1. By Judith Graham http://newoldage.blogs.nytimes.com/2012/10/02/the-deadly-threat-of-silent- heart-attacks/ The Deadly Threat of Silent Heart Attacks

2. Heart Attack Sedentary Lifestyle Lack of Physical Lifestyle Obesity Diabetes (I and II) Alcohol Consumption Smoking First Hand Second Hand Psychosocial Lifestyle Stress Poverty Social Isolation Age Atherosclerosis

3. Silent Heart Attack Article Silent Heart Attack More Common in older people Twice as common among older patients than recognized heart attacks (22% to 10%) Silent Heart Attack just as deadly as recognized heart attack Recognized heart attacks more serious in short run “Silent” heart attack patients have more risks Elevated blood pressure Plaque build up Get Tests Done if: Family History Present Older Personal History Shortness of breath Unusual Fatigue Unknown what causes “silent” vs. recognized heart attacks Tests Detect Heart Attack Coronary Angiogram Computerized Tomography EKG Nuclear Stress Test Used Research from Journal of American Medical Association Determine prevalence and mortality risk by cardiac magnetic resonance (CMR) Most MIs were unrecognized, despite associations with atherosclerosis

4. Cardiovascular disease prevention with a multidrug regimen in the developing world: a cost- effectiveness analysis Cardiovascular disease is the leading cause of death, with 80% of cases occurring in developing countries The primary prevention regimen was given to patients without a history of cardiovascular disease and consisted of aspirin, a statin, an angiotensin- converting enzyme inhibitor, and a calcium- channel blocker. The doses were 81mg aspirin, 40mg lovastatin, 10mg lisinopril, and 5mg amlodipine The secondary prevention regimen was given to patients with a history of cardiovascular disease and consisted of aspirin, a statin, an angiotensin- converting enzyme inhibitor, and a beta- blocker Recorded that preventive strategies could result in a 2-year gain in life expectancy Across six developing World Bank regions, primary prevention yielded ICERs of US$746–890/QALY gained for patients with a 10-year absolute risk of cardiovascular disease greater than 25% $1039–1221/QALY gained for those with an absolute risk greater than 5%. Compared with no treatment, the incremental cost per QALY gained with secondary prevention ranged in the six regions from $306 to $388 The sensitivity analysis showed that the drug efficacy was the most sensitive parameter, but the results remained generally stable; the cost- effective strategies remained cost-effective and the order of alternatives did not change

5. Cost (US$ in 2001) Event or early care† Myocardial Infarction$270-690 Stroke$404-910 Re-infarction$32-125 Yearly care after myocardial infarction$54-64 Yearly care after stroke$408-775 Yearly Drug Costs‡ Aspirin$2 Metoprolol$43 Amlodipine$9 Enalapril$7 Lovastatin$14 Screening$6 -12 Monitoring$6 -12 Unit costs consisting of different costs for events or yearly care (low and high estimates in parentheses): hospital bed day, $16.15 (8.07-49.88); health-center visit (hospital), $2.97 (1.35-4.96); operation room (per min), $3.12 (no range provided; specialist daily salary, $41.64 (29.36-105.3); family practitioner daily salary, $26.37 (19.73-63.60); nurse daily salary, $15.66 (11.84-38.27); health worker daily salary, $10.86 (8.12-26.14). †Event took place during first admission. ‡Range for sensitivity analysis was a half to two times more than stated value.

6. Compared with no treatment, the incremental cost per QALY gained with primary prevention ranged in the six regions from $746 to $890 for patients with a 10-year absolute risk of 25% or more; from $790 to $930 with a 10-year absolute risk of 15% or more; and from $1,039 to $1,221 with a 10-year absolute risk of 5% or more.

7. CONCLUSION  Early preventative care leads to an improved quality of life  If you have a familial history with heart disease, it is better to practice preventative measures early  Preventative measures less costly  Older patients who have experienced a silent heart attack will still have improved quality of life if detected so future ones can be prevented  Incremental quality of life improvement for those who have had a heart attack and have all underlying causes  Improved quality of life can lead to less spent on health care expenditure