...he is grave risk of a heart attack.
 

Hello Sue,

Timeline: History of Former President Bill Clinton's heart problems and procedures

- ...he is grave risk of a heart attack.
- ...he is at grave risk of a heart attack.
- ...he is at a grave risk of a heart attack.

I think that the second is grammatically correct. The first can't be correct. Do you think the third is correct?

Re: ...he is grave risk of a heart attack.
 

The first is not correct - they've obviously left "at" out by mistake. A typing error, or a cut.and-paste error probably.

However, the second and third are fine.

Here are a couple of examples without the article...

Sensitive information on millions of US military personnel and veterans remains at grave risk because of weak security controls
A top official for the UN's relief agency Sunday said three million people in Afghanistan are at grave risk

And some more with the article...

Asking for the patient in the ambulance to be taken to another unit puts that patient at a grave risk, but the alternative...
...than recent authors who have hinted at a grave risk of sudden death.
“Here, the children were put at a grave risk of death,” Bell told the judge

Re: ...he is grave risk of a heart attack.
 

Thank you, Sue.

- ...he is at grave risk of a heart attack.
Is the "a" necessary?

Re: ...he is grave risk of a heart attack.
 

No. To me it sounds much better with the article, but here are some examples without :

The deadly combination of obesity, inactivity, excessive smoking, and an unwholesome diet put Mr. Honeyman at grave risk of heart attack every day.
Meanwhile, millions of Americans have been placed unnecessarily at grave risk of heart attack.

However, these were the only two I found as opposed to over two thousand for "grave risk of a heart attack". So here, I think my intuition was probably sound.

Re: ...he is grave risk of a heart attack.
 

Hi Sue,

That "a" must be necessary because "heart attack" is a countable phrase.

heart attack - definition of heart attack by Macmillan Dictionary

Re: ...he is grave risk of a heart attack.
 

No. When you're talking about any type of illness you can see it as an abstract phenomenon ..

Her horse died of colic

or as a single incidence

Her horse died of an attack of colic.

The problem with "heart attack" is that the word "attack", which usually indicates a single incidence, is this time incorporated into the name of the disease itself. This is what, I think, pushes most people towards using the indefinite article.


The medical term for heart attack is "myocardial infarction" and there, interestingly, the tendency is reversed. I found 3,660,000 examples of the term used without the article :

Males are at higher risk of myocardial infarction than women

and only 216,000 with the article :

The authors extrapolated from this that the use of NSAIDs increases the risk of a myocardial infarction.

This backs up what I said before I think. Doctors and medical researchers are more likely to see disease as an abstract phenomenon. "Ordinary" people, on the other hand, are likely to see it as something that happens to you - a single incidence. The choice of the article or not rests on the meaning that the speaker wants to express.

Grammar exists to allow us to express different meanings, and you choose what you want to mean. The concept of grammar as "rules" regarding word classes is, in most cases, a myth.