I used to be a Nurse assistant and I thought this book was very informative. I learned a lot that I can take back to my practice and share with my patients. I would definitely recommend this to friends, family, and patients suffering from heart disease. Thank you to NetGalley and St, Martins Press for the advanced copy. All opinions are my own.

State of the Heart by cardiologist Dr. Haider Warraich explores the history, science, and future of cardiac disease..
Dr. Warraich weaves the heart’s story with threads of medical history, explanations of basic cardiac anatomy and physiology, and stories about real patients he has treated for a variety of heart conditions. Dr. Haider reports that 59% of COVID-19 patients who died had heart damage vs. only 1% of survivors, reminding us that heart disease is still the No. 1 cause of death in the U.S.

A really well-written account on the state and history of cardiology from a clearly competent author. There is a great balance of in-depth information and curious anecdotes without falling too much towards either side, which is always difficult in pop-sci books as the knowledge of the audience will vary. But even for readers who are not 100% interested in medicine or cardiology in particular, the convincing readability of the book still makes it a recommended read for most.

“More people die of heart disease than any other disease in the world, including even cancer. In fact, deaths from heart disease are on the rise around the world and in the United States as well. … In the United States, heart failure is the most common reason for admission to the hospital. … Yet, in many ways, heart failure is a disease few know about and fewer still understand. … Heart disease, in many ways, is the overlooked affliction of our times.”

At the same time, writes physician and clinical researcher Haider Warraich, “funding for research for heart disease and development of new innovations for heart disease continues to lag behind other diseases such as cancer. Fewer therapies are in development for heart disease today than before. This is driven by many thinking of heart disease as a battle that has already been won,” so vital funding is going to other diseases that claim far fewer lives.

And while there are some newer treatments for heart problems, including interventions such as using LVADs not just as bridges to transplantation but as longer-term “destination therapy,” Warraich emphasizes multiple times in State of the Heart that it’s the tried-and-true, “not-sexy” medications and lifestyle habits that make the most difference for the most people. Statins, for instance, he writes, are practically a miracle drug, with their benefits being “quite substantial and consistent. …Statins are so effective that no medication since their development thirty years ago has so far been shown to be better than they are.” What’s more, most are now available in generic form, so they are available at lower prices that are affordable for many people.

Warraich gives readers an overview of how the heart and its functions were viewed in the distant and more recent past; how treatments have evolved, especially in the past century and most recent few decades; how much can be done with not just proven medications and interventions but with some of the latest treatments to extend lives (and improve quality of life even as patients live with a diagnosis of heart disease), and how there are still new advances around the corner. He uses very brief anecdotes about patients he has treated and doctors and researchers who have contributed to the science we now use regularly. I often felt that those anecdotes were too brief; he used the information to make his point and then moved along very quickly. The book is scholarly but still approachable and on a level that many readers can understand, but it might benefit from more fleshed-out stories of some of these many individuals who must live with heart disease in its various forms.

Last year, I read Heart: A History, which was similar in topic, obviously, but focused on different aspects of the medical treatment of the heart and how we can all do better to take care of our hearts. That was fascinating; State of the Heart wasn’t quite as engaging, but I still found it interesting and important reading. I have to say that, if nothing else, I was left with the conviction that when my doctor suggests I take a statin, I’ll agree to do so. I also heartily agreed with Warraich’s conclusions that doctors have to be able to connect better and build relationships with patients so that patients will trust their medical providers enough to follow their recommendations. I don’t know how much our current health care system will allow that to change in its current setup, but it’s certainly an important observation.

The statistics are sobering, the outcomes can be grim and despite the fact that amazing advances in medical procedures and medicines have been made in the past 50 years, many of us will fall victim to heart disease. Dr. Warraich takes us through the history of the specialty from the days when doctors who treated pharaohs deduced that people who suddenly clutched their chests and complained of pain weren’t likely to have a good outcome to the days (not all that long ago) when cardiologists scoffed at the notion that high blood pressure was a bad thing.

Other chapters talk about the role of inflammation in forming the plaques that narrow blood vessels (which does turn into an ad for statins), the wonderful inventions such as ECG which give doctors an immediate “view” of what the heart is doing and LAVDs that allow people with weakened hearts to hang on while waiting for a transplant and the reality that sometimes all the gee-whiz gadgetry and interventions done during the last months of life only end up adding to a patient’s suffering. Chapter 8 which covers how heart disease is different in women ought to be read by every woman and every woman’s doctor.

