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.

Why I’m Doubling Down on Low Carb, Intermittent Fasting in 2019

I’m not much of a New Years resolution guy, but it’s hard not to think about the year ahead as the new year approaches. When it comes to my diet plans for 2019, I feel the need to echo the late George Herbert Walker Bush during the 1988 presidential campaign — stay the course.

All of my reading and research last year led to my full adoption of a low carbohydrate lifestyle, and nothing has changed that would lead me to rethink this approach. I’m not a doctor, but I’m fully confident that my cardiovascular health improved over the course of 2018. A year-end visit to my cardiologist confirmed my own analysis. In December I had an echocardiogram, a nuclear stress test, and a blood workup and all of these diagnostics returned very positive results.

The biggest danger for a heart attack survivor like me is to have a second cardiovascular event. In the first few years following my near fatal event, my heart performance was stable and improved a bit. My blood work was better, if not perfect, and all the other tests showed incremental improvement. Most importantly, my ejection fraction (my heart’s ability to pump blood out to my body) went up each year.

At the time of my heart attack, my ejection fraction (EF) was measured at around 30-35 percent. An EF of less than 40 percent may be evidence of heart failure or cardiomyopathy. For me, this was the scariest aspect of my event. It was also what has been driving me to make changes to my lifestyle.

Improving my EF has provided positive reinforcement for the things I’ve been doing to improve my cardiovascular health. I know that lifestyle led to my heart attack, and therefore lifestyle could keep me from having another one. This is why I’ve spent the past seven years exercising more, taking my prescribed medications, seeing my cardiologist regularly, and eating right.

Honestly, the only aspect of the above lifestyle changes that have provided any complications for me over the years since my heart attack has been eating right. I truly believe the medical establishment either doesn’t know or doesn’t want to suggest how to eat appropriately for cardiovascular health (I think they don’t want to provide advice because it is not so clear cut and if they are wrong they may be worried about liability). All the proof you need that the medical establishment doesn’t know the best way to eat is to Google diet advice — you’ll go down a rabbit hole from which you may never surface.

After my heart attack, my first cardiologist told me to avoid sodium because high blood pressure can lead to heart failure and/or cardiomyopathy. In that first year I avoided sodium like it was poison. Do you have any idea how hard it is to limit sodium intake to less than 1,500 mg a day?

But sodium didn’t cause my heart attack, so I spent a lot of time researching the latest medical advice on diet. I was really frustrated with what I found. I read about the China Study and Dr. Caldwell Esselstyn and thought perhaps meat was the cause of heart disease. I became a pescatarian, eliminating all meat except for fish. Then research started to point to the Mediterranean Diet as the best overall diet and that seemed reasonable so I went down that path. My blood work was better, but still not where I needed it to be.

I watched every movie about diet from Forks Over Knives to Fed Up to Fat, Sick and Nearly Dead and all I got was more frustrated and confused. But as time went on, I started to notice a trend — there was more and more information out there about the dangers of carbs and sugar. I really honed in on this trend, reading everything I could get my hands on. At the same time, I started working with a new primary care doctor who also believed that carbs and sugar were the real culprits of diseases like diabetes, metabolic syndrome, and heart disease.

I jumped in to the low carb movement under doctor care and with regular blood work checkups to assess how I was doing. And for me, the results have been compelling. My blood work is enviable by any standard, and my weight is in a good range. Best of all, my EF has continued to rise and last month was measured at between 60-65 percent — the best it has been since before my heart attack and within the normal range.

As of today, I have above average blood work and a normal EF. That’s all I could have asked for seven years post heart attack. I may cheat here and there (I do enjoy a beer now and again), and my sugars are not as low as I’d like them (that’s where the intermittent fasting is hopefully going to help), but basically, I am in great cardiovascular health. And I’m enjoying how I eat, which is to say I get to eat a wide range of foods including meat, eggs, and a little whole grain bread.

So here I am in January 2019 with probably the best cardiovascular health I’ve had since I was a teen. I attribute this to exercising more, taking my prescribed medications, seeing my cardiologist regularly, and eating right — that is to say, a low carb, low added sugar diet. I definitely need to exercise a bit more, but for the first time in a long time, I am confident I am eating healthy.

Intermittent Fasting Off to Metabolic Slow Start

Three months ago, in an effort to reduce my fasting glucose levels and hemoglobin A1c which are slightly elevated, I added 16/8 intermittent fasting (IF) into my diet routine. The idea was that by not eating during a 16-hour window each day, I’d lower my insulin resistance and bring my sugars into a more normal range.

It’s worth noting that my sugars were not too high (109), but rather near the top of the normal range (less than 100) butting up against the pre-diabetic range (100 to 125). My A1c was 5.2, within the normal range, but not too far away from the prediabetic range of 5.7 or above. With my cholesterol and triglycerides in wonderful shape thanks to my low carb high-fat diet, the sugars were the only thing threatening my overall cardiovascular health.

Yesterday I got my most recent blood test results, and while my cholesterol/triglyceride levels were flat, my friggin’ fasting glucose and A1c went up to 112 and 5.6 respectively. Needless to say, this was not the result I was looking for when I started IF in early September. In fact, while my doctor suggested I do IF five times per week I have been doing it virtually every day for three months.

Rather than panic and give up, I thought a little more about how I’ve been eating (and drinking) over the past three months and the truth is while I have generally been on a low carb high-fat diet, I have cheated a ton. It started with a 12-day vacation to London and Paris, where I ate more than my share of chocolate croissants, macarons, and muffins and drank more than my share of beer. When we got back from Europe, I continued to snack here and there on sugary cookies and muffins and continued to have a few beers every week. I went on a boys’ trip to Wyoming where in two days I drank more than I do in a typical month, went to a beer festival with my son, and then between Thanksgiving and Christmas I’ve sneaked an unhealthy amount of sugar-laden foods and drank plenty of beer. I also hurt my lower back, which still hurts by the way, and as a result, I have not exercised much at all.

Mmmm Beer.

All this is to say, I probably counteracted the good from the IF with the bad from my lack of dietary willpower. I sent my primary care doc a note to ask for her advice, and she said to continue with IF because it really takes closer to a year to see significant results on the A1c and sugar front. She suggested I try doing IF only five days per week, but to try to extend it a couple of days a week from 16 hours off to 18-20. On the diet front she told me to eat a diet that I will stick with.

Rather than freak out, I have decided to rededicate myself to eating a low carb high fat diet, get serious about cutting out the “holiday” snacking, do IF Monday through Friday, and increase my walking to 5-6 days per week or a minimum of 150 minutes per week as recommended by the American Heart Association and others. Honestly, I felt better physically when I was sticking to the low carb high-fat diet more religiously. And the more beer I drink, the worse my GI system feels. If I didn’t love beer so much I’d give it up completely, but for now, I suppose I’ll limit my intake of the nectar of the gods and only imbibe on special occasions.

The experiment continues!

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!

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.

Heart Disease, Depression Strongly Linked

anthony-bourdain-dead-6The 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:

1-800-273-8255

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.

 

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!

Don’t Be Fooled by Your Total Cholesterol Number

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.LDL-cholesteral-particle-size-matters

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.

 

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.