There’s No Such Thing as a ‘Mild’ Heart Attack

Boston Celtics President Dany Ainge, 60, suffered his second “mild” heart attack on May 1

This morning it was reported that Boston Celtics President Danny Ainge suffered a mild heart attack last night in Milwaukee and was treated and will return to Boston. Ainge had a similar “mild” heart attack in 2009. This comes just a few days following the news that R&B singer Peabo Bryson had a “mild” heart attack as well.

I’ve noticed reporting on heart attacks focuses on just two kinds — major and mild. Major usually means the victim didn’t survive or needed bypass surgery. Everything else seems to get the “mild” classification from the news media. I wonder if they do this because they don’t want to alarm people, or because they don’t feel the need to describe with any detail exactly what happened to the person? Either way it doesn’t help anyone, not the least of which the survivor, who may feel better that the doctors said he or she had a mild heart attack but it doesn’t change the fact that mild or not a heart attack of any kind is a signal that things are not okay with your cardiovascular system.

I think the term “mild” heart attack gives the survivor a false sense of security. Any heart attack is a major heart attack and needs to be treated as such. Popular culture plays a role in this disservice. I used to laugh at the Saturday Night Live skit where “da Bears” fans would have a heart attack and keep on eating as if it is a normal part of life.

I suspect this image isn’t that funny to Chris Farley’s family given he died at 33 from a combination of drugs and heart failure from atherosclerosis.

Peabo Bryson  is “stable” after he “suffered a mild heart attack” on Saturday morning. Yet he’s still in the hospital and is cancelling most of his scheduled May concerts. Doesn’t sound too mild to me.

What’s my point? Any heart attack is a serious medical condition that requires considerable medical attention and lifestyle changes. Myocardial infarction means you had a significant enough blockage in an artery to cause your heart to lower blood flow and perhaps even stop beating. Or it caused a clot to travel through your heart to block blood flow. Ain’t nothing mild about that.

Some suggest the amount of permanent damage to the heart helps to classify a heart attack as mild or major. But what amount of damage to the thing that keeps you alive should be considered mild? My heart is about 15 percent damaged. Did I have a mild heart attack? Hell no. I nearly died and ended up needing three stents.

I would argue that any damage is major. Which means news outlets or doctors trying to placate patients or family members by suggesting a heart attack is mild are minimizing the seriousness of the event. I suspect Danny Ainge, now having survived two heart attacks at just 60 years of age, isn’t going to take things lightly going forward. I suspect he’s going to change his diet, take new medications, increase exercise, get regular blood checks, reduce stress, and more. And that’s the right approach for anyone who has had a heart attack — mild, medium or major.

Climate Change is Going to Give You a Heart Attack

There has been a glut of news lately about the increasing severity of climate change, including this one reported just yesterday about the rise of sea temperatures. I have been thinking a lot about it, and while I have been concerned for decades (at least since I read Earth in the Balance back in the early 90s), this month I went to my first local chapter meeting of Citizens Climate Lobby. While we went around the room and shared our reasons for joining CCL, I was struck by how many of the people in the room mentioned the health ramifications of climate change.

If you think climate change is a hoax or isn’t going to affect you, I can’t help you. Clearly, you are “fact-challenged.” For the rest of us living in the reality-based world, the threats are real and imminent. The current administration, not exactly known for its embrace of science (or reality), published the second half of the Fourth National Climate Assessment 2017/2018 in November and while it is full of dire news, I’d like to focus on just the health aspects of climate change.

“Impacts from climate change on extreme weather and climate-related events, air quality, and the transmission of disease through insects and pests, food, and water increasingly threaten the health and well-being of the American people, particularly populations that are already vulnerable.”

Fourth National Climate Assessment 2017/2018

You can read the entire report online, and here’s a link to the health chapter, but in a nutshell climate change will expose us to extreme heat, poor air quality, reduced food and water quality, changes in infectious agents, and population displacement which in turn will create heat-related illness, cardiopulmonary illness, food/water/vector borne disease, and mental health and stress issues.


Figure 14.1 Climate Change and Health

Much of the cardiovascular health issues associated with climate change revolve around temperature changes. A recently published study from the University of Michigan suggests “climate change may lead to a significant uptick in heart attacks” because of dramatic changes in outdoor temperature. “Global warming is expected to cause extreme weather events, which may, in turn, result in large day-to-day fluctuations in temperature,” said Hedvig Andersson, MD, a cardiology researcher at the University of Michigan and the study’s lead author. 