There are some parts that drone on a little too much (the discussion of p values in research papers) and Dr. Warraich is passionate about statins and vaccines. The discussions of patient cases was the most interesting to me while the frequent discourses off the beaten path were informative but ultimately served only to distract me from those. But he manages to discuss just about everything in a way that is neither too medically elevated nor too dumbed down while adding twists of humor along the way. It’s not quite riveting but I’m glad I read it. B-

Wow! Fascinating book! When I started it, I wondered how interesting a whole book about the heart, written by a cardiologist, could be. How much was there to say about the heart that ordinary people could understand, much less enjoy reading? Well, I couldn’t have been more wrong. I was engrossed in this from start to finish and felt disappointed when I realized it was ending.
I expected to have to skim over parts where it became too technical, or to find some parts dry, but this too was dead wrong. He was able to explain everything so clearly that it was easy to understand, and I have absolutely no medical background and am embarrassingly ignorant about human anatomy.

By telling vivid stories about a wide variety of unusual situations, he was able to keep me riveted. He starts with the history of cardiology, from the Pharoahs of Egypt and their treatments for heart disease, and on to the present day, with all the amazing medical advances of the recent years. He explains how the heart works, what heart failure is, what techniques are available or in development, how things go terribly wrong, or surprisingly right and what he foresees for the future.

He is from Pakistan and quite a good example of how immigrants enrich our country. He came here with very little, went to medical school, and through many years of hard work, developed skills that have saved thousands of lives. He has also written this educational and entertaining book, for which I thank him.

Very highly recommended.

Note: I received an advance copy of the ebook from the publisher in exchange for an honest review.

I am a Registered Nurse and I thought this book was very informative. I learned a lot that I can take back to my practice and share with my patients. I would definitely recommend this to friends, family, and patients suffering from heart disease. Thank you to NetGalley and St, Martins Press for the advanced copy. All opinions are my own.

Fascinating. This well written volume covers a lot of issues related to, well, the heart and it does it well. Divided into pointed chapters on individual topics, it's a good tour of a subject that is important to all of us and yet so often opaque because of the difficulty of conveying the information effectively to the lay audience. Warraich has wisely mixed up his text with anecdotes and variables that might make you go huh occasionally. Thanks to Netgalley for the ARC. A very good, accessible, and educational read.

I have a fairly strong family history of breast cancer, and I used to worry about it. My husband had been known to tell me "Don't be so concerned. You have a greater chance of dying of heart disease." That was never very reassuring and not exactly what I wanted to hear, but after reading State of the Heart, I can see that it might very well be the truth. But this book about the history, science, and future of cardiac disease is full of empowering information and knowledge, not scary statistics.

Dr. Warraich gives plenty of information and data, but it's all made more interesting with personal patient stories. I was especially interested in his explanations of atherosclerosis, the role of salt in blood pressure, and the role of hypertension in heart disease. The chapter on women, how heart disease affects them, and how their symptoms can differ markedly from men is something that I think almost every woman would benefit from reading. I found the book to be a wonderfully readable combination of research, data, and anecdotes. It was difficult to read at times as the reader is forced to face mortality, but a valuable and enjoyable read nonetheless.

Thank you to St. Martin's Press and NetGalley for providing me with a copy of the book.

A fascinating book which taught me a great deal about not only the inner workings of the heart but also the evolution of humanity's understanding of the heart. Through patient stories the author put a a human face to the complexities of heart disease. The advances in surgical techniques and advances in life saving devices have been staggering. I can only imagine what further advances there will be within the next decade and beyond.

The human heart is undergoing both scrutiny and transformation as it never has before. The steep learning curve is teaching us how hearts interact with other organs, how lifestyles and medicines affect it, and how the medical fraternity can mediate its weaknesses and failures. In State of the Heart, cardiologist Haider Warraich continues his documenting of the process.

It is a collection of anecdotes and rants, peppered with dips into history and controversy. He loves teasing a term or a fact, coming back to explain it only further down the page. There is a lot of detective work, with someone’s life at stake for a wrong deduction. Many, many times, Warraich explains that no one had ever seen this before, be it a symptom, a reading or a reaction. The experiences he relates are mostly his own. In one case, the patient died, but his artificial pump kept his blood circulating until Warraich called tech support and learned how to shut it off.

