Heart attacks and heart disease are the number one killers of Americans in society today, made worse by habits like eating too much cholesterol, having high cholesterol and smoking.

Diabetes, too, is rampant and is a contributor to heart disease in America. But what exactly goes into having a heart attack and how do we get them?

Heart attacks start with the formation of cholesterol and calcium plaques in the coronary arteries, the arteries around the heart that supply blood to the heart muscle. Any time there is high blood pressure or a fast heart rate, it puts extra stress on these arteries to deliver enough oxygen to the heart. Add to that a plaque that narrows those arteries and you really have stress on the heart.

Having a plaque alone doesn’t mean you’ll have a heart attack.

Plaques can be 95 percent or more and you’ll still have enough blood to supply the heart muscle. The heart muscle is one of the few parts of the body that doesn’t have a duplicate circulation. If an artery fails, there is no second artery to make up the difference for the heart muscle.

An actual heart attack can begin with a viral infection or anything that causes blood to clot more than average.

No one knows exactly all of the triggers to a heart attack but what happens is that the blood clots in an area of a narrowed plaque of the heart, suddenly blocking the circulation to a part of the heart, causing a heart attack. This is why many people are asked by their doctor to take a baby aspirin every day. It prevents the clot that ultimately causes the heart attack to begin with.

Other ways to prevent a heart attack are to reduce the plaque in the heart vessels.

This can involve taking statin drugs, some of which are known to at least reduce the size of the plaque or to keep the plaque from developing any further. Statin drugs are in common use in those with cholesterol levels greater than 200 mg/dl.

In situations where the plaque is thick enough to be symptomatic or is just so thick that it obscures the blood flow in the artery, then a procedure known as a balloon angioplasty can be done.

A balloon angioplasty is a technique whereby a catheter is inserted into the groin and threaded up into the coronary arteries and into the area involved in the cholesterol plaque. A balloon is blown up at the tip of the catheter, cracking open the cholesterol plaque and reducing the blockage of the plaque. This procedure may need to be done more than once to keep the plaque from continuing its progression and closing off the artery.

Keeping the blood pressure down takes the stress off the heart and prevents heart disease.

High blood pressure stresses the arteries that supply the heart, making them deliver a poorer blood flow to the heart.

A heart attack is all about permanent narrowing of the coronary arteries (plaque formation), temporary narrowing of the coronary arteries (arterial spasm), and the clotting of blood—the ultimate final event that precipitates the heart attack. At least two of the above causes of a heart attack are treatable before the heart attack actually occurs.