Dossier: Healthy heart

Heart attacks in men: what you need to know

A heart attack can be fatal, so it’s important to act quickly. And a healthy lifestyle can prevent heart attacks before they even happen, particularly for men, because they are more at risk than women.

Author: Anna Miller; photo: iStock

We’ve all seen it on TV: the moment a man suddenly grabs his chest before collapsing. It’s terrifying – and many men live with this underlying fear their whole life. Heart attacks can be fatal. And you feel out of control. It seems that heart attacks can happen to anyone, anywhere and at any time. Is this true? What can you do to prevent a heart attack?

Thierry Carrel, probably Switzerland’s best-known heart surgeon, allays these fears: “90% to 95% of people who are admitted to hospital quickly survive a heart attack.” In Switzerland, around 30,000 people are affected by an acute coronary event every year. Cardiovascular diseases are a common cause of death and have to be taken seriously, but it’s also important to remember that the probability that a person who isn’t a high-risk patient will suffer a heart attack in their lifetime is less than 5%. In other words, heart attacks happen, but with good preventive care, a bit of attention and regular visits to the doctor, they don’t need to be a permanent concern.

Of course, a scar often remains after a heart attack because the corresponding tissue has died and scarred and is therefore definitely lost for pumping power, says Carrel, Professor of Cardiac Surgery at the University of Zurich. Whether it’s noticeable after a heart attack or not depends in particular on the severity and site of the heart attack.

Men are at much greater risk then women – due to hormones.

Men are much likelier to suffer a heart attack than women. There are a number of reasons for this. For example, men go to the doctor less often and later, and, in decades past, smoked more and suffered more from stress at work. “That’s why it will be very interesting to see what impact the lifestyle changes among men and women – with regard to working life and health awareness – will have on heart health data in the coming decades,” says Carrel.

Women are naturally better protected against heart attacks than men until middle age due to their hormones. The oestrogen in a woman’s body protects the heart vessels and slows down the ageing process of the heart wall. In contrast, testosterone is often associated with an increased risk of heart attack. Carrel has seen 30-year-olds who suffered a heart attack, but other risk factors were usually involved, such as a family history of hypercholesterolemia. Between the ages of 50 and 60, the risk of a heart attack increases sharply for men,

particularly the types of heart attack associated with risk factors such as stress and an unhealthy diet. This is because blood vessels age like the body itself and the heart also suffers if a person doesn’t take proper care of their health. Although a heart attack can never be entirely prevented – not even with the healthiest of lifestyles – you can do a lot to minimise the risk: eat healthily, don’t smoke, stay calm and exercise. “It’s easy to tell if a person lives healthily or not,” says Carrel.

See a doctor sooner rather than later – especially after 50

Family history also plays a role, says Carrel. Genetic factors are also important, so it’s worth checking whether cardiovascular diseases run in the family. It also makes sense to have a check-up from the age of 50 onwards. It’s always best to see a doctor sooner rather than later. A central element of the examination is the stress ECG, which shows how the heart reacts under stress. “It’s not a conclusive value, but it gives an indication of what’s what,” says Carrel. 

Not all heart attacks happen out of the blue and as dramatically as you see in a film. “What we often see on TV is a typical heart attack with classic symptoms: severe pain in the chest, radiating towards the left arm or jaw, sometimes the upper stomach.” And the pain doesn’t go away on its own. In acute cases, the pain can range from sharp to dull – it is clearly perceived and often occurs after exertion. In the case of angina pectoris, on the other hand, sufferers have noticeable chest pain, which initially only manifests itself during heavy exertion – and disappears again during rest. If the symptoms don’t disappear during rest, this can be an alarm signal. Therefore, it’s always advisable to see a doctor if these symptoms occur.

In addition to the typical heart attack and angina pectoris, there is also another important category: the silent heart attack. In this case, the patient is unaware of what’s happening, because it tends to affect smaller areas of the heart muscle. However, part of the heart muscle can also die with silent heart attacks due to vascular occlusion. “It is often only when the doctor conducts an ECG that the occurrence of a heart attack is detected,” says Carrel. That’s why it’s worth going to the doctor one time too many rather than one time too few. Early detection is also important. The long-term health costs for the general public are much higher if a person is off work for a long time after a heart attack than if they undergo a check-up from time to time,” explains Carrel.

An irregular heartbeat may not be anything to worry about

Check-ups also help to rule out psychosomatic factors, because chest pains are also often caused by stress and emotions. The heart is sensitive to stress. “Even healthy people can experience an irregular heartbeat from time to time. Rhythm disturbances are very common,” says Carrel. The circuit that regulates the heart rhythm is extremely sensitive. It is influenced by stress, emotions, the weather and many other factors. Many people have heart rhythm disturbances without them ever having any cardiological relevance. A large proportion of arrhythmias may not be relevant, but they are unpleasant. And of course it can be scary. That’s why it’s important to see a doctor to rule out anything serious. Then take a few deep breaths and vow to take better care of yourself.

About the expert

Thierry Carrel, 63, is a heart surgeon and university professor. Between 1999 and 2020, he headed the Department of Cardiovascular Surgery at Inselspital in Bern. He is currently a heart surgeon at Basel University Hospital and professor for heart surgery at the University of Zurich.