There are other studies that suggest the same, and I suspect we’ll soon be able to tie actual cardiovascular deaths directly to the effects of climate change. This is of particular interest to me, obviously because of my cardiovascular history, but also because I live in the desert where extreme heat and temperature fluctuations are part of the norm. Maybe I should move to a more temperate location? Oh wait, there may not be any temperate locations as climate change trudges on.

There are other heart-related consequences of climate change as well, such as the fact that increased ozone formation due to higher temperatures harms pulmonary gas exchange and causes stress on the heart and this is associated with heart attacks, increased particulate matter is associated with systematic inflammation, compromised heart function, deep venous thrombosis, pulmonary embolism, and blood vessel dysfunction, and of course stress and anxiety is associated with heart attacks, sudden cardiac death, and stress-related cardiomyopathy. Extreme cold and extreme heat increase hospital admissions for heart-related disorders and disease, such as dysrhythmias and stroke.

Climate change is the single most important issue facing mankind. It has far-reaching consequences for the planet and civilization. But it occurred to me that we’re just talking about the tip of the iceberg when we talk about sea-level rise, extreme weather events, drought and even infectious disease. Dirty air alone creates havoc for those already struggling with cardiovascular disease, and when you add in stress and mass migration and all the rest, it may not matter if you have to leave your home in South Florida for higher ground because you might not survive the heat and ozone pollution.

I for one am tired of sitting on the sidelines when it comes to climate change. For too long I’ve used the excuse that I wasn’t sure how best to make an impact, and because of that I haven’t made any impact. You can lose your mind researching what we should do about climate change, but I no longer wish to be paralyzed by indecision about how to help. Rather, I’m going to do something — something tangible.

I get a shit ton of eNewsletters and news about climate change. Any given day I may receive a message from The Union of Concerned Scientists, or 350.org, or the Sierra Club. Here’s a great list of organizations fighting climate change. It’s overwhelming, but with the start of the new year, I decided to pick one and do what I can.

I joined Citizens Climate Lobby because it has a singular focus that is easy to get behind and you can make an impact no matter where you live. And while I am not 100 percent sure a carbon fee and dividend law is the best approach to solving this thing, it’s an approach, which is more than most organizations are doing.

There are a lot of ways to get involved with CCL, and at a minimum you can simply stay informed and share news with others. Sometime this month, CCL will reintroduce its bill, the Energy Innovation and Carbon Dividend Act, while it is a long shot to make it to law with the current administration at the helm, we may be able to get enough momentum to make it a priority early in the next administration.

In the meantime, there are other things we can all do. We can fight fracking and other methane emitting causes like factory farming, ride a bike instead of driving all the time, wash clothes in cold water, consume less, personally divest from investments in fossil fuels, and eat more meat-free meals, for example. The point is, everyone can (and should) do something. It’s no longer just your kids and grand kids lives that depend on it — your life depends on it too.

Snoring is Much More Than a Simple Nuisance

I ran across an article today with the hyperbolic headline “7 Warning Signs That You May Be at Risk of a Heart Attack.” I truly hate headlines like this because they almost always lead to nonscientific blather. This article, from Men’s Health, suggests you may want to be concerned if you are exhausted (who isn’t), have erectile dysfunction (if your blood vessels down there are damaged, there’s a good chance the ones near your heart could be damaged as well), you have leg or hip cramps (again, blood flow issues), you’re bloated (too many beers?), and a few other seemingly innocuous maladies. But one potential symptom caught my attention and should catch your attention too — snoring.

Look at this sexy guy sleeping sound with his CPAP machine!

Snoring may seem harmless, but it could mean you have sleep apnea and that could be a big problem. Sleep apnea is a sleep disorder in which breathing repeatedly stops and starts and that can have major consequences for your heart health. In fact, obstructive sleep apnea increases the risk of heart failure by 140%, the risk of stroke by 60%, and the risk of coronary heart disease by 30%.

Let’s be honest, most of us snore once in a while or even all the time. The person who shares your bed has likely let you know you’re making noise with a late-night nudge or perhaps an occasional punch in the nose if it gets bad (kidding). You probably know if you snore, especially if you’ve ever woken yourself up from it. But you probably don’t know if you have sleep apnea unless you’ve been tested for it. A sleep apnea evaluation usually involves overnight monitoring at a sleep center although these days there are even some at-home sleep tests.

A few years prior to my heart attack my wife finally insisted I talk to my doctor about my snoring. Like a lot of people, I associated snoring with obesity and figured mine was just a minor case. But it had become so prevalent that oftentimes I’d wake up in the morning to find my wife sleeping on the sofa because I was keeping her up. I agreed to see my doctor about it, for her sake, but had I been paying more attention to the research I might have taken it a lot more seriously a lot earlier on.

