Are you a heart attack waiting to happen?

by Carolyn Thomas    @HeartSisters

woman screaming-5 I was asked last year by a large U.S. publisher to review a new book written by a woman who had recently become a heart patient. I enjoyed reading the first chapter or two until I came to the New York author’s dramatic story of the actual cardiac event itself. The part that left me gobsmacked was not the event, but her abject shock and disbelief that she (of all people!) could be experiencing a heart attack at all.  The pervasive “Why me? Why me?” focus in this chapter clearly ignored a reality that the author had somehow chosen to gloss over: she’d been a heavy smoker for several decades.

Don’t get me wrong. Any cardiac event is indeed a traumatic occurrence no matter who and when it strikes. Sometimes, we truly have no hint about the cause of said event. And my immediate gut reaction was not meant to mock this author, or minimize her experience (which was awful). 

But I felt honestly surprised that she was surprised.

Here was an intelligent, educated woman who’d been actively and relentlessly engaged year after year after year in one of the most well-known and downright dangerous risk factors for cardiovascular disease out there yet she’s surprised?

Cigarette smoking is considered the most important preventable cause of premature death in North America. So how is it even possible she would not know this? How is it possible that she would have no clue that her heavy smoking was damaging her heart? 

This basic disconnect between awareness of cause and effect turns out to be surprisingly common. And, as a recent Australian study reported, there are even more surprises to be found among heart attack survivors and what they believe caused their heart attack.(1)

Australia’s National Heart Foundation (NHF) had launched a “Warning Signs of Heart Attack” multi-media campaign. This campaign ran across the entire country for four years from 2008 to 2012 to help raise awareness of heart attack symptoms in an attempt to reduce deadly treatment-seeking delay

But in fact, this follow-up study found there was virtually no significant difference in the median pre-hospital delay time between patients who had encountered the NHF awareness campaign ads and those who had not (133 minutes vs. 137 minutes).  Only 26% of patients studied recognized that they were actually having a heart attack. In just 34% of cases, an ambulance was called.

So four years of flooding the public with consistent awareness messages had resulted in barely a blip of improved personal response to heart attack symptoms.  The study authors blamed a number of possible factors for this failure to recognize and respond.

But here’s the one reason identified in this study that may help to explain the New York author’s reaction of profound disbelief:

“Most patients have a limited understanding of heart attack risk factors and causes.” 

And as the NHF study authors explained:

“Lack of insight into one’s own personal cardiac risk factors appears to be another important barrier to the recognition of a potential heart attack

“In fact, only 22% of patients in this study could identify all of their own cardiac risk factors. Even well-known cardiac risk factors such as cigarette smoking, hypertension, diabetes or obesity were poorly recognized.”

But wait. It gets worse. 

A study of women over 40 called the LIPSTICK Survey done by The Federation of Medical Women of Canada reported that only 10% of women surveyed knew all of their personal cardiac risk factors, versus 64% of the same group who know how much they weighed in high school.

In another recent study of female heart attack survivors, Yale University researchers found that many of the women were so unaware of their personal risk of heart disease that when their heart attack symptoms did hit, women invariably blamed them on non-cardiac causes.(2)  For example:

“When asked to reflect on their health before their myocardial infarction (heart attack), participants acknowledged that they had not recognized their personal risk of heart disease. This lack of awareness occurred even among women who had a family history of heart disease or multiple known risk factors.

“Participants did not consider heart disease as the potential underlying cause of their common heart attack symptoms.”

Here’s my concern: while it’s crucially important to recognize and act quickly when you experience any symptoms of heart attack, it’s even more important to recognize and act on the cardiac risk factors you already have so you can help reduce the risk of that heart attack happening in the first place.

We know that we can significantly reduce the risk of about 80% of all heart disease.

And as I like to tell my women’s heart health presentation audiences, there is simply no downside to start living your life in a heart-smart cardioprotective way – just as if you already knew that you’re at very high risk for developing heart disease.

Yet far too many of us continue to waltz through life refusing to pay attention to smoking, junk food diet, inactivity, high blood pressure, chronic stress, impaired sleep and other important risk factors that we know significantly impact our chances of becoming a heart patient someday.

Worse, studies like the ones cited above continue to show that most of us simply have no clue what those cardiac risk factors even are.

For this reason, I’m completely onside with my heart sister Jen Thorson (who blogs at My Life in Red). She wrote recently:

“I have little patience with willful ignorance of cardiac risk factors (just as I do for ‘being embarrassed’ as the reason someone won’t seek care).
I’ve done this survivor/writer/speaker thing long enough and heard enough stories to just be over that.
“I get it, I do, but ladies, we need to get beyond it. We need to take control of our health and care.
“No one else is going to do it for us.”

Sadly, our medical care model in coronary artery disease is built entirely around opening blockages after the fact in patients with late-stage heart disease – which may relieve symptoms but, ironically, does not reduce the risk of heart attack. See also: The Cure Myth

And when cardiologists employ invasive procedures for coronary artery blockages by stenting or bypassing, they address only that specific area of the heart – not what caused the problem in the first place (likely decades earlier).

