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What to Know About Diabetes and the Risk of Silent Heart Attacks

Jan. 1, 1970

At first it seemed like a routine call—something the paramedics had dealt with countless times before. A man in his mid-50s was having a heart attack, and his physician had called for emergency support. But when the paramedics arrived, the physician pulled them aside and told them something peculiar: the man had no cardiovascular symptoms whatsoever.

The man had come to his doctor’s office because he’d woken early the previous morning sweating and with a sharp pain in his left wrist. These symptoms had quickly subsided and he’d gone back to sleep. Later, after going about his day, he’d visited his doctor to report the episode. The man showed no outward signs of heart trouble; he was breathing and acting normally—asking what “all the fuss was about”—and his heart rate and blood pressure weren’t elevated. However, when his doctor performed an electrocardiogram—a test that measures the electrical activity of the heart—it showed plainly that the man had experienced a heart attack. The paramedics repeated the test and came to the same conclusion. Later, at the hospital, further tests confirmed the attack and revealed a partial blockage of one of the man’s coronary arteries. Surgeons stented the blocked artery and, after a few days in the hospital, the man returned home.

The man’s experience was documented in a 2017 medical case report in the Irish Journal of Paramedicine, and it illustrates something experts call a “silent heart attack.” This is a type of attack that doesn’t cause typical or obvious symptoms. “Crushing chest pain that radiates down the left arm is the classic symptom,” says Dr. Amgad N. Makaryus, a professor of cardiology at the Zucker School of Medicine at Hofstra/Northwell in New York. “With silent ischemia, which is more common in diabetics, people develop atypical symptoms, or they might not develop symptoms at all.”

By some estimates, roughly 1 in 4 heart attacks is “silent.” This is likely an undercount because many of these heart attacks go unrecognized and unreported; most are only identified after the fact using an electrocardiogram or other test. While roughly half of silent heart attacks involve atypical symptoms, the other half are believed not to cause symptoms at all. And research has found that people with Type 2 diabetes may be up to twice as likely to have a silent heart attack compared to those who don’t have diabetes.

Silent heart attacks are dangerous precisely because they often occur undetected. Some studies have found that people who have experienced a silent heart attack are at greater risk of death than those who have a heart attack with recognized symptoms. “Compared to those without a heart attack, those who have had a silent heart attack have a three-fold greater likelihood of dying from heart disease in the future,” says Dr. Nathan Wong, director of the Heart Disease Prevention Program at the University of California, Irvine.

How can those with Type 2 diabetes protect themselves from silent heart attacks? Here, Wong and others explain everything you need to know—whether you have Type 2 diabetes yourself or are caring for someone with the condition.

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