There is a clear connection between sleep apnea and heart disease. Here’s a quote from an article on the American Heart Association’s website:

“The evidence is very strong for the relationship between sleep apnea and hypertension and cardiovascular disease generally, so people really need to know that.”

— Donna Arnett, Ph.D., chair and professor of epidemiology at the School of Public Health at the University of Alabama at Birmingham

A Google search for “sleep apnea and heart disease” brings up tons of articles and links to studies that show a clear connection. Unfortunately for me, while I discovered my sleep apnea before I had a heart attack I didn’t know it was a potential symptom of heart disease and therefore it didn’t raise any suspicions that would have caused me to get my heart checked out in time.

When I had my sleep study it turned out I had an apnea event (literally stopped breathing) about 80 times per hour. Think about that for a minute. That is more than once per minute. Of course that is going to cause strain on the heart!

Here’s some information on sleep apnea event occurrences. Normal is fewer than 5 breathing events per hour of sleep. Mild sleep apnea: 5 to 14.9 breathing events per hour of sleep. Moderate sleep apnea: 15 to 29.9 breathing events per hour of sleep. Severe sleep apnea: 30 or more breathing events per hour of sleep.

I was diagnosed with severe sleep apnea and nobody told me it could be associated with heart disease so I didn’t immediately go get checked out by a cardiologist. That seems like malpractice, but if I’ve learned anything over the past decade it’s that we have to be our own health advocates because doctors are overworked and under-educated in terms of knowing the latest science.

I ended up with a C-PAP machine, which applies mild air pressure on a continuous basis to keep the airways continuously open while I sleep. I have adapted well to it and use it religiously, every night. I hate having to use it, but using it means I no longer stop breathing 80 times an hour. I get a better night’s sleep and frankly, I feel safer using it. It’s a pain to travel with, but someday I’ll spring for a travel-sized machine as well.

So yes, snoring can be a symptom of heart disease or an impending heart attack. Now that you know this, you have no excuse for not talking to your doctor about your snoring. Trust me, it just might save your life.

Dying From Heart Disease is Pretty Much Optional

Punk rock legend Pete Shelley died on Thursday from an apparent heart attack at age 63, and once again my reaction was anger. Every time someone famous has a heart attack, I get in a fight with my inner voice. How did he not know he was at risk? Why didn’t he take care of himself? When are people going to start paying attention?

I know this might seem a touch disingenuous given I had a surprise heart attack when I was 45, but what I’ve learned about heart disease in the past seven years is enough to make me want to scream from the rooftops — you don’t have to go out this way! Heart disease is optional!

I’m not mad at these people, rather I’m mad at the situation. Nearly 18 million people die each year from cardiovascular disease (according to the World Health Organization) and 85 percent of those deaths are from heart attacks and strokes. 

Heart attacks and strokes are 80 percent preventable!

Yes, that’s right. The vast majority of these deaths can be attributed to preventable factors like obesity, poor physical activity, heavy drinking, eating unhealthy foods and not keeping your blood pressure and cholesterol under control. The CDC also found that about six in ten preventable heart deaths occur in people younger than 65 years old.

So why do people keep dropping dead from heart attacks? Do we not know how to prevent heart disease? Do we not care about getting heart disease? Are we too busy to worry about it? WTF people.

See, I get mad. It’s my issue, I know. Every time a famous person under…say…75, has a heart attack I am reminded of my own mistakes and my own mortality. I immediately go back to stage two of the five stages of grief. I’m serious. I get angry, then I get depressed (which is stage three).

Coach Mike Ditka had another heart attack recently. Alan Thicke. Garry Shandling. Carrie Fisher. Bill Paxton. It doesn’t make a difference who it is. Each time it happens I take it personally.

I wonder why I’ve become so passionate about heart disease prevention. Plenty of people have a health issue and keep to themselves. You don’t see Mike Ditka tweeting about heart disease. I think maybe there’s something in my personality that makes me want to stand up on a milk crate on the corner and preach the gospel of heart health. Is that a personality flaw or strength? I guess it depends on how obnoxious I am about it!

So, if you’re going to get anything valuable out of this post I probably ought to tell you how to prevent a heart attack so you don’t become one of the 14.4 million people who die each year from a preventable disease.

It’s pretty simple actually. I can tell you how to NOT have a heart attack in six words: Eat healthy. Move more. Don’t smoke.

Not smoking is the most obvious one. People who smoke are two to four times more likely to get heart disease. The risk is even greater for women who smoke and also take birth control pills. Seriously, don’t smoke.

