FOR HEART RESEARCHER Peter Kaufmann, it's not the pain but the lack of it that is most puzzling about heart disease.
Why is it, he asks, that some people with heart disease suffer from terrible chest pains that warn them of their dangerous condition, while others feel nothing at all and spontaneously drop dead none the wiser?
The answer may be firmly rooted in psychology, says Kaufmann, chief of behavioral medicine at the National Heart, Lung, and Blood Institute in Bethesda, Maryland.
Doctors know that mental stress tends to provoke myocardial ischemia, a lack of blood flow to the heart usually accompanied by difficulty breathing-and sharp chest pains. But nearly 80% of the 4 million Americans with coronary heart disease suffer from silent bouts of myocardial ischemia (SMI). Almost half die without ever knowing what hit them. Only in autopsy do the diseased arteries show up.
"If we can learn something about the types of patients who get silent heart attacks, we may be able to improve medical care by predicting the mental circumstances in which ischemic episodes occur," explains psychologist Kaufmann. A new multicenter study probing the mind-body connection in SMI is about to get under way.