Haider Warraich is a cardiologist at Duke University Medical Center in Durham, North Carolina. His medical training began in his native Pakistan, and this autumn he will join the faculty of Brigham and Women’s hospital at Harvard Medical School and the VA Boston (Department of Veterans Affairs medical facilities). In his book State of the Heart, he looks at the history, science and future of cardiac disease, and argues that it has become an overlooked condition.

People are more likely to survive a heart attack today, but heart disease is still the biggest killer worldwide. Why is that?

In the last few decades we’ve changed a heart attack from an almost certainly fatal diagnosis to one the vast majority of patients can recover from. However, those advances mean people live long enough that they develop other conditions, including heart failure, which is a chronic condition in which the heart is unable to get blood to the entire body.

What kills people today is chronic disease. Unless we change our health system to focus on chronic diseases, and have contact with patients throughout their lives rather than just waiting for them to get sicker, we’re going to keep having this disconnect.

What’s the biggest advance in heart health you think has gone unnoticed?

Until recently, open heart surgery was the only way that you would treat a condition called aortic stenosis. The aortic valve is the last valve in the heart that blood has to flow through to be able to get to the rest of the body. As we get older, it starts to thicken and harden. That increases the amount of pressure the heart has to beat against to force blood into the body, and can cause a lot of strain on the heart.

People have anticipated that we will be transhuman. Patients who have had LVADs fitted are a living example of that

But the last decade has seen the development of a new procedure called transcatheter aortic valve replacement (TAVR). Cardiologists are able to replace the valve through a minimally invasive procedure. They insert this valve through the veins in your leg and snake it up all the way to your heart. Recently Mick Jagger got this procedure done and just days after he was back touring, he was dancing – you would have no idea that he’d had this performed.

You suggest that one reason people don’t take heart disease seriously is because they think that when someone gets heart disease it’s their own fault. How much does diet feed into our heart health?

For many patients it’s not something they have any control over. For example, if a woman who gave birth develops postpartum cardiomyopathy, there’s nothing she could have done to avoid it.

At the same time, there’s a lot of heart disease for which you can reduce the risk by instituting lifestyle changes. We do everything in our modern lifestyle to hurt the heart: there’s very little aerobic exercise in our daily routines, the food we eat is highly processed, the salt we consume is so much more than we need, and there’s so much stress we experience. It seems like every fact of life has been designed to add fuel to this fire.

What action do you take in your own life to maintain a healthy heart?

One thing I try to do is run maybe once or twice a week, although I could probably do more. The diet we have the best evidence for is probably the Mediterranean diet, so I use a lot more olive oil, nuts and healthy fats. That’s something that I changed based on my reading of the evidence.

But one important factor as far as my risk is concerned is that I’m a south Asian male, and south Asians are at an incredibly high risk for heart disease. That really hasn’t been recognised much until recently.

Research has linked endurance sports with an increased risk of atrial fibrillation (AFib), a type of irregular heartbeat that 1 million people in the UK live with. Is there a chance that too much exercise could actually be bad for our hearts?

What we have seen is that it’s mostly a J-shaped curve: very little exercise is bad, and there’s some evidence that there is such a thing as too much exercise. But I’ve rarely ever been in a situation where I’ve asked a patient to reduce the amount of exercise they do. Our challenge is really trying to get people to exercise as much as possible. The benefits of exercise are so widespread.

Rich people can afford healthy lifestyles. Heart disease could transform from a medical ailment to an economic one

Do you think totally artificial hearts will ever become a reality?

I think they could. But right now we have done better with a mechanical pump sewn into the heart, called a left ventricular assist device (LVAD). These patients’ experiences are unlike any other human beings who have ever lived. Most of them don’t have a pulse. Listening to their chest, you actually hear the pump running. If they run out of batteries, they could die, sometimes instantaneously. But they also represent the dawn of a new age. People have always anticipated that one day, we will be transhuman, but that time has already arrived. Patients who have LVADs, who there are tens of thousands of around the world, are a living example of that.

Heart attacks are often missed in women because they look different from those in men. What can we do to fix that?

One false belief that still persists for many is that heart disease is a man’s disease. Women can have later onset of heart disease than men because they do get some protection from female hormones, but really, if you look at the entire span of life, heart disease kills as many women as it does men.

Not only do a lot of women not pay attention to their hearts, this is also true of clinicians. A lot of times we incorrectly think that women with heart disease may have something else going on. We’re better than where we were a few years ago but there’s still a long way to go.

Do you foresee a future in which we all wear a heart monitor that will report to our doctors when something irregular starts happening?

The Apple Watch already gets similar information, and there are other devices that are even better at assessing the heart – so this is not just something that’s going to happen in the future, it’s being vigorously studied now. To me what this represents is the democratisation of the EKG [electrocardiogram]. I think it’s going to be very good for many patients. But I also worry it may create a lot of false alarm.

The other thing this highlights is that heart disease is increasingly becoming a disease of socially disadvantaged people. People who are affluent can afford lifestyles that are healthy, healthier food and access to technologies that can monitor their own health. Heart disease could transform from a medical ailment to an economic ailment, in which just having heart disease becomes a synonym for poverty.

Can you die from a broken heart?

It’s possible – but you’d be surprised by what breaks people’s hearts. This is a condition called Takotsubo cardiomyopathy, first reported by Japanese cardiologists who were seeing a lot of mostly elderly women coming in after emotional traumas with very weak hearts. The mortality from this condition is the same as that from a heart attack, so it needs to be taken seriously.

People traditionally thought that Takotsubo occurred after something like a divorce or the death of a loved one. But any type of emotional overload can increase the risk – even joy. Studies are showing that the most common cause of the syndrome is actually work-related stress. This goes to a wider arc borne out by the data, which is that work-related stress is really one of the drivers of this ongoing epidemic of heart disease.

What do you think the next big medical advance will be when it comes to our hearts?

We already have so many medications that can help you live longer and better. The question is, how can we make sure that all the patients who would benefit from them actually get them and take them? So many patients with high cholesterol are not taking any cholesterol medications. So many patients with heart failure could benefit from simple medications, yet they’re not taking them.

What might define the next few decades is not a breakthrough technology, but thinking about how we can get the advances we already have to patients, not just in the UK or the US, but around the world in places like China, Pakistan and India.

• State of the Heart by Haider Warraich is published be Ingram International (£29.99). To order a copy go to guardianbookshop.com. Free UK p&p on all online orders over £15