Protect Your Heart This Heart Month: Know Your Risk, Take Action

February 2026

This February, as we paint our communities red for Heart Month, we're reminded of the incredible importance of heart health. Amidst the vibrant signs of solidarity, there’s a crucial message: preventing a heart attack isn’t just about reacting to chest pain when it strikes; it’s about how recognizing your silent risk could save your life – and the lives of those you love – long before it ever becomes a crisis.

The most common cause of heart attacks is Coronary Artery Disease (CAD), a condition driven by atherosclerosis—the gradual buildup of cholesterol-rich plaque inside the arteries.

What’s important—and often misunderstood—is this: atherosclerosis is a lifelong process.

Studies have shown that plaque can begin forming as early as the teenage years. 

By the time someone is in their 30s or 40s, many already have measurable coronary plaque—even if they feel completely well.

“Many people are blindsided by a heart disease diagnosis because they never felt unwell,” says Dr. Pakanati. “The disease can be progressing silently, even when everything seems fine.” 

This is why waiting for symptoms is no longer an acceptable strategy. Modern cardiology is about identifying risk early and intervening before damage becomes irreversible.

It’s important to remember that there are a multitude of risk factors that help us in understanding your risk for coronary artery disease, says Dr. Pakanati. 

“We have the traditional risk factors - including older age (men ≥45 years, women ≥55 years), male sex, hypertension, dyslipidemia, current or former smoking, and diabetes. And let’s not forget family history,” she says. “It’s important for you to know your family heart history,” says Dr. Pakanati. “If a close male relative—like your father or brother—was diagnosed with heart disease before age 55, or a close female relative—like your mother or sister—before age 65, your own risk is higher. In fact, it can potentially double risk compared to someone without that family history. 

The other group of risk-factors is what we call risk-enhancing factors - which help us further refine a patient's risk, especially if they are in the intermediate risk category. “Research suggests that nearly 40% of heart attacks occur in people with ‘normal’ traditional risk factors,” Dr. Pakanati says. 

Dr. Pakanati highlights some of these below (but this is not all inclusive).  

• Other lipid biomarkers: “Lp(a), a type of cholesterol particle in your blood, is one of the strongest inherited risk factors for heart disease—and one of the most underrecognized.” says Dr. Pakanati. “It is pro-inflammatory and pro-thrombotic, meaning it promotes plaque formation and clotting, and a High Lp(a) can accelerate atherosclerosis.” 
• Adverse pregnancy outcomes (APOs): These include hypertensive disorders of pregnancy, gestational diabetes, preterm birth, intrauterine growth restriction / small-for-gestational-age delivery, placental abruption, and pregnancy loss. “If it is imperative we take a thorough Reproductive history,” Dr. Pakanati notes. “As these outcomes can occur in 10-20% of pregnancies and are associated with 1.8 to 4.0-fold increased risk of future cardiovascular disease per the ACC.”
• Premature menopause: For women, menopause before age 40 (naturally or surgically induced) is a critical, often overlooked, risk factor. "Estrogen plays a protective role in women's cardiovascular health," Dr. Pakanati explains. "When that protection is lost prematurely, the risk of heart disease increases significantly."
• High-risk race/ethnicity: “Being South Asian,” Dr. Pakanati explains, “is recognized as a risk-enhancing factor due to higher prevalence of metabolic syndrome, insulin resistance, and premature CAD in this population.” 
• Inflammatory conditions: The 2023 AHA/ACC guideline for chronic coronary disease specifically notes that HIV and autoimmune disorders accelerate atherosclerosis through both the disease process itself and, in some cases, through treatments (such as antiretroviral therapy or glucocorticoids). “Adequate control of disease activity with steroid-sparing agents should be prioritized,” says Dr. Pakanti, and “high-dose glucocorticoids should not be used long term if alternatives are available.” 

It is important to note that while stress is not currently listed as a formal risk-enhancing factor in U.S. guidelines for coronary risk assessment, it can still increase your risk of heart disease. “Chronic stress does this in 2 ways”, says Dr. Pakanati “facilitating atherosclerosis progression over time and serving as an acute trigger for coronary events in individuals with underlying coronary disease.”

The good news is that the power to prevent heart disease lies largely within our hands. This Heart Month, let's commit to focusing on Life’s Essential 8 - which is defined by the American Heart Association and includes four health behaviors and four health factors that, when optimized, promote ideal cardiovascular health

The four health behaviors are:

1. Eat for your heart - Focus on a diet rich in vegetables, fruits, nuts, whole grains, lean proteins, and fish while minimizing trans fats, red and processed meats, refined carbohydrates, and sweetened beverages.
2. Physical activity - At least 150 minutes per week of moderate-intensity or 75 minutes per week of vigorous-intensity aerobic activity.
3. Quit smoking (and vaping) - Avoid all tobacco products and e-cigarettes.
4. Sleep health - Achieving adequate amounts of restorative sleep, defined as  7-9 hours of quality sleep per night.

The four health factors are:

1. Body mass index - Achieving and maintaining a healthy weight, which we currently define as a BMI <25 kg/m² (although for for Asian individuals, lower thresholds a BMI ≥23 kg/m² for overweight may be more appropriate).
2. Cholesterol levels - Maintaining healthy cholesterol levels, and we recommend discussing with a health care provider to understand what level that is for you based on your risk factors.
3. Blood glucose - Keeping blood sugar in the normal range.
4. Blood pressure - Maintaining blood pressure <130/80 mm Hg.

And remember - if you want to learn more about your cardiovascular risk, have an open and honest conversation with your healthcare provider. 

Ready to gain insights into your personal heart health? Take a heart health questionnaire today.

At Virginia Mason Franciscan Health, we understand that heart health is a lifelong journey, requiring a personalized and comprehensive approach. We provide world-class care for a range of heart conditions, from prevention to advanced treatment – including all stages of coronary artery disease.

"This Heart Month, I urge everyone to be their own best advocate," concludes Dr. Pakanati. "Don't wait for a crisis to understand your heart health, instead take simple, actionable steps, and work with your clinician to understand your heart health. Because when you understand your risk factors, you gain the power to change your future, long before a heart attack ever happens."