I read an interesting article today about how actor Christian Bale effectively saved the life of Vice director Adam McKay. As part of the Oscar-winning actor’s preparation to play former Vice President Dick Cheney in the upcoming film Vice, Bale learned everything he could about heart attacks because the veep had more than his share. At one point during the filming of the movie, Bale explained to McKay that not all heart attacks present with pain across the chest or shooting pain down the left arm.
Not long afterward, McKay was at the gym when he felt queasy and had tingling in his arm. He initially didn’t think much about it, but then he remembered what Bale had said about heart attacks and he rushed to the hospital. He was, in fact, having a heart attack, and getting to the ER so quickly likely saved his life and certainly saved his heart from having too much damage.
This is a lesson I try to share as often as I can. Not all heart attacks present in the same way, and in fact heart attacks in women often present in very different ways. When we think of heart attacks, many of us have the image of Redd Foxx as junkyard owner Fred Sanford clutching his chest and looking to the sky declaring to his dead wife “I’m coming to meet you Elizabeth.” That’s how I envisioned it. At least, until I had one.
Heart attacks can present in many different ways. Here are just a few: Pain in the area between shoulder blades, arm, chest, jaw, left arm, or upper abdomen. Dizziness, fatigue, lightheadedness, clammy skin, cold sweat, or sweating. Heartburn, indigestion, nausea, or vomiting. Discomfort or tightness in the arm or neck. Anxiety, chest pressure, feeling of impending doom, palpitations, or shortness of breath. In women, symptoms often include jaw pain, back or shoulder pain, shortness of breath, or nausea/vomiting.
Many times there’s little drama involved in a heart attack. My heart attack presented with a radiating heat across my chest, a cold sweat, indigestion, and pain down both arms. I didn’t think I was having a heart attack, though looking back I should have. And because my symptoms only lasted for about 20 minutes, I figured whatever it was had ended and I was OK. Because of that, I didn’t seek treatment for two days and ultimately that caused permanent damage to my heart that otherwise could have been avoided. I could very easily have died while I avoided going to the hospital. My E.K.G. was so bad when I did go to my doctor two days later that she called 9-1-1 and I got a ride to the ER where 30 minutes later I was in the cath lab receiving three stents for a mostly blocked left anterior descending artery (LAD).
Heart attacks are also not always caused by blocked arteries, otherwise known as atherosclerosis. Heart attacks can also be caused by a spasm of a coronary artery, arrhythmias (abnormal heart rhythm), cardiomyopathy (enlarged heart), undetected heart defects, and even electrical shock. In other words, heart attacks are not monolithic in nature.
WebMD has a nice list of common heart attack symptoms, but even if you’re having one or more of these symptoms it can be confusing to know if you should get to the hospital. It’s easy for me to say this in hindsight, but when it comes to heart attack symptoms I suggest you don’t take any chances. What’s the worst case — you spend a few hours at the ER and go home feeling silly? It beats dying!
Statin drugs, used to lower blood cholesterol, are among the most prescribed drugs in the world. In 2016, according to drug tracker QuintilesIMS Institute, the top-selling Statin in America, rosuvastatin (Crestor), brought in a whopping $4.2 billion for manufacturer AstraZeneca and atorvastatin (Lipitor), was prescribed 106 million times to top the list (it was ranked third behind only ACE Inhibitor lisinopril and thyroid drug levothyroxine). Crestor is currently among the top-selling drugs in the world, and Lipitor is the best-selling prescription drug of all time according to Forbes, raking in $148.7 billion since its approval in 1996. And while Lipitor went generic in the U.S. in 2011, manufacturer Pfizer still generated $1.76 billion in sales in 2016 with most of its sales coming from China and other overseas markets (https://www.fool.com) Any way you look at it, Statins are big business in America and around the globe.
Conventional medical wisdom suggests a direct link between high low-density lipoprotein (LDL) cholesterol and heart disease. The theory is that if you have too much bad cholesterol in your blood, it builds up in the walls of your arteries and over time causes hardening (atherosclerosis) which slows and/or blocks blood flow to and from the heart. This theory has been generally accepted for more than 100 years, culminating with the landmark Framingham Heart Study in the 1950s that among other things “proved” that factors such as smoking, high blood pressure, and high cholesterol were related to heart disease. As the science progressed, cholesterol became more understood and now cholesterol-lowering medicine is a cash cow for drug companies. This is an oversimplification, but suffice it to say there have been entire books written on the issue and we don’t really have the time or space here to delve too deeply into the research. Yet it doesn’t take a trained research scientist to type the words “does cholesterol cause heart disease” into Google and come up with hundreds of articles with conflicting conclusions. It is especially true that in the past few years the number of studies discounting the role of cholesterol in heart disease has increased substantially. Honestly, trying to understand cholesterol can give you a heart attack itself. Triglycerides. High-density lipoprotein. Low-density lipoprotein. Very-low-density lipoprotein. Apolipoprotein B.
