“The river warns before it overflows its banks.” In many cultures, this image conveys a guiding principle: significant events cast small shadows in advance. The same is true for a heart attack – it rarely comes without warning signs. Those who recognize the subtle precursors and act wisely protect not only their hearts but also their performance, joy of life, and longevity.

A heart attack occurs when a coronary arteryartery that supplies the heart muscle with blood suddenly becomes blocked – usually due to a atherosclerosisbuildup of cholesterol, inflammatory cells, and connective tissue-related plaque rupturetearing of a vascular deposit with clot formation. Warning signs are often nonspecific: newly occurring or increasing angina pectorispressure/tightness in the chest during exertion, unusual shortness of breath, jaw or back pain, cold sweat, sudden fatigue – especially in women, symptoms may be more diffuse. Key risk drivers include smoking, hypercholesterolemiaexcessively high LDL cholesterol levels, high blood pressure, visceral fat visceral fatfat tissue around internal organs, lack of exercise, and chronic stress. Crucially: these factors often act together over years. This makes proactive screening and lifestyle strategies highly effective.

For high performers, prevention pays double dividends: it prevents events and preserves daily energy. Data show that sustained stress increases cardiovascular risk independently of traditional factors – affected individuals experience heart attacks and heart-related deaths years earlier than those with less stress ^[1]. Additionally, non-cigarette tobacco products are by no means “harmless”: cigars, pipes, and smokeless tobacco are associated with stroke, heart failure, myocardial infarction, and increased cardiovascular mortality ^[2]. Untreated hypercholesterolemia – especially familial forms – accelerates atherosclerosis right from childhood and leads to premature events; aggressive LDL lowering is lifesaving in this context ^[3]. Lack of exercise promotes cellular stress processes in the heart muscle and worsens prognosis after a heart attack, which is experimentally supported by disruptions in mitochondrial dynamics ^[4]. The sum: risk factors do not just add up – they amplify each other. Thus, consistent prevention is even more worthwhile.

The view on nutrition is nuanced: the Mediterranean diet is considered beneficial based on observational data, yet intervention studies show only moderate or heterogeneous effects compared to other strategies. A recent review of 20 intervention studies found no consistent advantage of the Mediterranean diet on glycemic endpoints; it is possible that caloric intake, carbohydrate quality, and weight loss are more crucial than the label “Mediterranean” ^[5]. Additionally, another review shows that established patterns such as the Mediterranean and DASH diets, as well as calorie-conscious diets, remain robust approaches; time-restricted eating (TRE) is gaining potential as a time-limited dietary option – especially in combination with established patterns ^[6]. In stress interventions, a meta-analysis found significant improvements in depressive symptoms and mental quality of life among heart patients through eHealth-based cognitive-behavioral therapy (CBT) programs – indicating that scalable digital tools achieve clinically relevant effects ^[7]. On the risk side, a large multi-cohort analysis shows that cigars, pipes, and smokeless tobacco also carry independent cardiovascular risks – a clear argument against “lighter” alternatives ^[2]. Finally, consensus papers and new protocols underline the value of non-invasive screenings for detecting subclinical atherosclerosis and functional vascular changes to stratify risk earlier and more precisely – especially in women, whose risk is often underestimated ^{[8] [9]}.

- Nutrition that works: focus on a heart-healthy pattern with plenty of vegetables, legumes, whole grains, nuts, olive oil, and fish. Prioritize protein- and fiber-rich meals, reduce refined carbohydrates, and maintain a moderate energy balance – this drives weight and risk reduction, independent of the "Mediterranean" label ^[5]. Check if an 8–10-hour eating window helps you manage caloric quality and quantity better; TRE can improve cardiometabolic markers and complements established diets ^[6].
- Smart stress regulation: incorporate 10–15 minutes of daily “nervous system training”: breath protocol (4–6 breaths/minute), a short CBT exercise (observe and restructure thoughts), and an evening “thought parking lot” routine. Use digital programs/apps with a CBT approach – they enhance mood and quality of life among heart patients and are practical for daily use ^[7].
- Smoking cessation as a performance boost: quit completely – reduction without abstinence does not significantly lower risk. One year after quitting smoking, the risk of a heart attack is about halved ^[10]; large cohort data clearly show: quitters have significantly fewer strokes and heart attacks compared to “sustainers” ^[11]. Combine behavioral therapy with pharmacotherapy (nicotine replacement, bupropion, varenicline) for the best chances ^[10].
- Movement as a daily standard: plan for 150–300 minutes of moderate or 75–150 minutes of vigorous endurance exercise per week plus two strength training sessions. Avoid long periods of sitting: become active for 2–3 minutes every hour. This protects heart muscle mitochondria and improves cardiac resilience ^[4].
- Maintain LDL within target: know your LDL value. For high values, start lifestyle changes and – if necessary – initiate statin/ezetimibe therapy early; in familial hypercholesterolemia, PCSK9 inhibitors are often crucial ^[3]. Set target values individually with your doctor.
- Precise screening: from middle age or with a family history: discuss non-invasive screening (e.g., coronary artery calcium score, vascular elasticity, exercise blood pressure) for earlier risk recognition – particularly relevant for women, whose risk is often underestimated ^{[8] [9]}. Schedule annual check-ups for blood pressure, LDL, HbA1c, and waist measurement.

Precursors of a heart attack are rarely loud but detectable – and they give you time to act. Implement two steps this week: plan for smoking cessation or start seeking support, and schedule a check-up, including LDL and blood pressure. The rest – wise nutrition, stress management, daily exercise – cements your heart performance for the coming decades.