Not a lot of things would likely propel diet and exercise to the top of a busy mom's to-do list.
For Theresa Volpe, a 38-year-old Lutherville woman, it was crushing chest pain, a MedEvac flight and the prospect of her two little girls losing a parent.
It was March when she had her heart attack. She was at a family birthday party in Pennsylvania and had just finished a couple of appetizers when she began to feel sick. Her husband suggested it was indigestion. She insisted he call 911.
"If I had it all to do over, I certainly would have eaten better and exercised," she said. "Everyone tells you, but you don't understand why. ... I have two young kids, and that's why I wasn't doing it. Now I take time for myself, exercising at least five times a week. I do it for them."
Volpe's doctors told her that her family genes had played a big role, but they also pointed the finger at her extra 20 pounds and inactivity.
She is one of an increasing number of younger Americans with clogged arteries, high blood pressure or other cardiovascular maladies that are linked at least in part to their lifestyle.
Two-thirds of the population is overweight or obese. Recent studies have linked that to increasing levels of high blood pressure in children and death from heart disease in younger women. Despite medical advances that have been credited with saving lives for years, some in the health care community fear down the road that they will see more heart attacks - already the nation's leading killer.
They are getting more aggressive about diagnosis and treatment in their patients. They are also beginning to push prevention at an earlier age.
It's still more common for a 60-year-old to have a heart attack than a 30- or 40-year-old. And younger women are still less likely than younger men to have a heart attack.
But cardiologists say those statistics should not rule out a heart problem like Volpe's. Her blood pressure, among the biggest risk factors for a heart attack, was barely above normal and not alarming unless it was paired with her family history. Her father had a heart attack at 63, and her brother at 47.
More doctors are taking the threats seriously, but the challenge remains getting patients to change their lifestyle, said Shawn Robinson, a cardiologist at the University of Maryland Medical Center. A change requires a diet low in fat and salt, 30 minutes of daily exercise, quitting smoking and getting blood pressure and cholesterol checks.
"It is life or death over the long run, but it's not right around the corner, so patients aren't motivated," he said. "When I started attending in the intensive care unit, I would see heart attacks coming in. I was in my upper 30s, and they were in their upper 30s. I stopped eating pizza."
Most often, the patients had high blood pressure. About 70 percent of those having their first heart attack have the condition, as do 77 percent of those having their first stroke. That has turned the focus on prevention and treatment of the one in three Americans who have high blood pressure.
A third don't know they have high blood pressure, according to the American Heart Association. That makes testing crucial, Robinson said.
Typically, blood pressure is taken a few times before a diagnosis is made. Doctors always advise lifestyle changes that include a healthy diet and exercise, but they also are medicating younger people who can't or won't make enough changes to make an impact.
Blood pressure is the force against a person's arteries when the heart beats. It's measured in two numbers. The first is the systolic and represents pressure during a heartbeat. The second is the diastolic, or the pressure between beats. Presented as systolic over diastolic, an adult blood pressure reading should be less than 120 over 80, the heart association says.
Prehypertension is a reading up to 139 over 89. High blood pressure is 140 over 90. It means a person's heart has to work harder to pump blood. That can lead to heart disease, which includes ailments such as chest pain, called angina, where the heart can't get enough oxygen-carrying blood. That can lead to a heart attack, where blood is cut off from the heart and the muscle begins to die.
There is a host of drugs to lower blood pressure and control cholesterol, which also causes heart disease. But the prospect of taking a pill or two every day is daunting to young people, especially those who are physically fit but have inherited the condition, Robinson said.
Over time, the drugs are credited with significantly denting the death rate from heart disease, although a new study reported in the Journal of the American College of Cardiology showed a recent uptick in the number of women younger than 45 dying from clogged arteries.
And the situation does not appear better with kids. A recent study reported in the American Health Association's Circulation found an increasing number of children with high blood pressure, reversing a decades-long trend. In both studies, medical professionals link the problems to the growing rate of obesity.
Stephen Plantholt, chief of cardiology at St. Agnes Hospital, blames the modern family lifestyle. Families drive everywhere and eat too much of the wrong things because it's easier, and in a lot of cases, cheaper.
But the combination of smoking, eating salty and fatty foods, and not exercising is having an impact on younger and younger people. It usually takes years to clog arteries, but the eventual effect could be more heart attacks if there is no intervention.
Still, Plantholt does not view heart disease and heart attacks as inevitable.
He said it's a matter of educating patients and some doctors. Patients with a family history of colon cancer have gotten the message about having regular colonoscopies, and those who have breast cancer in the family are more frequently seeking mammograms.
Plantholt said people with close relatives with heart disease need a stress test, which is a treadmill test that checks how well your body handles work, or a CAT scan, which is an X-ray that is made into a three-dimensional image by computers.
"I view all heart attacks as mistakes: Either the patients made a mistake in not being checked and not controlling their blood pressure or smoking or cholesterol, or the doctor made a mistake in not treating them more aggressively," he said.
He also said, "It's easier to treat a risk factor today than a heart attack tomorrow."
Mike Conway, 39, knows that fact well. Conway had a heart attack last year, surviving only because the Baltimore Blast assistant general manager was at a game and the soccer team's doctor was on hand.
Conway, a former player, always had been pretty healthy. But, he said, he gained weight after he and his wife had two kids, and he had a family history of high blood pressure and heart disease. He started working out once he recovered, but 18 months later, he had a second heart attack.
With yet another chance, he has made it his mission to eat right and exercise, and to teach his kids to do the same. But doing the right things at home isn't enough, and he wants to send out a stern warning to people who believe it won't happen to them:
"Don't be macho and think you don't need to go to the doctor," he said. "It's better to check."
meredith.cohn@baltsun.com