I don’t know anymore if high cholesterol causes heart attacks. I’m not sure the medical establishment really knows. What I do know is that among the thousands of heart attack survivors in my Facebook support group, hundreds have reported that they did not have high cholesterol at the time of their heart attacks. Others used medication and lifestyle changes to lower their cholesterol and had second or third heart attacks. I had normal cholesterol and exceedingly high triglycerides prior to my heart attack, and both were under control through diet, exercise, and medications at the time of my heart attack. Had the damage already been done in my arteries? Perhaps. I don’t think I’ll ever know. I definitely have both my cholesterol and triglycerides under control now. In fact, as of this writing, my latest blood work showed my total cholesterol was 119, triglycerides 94, HDL cholesterol 41, and LDL 59. This gives me a total cholesterol to HDL ratio of 2.9. These numbers are fantastic by any measure and my primary care doctor, as well as my cardiologist, were very pleased, to say the least. How did I get my numbers to such cardiovascular-friendly levels? Well, I’ve been working on it and experimenting with various medicines, supplements, diet, and exercise. But before I tell you my secret, I must say once again that we are all individuals with different body styles, metabolisms, and, most importantly in my mind, genetic makeup. More than five years after my heart attack, I believe it was caused by years of high triglycerides. Note I used the word believe versus know. Nobody knows for sure why I had a heart attack at age 45, but given my personal history, I have come to believe that my nearly 100 percent blocked LAD was caused by a buildup of plaque due to high triglycerides in my bloodstream. Now I understand this does not account for why I only had a blockage in one artery, given that if in fact, this was the cause other coronary arteries could just as easily have been blocked. Maybe it was random. Or maybe there was something else going on, like inflammation in the LAD that gave the plaque a place to stick.
Regardless, my cholesterol levels were never very high and as you can see from my most recent numbers they are still very low. I was on a Statin prior to my heart attack, but that didn’t stop me from having a heart attack. It’s my understanding that Statins don’t do much to lower triglycerides, nor do they help raise good cholesterol (HDL). So were my doctors wasting my time by putting me on a Statin in the first place? Who knows. When I was first diagnosed with very high triglycerides I was put on a drug called fenofibrate (Tricor) to lower them, and it worked to some degree although while on Tricor they were never as low as they are now.
For the record, it’s my non-scientific belief that the combination of high levels of fish oil, moderate exercise, and a diet extremely low in processed carbs and added sugar has led to my low triglycerides and generally great blood work.
But what about Statins? If lowering LDL cholesterol is so important to the medical establishment shouldn’t we all be on a Statin? There are some doctors who believe this, perhaps most notably Dr. David Agus, professor of medicine at the University of Southern California Keck School of Medicine, who wrote in his New York Times bestselling book The End of Illness that everyone over 40 should discuss Statins with their doctor, even if they haven’t had heart problems or are at increased risk for heart disease or diabetes. Unfortunately, this strategy didn’t work for his most famous patient, Steve Jobs, who died of pancreatic cancer. Nevertheless, the anti-Statin forces are loud, so much so that some doctors are warning that the anti-Statin movement could actually be killing people.
“An internet-driven cult is attacking the safety and effectiveness of cholesterol-lowering Statins, despite mounds of clinical trial data showing the drugs work and produce minimal side effects,”
Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, told CBS News in 2017.
The anti-Statin crowd seems to align around a different cause of heart disease — inflammation. In fact, more and more it seems the medical community is lining up on one side or another in this debate about cholesterol vs inflammation. One popular inflammation argument, championed by Scottish doctor and author of The Great Cholesterol Con Dr. Malcolm Kendrick, goes like this:
“Chronic stress leads to dysfunction of the hypothalamic pituitary adrenal axis (HPA-axis) which leads to sympathetic overdrive plus added raised stress hormones leads to metabolic syndrome (raised BP, raised blood sugar, raised clotting factors, raised cortisol, raised all sorts of things) which causes endothelial damage plus increased blood clotting which leads to plaque formation and death from acute clot formation.”
Sounds reasonable, yes?
While the great cholesterol debate continues, millions of us remain on Statins and avoid high cholesterol foods, and it may not be doing anything at all to rid us of the number one cause of death in the world.
