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As many as 60% of heart attacks go unnoticed when they occur. So-called silent heart attacks occur for a variety of reasons, including differences in pain perception and people not recognizing symptoms or dismissing them. People may assume heart attack symptoms are limited to the chest, but nerves in the heart can send signals to the surrounding nerves, causing pain that radiates to the stomach, back, neck, arm, or jaw. Sometimes people assume their chest pain is caused by a respiratory infection or heartburn when they’re actually having a heart attack.

Loneliness represents an underappreciated health crisis in the United States and is linked to a 29% higher risk of heart attack and a 32% higher risk of stroke. The underlying mechanism is thought to be similar to what happens when people feel depressed or stressed. Reconnecting with old friends can help short up social skills. To find new friends, people might look online or at their local library for classes, in-person clubs, or volunteer opportunities that match their interests.

Following a plant-based eating pattern and cutting back on highly processed foods can help promote a more diverse, healthier microbiome. A healthy gut microbiome may decrease inflammation that promotes heart disease. Most fruits, vegetables, beans, and whole grains are good sources of prebiotic fiber, which is broken down by gut bacteria to create short-chain fatty acids. These fatty acids are linked to lower inflammation and reductions in other heart disease risk factors.

Too much saturated fat tends to raise levels of harmful LDL cholesterol, but limited amounts are not a problem. Eating mostly whole or minimally processed foods can help achieve that goal.

People who get most of their recommended weekly physical activity over one or two days may lower their heart disease risk just as much as those who are active more regularly throughout the week. Evidence also suggests there’s no particular benefit to exercising at certain times of the day, including with respect to mealtimes. So people should be physically active whenever they find it to be most convenient.