I have yet to meet the guy or gal that smokes, eats fast food, hunkers down at home and remains a couch potato who stays as healthy as another guy or gal that exercises every day, stays connected to the community, eats a healthy diet rich in vegetables, lean protein, and whole grains, and stays on the necessary meds.

But healthy lifestyle choices aren’t exciting. The beneficial effects are so slow that their effect is barely noticeable.

On the other hand, the effects of a heart attack, or bypass surgery, or angioplasty? Now, that's something you notice.

Which is why the guy or gal who smokes, eats garbage, does nothing but fry their brain watching TV or TikTok or Instagram usually becomes a born-again health guru after their heart attack or bypass or angioplasty.

I went through puberty later than my classmates, and I can remember staring at the mirror and hoping desperately to see a sign — any sign — that I'd started my growth spurt. I don’t remember when I gave up, but sure enough, as soon as I did, it happened without me noticing. By the time I metamorphosed into a gangly six-foot three-inch, knob-kneed weed of a kid, I assumed I'd always been that way.

My point is, we tend not to give much credit to things we don't notice. And if we don't notice it, does it exist? Kind of like that proverbial tree falling in a forest.

Take, for example, coronary disease causing blockages in the big arteries of the heart. The angiogram shows this big, beautiful ribbon-like blood vessel that suddenly narrows to a pinch like a sausage link. My interventional cardiology colleagues are great at opening up those arteries with a stent, saving lives and alleviating symptoms. We’ve justifiably poured massive research dollars and technology into this type of coronary disease.

But in the last few years, we've been noticing that sometimes people with chest pain whose arteries — the ones big enough to see — are not blocked, are actually having blockages in the vessels we don't see — the microscopic ones. It used to be called “Syndrome X.” Now it’s called "ischemia with no occlusive coronary arteries" or INOCA. But just because we can’t see them doesn’t mean that they aren’t causing problems. For the longest time, we weren’t able to see germs like the plague, or malaria, or salmonella or COVID. But that eventually caught up to us. We are still at the relative beginning of the diagnosis and treatment of INOCA. We don’t even know how big of a problem it is. Out of sight, out of mind. I admit, the degree of our ignorance is unsettling.

Which brings me back to lifestyle changes. Eating right, daily exercise and keeping blood pressure controlled are the best way to prevent both types of coronary disease, and while their effects are too subtle to see on a quick Instagram or TikTok video, their benefits take a long lifetime to notice — which is kind of the point, isn't it?