One thing we can say about cholesterol-lowering drugs like Statins is that they do in fact lower LDL cholesterol. There are hundreds if not thousands of studies to back these claims, so if you want to lower your LDL you should probably be on a Statin. I take a small dose of Crestor every day and my LDL is well below the danger zone. Common cholesterol-lowering drugs include:
Statins such as atorvastatin (Lipitor), pravastatin sodium (Pravachol), and simvastatin (Zocor)
Bile acid resins such as cholestyramine
Cholesterol absorption inhibitors such as ezetimibe (Zetia)
The Statin debate might be very different though if the drugs didn’t have such high reported rates of side effects. Common side effects include muscle pain and damage, liver damage, increased blood sugar or type 2 diabetes and memory loss or confusion. Perhaps these side effects are so widely reported because so many of us take Statin drugs, but perhaps they really do cause rough side effects in many people. I can tell you that no issue is more common in my Facebook support group than Statin side effects and the Internet is awash with people in chat rooms and on message boards complaining about Statin drugs.
It’s probably also worth mentioning that recently the American Food and Drug Administration approved a new type of cholesterol-lowering drug called evolocumab (Repatha) which has been hailed as a “breakthrough” to reduce LDL cholesterol without the side effects of Statins. No doubt, any advancement in cholesterol reduction is going to be big business and Repatha maker Amgen is counting on a huge windfall once the drug is more readily available. By the way, as for the side effect debate, even Amgen warns that Reptha’s side effects include: a runny nose, sore throat, symptoms of the common cold, flu or flu-like symptoms, back pain, high blood sugar levels (diabetes), and redness, pain, or bruising at the injection site.
Many of the survivors I speak to say their goal is to change their lifestyle so that they eventually can stop taking so many drugs. I have a slightly different attitude — I’m grateful for the science that led to these life-saving drugs. Yes, there are side effects and as science progresses we will likely find new therapies and maybe even debunk some current therapies. And while I agree that lifestyle changes are critical to post-heart attack health and well being, I’m fine chugging down a plethora of pills every day.
The bottom line for me is that I’m not so sure high cholesterol causes heart disease. And I definitely don’t think dietary cholesterol raises one’s cholesterol (I think sugar and carbs are the culprit). I’m all in on including healthy fat in my diet, and I have no problem eating eggs and other high cholesterol foods. That said, I don’t have any side effects from my Statin so unless the medical establishment publishes new clear-cut proof I don’t need it I’m going to keep taking it. Yep, hedging that bet a bit.
Two weeks ago I went to my first appointment with a new primary care physician and she said that while my bloodwork looked pretty darn good, she thought my sugars were still a little higher than she’d like to see. For crying out loud, I’ve been eating like a champ and my other numbers are, frankly, enviable. Total cholesterol 108. LDLs 59. HDLs 41. Triglycerides 94.
But my glucose was at 106, a touch higher than the recommended 99. And then there’s my LP-IR Score of 56. Any doctors out there agree that glucose of 106 and LP-IR of 56 is a concern?
Then my new doctor said something that surprised me. “You should consider intermittent fasting,” she exclaimed.
Wait, what? Don’t eat? But…but…but.
She explained to me that there was a lot of research out there that intermittent fasting (IF) was the best way to lower insulin resistance and that many people found it easy to integrate into their diets. She suggested I try IF 4–5 days per week and after a while, we could recheck my insulin numbers. She also jotted down the name of a Canadian doctor who has written a few books about the subject, Dr. Jason Fung, and sent me on my way.
I’ll be honest, I’m a connoisseur of popular diets and eating styles but I’d never heard of IF. So I went home and searched the interwebs for details, and before long I was fully down the rabbit hole. Holy moly there is a whole subculture of people who don’t eat for long periods of time in the name of good health.
Fasting has been around for thousands of years, and for our ancestor’s fasting was simply a matter of the difficulty of sourcing food. Our paleo brethren often went long periods without eating and I suspect there weren’t too many cavemen with type 2 diabetes. Fasting has long been used in religious worship across multiple belief systems. Hell, when you think about it we all fast daily — we don’t eat while we sleep. Intermittent fasting is just increasing the time you already don’t eat. I decided to use the 16/8 method of fasting, where you don’t eat after dinner and then skip breakfast before breaking the fast at lunch. What that looks like for me is that I don’t eat from 7 p.m. to 11 a.m. (water, tea, and coffee are fine).
Without going into too much scientific detail, IF is about insulin. When you eat, your insulin increases. When you don’t eat, it doesn’t. If your insulin is always elevated because you eat all day, and/or eat too much sugar and carbs, your insulin remains elevated and your body reacts by pumping sugar into your bloodstream. When you are fasting your metabolism increases. The bottom line is your body burns off sugar to provide energy, and when it runs out of sugar it burns stored fat.
