And,as Prokop-Prigge explainsin thisvideo for the Monell Center, a person's earwax odor is so unique that you can identify people by its smell. Due to security reasons we are not able to show or modify cookies from other domains. If the ears are producing too much wax, earwax thinning drops are the only safe way to help wax leave the ear canal at home. It then mixes with sebum produced by sebaceous glands. Some people have reported the fact that their ear wax smells like vinegar or another strange substance. Use a rubber-bulb syringe to try to wash the object out with warm water. But it's an odd place to look and no more reliable than a simple blood test. Having worked in some fairly vile situations I believe what they are both smelling of is nothing less than stale body secretions. Water does not need to be inserted into the ears either. Floppy-eared dog breeds like Spaniels and . When someone ages, their body gets a little dryer including the glands that produce earwax. The color, texture, and amount of earwax vary naturally from person to person. Consult a doctor about alternatives. I made a few votive candles last night. Most common signs of dog outer ear infection include: It's actually about earwax, and the smell of said earwax. By Here are some of the most common causes of ear itching. Some of the more common causes have been discussed further. After a few days, the person adds warm water to a silicone syringe and gently sprays it into their ear for irrigation, tilting their head to let the liquid drain out. In this case, a Spray Bottle Ear Wax Remover might be the better choice for you. We avoid using tertiary references. An otolaryngologist can also manually remove the earwax. You can learn more about how we ensure our content is accurate and current by reading our. These infections can come from: Fungal organisms There are a variety of fungal organisms which are known to cause stinky ears in your canine family member, one of which is yeast, Earwax buildup Periodic cleaning of your pets ears may keep this cause under control, Hormonal abnormalities This might include hypothyroidism, You May Like: Phonak Compilot Air Ii Pairing To Hearing Aid. Unwashed weepy belly buttons smell of sebaceous secretion as do unwashed cocks (specific name in this case is smegma - as you all know). Healthy ears contain wax, which is produced by a special lining in the ear canal. | READ MORE. Earwax is a natural substance that helps protect your ears against bacteria and debris. The most common cause of this is an ear infection. In infants, seborrheic dermatitis is known as cradle cap, but it affects up to 3 percent of the adult population, and its thought a certain type of yeast may be a cause. Symptoms of ear problems in cats include pawing at the ears, sensitivity to touch, a large amount of cream colored, orange, dark brown, or black wax; hearing loss; head tilting or shaking; and loss of balance. How do you, Earwax is a normal and an important part of keeping your ears healthy and clean. Ear wax buildup can occur if the normal self-cleaning mechanism of your dog's ear is disturbed. JavaScript is disabled. Earwax, or cerumen, is a natural substance that the ears produce to help protect the ear canal and eardrum. LIVESTRONG.com may earn compensation through affiliate links in this story. | Ear wax can be extremely smelly with impacted wax. Is this an emergency? Consequently, "there's no need to let the shower water or soap run into the ear canals in fact, it might be harmful," Dr. Kortbus says. in journalism. You can check these in your browser security settings. Using a cotton swab tends to pack the wax in the ear canal, which can result in a wax impaction that requires medical care. The ears should never be cleaned with cotton buds as is often thought. But that waxy, sticky (sometimes smelly) stuff inside your ears is perfectly natural and even vital for your ear health (more on this later). Since swimmers ear is an infection, it should be treated by a doctor. Cookie Settings, as Prokop-Prigge explainsin thisvideo for the Monell Center, Kids Start Forgetting Early Childhood Around Age 7, Archaeologists Discover Wooden Spikes Described by Julius Caesar, 5,000-Year-Old Tavern With Food Still Inside Discovered in Iraq, Artificial Sweetener Tied to Risk of Heart Attack and Stroke, Study Finds, The Surprisingly Scientific Roots of Monkey Bars. It is, however, something that happens as you grow older. Untreated earwax buildup can lead to hearing loss, irritation, pain in your ear, dizziness, ringing in your ears and other issues. While varying shades and textures of earwax can come from healthy ears, there are still some instances in which a person should see a doctor. Colin Schultz Here's a fun game: go over to your coworker, your family member, the person at the coffee shop next to you, and ask them if