Risk reduction strategies, however, can improve not only heart health but our overall general health as well.

Apparently – as noted in the Australian study’s results – even flooding people with heart health public awareness messages is not making us any more aware.  It’s why I so admire doctors like Dr. James Beckerman and Dr. David Sabgir (“Walk With a Doc”) who actually lace up their own shoes and accompany their patients out on regular walks or runs preceded by mini-lectures on important health topics – and best of all, encourage other docs to do the same.

Dr. Rainer Hambrecht, professor of medicine at Universität Leipzig in Germany, has presented the results of his ongoing cardiac research at European Congress of Cardiology meetings.(3) Both his original and follow-up studies five years later compare the surprising outcomes of two groups of similar heart patients:

  1. those who have had angioplasty/stents to reopen their coronary artery blockages
  2. those who were put on a regime of regular exercise instead (in his case, cycling)

His surprising findings continue to confirm his earlier results: regular exercise training is superior to angioplasty at reducing the risk of subsequent cardiovascular events.See also: Did You Really Need that Coronary Stent?

But as Dr. Hambrecht himself acknowledged:

“It’s difficult to convince people to exercise instead of having an angioplasty – but it works.

“For one, patients are not motivated to take responsibility for improving their own cardiovascular health – even if it means better event-free survival.

“For another, encouraging exercising is financially less appealing for hospitals. That was my feeling – that hospitals were reluctant to participate in this study, because they derive revenue from revascularization procedures in their cath labs.”

It’s also important to remember that, particularly in women, sometimes a serious cardiac event strikes those who seem to have no obvious risk factors that could be modifiable by lifestyle improvements.

Jen Thorson, for example, was a healthy 37-year old marathon runner when she suffered the first of two heart attacks.  She now suspects that her own cardiac events are linked to a pregnancy complication years earlier called HELLP syndrome (considered a severe form of preeclampsia). We know that pregnancy complications like this can raise a woman’s risk of future heart disease by 2-3 fold.

Spontaneous Coronary Artery Dissection (SCAD) is another type of heart attack – often fatal – that most often strikes young healthy women with few if any cardiac risk factors.

And speaking of cardiac risk factors, how many on this list do you have?

How to address your cardiac risk factors

♥  Stop smoking – all smoking (especially important if you are also on birth control pills).  Learn more about the effect of public smoking bans on our health.

  Eat a high-fibre heart-healthy diet (like the Mayo Clinic-recommended Mediterranean diet) and seek out heart-smart recipes to reduce sodium, sugar and saturated fat in your cooking.

♥  Maintain a healthy weight (waist measurement <35″ for women).

  Keep blood sugar, blood pressure and cholesterol under control.  If you’re living with diabetes, learn more about resources to help reduce your risk of heart disease.

♥  Exercise!  We know that 150 minutes of physical activity per week (that’s just 30 minutes a day for at least five days a week) is the minimum for good health.  What the heck – why not aim for 30 minutes of physical activity every single day? Yes, EVERY day! The human body was meant to move – not to sit around.  See also: “Heart Disease is a Sitting Disease“.   And as Dr. John Mandrola likes to say:

“You only need to exercise on the days you plan to eat!”

  Do other activities that can improve heart health all throughout your day – not just during a specific exercise period: gardening, walking to work, stair climbing – even doing housework. Just DO something. MOVE something.

♥   Get a good night’s sleep Sleep problems have been linked to increased cardiovascular risk.

  Talk to your doctor about screening tests for heart disease if you have a family history (Mum or sister under age 65, Dad or brother under age 55 when they had a cardiac event) or if you’ve ever had pregnancy complications like Jen Thorson and I each had.

  Learn how to reduce and manage your chronic stress (and don’t forget to b-r-e-a-t-h-e…)

  Educate yourself about your own heart health. If you have already been diagnosed with heart disease, your only job now is to become the world expert in your diagnosis. Knowledge is power. Be a survivor, not a helpless victim. If you haven’t already done so, subscribe free to get Heart Sisters email updates about emerging news on women’s heart health and each new weekly blog post published here (simply look at this page sidebar to your right and click Follow Heart Sisters, or click the Twitter icon to follow me there).  See also: “Listen Up, Ladies: 16 Things I’ve Been Meaning to Tell You”

  Stop being what we call a Type E-personality:  Everything to Everybody!”  This is especially true for women, who are often the nurturers and caretakers of both friends and family members, sometimes at the expense of their own health needs. See also: Are You a Priority in your Own Life?


(1)   Tummala, Shrikar R. et al.  Patients’ Understanding of their Heart Attack and the Impact of Exposure to a Media Campaign on Pre-Hospital Time. Heart, Lung and Circulation , Volume 24, Issue 1 , 4 – 10. January 2015.

