Doctor: Fitness is a fallacy in heart attack risk
July 11, 2006
It’s every aging baby boomer’s nightmare: You know a physically fit person who was riding a bike or jogging along when BAM! – a heart attack strikes and tragically claims their life.In the fitness-crazed Roaring Fork Valley, many people typically feel invincible, or at least confident that their level of exercise will fend off problems like heart disease.”I hear it all the time – ‘I can’t possibly have something wrong with me. I hike the [Highland] Bowl twice a day every day in the winter or I ride my bike up Independence Pass or I ride my bike up Smuggler,'” said Dr. Gordon Gerson, the cardiologist at Aspen Valley Hospital. “This is wrong.”Gerson recalled the famous author of the Complete Book of Running, who died of a heart attack at 52.”That was Jim Fixx’s theory: If you could run a marathon you couldn’t die of a heart attack. He disproved that one 30 years ago.”
Closer to home, many people were shocked – and probably unnerved – when T. Peter Craven, a popular judge in the 9th Judicial District, died of a heart attack last month while riding his bike in Aspen.While heart attacks snatch life in an instant, the conditions that lead to them usually build up for years. That means they can be detected and treated. Gerson said there is no magic formula for when a person should take a specific test for heart disease, unlike the recommendation for most people to get colon tests starting at age 50. Broad, sweeping generalizations don’t work, he said. Instead, individuals should work with their doctors to look at the presence or absence of risk factors and determine how aggressively they should test.Gerson recommends testing all children for cholesterol levels, simply because soft plaque that leads to heart attacks can start at such a young age. High cholesterol levels can be connected to the accumulation of plaque.By age 35, people should have their cholesterol levels tested no less often than every five years, he said. Over age 35, the test should be performed no less than every two years.Gerson uses two initial screenings to gauge the heart health of patients with high risk factors – such as high cholesterol combined with something like lack of exercise and a family history of heart attacks.One test is a coronary calcium screening. A CT scan helps assess the level of calcium present in the coronary arteries, an indicator of whether plaque buildup is advanced or potentially still coming. (Ironically, an artery can be 80 percent blocked by calcified plaque that poses no threat of rupturing and causing a cardiac event, while 10 percent blockage by soft plaque can pose a fatal threat, Gerson said.)
Gerson also uses a stress test with nuclear dye. A patient is injected with the dye and placed on a treadmill for exercise. The path of the dye indicates whether there are blockages that can affect the heart.Although it seems simple to be aware of your cholesterol level, examine your risk factors with a doctor and undertake further screenings if necessary, it isn’t always done. Numerous people go about their lives with undetected levels of plaque.”There are plenty of people out for a jog today in Aspen who probably have a blockage in their heart’s artery greater than 50 percent, but it can also be 10 percent,” Gerson said. “Whatever day for whatever reason, the bad luck of that day, that plaque decides to rupture. When it ruptures a clot forms and that artery is sealed off. So if the muscle downstream is unhappy, you go into an abnormal heart rhythm and you’re having a cardiac arrest.”Gerson compared those initial screenings for plaque to locating and fixing problems with plumbing in a house.”You’d rather find out that pipe in your house is getting clogged before it bursts, rather than after it floods your basement,” he said. “Well, this one’s worse, because when you have a heart attack, 30 percent of the time you’re not going to make it to the hospital alive.””Heart attack” in that context means myocardial infarction. That’s when the artery supplying blood to the heart muscle gets blocked. That causes tissue death in the heart.
Myocardial infarction can lead to an abnormal heart rhythm that doesn’t allow effective pumping of blood. That’s called cardiac arrest. Only 10 percent of people who suffer cardiac arrest make it to a hospital alive, Gerson said.So, it’s easy to see why Gerson and the medical world focus on prevention. Statin drugs and ACE inhibitors were proven effective in the 1990s for treating high cholesterol.”It’s hard to get people to subscribe to [taking the drugs] a lot of times,” Gerson said. “Especially in a healthy population like this, they have a built-in adversity to wanting to take a drug. Now, it’s funny that they don’t have a built-in adversity to wanting to take a vitamin pill. In my opinion, anything you put in pill form into your mouth to affect your health is a drug.”As Aspen’s baby boomers age and medical issues such as heart attacks become more of a threat to them, he expects treatment with drugs to be more acceptable – and he guarantees good results.”I think I’d be a fool to say heart attacks are 100 percent preventable today but, boy, we’re getting awfully close,” Gerson said.Scott Condon’s e-mail address is firstname.lastname@example.org.