RE: Sad News. Alberto Salazar heart attack

Bizarre - truly bizarre anecdotes. Makes me wonder about the validity of EKGs; I mean, they're only supposed to be 50% accuarate to begin with - at least that's what Doc Sheehan used to say. As the chief cardiologist at Riverview (?) in Red Bank, NJ, he pretty much neglected "diet" in his day-to-day life. Salazar is an eye-opener for all serious runners, no doubt. My cholesterol went from 170 to 223 over the last two years (along with a serious decrease in training), and I'm out to change that.

At what age should a male start getting tests done for cholestoral and various other things?

Absolutely GD right - denial is what brings about disaster.

there are many simple things one can do including diet (Pritikin is my fav), medication, change of career to reduce stress, etc. I made these changes because I saw what would be coming 10-15 yrs down the pike, as did my physician.

runners worry that BP and other meds will slow u down - they might. but the cost is well worth it.

All this discussion should raise the notion that running is supposed to be FUN. Not some neurotic pursuit of perfection. Its hard to have fun when you are dead. When you are 50, you cannot do SOME of the things you did when you were 25. there are, however MANY other things you can do at 50 (given your experience, resources, family & friends) that you could never accomplish at 25.

I am wishing AlSal the PERSON a quick recovery, not just AlSal the runner.

My last blood lipid panel showed hdl of 75, ldl of 140, triglyceride of 60 for a total cholesterol of 228. My physician freaked out and sent me to a cardiologist, who said my numbers were not high risk,(i am 50 years old) Does this warrant me pressuring my cardiologist for a stress ekg?

I suppose they are bizarre. I don't really know. They're just the experiences of someone (me) is his 50s who knows other men in their 50s. The EKG, of course, is simply a test, which has to be interpreted against a range of other data, including, for example, family history, as well as past tests (my current cardiologist always compares my yearly EKG against the previous year's one)--and it does seem as if the range of normal is fairly broad. Given what's being measured, I don't think this is too surprising. However, some tests are, indeed, more determinative than others. In my own case, I had an echo stress test, which turned out to give me a false positive, whereas thallium stress tests have always (I hope) been accurate. Nevertheless, up until recently, an angiogram has been the only gold standard, but now there are MDCT scans which apparently approximate (and by now maybe even equal) the exactitude of an angiogram, with the great advantage of being non-invasive.

Sodbuster wrote:

Bizarre - truly bizarre anecdotes. Makes me wonder about the validity of EKGs; I mean, they're only supposed to be 50% accuarate to begin with - at least that's what Doc Sheehan used to say. As the chief cardiologist at Riverview (?) in Red Bank, NJ, he pretty much neglected "diet" in his day-to-day life. Salazar is an eye-opener for all serious runners, no doubt. My cholesterol went from 170 to 223 over the last two years (along with a serious decrease in training), and I'm out to change that.

Thanks for putting it into perspective, Off the Grid. I know I needed the reminder.

let this be a lesson

that crap about "if the fire is hot enough .." complete nonsense - this is the perfect example.

Mike Lundgren wrote:

Exercise doesn't and cannot change a bad diet for the better. The higher the amount of saturated and trans fats consumed, the greater the risk for developing CAD (coronary artery disease). Think about it, would you continue to smoke cigarettes just because you used your lungs with running? So why would you pour garbage in with those fats? I should explain, sat'd and trans fats are PREFERENTIALLY converted to the bad form of cholesterol, LDL, by the liver. Those fats are the enemy to healthy arteries.

I was up with you until the lung part, poor analogy.

Your lungs have an ability to clear themselves out, so long as too much damage wasn't done. It takes something like 7 years of not smoking to clear a year of smoke damage. Running and keeping your lungs strong would definitely help with that and with keeping them 'clean'.

Symptoms are different for everyone, but a majority of people do have some, whether it is chest pressure and tightness and heaviness, or fullness and nausea, or jaw pressure or arm aches, or back aches, or fatigue and "just have not had it lately".

EKG's don't mean much by themselves without other data, obviously a change in them, as mentioned. A family history of heart disease with a personal history of smoking prior to being a runner, or family history of heart disease with a personal history of high cholesterol.

The AVERAGE heart attack occurs in someone with a cholesterol of 214! If there is a family history of CAD, your LDL's should be below 100!