you can smell their earwax. Your Privacy Rights Essential oils and such. This can be easily rectified by removing the excess ear wax and you wont need a trip to the doctors. Well, I ask because last season, I crushed and strained enough combs to give me 50lbs or so of honey. Squamous cell cancer is the most common type of ear cancer. About ear wax. But it is much more likely to be the cocktail of chemicals produced by the bacteria living in your sinuses or ears. Can poor sleep impact your weight loss goals? Healthy earwax color and texture can greatly vary. This might have to be repeated for a few days, depending on the level of buildup. The pus drains because there's a small tear in the eardrum. Normally the ear wax is slightly smelly and bitter. (You may hear a watery sound when you do this.) Excessive earwax Excessive earwax can cause a blockage. If you notice earwax that is markedly different than what youve seen before, its always good to call your doctor and check to see if theres anything you should be on the lookout for. If you notice sweet-smelling wax in your ears, this could be a sign of Meniere's disease or another inner ear disorder, such as acoustic . It is a condition called keratosis obturans, and it means there is a hard plug where the earwax comes out. This should help unclog your ear. Other symptoms include: Ear cancer is very rare, but can occur in the ear canal, middle ear, or inner ear. To treat your cat's ear infection, your vet can offer a range of solutions, such as ear drops, oral medications, or injectable antibiotics. An older study, from 2006, has linked people of East Asian descent to earwax that is typically dry and flaky. Dry cerumen is the most common cause of white earwax, which comes out in flakes. Wipe away any excess moisture or external wax with a towel. Now, scientists have made a second important discovery about my favorite gene. These skin growths are noncancerous. Tilt your head and pull your outer ear up and back, says the Mayo Clinic. You May Like: Are You Hungry In Sign Language. The general cause of unwanted earwax in dogs is an infection of the outer ear canal also referred to as otitis externa. Terms of Use It is a mixture of secretions from the sebaceous glands of the outer ear canal, sweat, dead cells, and dirt. Be grateful that yours smell of honey some peoples sinus bacteria give them the sneeze equivalent of halitosis. If you notice that your ear wax smells like vinegar then this could mean that you have an infection. If you buy through links on this page, we may earn a small commission Heres our process. They develop behind your eardrum, in the middle part of the ear. The authors also note that the Food and Drug Administration (FDA) have issued advisory notices and taken other steps to prevent the use of these tools. Local feral survivors in eight frame medium boxes. Our website services, content, and products are for informational purposes only. It protects the skin inside the ear canal from damage that can lead to infection. You may have an infection or damage in the middle part of your ear. Luckily, doctors tend to be able to quickly identify any infections or other abnormalities within your ears. There are a few different things that can cause your dog's ears to stink. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction. For some reason, even though the eardrum is normal, tiny skin cells get sucked into the middle ear, blocking the Eustachian tube. You can also take this information and your findings to your doctor to give them some more insight into the problem. BURGER/PHANIE / Getty Images. It can also seriously damage your eardrum or ear canal. DOI: seattlechildrens.org/conditions/a-z/ear-discharge, mayoclinic.org/diseases-conditions/earwax-blockage/diagnosis-treatment/drc-20353007, hearinghealthmatters.org/hearinginternational/2011/racial-differences-in-cerumen-type-and-consistency, focus.masseyeandear.org/earwax-left-alone, Nicole Leigh Aaronson, MD, MBA, CPE, FACS, FAAP, Relapsing Polychondritis: Symptoms, Diagnosis, Treatment and More, Debra Sullivan, Ph.D., MSN, R.N., CNE, COI. Asked by: Jill Smye-Waldenhurst, Little Horning. Also Check: Can Nasal Congestion Cause Loss Of Hearing. It is safe to rinse this wax away because it has performed its function. Infection in external ear is common among swimmers. What causes this? Racial differences are based on the genes you bear, and according to a new study,earwax odor is just one of the many variables these genes determine. Conversely, "if someone who did not have cerumen before suddenly develops a change in cerumen, this could signify a change in the ear canals or the state of health," Dr. Kortbus says. One of the most common causes of foul-smelling ears is an infection of either the external ear canal (otitis externa), or the middle ear (otitis media). A physician can