Moving more is actually pretty easy as well. The American Heart Association recommends adults get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week. What does moderate-intensity aerobic exercise look like? 

  • brisk walking (at least 2.5 miles per hour)
  • water aerobics
  • dancing (ballroom or social)
  • gardening
  • tennis
  • biking slower than 10 miles per hour

Seriously, all you have to do is walk for 30 minutes, five days a week. Nobody is suggesting you have to run a marathon or swim 50 laps a day.

Lastly, eat healthy. Well, this one may be a little more complicated. Note that I said complicated, not difficult. Most experts suggest you simply eat a diet that focuses on a variety of fruits and vegetables, whole grains, low-fat dairy, skinless poultry and fish, etc. 

There are some that argue a “Mediterranean Diet” is best. Some argue you should be fully plant-based. Others argue keto is the healthiest way to eat. Paleo? Pegan? You can spend the rest of your life trying to figure out the “best” way to eat and never figure it out. So pick one of the above because in truth, all of them are healthy enough for the average person to avoid heart disease in combination with moving more and not smoking.

I have written about this extensively, and I’m convinced from my own health and indicators that it’s working. I eat a low carb, very low sugar, high healthy fat diet. I’m also doing a little intermittent fasting and I’m doing great by any standard. 

Want to know how you’re doing? I recommend you sign up for Life’s Simple 7 and take the survey. It’s free and you can go back again and again as your numbers change. It’s not perfect, but it’s an easy way to see how you’re doing.

Yes, heart disease is voluntary. I wish I knew that prior to Oct. 11, 2011 and that someone had shared these tips with me. Then again, had I not had a heart attack maybe I wouldn’t be on the Interwebs sharing these tips with you.

Getting ‘Poked and Prodded’ is My New Normal

Tomorrow I head to my cardiologist’s office for another in a seemingly endless series of tests. I know my life changed on Oct. 15, 2011 when I had a heart attack and that things will never be the same, but I had no idea how often I’d be subjected to diagnostic tests. I feel like the proverbial guinea pig.

Since it has been seven years since my cardiac event, I only have to see my cardiologist a couple of times a year now. But between those exams, I am required to have a blood test regularly (keeping an eye on my cholesterol, triglycerides, blood sugars and more) and then regular stress tests and echocardiograms. Tomorrow I get the double whammy — a nuclear stress test and an echocardiogram.

A nuclear stress test is a type of stress test that uses radioactive dye and an imaging machine to create pictures showing the blood flow to your heart. This is more involved than a standard stress test in which the victim (er, patient) is simply hooked up to an electrocardiogram (ECG) and blood pressure cuff to measure your heart’s reaction to exercise. For the nuclear stress test, you are also hooked up to an IV for the dye injection.

During the same visit, I’ll be subjected to an echocardiogram which is basically an ultrasound of your heart (it’s just like the ultrasound a pregnant woman receives to check on the status of her baby except instead of finding out the sex of the baby you find out the strength of your heart). The echo is a simple test, but I’ll never get used to the cold goo.

To be more precise, an echocardiogram takes images of the size and shape of your heart and also show how well your heart’s chambers and valves are working. This is pretty critical for me since at the time of my heart attack I had permanent damage to my heart muscle and it’s important to keep track of any changes in the amount of blood my heart pumps (known as ejection fraction). A normal heart’s ejection fraction is somewhere between 50 and 70 percent, while anything below 40 means you are in heart failure. At the time of my heart attack my ejection fraction was between 30-40 depending on who you believe, but with medication, exercise and time it has bounced back to around 60 at last check. For me, my ejection fraction is how I keep score of how I’m doing and so far, I feel like I’m winning.

The stress test, on the other hand, basically tries to determine if any of the coronary arteries that supply blood to and from your heart and blocked. A typical stress test is not foolproof, but a nuclear stress test is a much better way to determine if you have any blockages. Frankly, neither test is perfect and to be sure the best way to check for blockages is to insert a camera into your arteries but that’s pretty invasive and only done if the stress test or other indicators (like actually having a heart attack) suggest you might have a blockage. Basically, if I “fail” the stress test they’re going to go in and check and if I have blockages they can blast them with a balloon (angioplasty) and/or insert coronary artery stents to prop open the narrowed pathway. I had three stents inserted at the time of my heart attack, but the angiogram showed no other significant blockages so…I have that going for me.

All this is to ensure I have not gotten any worse since my heart attack, and thankfully, so far, I have not. In fact, I’ve gotten better. Still, these tests have become part of my routine and will likely continue to be part of my routine until such time as medical science comes up with a better way to see if your heart and arteries are doing what they are supposed to do.