This "when it's my time, it's my time attitude" is not for me, since that means "I won't take the responsibility to manage my own health, I would rather look at immediate gratifications, like a young child does". I enjoy a great variety of foods, and have found that there are few that are dangerous, unless in high amounts. Again, I suggest 15 to 20 grams/day of sat/trans fats at most. It's very hard to get less, though possible. I also am motivated by being able to run, today, tomorrow, and next year, and not have to face the business end of a surgeon's scapel, and that is what is often the choice by a "I am not going to just eat seeds and nuts" attitude. There's much more to learn and enjoy life with, without limiting ourselves that way.

"I have a friend who runs occasionally and bikes--he's in his early 50s. He calls me to tell me he has pain in his jaw when he begins to exercise."

That's interesting. I'll be 39 next week and I've been running about 25 miles per week for the last few years. I've been noting that lately (maybe every other day for the last month or two?) when I run at lunch (about 80-90 degrees) I've started to get a slight tightening? cramping? right dead on my sternum as I start my runs. It's not terrible, and it only lasts maybe a hundred yards or so but it's been really bugging me. I have no problems with my runs, nothing else out of the ordinary, and I've just never felt this before. I was kind of worried at first but then figured it was just maybe anxiety...or...gas.. the heat... or starting out too fast but then it happened on a slow start too... I don't know, but this thread is making me think I should go to the doctor. Probably nothing but now I'm paranoid...

jhr wrote:

The difference in lifespan between a distance runner and a sedentary person is only a few years. I read this in a study that was even published I think in Running Times..

When it is your time, it's your time...as awful as that thought is.

I for one am not gonna go out eating granola bars and hickory nuts.....after 30 years and 80000 miles...I'll have my transfatty fats and ice cream after a 20 miler on a Sunday..and Monday and probably Tuesday too.

I just really DREAD "my time" that's all-ha.

Are you taking into account the quality of lifestyle differences between an active runner and a sedentary person? Probably not.

What is more important to me than living a long life is living a quality life. I don't want to be 80 years old riding a scooter in the grocery store and carrying an oxygen tank. I want to be winning age group awards in the local 5Ks.

Mike, thanks for all your insight into this matter/issue. I can attest to "anything can happen to anyone" I had my "episode' last December during hard workouts. Experienced discomfort in my chest. After a couple of weeks of self diagnosis, I figured I better see someone that really went to med school. No high cholesterol, no family histoery, etc. Discovered high BP, and ultimately after stress echo and nuclear stress, a blocked artery. Late February underwent angioplasty and stent implantation. After 46 years of running, I was obviously shocked at all this. I'm back up to 55+ miles per week, and am headed from NM to NY to run the Boilermaker next Sunday. No expectations after almost 4 months off, but happy to be running. I think I know my body pretty well, and pay attention to it. You can never know it well enough, hopefully those on this board will pay attention to the wisdom you've imparted. Al's in his late 40's, I'm in my early 60's. Anybody, anytime, no guarantees. Don't be macho, watch your diet, take meds if necessary, and hopefully you can run a long time. Looking forward to a cold Saranac after Boilermaker.

Any updates from Oregon? I'm sure plenty of people would like to know.

I believe that your risk for disease decreases over 5 to 7 years for every year of smoking, but "clearing smoke damage" cannot occur. When permanent damage occurs to the lungs, it's irreversible. How long that takes to occur is individual. I have seen women with only 20 years of one pack per day habit with a diagnosis of emphysema or COPD, hence their measurable pulmonary function studies are below 80% of normal.

Bottom line, damage is damage, whether it's to an artery, to a lung, or to the heart muscle, and that means permanent. How much "risk reduction" occurs, whether it's of heart disease, lung cancer, or anything else, depends on accumulated risk.

The American Lung Assoc. has a nice review of the benefits of quitting smoking, and what occurs over 20 minutes, two days, one month, a year, five years, etc. Even that is still subject to the years of smoking history, and smoking is just one part of heart disease risk, which is what we'd been going over.

You make a good point in that there are benefits to quitting most of the time, unless you're on your deathbed.

Wednesday, March 8, 2006

Caffeine metabolism tied to heart attacks

By LEE BOWMAN

SCRIPPS HOWARD NEWS SERVICE

When it comes to coffee consumption and heart-attack risk, a new study suggests that what's important is how quickly your body breaks down caffeine.

Research on non-fatal heart-attack patients in Costa Rica between 1994 and 2004 found that those with a gene variant that causes them to slowly metabolize caffeine have about a third greater risk of having a heart attack when they drank two or three cups a day, and 64 percent increased odds if they had four or more cups a day, compared with those who drank less than one cup a day.

