Heart health:Heads up

[TomPierce]

Apologies if this has already been posted, but I didn't see anything:

Jon's recent TR did a great job raising awareness about possibly lurking heart issues among our community. I suspect too many think that because they are active in the mountains they are immune to such issues. But some may be aware that Simone Moro, an uber high altitude athlete, recently had to be evacuated from a training climb in Nepal due to a heart attack. A very sobering reminder that super fitness does not necessarily insulate you from heart maladies. Here's a good link about the event, worth a look:

https://explorersweb.com/simone-moro-up ... condition/

-Tom

[jfm3]

I had a bout with heart problems in 2017-2018. I developed atrial tachycardia and arrhythmia that was eventually fixed with several ablations of the heart muscle inside both of my atrial chambers. I had to have 2 different surgeries- the first one was unsuccessful, and I used an anti-arrhythmic medicine for a year before the second, successful surgery. I was 22 at the time and the condition developed over a few months. Since the second surgery I haven't had any problems. EKG and ultrasound monitoring with a cardiologist, regular heart rate monitor use during training and physiology testing can all be used to monitor heart health. Elite athletes can sometimes be MORE susceptible to heart problems because of conditions like hypertrophic cardiomyopathy.

[Dave B]

Exercise has a well documented U-shaped curve for benefits. Improved health and benefits to a point, then a sharp inflection into dangerous territory. This graph is stylized but, to me, indicates that inflection could come unexpectedly but rapid.

[justiner]

Exercise has a well documented U-shaped curve for benefits. Improved health and benefits to a point, then a sharp inflection into dangerous territory. This graph is stylized but, to me, indicates that inflection could come unexpectedly but rapid.

I think language is very important here. The research paper you linked does not come to that same ("well documented") conclusion. It does say,

There are emerging data that suggest a U-shaped relation-
ship between exercise intensity and adverse cardiovascular
events; moderate exercise is better than no exercise, but
vigorous exercise may be harmful in some individuals

(emphasis mine)

I think calling that graph stylized is being generous; it shouldn't even be labeled on the x axis, as there is no evidence to correlate the data from the meta analysis with any findings to be graphed -- n is just too small.

The Copenhagen City Heart Study is a very interesting cohort study, but I would come to the same conclusion as the author of the paper you linked,

Perhaps we should be
prepared to accept that too much of a good thing, in the form
of chronic intense exercise, may foster abnormal changes in a
previously normal heart, but before we are accused of scare-
mongering or generating anxiety, we believe larger studies
are necessary to address the prevalence and pathophysiology
of such changes, as well as their long-term outcome.

I don't know how you would do that, except with studies similar to the Copenhagen City Heart Study. (You can't just have people exercise until they die)

Corollary to that, this is actually something I am personally worried about, as I have a related comorbidity: sleep apnea, which means my heart doesn't get much rest after exercise, when I do go to sleep. This I very much feel could lead to a sudden heart attack. Much like it's probably best to get drinking under control, getting apena symptons handled could probably help me live a longer life. (apnea generally gets worst at altitude)

[cottonmountaineering]

Apologies if this has already been posted, but I didn't see anything:

Jon's recent TR did a great job raising awareness about possibly lurking heart issues among our community. I suspect too many think that because they are active in the mountains they are immune to such issues. But some may be aware that Simone Moro, an uber high altitude athlete, recently had to be evacuated from a training climb in Nepal due to a heart attack. A very sobering reminder that super fitness does not necessarily insulate you from heart maladies. Here's a good link about the event, worth a look:

https://explorersweb.com/simone-moro-up ... condition/

-Tom

Simone Moro is nearly 60, it is quite dangerous to be high altitude mountaineering at that age due to risk of heart attack/stroke. Not sure what it has to do with this community though since we are not at high altitude/geriatrics for the most part.

