia trigger a heart attack?

You likely already know many of the underlying risk factors that can lead to a heart attack, well, by heart: high blood pressure, high "bad" or LDL cholesterol, family history of heart attack, smoking, lack of exercise, poor diet, diabetes, stress, obesity – the list is not short. But being in overall good health can go a long way toward reducing that risk.

RELATED: The 12 best diets for heart health

The 12 best diets for heart health
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The 12 best diets for heart health

#12 The Fertility Diet

According to research from the Nurses' Health Study, on which The Fertility Diet is based, women who consume “good” fats, whole grains and plant protein improve their egg supply, while those who eat “bad” fats, refined carbohydrates and red meat may make fewer eggs and increase the risk for ovulatory infertility. Your heart may benefit from such an approach, too, suggests research finding that replacing animal protein with good carbohydrates might protect against heart attack, stroke or early death from cardiovascular disease and improve artery health and blood flow.

#8 (tie) Dr. Weil's Anti-Inflammatory Diet

The Anti-Inflammatory Diet, which is based on the heart-healthy principles of the Mediterranean diet, reflects creator Andrew Weil’s belief that certain foods cause or combat systemic inflammation. According to the American Heart Association, inflammation is not a proven cause of cardiovascular disease, but it is common among heart disease patients. Plus, the program emphasizes a steady supply of omega-3 fatty acids, which research suggests protect against heart disease.

#8 (tie) Flexitarian Diet

Flexitarian is a marriage of two words: flexible and vegetarian. The plan revolves around the idea that you don’t have to eliminate meat completely to reap the health benefits associated with vegetarianism; an occasional burger is OK. One large 2015 study of more than 450,000 Europeans found that those who ate a diet of at least 70 percent plant-based foods had a 20 percent lower risk of dying from cardiovascular disease than those who were least "pro-vegetarian." Earlier research suggests a semi-vegetarian diet also helps promote healthy blood pressure and cholesterol levels. As a bonus, it's good for the environment, one reviewer pointed out.

#8 (tie) Mayo Clinic Diet

Experts agree the Mayo Clinic Diet is a sound option for preventing or controlling heart problems. It focuses on coaching dieters to develop healthy, lasting habits around which foods they choose to eat and which to avoid. Plus, it reflects the medical community’s widely accepted definition of a heart-healthy diet: heavy on fruit, veggies and whole grains but light on saturated fat and salt.

#8 (tie) Vegetarian Diet

A vegetarian diet has the potential to decrease the risk of cardiovascular disease, according to experts, as long as vegetarians don’t load up on full-fat dairy and processed foods. As one expert reminds, "vegetarian diets can be healthy or unhealthy"; the beer-and-popcorn version is the latter. Still, if you take a well-informed approach, a vegetarian plan is a good bet for heart-conscious dieters, especially those who don’t have the heart to eat animals anyway.

#7 Engine 2 Diet

This low-fat, “plant strong” diet was created by Rip Esselstyn, a firefighter, former professional athlete and medical scion. It’s thought to prevent and often reverse diseases, like heart disease, caused by the so-called Standard American Diet and should also help keep cholesterol and blood pressure in check. If you adopt the Engine 2 Diet, you’ll load up on fruit, vegetables and whole grains and slash all animal products, processed foods and vegetable oils from your diet.

#6 Vegan Diet

Veganism earned high marks for its potential to boost cardiovascular health. It emphasizes the right foods – fruit, veggies and whole grains – while steering dieters away from meat, dairy and salty, processed choices. In a 12-year study that compared 6,000 vegetarians with 5,000 meat-eaters, for example, researchers found that the vegans in the group had a 57 percent lower risk of ischemic heart disease than the meat eaters. (The condition involves reduced heart pumping due to coronary artery disease and often leads to heart failure.) Just keep in mind that vegans may need to take supplements to make up for some heart-protective nutrients like the omega-3 fatty acids found in fish.

#5 MIND Diet

This plan is a mashup of two other expert-endorsed diets – DASH and Mediterranean – and zeroes in on the foods in each that specifically affect brain health (think green leafy vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil and wine). Turns out, the heart likes the same foods, studies show. A downfall of the MIND diet: Physical activity, proven important for heart health, is not addressed in the plan, some experts pointed out.

#4 Mediterranean Diet

What can’t this eating style do? The Mediterranean diet has been associated with a decreased risk for heart disease, and it’s also been shown to reduce blood pressure and “bad” LDL cholesterol. One 2015 study even showed that Italian vegans, vegetarians and others who followed a mostly Mediterranean diet had more short-chain fatty acids, which are linked to a lower risk of heart disease. Since the approach largely shuns saturated fat (which contributes to high cholesterol) and includes healthier mono- and polyunsaturated fats in moderation (which can reduce cholesterol), you’ll do your heart a favor by following it.

#3 TLC Diet

The Therapeutic Lifestyle Changes diet, created by the National Institutes of Health’s National Cholesterol Education Program, claims to lower “bad” LDL cholesterol by 8 to 10 percent in six weeks. Research concurs: In one Journal of Lipid Research study, participants who shifted from a typical American diet to the TLC Diet reduced their LDL cholesterol by 11 percent after 32 days. No matter your aim, the diet is "very healthy and safe for all individuals," one expert said.