I know these tests are helping me live longer, but I still feel like I’m at the doctor or a testing center all the time. It’s a pain in the ass. I know I should feel fortunate that I live during a time when we have all these diagnostic tests, and on top of that I have darn good medical insurance to pay for all these tests. But it’s still a pain in the ass.

Christian Bale Reminds us That Heart Attacks Vary

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.

Fred Sanford on TV’s Sanford and Son had a “heart attack” in nearly every episode.

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!

Does a Statin a Day Keep the Grim Reaper Away?

Are Statins good or bad? It depends on who you ask.

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.”

Malcolm Kendrick

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.

52 Things I’m Thankful for on My 52nd Birthday

52-highsOne 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.
  • The heart attack support network I founded on Facebook has grown from a handful of survivors in Phoenix to nearly 3,500 across the globe.
  • 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.

Regrowing Damaged Organs no Longer Stuff of Science Fiction

timeismuscleI 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.

I ♥ science!

The One Thing You Should Do Today if You’re at Risk for a Heart Attack

1_lp5iquleQM96kgSkir-iegAs a heart attack survivor, I’ve had the opportunity to speak to hundreds of people about my experience. Whether I’m sharing the story over dinner with friends or blogging about the day of my cardiac event, one particular question always seems to pop up: what can I do to make sure this doesn’t happen to me?

People have preconceived notions about who is at risk for a heart attack and unfortunately these assumptions are usually very wrong. Most of us think heart attacks only happen to overweight people, or sedentary people, or smokers. People look at me and see themselves and it freaks them out. True, I didn’t have any outwardly apparent risks for heart disease, but below the surface I was a ticking time bomb. My triglycerides were significantly elevated. My high-density lipoprotein (HDL or good cholesterol) was low. My blood sugar was borderline high. My family history was chock-full of heart disease. I had what is commonly known as Metabolic Syndrome or Syndrome X — a cluster of conditions that increase the risk of heart disease, stroke, and diabetes.

Metabolic syndrome occurs when a person has three or more of the following measurements:

  • Abdominal obesity (Waist circumference of greater than 40 inches in men, and greater than 35 inches in women)
  • Triglyceride level of 150 milligrams per deciliter of blood (mg/dL) or greater
  • HDL cholesterol of less than 40 mg/dL in men or less than 50 mg/dL in women
  • Systolic blood pressure (top number) of 130 millimeters of mercury (mm Hg) or greater, or diastolic blood pressure (bottom number) of 85 mm Hg or greater
  • Fasting glucose of 100 mg/dL or greater

I had three of the above symptoms, all hidden below the surface. And I knew about it. And I tried to fix it on and off for years by adjusting my diet and exercising more. But I still had a heart attack at 45.

What could I have done to avoid having a heart attack?

When people ask me that question (and they always do), I say the same thing: if you have three or more of the signs of Metabolic Syndrome, or a family history of heart disease, and are over the age of 40 — go get a coronary artery calcium (CAC) scan.

Right now you’re probably thinking how come you’ve never heard of this test. Is this something new? It’s not new, and has been around since the early 90s, but for a long time it has been seen by many cardiologists as not reliable enough to recommend for their patients. But that is changing, as discussed in a newly published article by Harvard Health Publishing, and as evidenced by the growing number of hospitals and diagnostic labs that offer the test.

“CAC results can help identify a person’s possible risk for heart attack or stroke, even if that person doesn’t have the obvious risk factors or symptoms,” says Dr. Jorge Plutzky, director of preventive cardiology at Harvard-affiliated Brigham and Women’s Hospital. “It can be a way for some people to get the necessary treatment early and hopefully head off a serious cardiac event.”

If I’d had a CAC at a local hospital prior to having a heart attack on Oct. 15, 2011 it’s very likely the test would have shown that I had a severe blockage in my left anterior descending artery. Instead of having the heart attack that nearly killed me and permanently damaged my heart, the test results would have tipped off doctors that I was in danger and they could have gone in and stented the artery before the damage was done.

I’m not saying everyone should run out and get a CAC. But if you are at risk for heart disease it’s a valuable tool in the arsenal and it just might save your life. And while insurance companies aren’t yet sold on its value (and since when have insurance companies cared about your health), it’s a relatively inexpensive test and in most places you don’t even need a referral from a doctor. That’s right, you can use Google to find a test location near you, make an appointment, and plop down less than $100 for a 15 minute non-invasive test that might save your life.

That seems like a small price to pay for peace of mind.