remove earwax by using irrigation or ear syringing. So I wonder if their nectar source has something to do with the smell of the beeswax also. Authors of an editorial published by the American Academy of Audiology warn that even when a person uses an ear candle correctly, it can cause serious injuries, including burns. A foreign object in the ear canal can also cause muffled hearing. How about your friend's earwax? I noticed the first time I got a shipment of foundation from Kelley, it smelled so good I wanted to eat it. To examine your own ear wax and make sure that your doctors appointment is not for nothing, you will need a way of removing the wax. Last medically reviewed on August 19, 2019. Black Wax Black wax is typically indicative of old wax. You can learn more about how we ensure our content is accurate and current by reading our. When youre done, tilt your head to the side again, and let the water drain out. Fortunately, your doctor can prescribe medicine that can clear up that infection, which will take care of the smell, too. Soften the wax with an eyedropper of baby oil, hydrogen peroxide, glycerin, or mineral oil. The best way to know what is causing your ear wax to smell is to visit your doctor. The most common cause of this is an ear infection. Old earwax eventually moves out of the ear canal and falls out naturally, taking any debris and dead skin cells along with it. This condition is called dry earwax. MNT is the registered trade mark of Healthline Media. If your dog's breath starts to smell like acetone (nail polish remover) or any other harsh, chemically scent, it could be a sign of diabetic ketoacidosis . When your earwax smells terrible, pay attention because it most likely indicates a severe infection. Massage the base of her ear for 30 to 45 seconds. About a half hour later, the ears are irrigated and the wax is removed. Also Check: Witch Hazel For Ear Infection. And, I'm sharing this not to scare you, but in older cats, tumors of the ear canal can be an issue. This includes cotton swabs and paper clips. Jul 21, 2015. We explain the causes of black earwax and how to treat it. Wax is constantly travelling towards the outer ear where it can drop out. Join PopSci+ to read sciences greatest stories. Why not take a look at yours to see its trying to say.. Causes of earwax build-up A build-up of earwax can happen if: you have narrow or damaged ear canals you have lots of hair in your ear canals you have a skin condition affecting your scalp or around your ear you have inflammation of your ear canal (otitis externa or "swimmer's ear") Preventing earwax build-up You cannot prevent earwax. When you purchase through links on our site, we may earn an affiliate commission, which supports our community. Ear wax (properly referred to as cerumen) is a sticky substance that serves as a skin conditioner, dust catcher, insect repellent, and has pretty impressive anti-fungal and anti-microbial properties. Indeed, our ear canals are warm, dark and moist, providing the perfect place for microbes like fungi to flourish, which can contribute to outer ear infections. Explore which household items you can use to clear your ears of excess earwax, and about some potentially dangerous techniques to avoid. Often, it is not until there is discharge, swelling of the ear, a highly offensive odor, or the dog begins to whine that an owner will realize a problem exists. I have some white beeswax in a sandwich bag by my computer. Alternatively, lock in for longer and pay just 37.99 per year, saving 51%! It helps remove debris from the ear canal, prevents foreign bodies and particles from penetrating deep into the ear, and it even helps protect against germs. There are other possibilities, though. by Hearing and Balance Center | Apr 10, 2018 | Hearing Loss Articles. Anyone who experiences blockages of earwax or who believes that they produce an excess of wax should see a doctor for specific guidance. As mentioned above, you should go see your doctor as soon as possible if you notice that your ear smells like vinegar. Definitely enhanced with something, but I'm not sure what. Is your earwax trying to tell you something about your health? Some medical experts believe earwax signifies a great deal about the general status of someones health and can be influenced by a persons endocrine state for example, that the nature and color of wax could change based on hormones or blood sugar but this has not been proven in medical research, Dr. Kortbus says. I didn't change anything - diet is the same, I am pretty healthy, etc. Adding a few drops of mineral oil to the ear canal can ease that discomfort and soften the earwax at the same time. Wet-wax guys had much greater amounts of 11 of the 12 compounds, which falls in line with previous studies findings that the wet-wax gene is associated with greater body odor. Additional