About 80 million Americans live with the threat of heart attack. And a million Americans die from heart disease each year.
Cleveland Clinic Doctor Stanley Hazen is learning more about what puts you at risk.
"If it's not your genes, it's your environment, and our biggest environmental exposure is what we eat," said Hazen.
In a clinical study, Hazen and his team discovered people who have more of a compound called TMAO in their blood are two and a half times more likely to experience heart attack, stroke or death.
"TMAO just stuck out like a sore thumb as being highly correlated with future event risk," said Hazen.
TMAO is produced when intestinal bacteria digest nutrients found in certain foods like meat. Hazen believes avoiding those foods plus increasing fiber intake can offset this link over time.
Hazen also found HDL cholesterol, often referred to as the "good cholesterol," may not be so good after all.
"Simply measuring how much cholesterol is in the HDL particle does not give us a good reflection of its role in protecting from heart disease," said Hazen.
The study showed dysfunctional HDL cholesterol in the artery wall actually contributed to heart disease.
"It's the function of the particle that seems to be more important," said Hazen.
Dr. Hazen says there will likely be a TMAO blood test available in clinics around the country this year. He says identifying this compound is the first step. The next is to develop therapies to stop it, which may prevent heart disease from starting in the first place.