Similar consumption rates in people with a gene variant that causes them to process caffeine quickly actually reduced the odds of a heart attack by 22 percent and 1 percent, respectively.

Although coffee is a major source of caffeine, previous studies that have sought to measure a link between consumption and heart attacks have been inconclusive.

It's known that caffeine raises the heart rate, and may be linked to high blood pressure. But it hasn't been clear in other studies whether caffeine alone or perhaps other chemicals found in coffee might contribute to heart-attack risk.

But in the new study, researchers from Harvard University, the University of Costa Rica and the University of Toronto found that there are two kinds of people -- those whose livers process caffeine at a rapid clip, and those whose metabolism lingers over every cup.

"Depending on your ability genetically to detoxify caffeine, your response might be quite different than someone else," said Ahmed El-Sohemy, an assistant professor of nutrition science at the University of Toronto. He led the study, published today in The Journal of the American Medical Association.

The difference is in which variant of a gene called CYP1A2 someone carries. For those with the slow-processing variant, "the amount of caffeine that lingers in the system is much greater," El-Sohemy said.

"So, one cup of coffee for them might be the equivalent of four cups for the fast metabolizers."

Working with Costa Rican researchers, the team matched up 2,014 patients who had suffered a first acute -- but non-fatal -- heart attack over a 10-year period with 2,014 healthy but otherwise similar controls.

All were tested to see which gene variant they had, and questioned about food and drink consumption and other health habits, including smoking.

Fifty-five percent of the heart-attack patients and 54 percent of the control group were slow caffeine metabolizers; the rest carried the faster variant.

Within the slow-metabolizing group, the risk from increased coffee consumption was actually greater for younger individuals. The risk associated with drinking four or more cups a day compared with less than a cup a day increased twofold for those younger than 59 to more than fourfold for those younger than 50.

El-Sohemy said that since the association between coffee and heart attacks was found only among individuals with impaired caffeine metabolism, "it strongly suggests that caffeine plays a role" in heart-attack risk.

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http://www.zimbio.com/Energy+drinks

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For those on the message board who are coaches, I would strongly recommend that you do what you can to disuade your student athletes from drinking these beverages. They are marketed to kids like cigarettes. The difference is neither kids or adults realize the dangers, despite the disclaimers on the can. When I find my chart on the caffeine levels in these drinks, I will post.

Full disclosure: I am an MD, sub 2:20 marathoner x several, and I do drink Diet Coke. "Wired" and "Ultimate" and their ilk are like 151 rum and Absolut vodka. Dangerous, esp for kids and those who are not in perfect health. Lots of fast runners are not in perfect health. Ask Jim Fixx or George Sheehan if you can contact them.

QC

Jim Fixx had been a multi pack a day smoker for 2 decades, his dad died of heart disease at about the same age, and Fixx had all of the symptoms but chose to ignore them. Fixx has been the poster boy for every runner death for regarding anything - it is time to give it up. Fixx was a walking coronary waiting to happen.

Sheehan was in his mid 70s when he died ... why do you mention his name?

Give it a rest doc - people have been drinking coffee with lots of caffeine for easily hundreds of years along with many other substances. Why don't you rail on kids being fat instead of the mythical caffeine boogyman that was dredged up from Costa Rican heart disease patients?

Earlier I came on here and asked about saturated fat and cholesterol intake in runners but I think my question may not have been entirely clear. I realize that a high intake of saturated fat/cholesterol is a risk factor. But if I run a lot and eat more calories per day, am I at higher risk even if my percentage of saturated fat/cholesterol is normal. For example, I rarely eat pizza but when I do I probably eat twice as much as the next guy simply because I consume more daily calories than the next guy. As a whole, I still eat less than 30% of my diet as fat but I probably consume more total saturated fat than the average dude simply because I eat close to 4000 kcal per day. Does this place me at higher risk?

What hope is there for the 5 - 6 minute miler weekend warrior when a world class athlete gets heart problems. Why am I wasting my time trying to break 5 for the first time in 20 years. It all comes down to genetics. If you have the right genes you can be a fat slob and live to 90.

Good point. I figure that you need to control your controlables. Give yourself the best possible shot at living a long healthy life. If you get unlucky you get unlucky but you do have some contol over the situation. Use it to your advantage.