#1 (tie) DASH Diet

The Dietary Approaches to Stop Hypertension program, or DASH, was created to help control high blood pressure – and it works. One expert called it "by far the best with data to back up lowering hypertension." Indeed, extensive research suggests it's one of your best bets if you want to lower your blood pressure as well as improve other markers of cardiovascular health. If you adopt the diet, you’ll emphasize the foods you’ve always been told to eat (fruits, veggies, whole grains, lean protein and low-fat dairy), while shunning those we’ve grown to love (calorie- and fat-laden sweets and red meat).

#1 (tie) The Ornish Diet

This rules-heavy plan has ranked No. 1 for heart health for seven consecutive years, although this year it shares the title with the DASH diet. Followers adhere to a strict regimen: Only 10 percent of calories can come from fat, very little of it saturated, and most foods with any cholesterol or refined carbohydrates, oils, excessive caffeine and nearly all animal products are banned. Research suggests the Ornish Diet, combined with stress-management techniques, exercise, social support and smoking cessation, could actually reverse heart disease.


Not only that, but taking care of yourself may also help reduce a trigger of heart attacks that cardiologists are aware of, even if you're not: respiratory infections.

Recent research found that the risk of a heart attack was 17 times higher in the seven days following a respiratory infection, such as pneumonia or bronchitis. Though heart attack risk dropped after that, it still remained elevated for a month. Those with milder, upper respiratory infections, like the common cold, saw their heart attack risk increase 13.5-fold.

The study, published in Internal Medicine Journal in May, added to the suggested link between respiratory infections and heart attacks. "While the absolute risk that any one episode will trigger a heart attack is low, people need to be aware that a respiratory infection could lead to a coronary event," senior author Dr. Geoffrey Tofler wrote in an email. Tofler's a cardiologist at Sydney University, Royal North Shore Hospital and Heart Research Australia, which supports researchers doing study in the prevention, diagnosis and treatment of heart disease.

[See: 6 Signs You're Having a Heart Attack.]

The extent to which a respiratory illness might raise one's risk of having a heart attack varies by the study suggesting the link. The latest research used coronary angiography, special X-ray imaging to detect heart artery blockages, to confirm heart attacks in 578 patients studied. The researchers noted, though, that the respiratory symptoms were self-reported by patients – so it's possible not all who described having respiratory illness in fact did.

However, doctors say the link between a respiratory infection as a trigger that ticks up the risk for a heart attack has been established – even if it's something most patients don't know about. "While this concept may not be novel to clinicians, it may not be on the public consciousness," says Dr. Dave Dudzinski, cardiologist at Massachusetts General Hospital in Boston.

Of course, underlying cardiovascular risk factors still set the stage. "It's not that pneumonia will take somebody who's completely healthy with no plaque in their arteries and all the sudden make a bunch of plaque show up and give them a heart attack," says Dr. Mike Miedema, a preventive cardiologist with the Minneapolis Heart Institute at Abbott Northwestern Hospital in Minneapolis.

Rather, for a person who already has a buildup of plaque – the accumulation of various substances including calcium, fat and cholesterol – the respiratory illness sharpens the danger. "There's something about the respiratory infection that makes those plaques less stable," Miedema says. When plaque breaks off it can cause sudden clotting that can lead to a heart attack.

Respiratory infections are known to increase platelet (red blood cell) activity that's been associated with heart attack among patients who had pneumonia as well. And infections may also contribute to inflammation in the body, which may play a role in raising heart attack risk.

[See: How to Avoid a Second Heart Attack.]

Confusingly, the symptoms of a respiratory illness and heart problems can sometimes be similar. Got a cold? Don't ignore chest pain, though the likelihood a heart attack would be triggered by a cold is quite low. "Patients who develop a respiratory infection should not dismiss chest pain symptoms as necessarily respiratory and not cardiac in origin," the researchers said in Internal Medicine Journal. Better to get checked out if you're not sure, experts say.

While you're at it, be prompt in treating respiratory illnesses – particularly if you have underlying cardiovascular risk factors. The higher rate of these illnesses as temperatures dip may contribute to the peak of heart attacks in winter, according to previous research. Take preventive medications, such as statins to reduce cholesterol levels and drugs to lower blood pressure, if recommended by your doctor.

Anything that significantly stresses or taxes the body could have an impact on the heart. "It's one of the reasons that we do recommend a flu shot," Miedema says. "We know influenza can have a pretty significant impact on the body, but also we do see cardiovascular complications [for] people who do have severe viral infections." The American Heart Association and the American College of Cardiology recommend an annual flu vaccine in injection form for cardiovascular disease patients "with coronary and other atherosclerotic vascular disease," according to the AHA website.

Research cited in the paper found having a flu vaccine played a protective role in lowering the risk of a heart attack.

For some, a pneumonia vaccine may be appropriate, as well. Historically, these have been recommended for anybody over age 65, and anyone between 18 and 64 who had certain risk factors like being immunocompromised or having severe dysfunction of the liver, kidney, heart, lung or another organ, Dudzinski says. Talk to your doctor to determine if a vaccine is appropriate.

[See: 17 Ways Heart Health Varies in Women and Men.]

"Once a person is exposed to respiratory infection, secondary prevention methods may include prompt treatment of the infection as well as possibly taking aspirin to reduce the transient increase in [cardiovascular disease] risk," the researchers wrote. They reported that the relative risk of heart attack after respiratory infection tended to be lower in patients taking preventive medications – aspirin, statins, beta blockers and ACE inhibitors.

But whether sick or not right now, taking preventive medications as recommended, and making lifestyle changes to be heart healthier, could lower your risk of heart attack – no matter what the next future cold and flu season has in store.

Copyright 2017 U.S. News & World Report

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