The life of a cardiologist is the other side of this:
“Being sick is like being given a new job that you didn’t ask for, didn’t want anything to do with, in fact. And now you are stuck with it. The moment you wake up, you swipe in until you fall asleep and you swipe out. There are no days off. Being sick is even worse when you have a chronic disease, like when you develop heart failure, because there is almost no chance you will get to have retirement party and ride off into the sunset. If anything, as you get older, chronic disease just gives you more work to do: more medications to take, more visits to the hospital, more limitations on your daily life, with a diminishing chance of a return to normalcy.”

The chapters are neatly divided into issues. They include history, cholesterol, meds, surgery, devices, women, cancer’s relation to cardio, transplants, and end of life. The meds chapter focuses not on benefits of individual drugs, but testing, placebos and studies. The chapter on devices tells the history of catheters, balloon angioplasty, stents and electronic implants. The stories include serendipity, dumb luck, pure accident, and arrogant persistence. Warraich goes into the failings and weaknesses of these devices, and the anatomy lesson they entail is most valuable.

Of particular interest to me was the chapter on women. Women manifest heart ailments differently than men. Their hormones protect them, but taking hormone replacements does no good whatsoever. Pregnancy and birth are stressful and traumatic, and the effects can linger for life. Doctors have long dismissed women’s cardiac issues, calling them cardiac neuroses. Male doctors tend not to believe their female patients. Instead, they believe their own misogynist stories that women don’t get heart attacks as much as men (they get more). They also suffer more depression and anxiety, the feeding grounds for heart ailments. Women are bigger deniers than men, postponing diagnosis and treatment due to family responsibilities, guilt, altruism and even vanity (I hadn’t even brushed my teeth – ugh – is a real excuse he cites). Cardiac issues kill far more women than breast cancer ever has. This chapter alone needs to be read out loud for all to hear.

At the other extreme is the chapter on cholesterol. Warraich explains it well enough, but the chapter turns into a commercial for statins. He finds nothing whatever to keep anyone from taking them for life. He presses this point continuously. He doesn’t address the scoring system, where good and bad cholesterol are lumped together and the total is always bad. Doesn’t matter if you have a great balance between HDL and LDL, the sum total is too high for the medical establishment. He doesn’t even say what good numbers would look like. The fact is the drugmakers are continually pushing to lower that threshold, so that essentially everyone in the world has too high a score all the time and should therefore take prescription statins every day for life. There is no medical basis for it, other than the current thinking is lower-is-better. We don’t really understand why the body produces LDL at all or what the optimum level might be. This is a major gap in the chapter, and makes me wonder what he has left out elsewhere.

Less newsworthy are the deleterious effects of modern life. Constant stress shows up in the heart. Bad food, lack of exercise and relaxation are life enders. People are 27% more likely to have a heart attack on their birthday than any other day. Stress is a major driver of obesity and overeating, major factors in heart disease. The human body has not evolved to keep up with constant stress. It still focuses on infection, and its solution to everything is inflammation. Inflammation means heart ailment, blocked circulation, weakened hearts and hearts out of control. ”I am here to tell you that inflammation is the central mechanism of atherosclerosis and that how we have evolved has led to more inflammation afflicting more people than any other disease in our times,” he says. Our labor-saving devices necessitate the invention of heart-saving devices. It may not be a great bargain.

The thing about cardiac death is that it is usually sudden, silent and painless. Warraich shows that heart interventions near death can prolong suffering and add extra, extreme pain. For example, electric assists (LVADs) are programmed to massively shock the heart if it falters, even if death is near. It is the equivalent of being dropkicked in the chest by a horse, Warraich says. Yet doctors rarely, if ever, inform patients they can have the device turned off. Some doctors don’t even know this themselves. Technology, as in so many areas, has taken off in its own direction, and left humanity behind.

State of the Heart is intense and both inspiring and massively uncomfortable. It could not be otherwise.

David Wineberg

As someone who works in a cardiology ward, this was right up my alley. Not exactly a scientific treatise, it is more an informative look into the present and future of heart disease, the number one cause of death in America. I know of a few people who could use this book.

State of the Heart is a extremely interesting book. The author has done a lot of research and the book is easy to understand. Too many people due of cardiac disease and this book gives a lot of good information.