symptoms of excessive earwax are: Ear infections usually occur in your middle ear. The process is first to soften the wax that's impacted. alcohol and distilled white vinegar. Unperfumed beeswax does not smell like a lot of what is on the market. Earwax, who knew it was so interesting. To help your ear heal, dont swim or fly, and dont wear a hearing aid, earplugs, or headphones until cleared by your doctor. Earwax serves the important purpose of protecting your ear by preventing dust, germs, and small objects from getting into your ear and damaging it, according to the U.S. National Library of. There is no reason to ever insert anything into the ears to remove earwax. Especially big green, wet ones. Earwax is made by your body to protect your ears from dirt, dust, and other foreign particles. It also prevents the delicate skin of the ear canal from irritation when it encounters water, per the U.S. National Library of Medicine. Earwax blockage. If home treatment doesnt cure your wax buildup, your doctor can remove the wax. Learn more about why this works, how to try it, and other treatment options. This is because of a mutation of a gene that aids in making the earwax wet. A clogged ear can happen for a variety of reasons. Consult a doctor if you have white or grey earwax flakes with itchiness, inflammation, and pain. Earwax is a natural component of the ear that works to protect, clean and lubricate the ear; however, it can also accumulate and cause similar symptoms. Prescribe a daily medication to prevent . Many people report slight changes in the color of their ear wax, but not so much the smell. Close the ear flap, and gingerly massage the ear for 30 seconds to dislodge any buildup. If it gets lodged in a certain way, earwax can cause a cough by stimulating the branch of the vagus nerve that supplies the outer ear. The ear wax will be a yellow color. Let your dog shake it off, and use the gauze or cotton ball to mop up any excess fluid on the outer ear. If your earwax smells, it may be caused by a medical condition or other complication. Cleaning a working ear can be done by washing it with a soft cloth, but do not insert anything into the ear. Does Cold Air Aggravate Asthma? Because, apparently, people's earwax smells differently, and the variations depend on your race. Last year, biologists examined the earwax of a blue whale to learn about the pollutants hed encountered, his testosterone levels and his stress levels. What Are Ear Stones, Also Known as Otoconia? However, when ear wax builds up in a dog's ear canal, it can emit a mildly unpleasant smell. Some practitioners claim that this helps remove wax and reduce other symptoms of ear issues, but no scientific evidence supports this claim. Awareness: Smelly Ears | Miss Charlotte Burley, Smelly Ear Infection Removal of Dead Skin & Debris by Endoscopic Suction #382, Foul Smell Nasal Discharge In A Child-Earwax removal | Xt mi hi mi tr em, When Can Babies Start Learning Sign Language, How To Get Rid Of Excess Ear Wax Build Up, How To Treat Ear Infection During Pregnancy, How Many Decibels Of Noise Can Cause Temporary Hearing Loss, How To Turn Up The Volume On Phonak Hearing Aids, How To Become A Hearing Aid Specialist In Texas, Phonak Compilot Air Ii Pairing To Hearing Aid, Can Nasal Congestion Cause Loss Of Hearing, Journal of Clinical and Investigative Dermatology, How To Get Water Out Of My Ear After Swimming, Are Clogged Ears A Sign Of Sinus Infection, Various bacterial organisms which are common to the skin and ear canal of the canine can take advantage of opportunities created by abrasions, cuts and other wounds allow the bacteria to cause an infection, Ear mites and other parasites can cause parasitic infections which will produce a foul smell, Allergies This can include food allergies as well as inhaled irritating allergens, Ear environment This includes moisture which is retained or other ear environment which prevents the normal natural cleaning process that is built into the canine ear, Hereditary conditions, immune issues and tumors. higher if you can find it). Any drainage from your ear means you need to see a doctor and find out why that is happening. Research shows the treatment doesnt work and may cause injury. It can. Luckily, these types of abrasions tend to heal themselves. An ear infection can cause drainage and you might notice a bad smell. You can unsubscribe at any time. 2023 Smithsonian Magazine Spread the cost and pay just 3.50 per issue when you subscribe to BBC Science Focus Magazine. Lets take a look into why your earwax might have a bad smell. Usually, a tiny bit of wax naturally flows out of the ear, and it doesn't have a smell. They are caused by bacteria or viruses and should be seen immediately by a doctor in. Foreign object in the ear: First aid. Dadant seems to add some perfume to theirs. Think