Every minute of every day, thousands of people are walking around with the equivalent of a hidden time bomb ticking away in their chests. Silently, painlessly, their hearts are being injured by repeated interruptions of the vital, nourishing flow of blood through the coronary arteries to the heart itself. As time goes by, the heart sustains more and more damage … but there is still no pain until the fateful moment when this process all too often reaches its deadly, unexpected conclusion in a massive heart attack or even sudden death.
While scourges like deaths from drug overdoses and Alzheimer’s capture the media’s and the public’s attention, the cold, hard fact of the matter is that heart disease remains the number one killer of American adults—responsible for five times the number of deaths from drug overdoses and Alzheimer’s combined. When calculated with the related medical condition known as stroke, cardiovascular disease felled nearly 850,000 U.S. residents in 2017, accounting for one in every three deaths. Cardiovascular disease claims more lives each year than all forms of cancer and chronic respiratory diseases.
About half of all heart attacks are mistaken for less serious problems or completely missed. But make no mistake: “silent” heart attacks can increase your risk of dying from coronary heart disease.
Silent myocardial ischemia (SMI), or silent heart disease, is a particularly insidious form of the disease suffered by 25 percent of those with heart conditions. As the name implies, patients suffering from silent heart disease are not aware that their heart is being injured because they feel no pain (or not enough to be concerned). Despite undeniable evidence and decades of research, not to mention new diagnostic tools, the perception by the public and, I’m sorry to say, many members of the medical profession is that unless less there’s chest pain (angina), then there’s no heart attack or damage to the heart.
In 1970, I broke with the medical orthodoxy of the time that said that unless a heart attack was accompanied by chest pains, it really wasn’t a heart attack, and patients and their doctors need not be concerned. My experience as a practicing cardiologist, the cofounder of a cardiology practice in Beverly Hills, California, and a clinical professor at UCLA’s school of medicine told me otherwise.
Two years earlier, my two partners, Drs. Daniel and Selvyn Bleifer, and I had purchased an early diagnostic machine, the Holter electrocardiograph, which used magnetic tape to record electrical cardio impulses through the human body. It weighed eighty-five pounds, but it was state of the art at the time and, most importantly, ushered in a whole new dimension in cardiology. Instead of just examining the heart with the standard electrocardiogram for a period of one minute—hardly adequate for a comprehensive evaluation—the Holter equipment permitted evaluation of up to twenty-four hours of heart action. The patient’s heart now could be studied in the patient’s home or office, not just in the doctor’s examination room or medical lab. It was the precursor to today’s wearable health devices.
We could now evaluate the effects of stress or ordinary living and working activities on heart action and coronary artery blood flow. Getting this information was vitally important since 95 percent of all heart attacks are caused by restriction of blood flow in the heart’s arteries, typically caused by the buildup of plaque or various substances, notably the waxy, organic stuff called cholesterol.
Based on our new research using the new and improved diagnostics, as well as our own clinical observation over twenty years, we were pretty sure that the old trope that a heart attack must be accompanied by chest pain (otherwise, it was not a heart attack) was dead wrong. In September 1970, we presented our research findings at the Sixth World Congress of Cardiology in London, attended by thousands of the world’s leading heart doctors. In a paper titled “Clinical Applications of Dynamic Electrocardiography,” we proved conclusively that our suspected silent heart disease was in fact a real condition likely suffered by tens of millions of unknowing adults worldwide.
Then we waited for the accolades to pour in for what was obviously our groundbreaking work. They didn’t. The reaction among the cardiology profession was more a trickle of acknowledgment than a tidal wave of acceptance.
As it turns out, most physicians were wholly unfamiliar with the development of the then modern-day diagnostic equipment, since the Holter had been in use for only two to three years before the conference and in widely scattered medical facilities at that. For the average physician attending the event, we might as well have been saying that our friends on Mars had beamed the information to us. To be clear, relatively few cardiologists were convinced the newfangled electrocardiograph equipment was significant, and still fewer believed in our hypothesized silent heart disease.