I’ve been doing IF for almost three weeks now. Truthfully, it’s not difficult. I just don’t eat after dinner and then skip breakfast. I start eating again around 11 a.m. and between lunch and dinner, I try not to snack too much. Of course, when I do eat I eat a low carb, low added sugar diet. I call it a modified Mediterranean Diet or Pegan (which I’ve written about before).
I won’t know if IF has lowered my insulin levels until I get them checked again in a few months, but I can tell you I have lost weight. Belly weight. My midsection is definitely tighter and my pants are looser. I mean, it’s not rocket science. I’ve been eating less. Is that a crazy idea? I don’t think it is.
One thing about nearly dying is that it makes you appreciate life more. It may sound cliche, but there was a time not too long ago when I wasn’t sure I’d make it to 52. And even though it’s not a nice round number like 50 or 55, I still feel like celebrating simply waking up for another birthday. Happy 52nd birthday to me.
Even for those who did not have a near-death experience, the world sure seems to be coming apart at the seams. Things feel pretty dire. We have a lunatic in the White House. The world looks to Germany for moral authority. The climate is changing so rapidly that huge chunks of the polar caps are falling off and melting into the sea. The American wage gap is getting wider. Americans are getting wider. Kids keep getting gunned down at schools. The U.S. Men’s National Team didn’t make the World Cup!
Yet even still, perhaps because I have been consciously trying to pay less attention to politics and the news, I feel like I have a lot for which to be thankful (including knowing how not to end a sentence with a preposition).
I’m not really going to tick off 52 things I’m thankful for as I turn 52 (not because I can’t come up with 52, but because I don’t think you’d read through a list that long). I am, however, going to hit some high notes.
First and foremost, my heart is strong and while it will never be fully recovered it is pumping within the normal range (ejection fraction at 55). My arteries are clear. I recovered completely from the little stroke I had last year with no permanent deficiencies. Aside from a few normal age-related aches and pains, I’m in pretty good health given my history.
I have a loving wife/best friend who treats me like a king despite my often whiny personality. In a few months, we’ll be celebrating our 25th wedding anniversary.
We have raised a remarkable son who at 20 is wise beyond his years. He may still be trying to find himself, but he’ll never be lost.
I live in a wonderful town in a perfect townhouse in a great neighborhood.
For the first time in my life, I can truly say I love my job. I had a great year raising money for the American Heart Association and I am honored to be able to do this work for a living. Strange way to find a calling, but I’ll take it.
Despite some ups and down this year, my mom, dad, and sister are doing well (as well as can be expected given they all live in Tucson now).
We’re doing well enough financially to afford to travel more and are starting to tick off our bucket list one by one.
I have great friends both online and in real life.
I serve my community as a board member of a great nonprofit that unites, strengthens and advances the state’s nonprofit sector.
The Suns have the first pick in the NBA Draft tonight and will finally land the “big man” they’ve always needed. The Padres are not winning, but they are on the right track with a great young core and some special players almost ready for the big leagues. The Cardinals drafted a QB of the future. No team I’ve ever rooted for has ever won a world championship — but that will change in the next few years. Go Cardinals. Go Padres. Go Suns.
I have found a new passion in soccer and have become a rabid fan. Seriously, I wake up early every weekend during the season to watch Arsenal play.
All this is to say that I’m living a great life. It’s nothing like the life I imagined I’d be living in my 50s, but it’s great nonetheless. And despite world events, my own life is really good. And I’m grateful. And I need to remind myself to share that fact more often, and certainly not just on my birthday.
I’m a heart attack and stroke survivor and I’m grateful for everything I have in this world.
I was struck by a report yesterday in the Daily Mail about a new study that says lonely people are twice as likely to die from heart problems. You can read the report for yourself, but the study found, among other things, that:
Lack of social support may cause people to not take medication correctly
Loneliness increases people’s risk of anxiety and depression by three times
Approximately 42.6 million adults over 45 in the U.S. report being lonely
In the U.K., 3.9 million people say the television is their main source of company
Loneliness is a strong emotion and I’m not surprised it can cause health issues, but being lonely makes you twice as likely to die from heart problems? I guess you really can die of a broken heart.
“Loneliness is a strong predictor of premature death, worse mental health, and lower quality of life in patients with cardiovascular disease, and a much stronger predictor than living alone, in both men and women.” – Study author Anne Vinggaard Christensen, Copenhagen University
The caveat here is that the study looked at patients with existing cardiovascular disease, and I can tell you from experience that having a friend or partner to talk to when you have a health issue is critical. But this also speaks to finding a support network when you have a heart attack or frankly any health crisis.
