You probably already know many of the factors that increase your risk of a heart attack, which occurs when blood flow to the heart is blocked. These include:

  • A family history of cardiovascular events
  • Diabetes
  • Stress
  • Lack of exercise
  • Smoking
  • Excessive drinking
  • Uncontrolled high blood pressure and high cholesterol

According to the Centers for Disease Control (CDC), someone has a heart attack every 40 seconds in the United States, which translates to 805,000 people a year. To lessen your risk of becoming part of that statistic and increase your overall wellness, you should pay attention to the well-known stressors. You should also give a thought to other less well-known heart attack triggers that may be surprising to you. Below are the top eight—and what you can do about them.

1. Air Pollution

Well over 60% of deaths attributed to air pollution are due to cardiovascular disease, according to a study published by The New England Journal of Medicine. There are several reasons for this, but the most important is oxidative stress, which happens when fine particles in air pollution (especially from exhaust) damage the heart’s defense systems.

Protect Your Heart:

  • Check the Air Quality Index to see when pollution is high: When air quality is bad in your area, minimize your time outside.
  • Take B Vitamins: A Columbia University study shows that this vitamin can reverse the detrimental effect of air pollution on the heart.
  • Reduce your time stuck in traffic: Instead, you can try taking the scenic route to avoid tie-ups.

2. Anxiety, Depression, Stress and Rage

Prolonged stress from uncontrolled negative emotions, like road rage, can pack a wallop on your heart health. According to the American Psychological Association, people with clinical depression have twice the risk of heart attack for up to 10 years after a depressive episode. Another study published by Harvard Medical School found that people with high levels of anxiety and anger are at a higher risk for a heart attack.

Protect Your Heart:

  • Seek help: Look for a trained, accredited psychotherapist who can help you develop coping strategies. If necessary, they may prescribe medication.
  • Practice mindfulness and meditation: A statement published in the Journal of the American Heart Association reported that meditation may reduce your risk of a heart attack. (Search “guided meditation” on YouTube to get started.)
  • Reduce your stressors: If you are feeling overwhelmed by life, divide your responsibilities up by what you must do, what you want to do and what you should do but’s it’s not that important. Get rid of the third one! Then ask yourself what chores you can delegate to someone else.
  • Exercise: No, you don’t have to become a gym rat, but get your body moving in a way that sparks joy. Whether it’s a daily walk, yoga session or bike ride, find what feels good to you. The Mayo Clinic recommends 75 minutes a week of aerobics. They also suggest doing strength training for all muscle groups twice a week for around 12 to 15 repetitions.

3. Skipping Your Flu Shot

The flu is nothing to mess around with. An investigation published by the Mayo Clinic showed that coming down with the flu is significantly associated with heart attacks and heart failure.

Get Your Flu Shot

Protect Your Heart:

Get to a healthcare professional or pharmacist to get your flu shot every year. At most pharmacies, you won’t even need an appointment. In addition, use the below precautions:

  • Wear a mask
  • Stay six feet apart when you are out in public
  • Wash your hands frequently

4. Migraines

People with a history of migraine headaches have an increased risk of a cardiovascular event, according to a study sponsored by the American Migraine Foundation. They also showed a twofold increase in the risk of stroke. Migraines differ from headaches in their intensity. They are often accompanied by nausea, auras and sensitivity to light and sound.

Protect Your Heart:

If you suspect you have migraines, see a doctor right away for diagnosis and a healthcare plan that will include medications that can prevent migraines or give relief during one. Also, learn and avoid your migraine triggers—the most common ones are:

  • Alcohol
  • Stress
  • Bright light
  • Strong smells
  • Sleep disruption
  • A change in barometric pressure
  • Food additives such as monosodium glutamate (MSG)

5. Sleeping Too Little—Or Too Much

Sleep recommendations say to aim for six to nine hours a night. A recent study published by the Sleep Foundation looked at what happens when you go over or under that amount. Results: People who slept longer than nine hours had a 34% higher risk for heart attack, while people who caught less than six hours of sleep had a 20% higher risk.