(2) Judith H. Lichtman et al.  Symptom Recognition and Healthcare Experiences of Young Women With Acute Myocardial Infarction. Circulation: Cardiovascular Quality and Outcomes.  OUTCOMES.114.001612

(3) Hambrecht, Rainer et al.  Percutaneous Coronary Angioplasty Compared With Exercise Training in Patients With Stable Coronary Artery Disease: A Randomized Trial. Circulation. 2004; 109: 1371-1378. March


Q:  Why do you think we’re just not getting it?

See also:

Yet another cardiac risk calculator? My response in the British Medical Journal

Why you’ll listen to me – but not to your doctor

Squishing, burning and implanting your heart troubles away

Why female shift workers may be at risk for heart disease

What other diagnosis doubles your risk of having a heart attack?

Heart disease is a sitting disease

The cure myth

Why are heart patients who smoke leaving hospital still smoking


5 thoughts on “Are you a heart attack waiting to happen?

  1. Well, what you say is all well and good. If you don’t already have health problems. I have MD and RA. I eat healthy, have never smoked, drunk, or used drugs. My mom died at 63 after almost 20 years of heart problems. My cholesterol runs a bit high, but I am unable to take statins. I am on 3 meds for hypertension. I do everything I am told. I was told I would never have a heart attack, I have a pacer because of rhythm problems, but was assured I would never have a heart attack. Stress test 2 years ago, completely clean. Wrong.

    5 months ago.I lay in my bed and had that thing and then waited 5 days to be seen. My take on what you are saying is, any woman who manages to have a heart attack, has it because she’s an idiot who has no clue about anything. You give me the impression that doctors I have seen in the ER give me. That clearly only an ignorant and lazy woman would allow this to happen to herself. I am very cognizant of ALL my risk factors and I still had an MI. If you want to critique people, please qualify your statements! I have MD and am unable to exercise because of the arrhythmias it causes. Your article would have been far more appealing to me if you had taken the time to say…sometimes, despite our best efforts, heart attacks happen. I feel “gaslighted” by you….guess I better buy that zillion dollar bike and do the iron man….good grief….

    If I had wanted a lecture on my “denial” symptoms, I would go to an ER…


    1. Debbie, you were clearly offended by what I wrote. You’re unlikely to do this, but if you re-read this post, you will see that I did indeed (at least four times) specifically mention that cardiac events can and do happen – even with few or no risk factors. And significant evidence does in fact suggest, as I wrote, that the majority of us, unlike you, really have “no clue” about our own risk factors (e.g. that New York author who was “surprised” by her MI despite her decades of chain smoking). The fact that you were told (twice!) that you’d “never have a heart attack” was unfortunate, as no one is qualified to make such a guarantee to any patient.


      1. I did re read it. I may be a bit reactive, but I do listen to others opinions. I was a nurse for 30 years. It wasn’t until the very end of those thirty years it was acknowledged that women could even have heart disease. And then when someone finally paid attention, they discovered more women died of heart disease than men.

        I think there is a population of an older generation of women that just do not realize it’s even possible. I saw it with my own eyes. The doctors and their attitudes and the women who shook their heads in disbelief because they had been told only men got heart disease. My mom was a prime example. Went to her doctor, who told her she was “just anxious.” She came home from that appt and coded in the living room.

        I think what you are doing is very important. I think women and men ignore many signs of many illnesses out of fear and denial. I have seen it over and over. And some are just ignorant..although it’s hard to believe in this day and age people don’t see the correlation between cigarettes, or poor diets, and heart disease.

        I still believe your article could have been a bit more forgiving to the people who, despite doing all they can to prevent it, have an MI anyway. And I still think it implies that all people need to do is work out whether they can or not. If you don’t, you are just unmotivated or lazy.

        Trust me…I despise having to give a penny to hospitals for the stent I had to have. But I would be worse off trying to ride that bike or do aerobics thirty minutes a day.

        I applaud your efforts to supply knowledge to people, I just think some of it could be a bit more tactful. Thanks for allowing me to
        voice my opinion.


  2. Wow!!!!! What an outstanding, powerful post today. You have certainly hit the nails on the head.

    I hope that you had taken your blood pressure meds before composing that emotionally charged piece. I do wish I had the answer to those questions. I don’t know why so many continue to be in denial because that strategy is not working is it? Like you, I feel so passionate about proclaiming the message of the importance of heart health. ( I wrote the recently published book, “How Could I Have Had a Heart Attack? I Watch Doctor Oz!”).

    It truly frustrates me when I talk with people who have the mind set like I uses to have. I really want to reach them. I want to prevent others from making the same mistakes that I did. Complacency kills! It’s that simple. But I, like you, will continue my campaign to educate others. Our work is not in vain; I know we must be helping some and even though we wish it to be more, some are better than none! Keep up the good work that you are doing! You are inspiring and bringing hope to so many.

    Your heart Sister,
    Kim Waldrup

    Liked by 1 person

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