Following my heart attack at age 45, I couldn’t find anyone to talk to that shared the same experience with me. There were support groups, but the most prominent one was full of patients much older than me. During cardiac rehab, I was the youngest patient by 20 years. I felt alone, which is what led me to start my own support group specifically for young heart attack survivors. The group started small, but today the Under 55 Heart Attack Survivors Group on Facebook has grown to more than 3,300 members from all over the world. The American Heart Association also has a support network.
Loneliness is a tricky thing. I can’t imagine how I’d have gotten through my health issues without the love and support of my wife and son and my extended family. I know survivors who don’t have a significant other and that fact alone can make things so much worse. There’s nobody to go with you to doctor appointments. Nobody to celebrate with when you reach a milestone. Nobody to lean on when things don’t go as planned. Being a heart attack survivor is something I deal with every day — I’m so fortunate I don’t have to deal with it alone.
That said, I probably don’t do as good a job as I should simply getting out of the house to meet with friends. Men have a harder time making close friends than women, I think. There’s something very offputting about calling up a guy you don’t know that well and asking him to join you for a ballgame or a movie. Most men, and probably a lot of women, only have a handful of really close friends. I mean, lots of people checked in on me in the days and months following my heart attack, but after a while that petered out and now I often can’t find a guy to go to a concert with or have a drink with.
It’s definitely a two-way street though. If you want friends you have to be willing to take the first step. Excuses are easy to find. Maybe he or she has young kids and you don’t. Or maybe you live just a bit too far away for it to be convenient. Or maybe you like country music and she prefers hip hop. Or maybe I’m just overthinking it!
Recently I’ve tried to push myself on this front. In the past few months, I initiated lunch with a guy I didn’t know that well. I invited a newer friend to a concert I wanted to attend. I launched a monthly book club. I’m trying.
I think a lot of the difficulty stems from our busy lives in general. But I’m now at a point where I don’t have a young child in the home and I have a job that doesn’t keep me up working at all hours of the night. I do think, though, that there’s something of a societal issue going on. One-quarter of the U.S. population lives alone. And we’re working more. And if we’ve got kids we’re running them around to karate and soccer and swim practice. There’s also been a decline in civic activity in general.
In 2000 author Robert Putnam wrote Bowling Alone: The Collapse and Revival of American Community. In the book, Putnam reported that “we’ve become increasingly disconnected from family, friends, neighbors, and our democratic structures.” By this, he means we’ve stopped joining clubs and social groups. In fact, in the 25 years prior to the book coming out, Americans had a 58% drop in attending clubs, a 43% drop in family dinners and a 35% drop in having friends over. I don’t know too many people my age who are involved in Kiwanis or the Jaycees, or who participate in sports leagues or bridge clubs.
I do think there’s a growing trend in these activities among millennials and generation Z. I have some young friends at work who are in a kickball league (how very millennial). And maybe some of you are doing things and I’m just not aware. I have at least one friend who goes lawn bowling (and yes, he’s under the age of 80). I have another friend who is very active in Rotary. But in general, I think the trends outlined by Putnam haven’t changed much since 2000.
All this is to say, there’s a cure for loneliness and all it requires is for us to step out from behind the computer and go outside. And lest you think loneliness is not a health concern, this study surely proves otherwise. And for me, I just have to think about that “buzz” I have when I come home from dinner with friends or a concert with a buddy. Those are endorphins and increasing them releases stress and is good for your heart.
I enjoy alone time as much as the next guy — maybe even a little more than the next guy. But I can also tell when I’ve been hanging out by myself too much. I actually get sad and mopey. I need to remind myself to make time to engage with others in the real world.
What do you do to ensure you spend quality time with other human beings? Are you good at being the one who initiates a dinner or a coffee meetup? I’m going to keep looking for new ways to get out there and now I can say I’m doing it for my heart.
The suicides this week of Kate Spade and Anthony Bourdain have left many of us wondering how in the world such successful people can feel so helpless as to end their own lives. For sure, depression is a dark passenger that is tough to shake.
Depression is also decidedly linked to heart disease. Heart disease can cause depression, and in fact, does in a large percentage of those who suffer a heart attack or similar major cardiac event. Up to 15 percent of patients with cardiovascular disease and up to 20 percent of patients who have undergone coronary artery bypass graft (CABG) surgery experience major depression (American Heart Journal).
On the flip side, depression can actually cause heart disease. Studies have shown that depression and stress has a negative effect on the heart and can lead to high blood pressure, irregular heartbeat, and even increased inflammatory markers like C-reactive protein which is a risk factor for cardiovascular disease.
I bring this up to remind us all that depression is a serious matter that can destroy a life in many different ways, not just through suicide. So much of what we read about how to prevent heart disease focuses on diet, exercise and risk factors like smoking. But not much is written about the cardiovascular effects of poor mental health.
