The heart can naturally heal itself after a heart attack—and it happens in around 20 percent of all cases. Now researchers are investigating the phenomenon that could herald the end of the world’s number one killer. Bryan Hubbard reports
One in five people who suffer a heart attack (myocardial infarction) never know they’ve had one. They continue living normally, and all the while the heart is repairing itself, a process that can take anything from two weeks to three months.
But this phenomenon doesn’t happen to everyone who suffers a heart attack. The heart’s ability to heal depends on the damage the attack causes in the first place. Of the roughly 805,000 Americans who suffer a heart attack every year, 604,000 suffer a catastrophic attack that results in death or permanent disability—the usual outcomes we associate with a heart attack. But more than 200,000 have a “silent attack” that causes mild damage and allows the heart to heal itself.
The heart can also be damaged after heart failure—when the heart can’t pump enough blood around the body—and this is far more common, affecting more than 64 million people around the world.
These silent survivors are intriguing medical researchers. What conditions are needed to allow the heart to heal itself, and how come some hearts switch on this ability, which naturally stops the moment they start beating?
Knowing these answers opens the door to new therapies and offers hope to others whose heart attacks weren’t so silent. Right now, researchers know a badly damaged heart needs to be relieved of its pumping duties.
The help of an artificial heart, more technically known as a left ventricular assist device, allows it to focus on regeneration, as it was exclusively doing in the womb. A mildly damaged heart, on the other hand, seems to be able to beat and heal at the same time.
A team from Karolinska Institutet in Sweden used carbon dating technology to witness cells, taken from people who had suffered heart failure, regenerate and form new, healthy cells. They obtained most of the samples from people who had artificial hearts fitted, but they think the same phenomenon could happen in anyone who has suffered heart failure or a heart attack.1
“Heart muscle cells can actually regenerate, which is really exciting because it solidifies the notion that there is an intrinsic capacity of the human heart to regenerate,” said Hesham Sadek, a cardiologist at the University of Arizona Health Sciences, who has been working with the Karolinska team.
The idea throws open a whole host of exciting possibilities. For one, people could have their artificial heart removed after the real heart has healed, but there’s an even more tantalizing idea—could a healthy heart regenerate and renew while it’s pumping, and so never suffer an attack, thus eliminating the world’s number one killer?
As Olaf Bergmann, one of the Karolinska researchers, put it, “There might be a hidden key to kick-start the heart’s own repair mechanism.” Although the assist device is an artificial stimulant that starts the healing process, the researchers believe there could be a natural way to encourage new growth in the heart for everyone, whether or not they’ve suffered a heart attack.
Right now, they’re baffled by the phenomenon. “In the existing data we cannot find an explanation for the effect, but we will now continue to study this process at a cellular and molecular level,” Bergmann added.
A research team at University of Texas Southwestern Medical Center in Dallas has been exploring the heart’s healing abilities for the past decade, and they think it may be further down the research road. In 2021, they applied to patent a drug formulation that could kick-start the heart’s healing mechanisms, and their work has also attracted the interest of four drug companies researching heart regeneration implants, injections and tissue patches.2
They’ve also been looking at viral and stem cell technologies that act as reminders to the heart to revert to its ability, last practiced in the womb, to generate new cells.
It shouldn’t be so surprising. Most muscles heal themselves after injury, and the heart is the same—especially in the womb—but it seems to be a poor multitasker after birth.
From the moment we’re born and take our first breath, the sudden inrush of oxygen changes the heart from a growing and renewing muscle to one that pumps. Heart muscle cells, known as cardiomyocytes, take over, and the heart stops regenerating.
Oxygen produces two proteins, Meis1 and Hoxb13, that stop cell division in the heart after birth. But the UT researchers have seen how division starts again when the genes that code for these proteins’ production are removed from cell samples.
If oxygen stops the heart’s regenerative abilities, could a lack of oxygen restart its healing abilities? The UT researchers have been looking at hypoxia therapy, or prolonged periods of low oxygen, as a way to do this.
They reckon that an oxygen level of 7 percent—the same ratio found at the top of Mount Everest, which is just one-third of that at sea level—could be the sweet spot that gets the heart healing itself. They put damaged cardiomyocytes in a dish at that low oxygen level, and after two weeks, the cells started to divide and regenerate.
The researchers are teaming up with the German Aerospace Center to test whether the same phenomenon happens in people. They’re enlisting mountaineers and extreme sportsmen, who are already acclimatized to lower oxygen levels, to take part in clinical trials.
The researchers recognize that this is not a practical way forward. It would be challenging for every heart patient to have hypoxia therapy, and it wouldn’t be cost-effective to build hypoxia centers around the globe. For another thing, the therapy can also damage other organs, such as the kidneys and brain.
Nonetheless, silent heart attack survivors are providing clues that could lead to the heart’s ability to spontaneously heal itself, even before a heart attack has happened.
A heart attack isn’t usually a sudden, catastrophic incident. It’s often far more gradual and passes through four phases. The phase when the heart attack happens could also be a key factor in the heart’s ability to start healing.
Without any lifestyle change, such as a better diet, the heart can heal damage caused by a mild heart attack in as little as two weeks to three months. But you can speed the process with a heart-healthy diet—or keep it healthy in the first place.
Eat whole, unprocessed, organic foods grown locally and in season and cooked using traditional methods.
Follow a Mediterranean-style diet, which is rich in fruits and vegetables and olive oil, with meat as a condiment rather than the centerpiece of meals. Make sure raw and cooked vegetables occupy most of your dinner plate.
Eliminate processed foods, especially ultra-processed, packaged foods including bagged breads, cookies, crackers, cakes, breakfast cereals, granola bars, fast foods and anything that contains heat-destroyed, processed vegetable oils.
Avoid added sugar, especially the processed kind. Sugar fuels diabetes, and soaring blood sugar levels are behind insulin resistance, which has been implicated in heart disease. When you want something sweet, have a piece of fruit or a square of organic dark chocolate.
Eat a handful of fresh nuts every day. The more nuts you eat, the less likely you are to die from heart disease.
Eat fish, a good source of heart-healthy omega-3 fatty acids. But choose carefully to avoid consuming harmful contaminants like mercury and dioxins. Avoid fish from the North Sea, large predator or deepwater fish like tuna and swordfish, and farmed fish.
Eat legumes, such as well-cooked (several hours or more) lentils and kidney beans.
Ditch homogenized or low-fat dairy.
Avoid all hydrogenated margarine and hydrogenated oils, but don’t limit saturated fats.
Eat organic eggs liberally. They’re among the richest sources of antioxidants, which protect against heart disease.
Drink red wine in moderation—one or two glasses a day seems to be protective (but avoid, of course, if you’re pregnant).
Drink green tea, which has several heart-protecting effects.
Nutritional supplements can play an important role in heart health. Here’s a quick guide to what to take daily alongside a healthy diet:
A good-quality multivitamin/mineral supplement produced by a reputable manufacturer
B vitamins—all are important, but especially these:
Antioxidant vitamins:
Minerals:
Coenzyme Q10, 60–100 mg or more with supervision
L-carnitine, 250–750 mg
L-theanine, 400 mg
Vitamin D made in the body by exposing your skin to the sun for about 15 minutes early in the day without sunscreen, or 600–1,000 IU (minimum) as a supplement
A high-quality probiotic supplement (follow the label instructions)
Omega-3 fatty acids, such as fish or flaxseed oils, 1,000–1,500 mg
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