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The death toll from heart ailments remains the nation’s largest disease problem. The human suffering has been compared in scope to several fully loaded jumbo jets crashing each day. And the economic cost for medical care and lost productivity will total about $167 billion this year, according to the American Heart Association. Moreover, contrary to popular opinion, heart disease is not an easy way to go. Just ask anyone who has suffered the searing pain of angina, survived a heart attack, or undergone heart surgery. Nor is heart disease the exclusive province of older people. Children have never been exempt. An estimated 32,000 babies are born each year with congenital heart defects, and early signs of heart disease can be found in teenagers and young adults who consume high-fat, high-cholesterol diets. People in these age groups are putting themselves at risk by gaining more weight, exercising less, and smoking more, too. And heart disease among people in their forties and fifties may soon become a great deal more common. Indeed, as baby boomers enter middle age after living a life of affluence, we may face a twenty-first century epidemic.

Heart pain and suspected heart attack lead Americans to call the 911 emergency system or visit a doctor or a hospital about 6 million times a year. About 10 percent of the time the problem is a bonafide heart attack; the other 90 percent of the time it’s gallbladder pain, indigestion, a panic attack, or something else entirely. But about 2 to 3 percent of those sent home with a diagnosis of no heart attack incur an attack in the next day or so, according to Thomas J. Ryan, chief cardiologist at Boston University. “Patients don’t appear at the ER with acute myocardial infarction [heart attack] tattooed on their foreheads,” he notes. “Sometimes you just can’t diagnose this disease.”

An even bigger mystery is exactly who is at risk. The truth is that the medical profession often does not know. In fact, of the 50 percent or so of heart-attack deaths classified as “sudden,” meaning that death comes within an hour, about one-fifth to one-third occur in people with no previously identified risk factors. Yet we are learning more and more about heart disease. Researchers are closing in on a range of suspect risk factors. And the answers they find could suggest innovative prevention strategies as well.

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