That said, a focus on total health that includes mental health is the first line of defense against heart disease. Any medical professional worth their weight in education should prescribe mental health therapy as part of any approach to overall wellness. Mind and body are inexorably linked.
The good news is that many of the things prescribed for overall health work to balance mental health and stress as well. Eating well, sleeping well and regular exercise positively affects the body and the mind. Activities like yoga, meditation and mindfulness also have powerful ramifications for both physical and mental wellbeing.
I have to admit I’m not a big fan of exercise and while I’ve tried yoga and meditation I can’t seem to get inspired to make either of them part of my daily routine. I know I should, but since I don’t enjoy it I always find excuses. But every time, without fail, I feel better mentally after exercise.
I’ll try to find more inspiration to exercise, not only for my physical health but for my mental wellbeing. As a heart attack survivor, it’s even more important for me to exercise. The American Heart Association recommends at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise (or a combination of moderate and vigorous activity). That doesn’t seem so hard.
Just a few days ago a new study was published that suggested just 30 minutes of exercise four to five times per week is enough to keep your heart young.
“Exercising four to five times a week appears to be a sweet spot for overall artery health.” — Study author Dr. Benjamin Levine, a professor of internal medicine at UT Southwestern Medical Center
As for depression, don’t let it get the best of you. It’s bad for your heart and it can easily spiral out of control. If you’re experiencing depression, seek help immediately. There’s no stigma associated with getting help for mental health. And there are so many ways to treat depression, from the aforementioned exercise to therapy to medication.
If you have any suicidal thoughts, reach out right away to the The National Suicide Prevention Lifeline, a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week. The number to call is:
Given how Anthony Bourdain lived — eating everything and anything, drinking, smoking, and taking drugs, it’s amazing he didn’t die from a heart attack. In fact, when I first saw the headline this morning that’s exactly what I thought happened. But no, it was depression. It’s ironic and sad that a guy who lived life on the edge was taken by his mind not his body. Perhaps there’s a lesson there for us all.
I have only one regret from my heart attack experience in 2011, and that is that I waited two days from the onset of symptoms to seek treatment. Aside from the fact that I very likely could have died during those 48 hours, the time I waited very likely caused more damage to my heart than if I had gone to the hospital right away. In the heart attack business, time is muscle.
It’s a sobering experience to hear your cardiologist say that part of your heart is dead, but that’s exactly what happens to your heart when oxygen is cut off. In my case, I lost about 15 percent of my heart muscle in the area at the lower left ventricle known as the apex. Because of this dead muscle, I have what the doctor calls left ventricular hypokinesis. Basically, it means my heart doesn’t contract as much as most people’s hearts resulting in a lower ejection fraction.
This means my heart doesn’t pump out as much blood as a normal heart, which is no big deal until it gets too low (an ejection fraction of 50 percent or lower is considered reduced) and if it gets down below 40 or so it means you are in heart failure. At the time of my heart attack my ejection fraction was around 35-40, but today it’s in the 55-60 range which is at the low end of normal. Lucky me.
Every cardiologist I’ve seen, and everything I’ve read, says heart muscle damage is permanent. But as college football broadcaster Lee Corso says — not so fast my friends!
Medical science is progressing at a breakneck speed. Just think about coronary stents for example. It seems like they’ve been around forever, but the first one was inserted into a human in 1986 (just 32 years ago). If I had the very same heart attack in 1985 I’d be walking around with a 90 percent blocked left anterior (LAD) descending artery (also known as the widowmaker) instead of having three stents. Or more than likely I’d be dead.
Which brings me to that dead heart muscle. This week in the magazine Nature I read about a new procedure that will be done on three patients in Japan. Doctors at Osaka University will take thin sheets of tissue derived from cells and graft them onto diseased human hearts. The team expects that the tissue sheets can help to regenerate the organ’s muscle when it becomes damaged.
If this works as it has in lab animals, these doctors will in effect reverse thousands of years of medical orthodoxy. Time may be muscle, but science is more powerful than current knowledge.
This experiment is part of a field known as regenerative medicine. Rejuvenating or regrowing human tissue has limitless possibilities for medical science, and while the field is in its infancy it feels like every day we hear about a new breakthrough. Just a few years ago scientists grew a complete human bladder outside the body, and we’re not very far from the ability to grow more complex organs to use for transplantation. How long before scientists can grow a human heart that can be used to replace failing ones? The stuff of “science fiction” is no longer outside the realm of possibility.