[Dave B]

I think language is very important here. The research paper you linked does not come to that same ("well documented") conclusion. It does say,

There are emerging data that suggest a U-shaped relation-
ship between exercise intensity and adverse cardiovascular
events; moderate exercise is better than no exercise, but
vigorous exercise may be harmful in some individuals

(emphasis mine)

I imagine this is typical language in the field when reporting findings from observational or meta-analysis studies as one can't truly define causation without proper experimental design such as randomized controlled trials. Such trials with risk of death are a bit unethical so observational studies (and cohorts) predominate but are interpreted more cautiously (although there's a whole world of uncertainty with statistical analyses even in gold-standard analyses). To me, this reads as the authors being careful with reporting findings rather than emphasizing the modifiers in the sentence.

While I'll agree that "well-documented" might be a bit too strong, these shapes of curves are common in biological functioning and are common in other organisms and even at ecosystem to global scales. For example, plants need water, but too much will starve their roots of needed oxygen. Sufficient phosphorous leads to enhanced growth, too much can reduce growth, cause death, or a host of other issues when allowed to accumulate. In humans, there's a similar U-shaped curve for sleep, with 7 hours being ideal and adverse events increasing in either direction. So, I don't think it's too unexpected a similar curve exists for exercise, it's just a hard one to accept as exercise is never taught as having the potential to be harmful.

[justiner]

it's just a hard one to accept as exercise is never taught as having the potential to be harmful.

That's not true either. For example, "running" and "injury" are basically synonymous. Overtraining Syndrome. Strains and pulls while weight lifting. Golfer's elbow. But these aren't so much deadly, which is what the hypothesis for endurance training in your 40's and beyond is talking about.

I wish there was more reported on the deaths of the individuals in this analysis and what, if any, comorbidities were found.

The METS being reported as causing death isn't really all that high. We're talking the training load of a ~4hr marathon runner, not top ten at UTMB. One would think marathon races would be killing fields. Over 4,000 people aged 60 or over ran the New York City Marathon this year.

[mtree]

As with many of these types of "studies" the population involved is highly skewed. There are many other factors to consider (although I did not read the article) which may be related to cause and effect. Kinda like driving a car. The more you drive the more likely you're involved in a wreck. This is how myths are created.

[RhodoRose]

[/quote]
Simone Moro is nearly 60, it is quite dangerous to be high altitude mountaineering at that age due to risk of heart attack/stroke. Not sure what it has to do with this community though since we are not at high altitude/geriatrics for the most part.
[/quote]

Eh!? 60 is the new 40! or maybe 35!

[Jon Frohlich]

Tom, thanks for posting this.

I'm 48 and I really had no clue any of this was coming prior to my heart attack. If I hadn't been exercising would the plaque have ever broken off and caused an attack? Who knows and really doesn't matter at this point. So yes it can happen to anyone. I guess the only advice I have is listen to your body and get yourself to the doctor/ER if something isn't right. Don't ignore symptoms.

My prognosis is good and in theory I will more or less fully recover but it easily could have been death instead. Numerous others in my situation didn't make it. Take your health seriously.

Happy to talk to anyone if they want who's going through something like this. The mental aspect is worse than the physical. I've been talking to a therapist and after this it really clarifies what's important to you in life and what your priorities need to be. Those first few high peaks next spring/summer are going to be tough mentally but I will be back. I'm not letting it stop me.

Simone Moro is nearly 60, it is quite dangerous to be high altitude mountaineering at that age due to risk of heart attack/stroke. Not sure what it has to do with this community though since we are not at high altitude/geriatrics for the most part.

As I said above I'm still in my 40s and it happened to me. And I know of stories of athletes even younger. Undiagnosed heart trouble can hit any of us.

[Bale]

Conrad Anker had a heart attack in the Himalaya at 54. Scary stuff, but these are exceptions. Idk how high altitude factors into this case, but I wouldn’t stop exercising/ climbing. Glad you are ok Jon!

[Rick Canter]

People on this forum include people who are 60+, and also start from sea level. You should assume that some of us are exposed to large changes (12,000'+) in altitude when hiking in Colorado. I am grateful for the dialogue, being aware of risks is part of the solution, but I think we have to agree that part of it is luck.