Half of all heart attacks may occur without their victims realizing they are happening, according to the American Heart Association’s (AHA) journal Circulation. These heart attacks cause no obvious symptoms, but may be life threatening, according to the research conducted on more than 9,000 middle-aged men and women.

The researchers at Wake Forest University’s medical school showed that 45 percent have a silent heart attack, where the patient thinks they have a strained muscle or indigestion.  Other symptoms include fatigue, discomfort in the jaw, upper back, or arm. They found that silent heart attacks:

  • Increase the chance of dying from heart attacks threefold;
  • Increase the chance of dying from all causes by 34 percent; and
  • Were more likely to lead to death in women, even though more common in men.

Elsayed Soliman, MD, MSc, MS, a lead researcher of the study (http://www.heart.org) said that “women with a silent heart attack appear to fare worse than men. Our study also suggests that blacks may fare worse than whites, but the number of blacks may have been too small to say that with certainty.” Among black women, silent heart attacks were more likely than full blown heart attacks. The rates were about the same for white women. Classic heart attacks were more common in white men. Both silent and classic heart attacks were about equal for black men.

Participants in the study had periodic clinic exams, electrocardiograms, and phone interviews with researchers between 1987 and 2013. Nine years into the study, 7.4 percent of the volunteers had heart attacks. Silent heart attacks were found on EKGs in 317 participants in the study. By contrast, 386 patients had full-blown heart attacks with symptoms, such as chest pain, jaw and arm pain and shortness of breath. About 1830 participants died during the study, with 189 dying from heart disease.

Once discovered, the researchers said that silent heart attacks should be treated as aggressively as full blown heart attacks with symptoms. “Doctors need to help patients who have had a silent heart attack quit smoking, reduce their weight, control cholesterol and blood pressure and get more exercise,” said Dr. Soliman.

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