I recently read Never Let Me Go by Nobel Prize winner Kazou Ishiguro. Spoiler alert: it’s about clones who are created to harvest replacement organs. But given the direction of real science, the dystopian world laid out by Ishiguro will not be needed!
This is a long way of stating that I am grateful for medical science. In fact, science is the closest thing I have to a religion. I put my faith in regenerative medicine, CRISPR, biotechnology, immunology, and everything else that involves the scientific method. My heroes are scientists, doctors, and inventors. They bring me peace of mind and hope for the future.
My heart damage is probably not severe enough to warrant stem cell therapy or regenerative cell sheets. But it’s nice to know if things get worse for me, or as science continues to progress, my heart could easily be fixed. Permanently.
We all know that elevated cholesterol is an indicator of heart disease risk, but the truth is most of us have no idea what our cholesterol data tells us. Even if you’ve been a good steward of your heart health and have your cholesterol checked regularly, most doctors only tell you the basic results of your blood tests — and that doesn’t tell the whole picture.
You probably know your total cholesterol level, and perhaps you even know that the Centers for Disease Control and other medical experts suggest your total cholesterol should be less than 200 mg/dL. This common wisdom also suggests that your LDL (“bad” cholesterol) should be less than 100 mg/dL, your HDL (“good” cholesterol) should be 40 mg/dL or higher and your triglycerides should be less than 150 mg/dL.
Too often we look at our total cholesterol number and if it’s under 200 we figure we’re fine. Unfortunately, I can tell you hundreds of stories about seemingly “healthy” people who had cholesterol levels under 200 and still had a heart attack. Myself included.
So if these numbers don’t tell the whole picture, what’s a better indicator of your cholesterol-related health? Well, a study published in the American Heart Association journal Circulation found that those people with the highest triglyceride-to-HDL cholesterol ratios had a sixteen times greater risk of heart disease than those with the lowest ratios.
Why? It turns out not all LDL cholesterol is the same, so just knowing your LDL number doesn’t tell you much. In fact, LDL particle size is a much better predictor of heart disease. Some LDLs are large and fluffy while other LDLs are small and sticky. The small sticky cholesterol plays a more critical role in determining your cardiovascular health and it turns out a higher triglyceride to HDL ratio is more indicative of small sticky LDL.
The triglyceride to HDL ratio also indirectly measures insulin resistance, and that is a predictor of diabetes — and diabetes is also a major risk factor for heart disease.
Ideally, you want no more than a 2:1 ratio of triglycerides to HDL cholesterol. So, if your triglycerides are 100 mg/dl, your HDL cholesterol should be 50 mg/dl. — Dr. Stephen Sinatra, cardiologist
It turns out a better strategy for lowering your risk for heart disease is to lower your triglycerides and/or raise your HDL. Ironically, the first line of defense for elevated cholesterol recommended by most cardiologists is a statin to lower your LDL. But statins don’t affect your triglycerides to HDL ratio.
It’s also possible to get a newer type of blood test that measures particle size. The Vertical Auto Profile (VAP) test or a similar test is available at most labs and can give you a sense of whether you are one of the unlucky ones who create small sticky (known as pattern B) cholesterol. Here’s a pretty good explanation of why VAP is better. The site suggests the standard cholesterol test fails to identify as many as 60% of people who are at risk for cardiovascular disease.
Cholesterol is much more complicated than a single number. Don’t let that total cholesterol number fool you into complacency. If you have other risk factors (like diabetes, high blood pressure, elevated blood sugar, family history of heart disease) you shouldn’t assume your total cholesterol number or even your LDL number means you’re safe. Check out your triglycerides to HDL ratio and ask your doctor for an advanced cholesterol test.
Oh, and as I’ve mentioned before, if you have these risk factors you might consider having a coronary artery scan as well.
It’s amazing to me how many people I’ve met in my life who complain about prescription drugs. They treat headaches with meditation, muscle pain with acupuncture and guzzle herbal tea for everything from indigestion to toe fungus. In America, measles is making a comeback because uninformed parents refuse to inoculate their kids because some quack on the Internet referenced a flawed study in a phoney medical journal. Yes, some “alternative” treatments have therapeutic value. But you’ve had a heart attack — it’s time to put your big boy pants on and take your meds. Former heavyweight boxing champion Mike Tyson famously said “everyone has a plan until they get hit.” That’s how I feel about people who refuse to take the life-saving drugs available today. Think about how lucky we are to live in a time when researchers have developed extraordinary medicines to keep us alive. There’s a reason why your grandfather died after a heart attack when he was 45 — all he had to treat his diseased heart was aspirin and Alka-Seltzer.
