Primary prevention - prevention that will keep you from having a heart attack in the first place - works. If you never have a heart attack, you won't need that cocktail of drugs that helps prevent a second one.

Primary prevention begins by understanding the risk factors and causes of heart attack.
Some risk factors are beyond our control, such as:

• Genetics: a family history of heart disease and early heart attack can increase one's risk of heart attack
• Age: the coronary arteries narrow with age, so that men over 45 and women over 55 are at a higher risk of having a heart attack
• Diabetes: individuals with diabetes have coronary artery disease and are at risk for hypertension (high blood pressure), both of which can lead to heart attack
• A previous heart attack, or history of coronary artery disease, high blood pressure, and other heart problems: these can all increase one's risk of having a first or second heart attack

But we can control many other risk factors.  They relate to how we live, and we can always change that if we try.  These risk factors include:

• Smoking
• Not controlling high blood pressure
• Not controlling diabetes
• Not getting enough exercise
• Obesity and not controlling weight gain
• A "heart unhealthy" diet

The single most important cause of heart attack is coronary artery disease.  Coronary artery disease (or atherosclerosis) is a general term for any condition that blocks blood flow through the coronary arteries.  Usually, what blocks blood flow is a fatty substance called plaque that is deposited on the inner lining of the arteries.  As these deposits build up, the arteries become narrower and blood flow is reduced. 

All of the controllable risk factors can contribute to the onset of coronary artery disease.  For example, a leading cause of coronary artery disease is hypercholesterolemia - too much cholesterol in the blood, or more precisely, dyslipidemia.  Cholesterol, a fat made up of several substances, can be a major component of plaque in the arteries. But we can partially control the level of cholesterol in our blood by controlling our diet. 

So the logical conclusion is, primary prevention means living in a "heart-healthy" way.

And that means:

• Keep your cholesterol (lipids) under control; if you need lipid lowering medicine, get it and use it
• Eat a heart-healthy diet, which includes:
• Fruits and vegetables
• More fish, less meat
• "Good" oils, such as olive oil and canola oil
• Portion control, and fewer calories late in the day
• Antioxidants
• Antioxidants are nutrients and other substances that protect cells in the body from the damage caused by "oxygen free radicals" (molecules that seek to become oxidized, a process that harms body tissues and has been linked to many diseases, including stroke, heart disease, and cancer); antioxidants are found naturally in food but are also available as dietary supplements
• Important antioxidants include:
• Vitamins A, C, E and beta-carotene (found in carrots)
• Lycopene  (found in tomatoes)
• Flavonoids  (found in ginkgo biloba, black cherries, blackberries, bilberries and blueberries)
• Quericetin  - a specialized flavonoid found in apples, onions, tea and red wine
• Coenzyme Q10 - a vitamin-like substance found in soy, whole grains, mackerel, and chicken
• Folates - foods rich in folic acid, such as:
• Green vegetables
• Strawberries, oranges, raspberries
• Tomatoes
• Nuts and seeds
• Get more physical exercise, including aerobic and resistance
• Stop smoking
• Drink alcohol only in moderation
• Keep your blood pressure under control; if you need blood pressure lowering medicine, get it and use it

You can learn more about the risk factors for heart attack from the American Heart Association.