‘Silent’ heart attacks happen just as often as those with symptoms, but they have a greater overall impact on the health of women and minorities.

The image of a man clutching his chest before hitting the ground in pain is quite possibly the quintessential image of someone having a heart attack.

However, that’s more of a theatrical version of a heart attack than a realistic one.

New research suggests that nearly half of all heart attacks show no symptoms, yet they can still increase a person’s chance of heart failure.

These “silent” heart attacks represent 45 percent of all heart attacks, yet affect different groups of people in different ways, according to a study appearing in the latest issue of Circulation, the journal of the American Heart Association.

Dr. Elsayed Soliman, the senior author of the study and director of the epidemiological cardiology research center at Wake Forest Baptist Medical Center in North Carolina, says these heart attacks that show no symptoms are just as common as those that do.

“Silent heart attacks are still heart attacks,” he told Healthline.

Read More: Seven Warning Signs of a Heart Attack »