about how you can protect your overall health and how that can benefit your ears. The sensation of the taste of the ear wax could be due to the post nasal drip from the paranasal nasal sinuses. Organs in your inner ear called the saccule and utricle contain tiny calcium carbonate stones that help your body sense acceleration. Ear Wax Buildup. There are a host of different ear problems that could result in a smelly ear odor, with or without discharge. If they experience any symptoms, such as muffled hearing, they should see their doctors to discuss how to safely eliminate the wax from their ears. Using things like bobby pins or cotton-tipped applicators to clean out the earwax can actually push in the earwax, resulting in an impaction of earwax. You can do this by placing a ball of cotton wool coated in Vaseline at the opening of your ear canal. But for many people, earwax is manifestly too much of a good thing. If you . Dr. Kortbus recommends this simple remedy for those who have an issue with recurrent ear infections: If this home remedy doesn't help, seek medical care. https://www.youtube.com/watch?v=nnzONmA2nCM, Types of ear discharge Colour, Smell & its meaning Dr. Harihara Murthy | Doctors' Circle (https://www.youtube.com/watch?v=nnzONmA2nCM). Why You Should Never Use Q-Tips in Your Ears. He has a B.Sc. (2017). Even better is when I smear it above my upper lip so I can smell it all day long. Irrigation or ear syringing is commonly used for cleaning and can be performed by a physician or at home using a commercially available irrigation kit. For some people, it is drier and lighter in color, closer to off white or yellow. You When earwax becomes clogged or hardened, it can cause discomfort. Let this rinse into the ear canal to clear away any wax that has fallen away from the walls of the canal. Good. Repeated exposure can result in bacterial growth and future infection that leads to fluid accumulation within the ear. Listen to some of the brightest names in science and technology talk about the ideas and breakthroughs shaping our world. If its greenish, sticky, or has an unusual odor, it may indicate an infection, so book an appointment as soon as possible. It can be shades of yellow, white, brown, and even black. This only pushes the earwax farther into the ears and can also cause injury to the ear. In fact, the ears are self-cleaning, and old earwax, along with dead skin cells, gets moved from inside the ear to the ear opening, where it eventually falls out. We fully respect if you want to refuse cookies but to avoid asking you again and again kindly allow us to store a cookie for that. Didn't you say you have been treating your hives? No smell, apart from the faint hint of brood cocoons. Using a syringe or eye dropper, apply the You can learn more about how we ensure our content is accurate and current by reading our. If his ears smell yeasty or downright stinky, it's likely that a bacterial or yeast infection is brewing. This could be the smell of ketones from your bloodstream, which might be a sign of diabetes. But, regardless of the cause, an infection would require a trip to the vet as untreated ear infections can lead to a host of other problems. In the study,led by Katharine Prokop-Prigge, the researchers measured the types and quantities of volatile organic compounds coming off ofearwax samples. Largely, the dead bacteria and the stuck debris are responsible for smelly cerumen. Swimmer's Ear. B vitamins in your . Because the behind-the-ear area is rich in sebaceous glands, its also prone to seborrheic dermatitis , notes a December 2015 review in the Journal of Clinical and Investigative Dermatology. makesmellingsmells likecheese Wipe the outer part of the canal with a Placing cotton swabs and other objects. Also, a highly refined butane must be used( at least 4x refined. Or it may just be time for a good ear cleaning. Blockages in the ear can change the color and texture of the wax. Home remedies will partly depend on the cause of your smelly earwax. Ear wax is essential in keeping your pet's ear safe from dangerous bacteria and other pathogens. Thanks to the motion of talking and chewing, as well as the shape of the ear itself, earwax naturally moves up and out of the ear. When the canal fills up, the gunk can start to overflow and come out the ear. Mayo Clinic Staff. The earwax came from eight men of Asian descent with dry wax, and eight men of European descent with wet wax. Smelly ear wax might be simply down to the fact that you have too much of it and therefore it has caused a blockage. Earwax is made up of extra wax that comes from the sebaceous glands in the outer ear canal. Privacy Statement You might notice fluid containing blood or pus leaking from the ear. Googling internet had people with similar "issue", well with ear wax smelling like something else. Earwax