Essentially, the “no pain, no heart attack” school won the day. The battle, yes, but not the war.
Over the next seven years, the Holter and other electrocardiographic recording devices became more prevalent and more sophisticated. Additional studies by Drs. Daniel Tzivone and Shlomo Stern in Israel in 1974 suggested these painless episodes of poor coronary artery blood flow could occur even during resting activities—another heresy, since it was widely believed that strenuous activity was usually a precursor to a heart attack. Imagine, then, if significant and even life-threatening heart damage was occurring all the time while patients were relaxing and with no indication of any chest pain. Impossible!
However, year after year additional studies confirmed our earlier research, including one in 1977 by Drs. Steven Schange and Carl Pepine from the University of Florida, which confirmed that as many as four episodes of silent heart disease occur for every episode of chest pain. You see, it was not an either/or proposition—angina or silent ischemia—but oftentimes both.
By 1983, the tide was beginning to turn as more studies using other kinds of rapidly developing diagnostic techniques, such as treadmill testing, radioactive isotopes, and echocardiography, confirmed the widespread existence of silent heart disease. The benchmark symptom of chest pain as the exclusive indicator of heart damage was crumbling before the facts.
In 1989, I compiled my own research as well as subsequent medical studies into the first book ever written on the topic for the consumer, Preventing Silent Heart Disease: Detecting and Preventing America’s Number 1 Killer. Now, three decades later, I have written this entirely new book, The New Science of Fighting Silent Heart Disease. In brief, the book shows the average reader what to do and how to do it to reduce the chances of developing or even to reverse the effects of silent heart disease.
Much has changed and much has remained the same over the thirty years since I wrote the first book. Heart disease remains the nation’s number one killer of men and women. However, today new technologies and science for detecting, treating, and preventing coronary disease and its most insidious manifestation—silent heart disease and sudden death—can empower virtually everyone to take the necessary steps to avoid falling victim to the silent killer.
Let’s do a quick recap: On average, 45 percent of all heart attacks are silent—that is, they are painless and leave behind damage that remains undetected, unless the patient and his or her doctor are looking for it. Silent heart disease is the main cause of sudden death; it is American’s number one public health problem, with more than six hundred thousand sudden deaths and 1.5 million heart attacks occurring in the United States each year. This book tells you what you need to know in order to vanquish this silent killer.
The book is divided into four parts. Part I provides background on how the heart works and what happens when it doesn’t. It’s important to know the basic biology of the heart muscle and coronary artery disease to fully understand silent heart disease.
Part II provides an overview of what we know today about the causes of silent heart disease since my colleagues and I first identified the condition in the 1970s. Today we know the disease is the result of both inherited and environmental causes—a combination of nature and nurture somewhat unique to each individual. We look into the leading risk factors and how they’ve changed—in some instances, quite dramatically for the worse. The idea here is not to scare but to inform; knowledge is power. The better we understand the risk factors for and mechanisms of silent heart disease, the more effective we can be in fighting it.
In Part III, we discuss the best in detection and treatment techniques proven over the last five decades, as well as the latest in diagnostic tools, new medications, recent surgical innovations, and cutting-edge treatments, from gene therapy and stem cell manipulation to bioprinting and implantable devices. As someone on the frontlines of fighting silent heart disease for the better half of a century, I can say that many of today’s treatments would have been considered science fiction just a generation ago, and even more fantastic innovations are on the near horizon.
In Parts II and III you’ll also encounter case studies taken from my medical practice files, which will illustrate key points. They’re all based on real-life patients of mine; only their names have been changed to protect their privacy.
In Part IV, the final part of the book, you become part of the solution. By taking an easy, self-administered test, you determine your “risk profile.” A necessary word of caution: Always consult with your physician before proceeding with any changes in your health regimen. The information provided in this book is meant to educate, not instruct.
Now, let’s get started on our journey to preventing silent heart disease.