Heart health:Heads up

[rijaca]

Jon,

I had a heart attack on June 6, 2006 (age 49). Angioplasty on two arteries (left descending and left circumflex), and two stents implanted. By Labor Day weekend in 2006, I was hiking 13ers again without issues. Exercise, diet, and statins and I haven't looked back. You'll be back too!

[rmcpherson]

Glad to hear you are expected to make a full recovery, Jon! It was great meeting you at the CMC trad climbing class this summer!

For anyone concerned about their risk levels, a Coronary CT calcium scan is an inexpensive diagnostic tool for understanding severity of coronary artery disease, the most common cause of myocardial infarction. Talk to your doctor, obviously, but most will approve the test if there are any risk factors.

[DaveLanders]

For anyone concerned about their risk levels, a Coronary CT calcium scan is an inexpensive diagnostic tool for understanding severity of coronary artery disease, the most common cause of myocardial infarction. Talk to your doctor, obviously, but most will approve the test if there are any risk factors.

+1

I had this test done and one of my arteries had a very high score. My doctor immediately put me on a statin to reduce the risk of the plaque breaking loose and causing a heart attack. Unfortunately, I was told that there's nothing I can do to get rid of the plaque that has already formed.

[Jorts]

There are people who are genetically predisposed to high cholesterol irrespective of diet, but aside from those individuals, cholesterol can be managed with diet to prevent and reduce (not cure) arterial plaque buildup. The old wisdom was you could put whatever you wanted in your body as long as you're active. The new wisdom: diet's important regardless of activity level. An anecdotal case is Bill Clinton. He used to be a fast food junky who looked like he was knocking on death's door. Since leaving office, he's become a vegan and now looks healthier than he did in the late 1990s.

https://my.clevelandclinic.org/health/a ... rition-tlc

[randalmartin]

I have a family history of heart attacks killing my Father, Uncles in their 60s/70s. A few years ago I gave up relying on my Cardiologist giving me good advice about my heart. I started going to a Functional Doctor. Transformative. The key information for me was learning that it isn't cholesterol we need to worry about it's Triglycerides. I have eliminated as much starch and sugar from my diet as practical. Effectively a Low Carb (i.e., High Protein/High Fat diet (good fats like Olive and Avocado Oil)) for me was the key to getting my triglyceride down and overall doing much better. For some their genetics may give advantages that don't require such significant dietary changes.

The medical establishment do NOT understand the real nutritional impacts to health. Even a lot of "Nutritionist" do not. Too many doctors and nutrionists are stuck on an old understanding based on the food pyramid.

I am currently reading the book Metabolical. Highly recommend if you want to understand just how compromised our medical establishment has been. This isn't some conspiracy theory it is understanding the compromise that Big Pharma and Food Industry have on our medical institutions and including medical schools.

[Jorts]

Careful with the low carb stuff. There’s a lot of dogma surrounding it. Highly processed food is bad and often full of carbs. But blanket statements about carbs being the enemy are just throwing out the baby with the bathwater. If you’re active you need carbs for performance. And fat. And protein.

https://www.acc.org/About-ACC/Press-Rel ... igher-Risk

[randalmartin]

Not saying that carbs are the enemy, more focused around starch and sugar. Vegetables are great.

[Jon Frohlich]

+1

I had this test done and one of my arteries had a very high score. My doctor immediately put me on a statin to reduce the risk of the plaque breaking loose and causing a heart attack. Unfortunately, I was told that there's nothing I can do to get rid of the plaque that has already formed.

To add to this for those that don't know (I certainly didn't) statins don't only reduce cholesterol but they stabilize and calcify the existing plaque. Which might actually make your calcium score go up.

Basically the calcium score needs some context depending on your medication and your situation. Calcified plaque is better than plaque that decides to move and kill you.

If you're wondering in the hospital my values were -

Cholesterol: 185
Triglycerides: 89
LDL: 123
HDL: 44

Not great. Not horrible.

[supranihilest]

I feel compelled to share my own experience now that I've had one similar to Jon's (and ironically was with him when his was happening, then had my own within weeks).

Last night I was admitted to the hospital with excruciating left chest pain, like someone was stabbing me between the ribs and wrenching the knife around. It started off mild and bearable for about 36 hours when it just blew up on me. I also had shoulder pain, chills, a fever, and shortness of breath with painful breathing throughout most of this. My first thought, and most reading this? Heart attack. I tried driving myself to the hospital and only made it a few miles before the pain got so bad I couldn't focus on the road and I pulled over to call an ambulance.

At the hospital they ran a number of tests and took an x-ray which showed a significant pleural effusion (fluid buildup between the lungs and chest wall) over the bottom of my left lung. An additional blood test for d-dimer was taken and was extremely high, nearly 8x the top of the normal range. D-dimer tests for specific proteins caused by blood clot breakdown. This led to a CT scan, which showed not a heart attack but multiple pulmonary embolisms (blood clots) in both of my lungs. I was given IV Tylenol and one dose of a blood thinner, then monitored overnight. In the morning I was discharged and prescribed more blood thinners.

The exact details of both of our experiences are different but share some similarities, probably the biggest being that both were caused by clots blocking major arteries, his the left anterior descending artery and mine the pulmonary artery. Both can cause severe damage to the heart or lungs, respectively, and can lead to death. I think we both got very lucky. Being aware of these things can help when minutes or hours might be the difference between survival and dying.

The point of my story is that if it can happen to Jon, if it can happen to me, then it can happen to anyone. That's not meant to be a scary statement, but one of awareness. I'm 38 and fit, Jon is 48 and fit. If it can happen to us, it can happen to anyone. We will be OK because we dealt with it immediately. I think awareness of such health problems, especially in otherwise healthy individuals, is vital. Know the signs and symptoms. Know when to go to the ER. Don't try to fight severe chest pain especially. Going in immediately saved both of our lives.

[SkaredShtles]

Yeesh. ++vibes to all of you experiencing these events. Sounds suboptimal, for sure.

[two lunches]

GREAT GOOGLY MOOGLY BEN. i think the lesson is you both need to stay off the dinky 7ers, 8ers, 9ers, etc…

but in all seriousness i’m so happy you’re here to write this post and joke about winter sufferfests. take it easy!!

[onebyone]

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)

This doesn't surprise me at all. I can easily see how too much exercise can have adverse effects. Personally I think the key to longevity is sleep, maintaining a good weight, don't smoke and keep drinking to a minimum, keep moving, moderate exercise but getting the heart rate up a few times a week. Get a blood test once a year- who knows what they might find in early treatable states. The biggest factor is simply genes but all the aforementioned can lessen the effects of bad genes or enhance good genes.
I also did a heart scan 5 years ago. Scored 0's across the board. It doesn't mean I won;t have a heart attack but it does rule out that I'm a walking time bomb with a 75% blocked artery having no clue.
Now excuse me while I go grab a stack of chocolate chip cookies and a glass of milk..