I don't fully understand your post. What article are you quoting? Are they suggesting most fatal heart attacks occur at areas of the arteries with 20% blockage?
Stress tests probably don't show wave changes in blockages of less than 50%. For a stress test to show a blockage, it has to show a reduction in the hearts need for blood flow. Often a major heart artery branch is blocked as much as 100% but collateral arteries have picked up the load, so a stress test might not be completely accurate as to what is really happening.
You didn't explain what tests you have had. I'm guessing you had a calcium scoring test, I have no idea how this relates to a stress test.
EKG's, calcium scoring tests and stress tests are indicators, as I understand it. There are more accurate tests, such as an angioplasty that will give you a great deal more information.
Could you post back and let us know what tests you had and the name of the study you are quoting?
Keep us informed.
Calcium scoring can be misleading too. The problem is, it only detects calcium, in other words, calcified plaque. You could have 80-90% of your plaque which is soft (vulnerable) and has not yet calcified. In some ethnic groups, uncalcified plaque makes up a very high proportion of their disease, yet a calcium score very low specifies them as low risk. I do believe they have attempted to use different tables per ethnic group, but a calcium score of zero still really proves nothing except you don't have a specific lesion type.
The risks can be lowered as you probably know, by making lifestyle changes. Avoiding stress, not smoking, healthy diet of fruit, veg and nuts etc, exercising, regular cholesterol level checks and taking an anticoagulant medication such as aspirin.
As you have mostly calcified plaque, the progression is generally slow as it builds up (IF it does), and you will develop symptoms as warning usually well before a life threatening event. I had warnings for a whole year before my first MI, but Doctors misdiagnosed it as a stomach disorder. My second MI I felt symptoms three months prior but Doctors kept telling me it wasn't my heart. My Cardiologist and regular Doctor have now sworn to me that they will listen when I say I have symptoms of heart problems. I obviously have learned what they feel like and recognise them well in advance.
The article is from Wikipedia, search for "Atheroma". Ok, apart from the CT scan for the Calcium Score, I had ECG, Echocardiogram, Ultrasound of carotid arteries and Nuclear Stress test. I know that the Calcium Score is misleading, that's why nobody can tell me how far my LAD is blocked. But this is not really a question about myself, I did what I did because of the high Calcium Score and I did that because I have high Cholesterol and the doctor kept insisteing (and still does) for me to take Statins. What I am saying, though, is that reading that article - and again I have to stress the point that I don't have angina - all these tests seem to be a waste of time if most males (65%) have a heart event and don't even know what hit them. Again, assuming with less than 50% narrowing lumen you don't generally have angina.
My struggle with your post is the percentages that are stated. Yes, it is true that 65% of males don't have symptoms before a heart attack, but what you don't know is what state their health was in before the heart attack. You don't know if they were smokers, had high BP, high cholesterol, family histories or what. They may have been heart attacks waiting to happen.
When you are only looking at the males that had heart attacks, that's not a proper control group to compare the rest of the general public, including yourself, with. Each case is different, and there are many mechanisms for heart attacks. That is far too general of a statement for me to use to make a decision about my future treatment.
I Hope everything works out for you.
Erijon brings up a very interesting fact, heart attacks come from a number of reasons. Erijon is the Moderator of the Cholesterol forum on the Medhelp site and has a lot of experience and done a lot of research. I'll add this, if you have high cholesterol scores, you have a definite risk factor for a heart attack. This is especially true if you smoke, are inactive, have low HDL levels and high Triglicerides, have a stressful lifestyle, etc. By having the tests, you have established a baseline that can be used in the future should you experience problems.