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You may be at risk for forms of silent heart disease, like atherosclerosis, without feeling obvious or expected symptoms. Find out how to protect yourself.
By Vanessa Caceres
Medically reviewed by Farrokh Sohrabi, MD
Not all forms of heart disease are obvious. You could have plaque in your arteries or an enlarged heart and not even know it; even heart attacks could be mistaken for bad indigestion. This lack of awareness puts those with so-called hidden heart disease, or heart disease that has no symptoms, at greater risk for serious health problems and death. It’s important to be aware of the possibility of heart disease — even in young people. By learning about different kinds of hidden heart disease, you can help control your risk and protect yourself.
1. Hidden Heart Disease: Silent Heart Attack
Many people imagine a heart attack as someone clutching his chest and grimacing from the extreme pain, but that’s not always the case. “Some people may think it’s just awful indigestion,” said Tracy L. Stevens, MD, a cardiologist at Saint Luke’s Health System in Kansas City and a national physician spokeswoman for the American Heart Association. “Or they may feel a pain between their shoulder blades and go to a chiropractor to get their back popped when they really felt a heart attack.”
Dr. Stevens believes that health care providers as a whole do not always identify “silent” heart attacks because they tend to focus only on asking about previous chest pain. “Patients don’t recognize the other symptoms from a heart attack,” she said. In particular, people with diabetes are less likely to feel heart attack symptoms, she added.
2. Hidden Heart Disease: Atherosclerosis Without Symptoms
It’s often not until someone dies of a heart problem and an autopsy is performed that physicians find severe coronary disease and artery blockages, said Hugh Calkins, MD, an electrophysiologist and professor of cardiology and medicine at the Johns Hopkins University School of Medicine in Baltimore and president-elect of the Heart Rhythm Society.
Although cardiologists say it’s hard to pinpoint the number of people at risk for a silent heart attack, a study published in the medical journal JAMA found that a large number of older people were not being treated for their increased heart attack risk even though they had related risk factors such as atherosclerosis, or plaque-thickened arteries.
Atherosclerosis isn’t a condition that affects only seniors — younger people can develop these cholesterol-based deposits too. To assess your risk, try a simple test called the waist-to-hip ratio: If your waist measurement matches your hip measurement, this indicates an increased risk for atherosclerosis. Researchers have recognized this risk even in young people who appeared otherwise healthy.
A second measurement can also tip you off to heart disease risk, said Stevens. Measure your waist one inch above your belly button. To help lower your risk for high cholesterol, diabetes, and other heart disease risk factors, that measurement should be half or less of your height (in inches). So if you’re 5-foot-4, or 64 inches tall, your waist would optimally measure 32 inches or less.
Talk with your health care provider for help losing weight if you don’t pass these “tests.”
3. Hidden Heart Disease: Undetected Weak Heart
Cardiomyopathy is a weakened heart muscle. Stevens said it often doesn’t cause symptoms until it’s severe. Cardiomyopathy is frequently found by accident; for example, a patient with a bad respiratory infection may have a chest X-ray that happens to show an enlarged heart.
One cause of cardiomyopathy is uncontrolled high blood pressure. Other causes include diabetes and a family history, said Christine E. Lawless, MD, co-chair of the American College of Cardiology Sports and Exercise Cardiology council and director of cardiac athletic research at Bryan Heart Athlete Care at the University of Nebraska-Lincoln. A person with cardiomyopathy may not feel symptoms because the heart works harder to compensate for the problem, said Stevens. Undetected, cardiomyopathy may lead to cardiac arrest and even death.
Uncovering Silent Heart Disease
You can make some changes to lower your risk for hidden heart disease, but it requires having healthier habits. “Many people take better care of their car than their bodies,” said Dr. Calkins. The first step is to get regular checkups with a physician. By age 50, Calkins said, this should be an annual visit.
When you go for a checkup, have your blood pressure and cholesterol checked — high readings can put you at a higher risk for heart problems, Calkins added.
Also, consider getting heart-related screenings, such as echocardiography, an ultrasound of the heart, or a stress test, at health fairs in your area, said Dr. Lawless, adding that a number of patients she has treated were tipped off to heart disease this way. Though regular heart screenings starting at age 50 is the general rule, she suggested starting at age 40 if you have related risk factors.