If you are one of those lucky people that has gotten through life having barely having to take even a simple Tylenol for a headache, congratulations. But if you’ve had a heart attack, that part of your life is over. The sooner you get over the fact that you have to buy one of those pill cases with the days of the week on them to keep track of all your medications the better. Seriously, what’s the big deal? Take your medicine.
Current treatment methodologies for heart attack patients have drastically reduced the risk of death from 30% in the 1960s to approximately 3–4% today. Part of this is due to medical advancements like angioplasty and stents, and part of it is due to the discovery of new medications. Historically speaking, it wasn’t that long ago that first-line treatment for heart disease included bloodletting or mercury.
In truth, it’s a glorious time to be alive. Medical advancements in the 20th century have had a significant impact on the health of humans and one need only look at life expectancy to see just how significant we’re talking about. At the start of the 20th century, according to the World Health Organization the average global life expectancy was 31. 100 years later, it is 65.6 and in some countries it is as high as 80. The reason for this dramatic improvement is multifold, but some of the key reasons include the eradication of infectious diseases like smallpox, polio and leprosy and the decline in deaths from diseases like measles. In fact, in just the past century science introduced vaccines against the six most deadly childhood killers (polio, diphtheria, measles, mumps, rubella, and chickenpox). Advances in childbirth safety made a huge impact too. Other important advancements included the use of randomized clinical trials, vitamin supplements, insulin treatment for diabetics, chemotherapy, x-rays, and of course the introduction of antibiotics. In the heart diseases realm, the past 100 years have seen the introduction of bypass surgery, heart transplants, and pacemakers to name a few. And in terms of noninvasive treatment, we’ve seen the development of numerous drugs to treat all aspects of heart disease.
All this is to say, depending on your specific condition, today’s medical professionals have a huge arsenal from which to choose to treat your heart disease. And yes, with many medications there are side effects, but the side effects are far outweighed by the success of these drug treatments. To be sure, some of us will experience a side effect that is too severe to live with, but even then there are both mainstream and alternative treatments.
I am now nearly six years post heart attack, and my heart is doing great; in fact, I suspect it’s in better shape today than it was before my heart attack. I attribute this to following a good diet, exercising, and taking my meds. Yeah, I had to buy two pill boxes to keep track of everything I’m taking (one for the morning and one for the evening) but what’s the alternative? I’ll tell you what the alternative is — dying.
I have been thinking about reintroducing red meat into my diet after a decade or so of avoiding the stuff. In the ongoing saga that is my diet, I feel like I’ve finally settled into some themes about how to eat healthy — I call how I eat a modified Mediterranean diet but it has also been called Pegan. Basically, I’m all in on eliminating all processed carbs like bread as well as all added sugars while increasing my intake of healthy fats from sources like avocado and nuts/seeds. As for meat, I’ve been sticking with fish, chicken and turkey. We have the meats!
The more I eat this way, the better I feel and the better my blood test results. My triglycerides are very low (under 100 at last check) and my LDL cholesterol is well below the 70 mark recommended for heart disease patients. The “experts” I’ve been following such as Dr. Mark Hyman, Dr. Stephen Sinatra, and Gary Taubes to name a few all suggest sugar, not fat, is the demon that causes heart disease and frankly the data is compelling. The common theme among these low carb/high fat evangelists is that red meat (and the saturated fat that comes with it) is fine.
There are good scientific and health-minded reasons to eat high-quality, organic, grass-fed, sustainably raised meat as part of an overall healthy diet. — Dr. Mark Hyman
Yes, everyone agrees plants are better for you and that they should make up the largest part of your diet, but if saturated fat isn’t bad then grass-fed red meat should be back on the plate in modest portions.
Not so fast.
A new study found that eating meat regularly is associated with a 60 percent increase in the risk of heart disease, while plant-based proteins have been found to benefit the organ.
But the study doesn’t point to saturated fat as the culprit, rather it suggests there’s something troubling about the protein in meat versus the protein in plants, nuts and seeds.
“Our results suggest that healthy choices can be advocated based on protein sources, specifically preferring diets low in meat intake and with a higher intake of plant proteins from nuts and seeds,” the authors said.
This research doesn’t vindicate the anti-meat people because the argument against meat has long been about saturated fat. If true, and protein is the issue, then they have been right all along but not for the reasons they believe.
The saturated fat debate is far from over. Both sides make compelling arguments based on real research. Personally, I’m not willing to risk it by introducing saturated fat to my diet when I haven’t been eating it for years. No butter, no red meat, no coconut oil.
But I was, as I mentioned above, considering adding back in a little grass-fed beef to mix things up. Hey, I haven’t had a good burger since the George W. Bush administration.
Thanks for nothing Loma Linda University School of Public Health, AgroParisTech, and the Institut National de la Recherche Agronomique!