Heart Attack Trigger Too Much Sleep

Protect Your Heart:

For Short Sleepers:

  • Establish a firm bedtime routine and stick to it.
  • Make your bedroom a sanctuary—banish all technology that might tempt you to stay up.
  • Don’t use any lighted technology for the hour before bedtime.
  • Don’t drink alcohol in the hours leading up to sleep. Contrary to popular belief, it actually disrupts sleep and causes shorter sleep cycles.
  • Intense exercise right before sleep will just jazz up your system. If you must, gentle yoga stretches can actually promote sleep.

For Long Sleepers:

  • Stick to a strict sleeping schedule, even on weekends.
  • Use a natural light alarm clock. These emit a glow that gets stronger, mimicking the rising sun, which signals to your circadian rhythm that it is time to get going. Some also include gentle wake-up sounds.
  • Check your medications with your prescribing doctors. Some can be very sedating. (Never stop a prescribed drug without first talking with your physician.)
  • If you find that despite all this, you still feel exhausted, see a doctor. There may be an underlying medical reason you’ve lost your get up and go, such as obstructive sleep apnea (when you stop breathing for a moment while sleeping). This in itself is a risk factor for heart attack.

6. Gum Disease

A study published by the CDC found that around 47% of American adults have some level of periodontitis, a serious gum infection. So, what has that got to do with your heart? Several studies have shown that there is a link between gum disease and heart disease. Researchers aren’t entirely sure why, but guess that it may have to do with the inflammation.

Protect Your Heart:

  • Prevent gum disease: Brush your teeth (and tongue) after meals, floss, rinse with mouthwash and see a dentist or periodontist regularly.
  • Know your risk: Smoking, age, diet and genetics can all increase your chances. Talk with your dentist or periodontist about how to minimize them.
  • See your dentist at the first signs of gum infection: If your gums are swollen, bright red, tender to the touch, bleed easily, pull away from your teeth or if your teeth feel loose or crooked, they could be infected according to the Mayo Clinic.

7. Cold Weather

When the temperature gets frigid, your heart has to work harder to try to keep your body warm. In addition, your arteries constrict, which limits blood flow to the heart. But don’t worry, you don’t have to move someplace warm to keep your heart healthy.

Stay Warm to Avoid Heart Attack Triggers

Protect Your Heart:

  • Dress warmly in layered clothing: This helps trap the heat inside. Don’t forget a hat and gloves.
  • Wrap a scarf wrapped loosely around your mouth and nose: This allows you to breathe in warmer air.
  • Wear waterproof boots or shoes: This way if you step in a puddle, you won’t have freezing toes or feet after.
  • Use hand warmers and toe warmers: Slip them into your gloves and boots to stay warm in extra cold conditions. You can get disposable or battery-operated ones.
  • Stay hydrated: Bring along a thermos of something hot – cocoa, coffee or tea, for example.
  • Take breaks inside: If you feel yourself getting uncomfortable (shivering, feeling numb, tingling or stinging), go inside and warm up.

8. Rich Meals

It’s hard to resist a rich, tasty meal that starts with hors d’oeuvres, flows with wine and ends with gooey chocolate dessert and maybe a digestif or two. And while it’s great to treat yourself from time to time, your heart may have something to say about it, especially if it becomes a regular habit. Data shows that your risk for a heart attack is quadrupled within two hours of a heavy meal, particularly if you are already diagnosed with heart disease, according to UCI Health, California.

Protect Your Heart:

  • Snack satisfying: Try having more high-protein snacks throughout your day, such as yogurt, nuts, edamame or veggies and hummus, so you will be satisfied and properly fueled before heading into dinner.
  • Balance your plate: When looking at the spread of appetizers, try to diversify your plate. Instead of loading up on one specific thing that may not be the most healthy, instead ask yourself, “What can I add to my plate to make it more satisfying and nutritious?”
  • Pace yourself: We tend to get excited at big meals and eat really quickly. When that happens, your body doesn’t even get time to register that it’s full. Listen to your body, and be mindful of when you are eating, how it is making your body feel and when you feel satisfied.

The heart is a complex organ, and there are many factors involved in keeping it healthy and strong. Think about these eight additional heart attack triggers and how you can add in more protection to keep you going for years to come.

Were you surprised by some of these heart attack triggers? Will you change some of your habits, and if so, how? Share in the comments below.