helps to prevent debris, dirt, and other things from entering the ear canal, and also helps to prevent infection. A bad smell can also mean an infection is causing middle ear damage. For most people who produce a regular amount of earwax, the ears can easily remove the wax on their own. An ear canal plugged up with earwax can cause earaches, infections, and other problems. Smelly earwax or drainage can be one of the first symptoms of a cholesteatoma. Why is my ear wet when I wake up? A cholesteatoma is a lot like a cyst, but one that appears inside the ear blocking the canal. These harmful microbes need something to help them grow, and allergies provide them with the optimal environment. A range of ear irrigation kits is available online or in stores. These will come in the form of internal or topical medications. Kind of a spicy, vanilla or sweet woodruff kind of smell. This can lead to a number of symptoms that, together, doctors refer to as "chronic otitis media.". It is also possible that you have a type of skin growth inside your ear canal called a cholesteatoma. Putting anything into the ear canal only increases the risk of pushing wax deeper in, where it may get stuck and cause blockages. This situation is called cerumen impaction. We explain. Nearly all people of Native American and East Asian ethnicity have the dry type. Cholesteatomas are skin growths that are usually cysts. any moisture in the ears. Nicole Leigh Aaronson, MD, MBA, CPE, FACS, FAAP. Meniere's disease or other inner ear disorders. Truthfully, it was fairly common for a grooming guest to have anything from a simple build-up of ear wax to a severe, sometimes chronic infection of the ear. [6] 5. Avoid getting water in your ear when you take a bath or shower. Additionally, anyone who is prone to buildups of earwax should consult a doctor at the first sign of a blockage, such as muffled hearing. 2005-2023 Healthline Media a Red Ventures Company. Here, Michael J. Kortbus, MD, FACS, a board-certified otolaryngologist and fellow of the American College of Surgeons, helps us decipher earwax, explaining what's normal and when it's time to see your ear doc. When that happens, stuff like earwax and dirt build up. To clean the ears, just wash the outside of the ear with a soft washcloth; nothing needs to be done internally. 6 Reasons You Suddenly Have More Earwax Than Usual, 7 Reasons Why Your Ears Are Itchy (and What to Do About It), U.S. National Library of Medicine: Earwax, Hearing Loss Association of America: 9 Facts About Earwax, Cleveland Clinic: Earwax Buildup & Blockage. As mentioned above, you should go see your doctor as soon as possible if you notice that your ear smells like vinegar. Although they are rarely a sign of anything more serious, earaches can be painful and frustrating. However, smelly earwax can indicate a problem. However, smelly earwax can indicate a problem. Your treatment may include cleaning your ear with a suction or medication for the infection or for pain. Earwax Blockage. What Causes Ear Discharge and How Do I Treat It? A clogged or stuffy ear can be uncomfortable and make it difficult to hear. Garlic. Healthline Media does not provide medical advice, diagnosis, or treatment. Traynor R. (2011). Registration on or use of this site constitutes acceptance of our Terms of Service. However, sometimes there is strong odor emitted from ear wax. One . For individuals with the other types of earwax (tarry, nuggets), Q-tip use generally pushes and packs the earwax deep in the ear canal which . Heart failure: Could a low sodium diet sometimes do more harm than good? Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press.. Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence; NEW - The Essential Diabetes Book - Mayo Clinic Press NEW - The Essential Diabetes Book; NEW - Ending the Opioid Crisis - Mayo Clinic Press NEW - Ending the Opioid Crisis might momentarily experience muffled hearing that means the solution is But yes, a team of researchers from Pennsylvania gathered samples of earwax, baked them to get them to release their volatile compounds, then analyzed those compounds with gas chromatrography and mass spectrometry. Earwax isn't the only cause of an ear blockage. Complementary Medicine / Alternative Medicine, https://www.audiology.org/news/ear-candles-and-candling-ineffective-and-dangerous, https://www.fda.gov/consumers/consumer-updates/dont-get-burned-stay-away-ear-candles, https://books.google.de/books?id=iCsYzjLLs4sC&pg=PA25&lpg=PA25&dq=earwax+color&source=bl&ots=plGL_1Yxcu&sig=ACfU3U2gMtr3gHvsKyjrhCQ5SmdNDUsNCQ&hl=en&sa=X&ved=2ahUKEwie9YLFuP_jAhU7wcQBHdCLDi04FBDoATAGegQICBAB#v=onepage&q=earwax%20color&f=false, https://journals.sagepub.com/doi/full/10.1177/0194599816671491, https://www.ncbi.nlm.nih.gov/pubmed/16444273, Cardiovascular health: Insomnia linked to greater risk of heart attack.