WEDNESDAY'S MOST CLICKED
The PREVENT calculator
The American Heart Association's free tool. Enter your age, sex, blood pressure and cholesterol, and it estimates your chance of a heart attack or stroke in the next 10 years.
NEXT WEEK: YOUR QUESTIONS
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Picture a heart attack. Most of us see the same scene: a man grabs his chest and drops to the floor.
On Katie Couric's podcast this week, cardiologist Stacey Rosen called it the "Hollywood heart attack." Real ones are often slower and easier to explain away: a tight chest on the stairs, an ache in the jaw, nausea you blame on lunch. The average person waits 3 hours before getting help, according to the US National Library of Medicine.
This week was about what a blood test and a scan can show you. On Monday, what to do when your cholesterol comes back high. On Wednesday, the heart calcium scan. Here is where we land.
No scan can show you your family's history or what a heart attack feels like. You can learn both this weekend.
If you haven't had this conversation with your family, start with one phone call to whoever knows the family history best, often a parent, aunt or uncle. Ask about grandparents too. Set a reminder to ask on Sunday.
1. Your family history goes wider than your parents
Most people know about their parents. A grandparent's heart attack, or an uncle's, is easier to miss. A Danish study of 4.4 million people in PLOS ONE traced heart attacks across whole families using hospital records, so nothing relied on memory. Risk rose with every affected relative, and the pattern was the same for men and women:
One grandparent, aunt or uncle: about 1.2 times the risk. Two: about 1.9 times.
One parent, brother or sister: about 1.5 times. Two: 2.4 times. Three or more: 3.6 times.
Both sides of the tree: between 36 and 55, two or more close relatives plus two or more wider ones meant about 7.5 times the risk.
When it happened matters as much as who. Heart attacks in relatives over 70 added little. Early ones added the most. Among people who went on to have a heart attack, those with an affected parent, brother or sister had theirs 6 to 7 years sooner: around 50 rather than 56 for men, and 53 rather than 60 for women.
The link held after accounting for blood pressure, diabetes and cholesterol treatment, and it was strongest between 36 and 55, when risk calculators most often land in the uncertain middle. The 2026 US cholesterol guideline counts early heart disease in a parent, brother or sister as a reason to treat sooner, and the wider family fills in the rest of the picture.
Family history picks up something your Lp(a) test can't. Lp(a) is one inherited particle that a single blood test measures, which we covered in Your cholesterol was set at birth. Family history reflects many other genes, plus the cooking, smoking and exercise habits a family shares. In a US study of 12,149 men and women in JACC, each one raised risk on its own, and people with both had about 43% higher risk than people with neither. A normal Lp(a) result doesn't cancel out a family history, and the reverse is also true.
2. Chest pain is still the main sign, in women and men
The difference is in what comes with it.
In an Edinburgh study of 1,941 emergency patients, chest pain was the main symptom in 91% of men and 92% of women having a heart attack.
In the VIRGO study in Circulation of 2,985 heart attack patients aged 18 to 55, 62% of women had 3 or more other symptoms, such as pain in the jaw, neck, arms or between the shoulder blades, against 55% of men.
Women more often put their symptoms down to stress or anxiety (21% against 12%). Men more often blamed a sore muscle (21% against 15%).
Of those who had seen a doctor with similar symptoms beforehand, 53% of women and 37% of men were told it was not their heart.
It works like a smoke alarm going off while you are cooking. The alarm is working, but it is easy to dismiss it as just smoke, not fire.
3. Every half hour of waiting counts
Your heart is a muscle, and while you wait, part of it is dying. It runs on blood delivered by its own arteries. In a heart attack, one of them is blocked, and the patch of muscle it feeds is starved of oxygen. That muscle doesn’t grow back and can no longer pump blood through it. The longer the artery stays blocked, the more you lose.
In a Circulation study of 1,791 heart attack patients, each 30-minute delay before the artery was reopened raised the risk of dying within a year by about 7.5%.
Women, people over 70 and people with diabetes were the most likely to be treated late.
Two things shorten the wait:
Call an ambulance instead of driving. Paramedics can start treatment on the way, and arriving by ambulance often means faster treatment at the hospital.
Say the words. Tell the call handler "I think I'm having a heart attack," even if you feel silly saying it.
It is better to be wrong than to wait.
Your Weekend Action
It's as simple as this.
Ask about the whole family. Call whoever knows the family history best: has anyone, including grandparents, aunts and uncles, had a heart attack, stroke, stent or bypass, and how old were they?
Write down who, how they're related, and their age at the time. In a parent, brother or sister, early means before 55 for a man and before 65 for a woman. Keep the list in your phone next to your PREVENT score and your Lp(a) result if you have one, and take them to your next check-up.
Notice whether the call turns up anything you didn't know, and see whether it changes the advice at your next check-up.
The American Heart Association, British Heart Foundation and Heart Foundation each keep a one-page list of the signs worth saving.
FROM OUR INSTAGRAM
Cancer runs in families far less than people think
Heart disease is the one where family history counts. Saved by more than 1,200 people this week, this post covers the 10 changes that matter more than genes for cancer.
The Week in Longevity
Four studies making news this fortnight. Thirty seconds each.
01 · HEART
Scans of 16,808 adults aged 18 to 70 with no known heart disease found plaque in 57%, rising to 9 in 10 at 60 to 70. Men's plaque appeared 5 to 10 years earlier, while women's rose most between 40 and 60. Funded by the Novo Nordisk Foundation. Go deeper →
02 · BRAIN
In 1,647 Framingham adults scanned over about 12 years, eating closer to the MIND diet went with slower grey matter loss. It is observational, so it shows a link, not cause. Go deeper →
03 · FOOD
A review of 10 trials and 12 long-term studies found no link with heart disease, stroke or type 2 diabetes, unlike factory-made trans fats. Funded by the US National Dairy Council. Go deeper →
04 · STRENGTH
Seven sessions reduced visceral fat and fat cell size before body weight changed. Male mice only, so it still needs testing in people. Go deeper →
Monday Preview
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Until Monday.
Longevity Daily / The Building Decades