To­day is World Heart Day and this year’s theme, “Heart Dis­ease Can Hide in Plain Sight: Don’t Miss a Beat”, warns that it is a mas­ter of dis­guise. The World Health Or­ga­ni­za­tion es­ti­mates that car­dio­vas­cu­lar dis­ease is the lead­ing cause of death world­wide.

Hy­per­ten­sion, high cho­les­terol and the ear­ly in­jury caused by di­a­betes are silent killers. So­cial iso­la­tion, smok­ing, stress, de­pres­sion, traf­fic noise, air pol­lu­tion, heat, poor sleep, ar­ti­fi­cial light at night and virus­es such as in­fluen­za, shin­gles or COVID are car­dio­vas­cu­lar con­cerns.

Un­for­tu­nate­ly, heart dis­ease can be missed in the ear­ly stages. A man no­tices that the short climb to his front door now re­quires a pause. A woman be­gins sleep­ing propped up be­cause ly­ing flat leaves her breath­less. Some­one feels pres­sure in the chest and de­cides it must be “gas”. Calf pain that re­peat­ed­ly ap­pears dur­ing walk­ing and eas­es with rest can sig­nal pe­riph­er­al ar­te­r­i­al dis­ease (PAD). Erec­tile dys­func­tion is an ear­ly “dip­stick” of dis­or­dered blood ves­sels.

Chest dis­com­fort that is new, se­vere or per­sis­tent, par­tic­u­lar­ly with sweat­ing, breath­less­ness, dizzi­ness, pal­pi­ta­tions, nau­sea or pain spread­ing to the arm, back or jaw, needs ur­gent med­ical as­sess­ment. Not every­one has the quin­tes­sen­tial crush­ing pain in the mid­dle of the chest. Some peo­ple, in­clud­ing women and di­a­bet­ics, may no­tice breath­less­ness, un­usu­al fa­tigue or nau­sea in­stead. If you think a heart at­tack is pos­si­ble, seek emer­gency care im­me­di­ate­ly.

Know your num­bers. If the blood pres­sure is el­e­vat­ed above 130/80 mmHg, arrange prop­er fol­low-up. Ask about your cho­les­terol and blood sug­ar. If you have been pre­scribed treat­ment, take it as agreed and speak to your clin­i­cian about safe­ty, ef­fi­ca­cy, side ef­fects or cost.

Some folks re­quire 24-hour blood pres­sure mon­i­tor­ing. The small cuff goes home with you and takes read­ings as you work, type a vit­ri­olic com­ment on Face­book, eat din­ner and sleep.

It can de­tect those in­di­vid­u­als whose pres­sure is su­perb in clin­ic but ris­es through the rest of the day (“masked hy­per­ten­sion”). It can al­so spare some­one a di­ag­no­sis based on num­bers that soar on­ly when a grumpy nurse ap­pears (“white-coat hy­per­ten­sion”).

Di­a­betes and hy­per­ten­sion in preg­nan­cy can sig­nal a high­er risk of heart dis­ease years lat­er. There is al­so a cho­les­terol-re­lat­ed par­ti­cle called lipopro­tein(a), or Lp(a). Its lev­el is large­ly in­her­it­ed and the usu­al blood test does not mea­sure it. New guid­ance rec­om­mends check­ing it at least once in adult life.

Fa­mil­ial hy­per­c­ho­les­tero­laemia gives a child very high LDL or “bad” cho­les­terol long be­fore any­one thinks to call that youth a heart pa­tient. With a trou­bling fam­i­ly his­to­ry, test­ing can be­gin ear­ly.

Urine is pure liq­uid gold in clin­i­cal med­i­cine. A small amount of pro­tein there may sig­nal kid­ney dam­age and a high­er risk of heart dis­ease, es­pe­cial­ly in a per­son with di­a­betes or high blood pres­sure.

Oth­er com­pli­ca­tions are le­gion. Heart dis­ease may ar­rive as heart fail­ure, with swollen an­kles, mount­ing breath­less­ness or lung con­ges­tion; as an ir­reg­u­lar rhythm called atri­al fib­ril­la­tion; or as a de­bil­i­tat­ing stroke. A blood test called BNP or NT-proB­NP can help as­sess sus­pect­ed heart fail­ure. An echocar­dio­gram then shows the heart’s struc­ture and func­tion.

A coro­nary cal­ci­um score mea­sures cal­ci­um in the artery walls, and that can help when one is gen­uine­ly un­sure whether to start cho­les­terol-low­er­ing med­ica­tion. Its val­ue lies in choos­ing it for the right per­son and ques­tion.

If deemed fit to do so, ex­er­cise for 30 to 60 min­utes per day. This may in­clude brisk walk­ing, danc­ing, jog­ging, swim­ming or chas­ing a tod­dler (this may count twice, al­though no pro­fes­sion­al so­ci­ety has yet award­ed me the ex­tra cred­it). Salt is a four-let­ter word in hy­per­ten­sion and should be lim­it­ed to a tea­spoon­ful per day. Stop smok­ing if you do.

World Heart Day will bring red rib­bons, posters and, some­where, a gi­ant in­flat­able heart. I have noth­ing against the in­flat­able heart and rather like the one at home. It has prob­a­bly per­suad­ed more peo­ple to stop at a screen­ing booth than some doc­tors. How­ev­er, these health fairs are use­ful if the ran­dom test­ing leads to ap­pro­pri­ate care.

It is an ide­al re­minder to make the ap­point­ment you have post­poned. If a med­ica­tion low­ers the chance of a heart at­tack or stroke, tak­ing it is an act of care for your life. Ask the per­son you love about the breath­less­ness they keep brush­ing aside. Take a walk with fam­i­ly. The heart has ac­com­pa­nied us through every ver­sion of our­selves, and it is rea­son­able, once in a while, to lis­ten.