Are the odds stacked against you?

Friday, July 20, 1984, in northern Vermont. A passing motorcyclist discovered a man lying dead beside the road. He was clad only in shorts and running shoes. The man was Jim Fixx, author of The Complete Book of Running.

This amazingly successful book had topped the best-seller lists for nearly two years, helping to accelerate the running boom of the late 1970s. Jim Fixx had become one of the leading spokespersons on the health benefits of running. Now he lay dead--with his running shoes on. And this is why so many of us were disturbed--Jim Fixx died of cardiac arrest while pounding the pavement for the fitness and health he advocated for all.

On autopsy, it was discovered that all of Jim Fixx's blood vessels were partially or nearly completely blocked with plaque buildup. The autopsy also showed scar tissue from three previous heart attacks, and a congenitally enlarged wall between his heart's two ventricles.

How could such a man in seemingly peak condition, who had run 60 to 70 miles per week for more than 12 years, be stricken by a disease most strongly associated with a sedentary life?

At high risk. Jim Fixx, despite his running, was at extremely high risk for heart disease--yet he chose to ignore the warning signals. Jim's father had died of a heart attack at age 43. Family history of heart disease, especially before the age of 55, is an extremely potent risk factor for it.

Up to his mid-30s, Jim Fixx was smoking two packs of cigarettes a day, weighed 220 pounds, and had a high-stress executive job. At age 35 he tried to turn his life around by running. He soon began racing marathons and lost weight, but he chose to continue a poor-quality diet. He decided there was no need to see a doctor, despite experiencing heart disease warning signals such as throat and chest tightness. In addition, Jim Fixx was not coping well with the stress that popularity had handed him. Seventeen years later he lay dead of a heart attack.

Experts feel that Jim Fixx had too many heart disease risk factors stacked against him early in life. Although he tried to improve the odds by running and quitting smoking, for him it was too little too late. "Jim felt a daily jog was all he needed to stay healthy and avoid his father's fate. Indeed, Jim's faith in running was almost religious," says Dr. Neil Gordon of the Aerobics Center in Dallas, Texas.

What Jim Fixx failed to realize is that there are 10 major risk factors for heart disease, and a sedentary lifestyle is only one of them.

Heart disease risk factors. The American Heart Association has organized the 10 heart disease risk factors into three categories:

Major Risk Factors That Can't Be Changed

* heredity 

* male sex

* increasing age

Major Risk Factors That Can Be Changed

* cigarette smoking

* high blood pressure

* high blood cholesterol

* inactivity

Contributing Factors

* diabetes

* obesity

* stress

While you can't do anything about some of the risk factors, others are largely under your control. And some of them are related to one another. For example, most experts agree that obesity is the most important cause of high blood pressure and non-insulin-dependent diabetes, and is also strongly related to high blood cholesterol levels.

People who are physically active tend to have lower blood pressure and cholesterol levels, are better able to maintain ideal weight, and often report they can manage stress better than sedentary people.

What about diet? You may notice that diet is not highlighted in the risk factor list. The American Heart Association asserts that diet lies at the foundation of nearly all the risk factors, and decided not to list it separately. We are strongly urged that a low-fat (less than 30 percent of all calories), low-cholesterol (less than 300 milligrams per day), low-sodium (less than 3,000 milligrams or the equivalent of 1.5 teaspoons of salt per day), high-carbohydrate (more than 50 percent of all calories), high-fiber (20 to 35 grams per day) diet be adopted by all who wish to lower their risk of heart disease.

These risk factors do not answer all questions about the causes of heart disease, but they do appear to account for the majority of heart disease in most Westernized countries such as the United States and Europe. Many other factors probably play a role, but not enough is known about them at this time.

Controlling risk factors. The danger of heart attack increases with the number of risk factors. Jim Fixx, at age 35, probably had seven risk factors for heart disease, putting him at extremely high risk. Forty percent of those who have high blood pressure also have high blood cholesterol levels, which strongly increases their risk of early death from heart disease.

Often people who are 'stricken with heart disease have several risk factors, each of which is only marginally abnormal.

However, much can be gained by keeping the risk factors under control. Dr. Jeremiah Stamler, one of the foremost researchers in the area of health and disease, has estimated that the total effect of eating a low-animal-fat diet (rather than the typical diet), having a serum cholesterol of 200 mg./dl. (rather than 240 mg./dl.), a systolic blood pressure of 120 mm. Hg (rather than 140 mm.Hg), and not smoking cigarettes (rather than smoking 10 a day) would add 12 years of life to the average individual, not to mention improving the quality of life.

What about you? The United States Public Health Service has strongly recommended that all of us keep a careful tally of our risk factors, with regular assessments of blood pressure and cholesterol. Be sure to check you heart disease risk by taking the test on page 7. The fewer risk factors you have, the lower your risk of heart disease.

Jim Fixx carried a full backpack of risk factors until age 35, and although he tried to lighten the load a bit, the stress on his heart was too great.

You no doubt have heard people cite the few case histories of those who smoked all their lives, ate bacon and eggs every morning, and lived without heart disease into their 100s. Researchers tell us that these exceptions are poor role models indeed for the majority.

Dr. Walter Bortz, in his book We Live Too Short and Die Too Long (New York: Bantam Books, 1991), writes: "We squander health as we would never squander money.... And still you may protest, 'But what about the patient who drinks like a fish, smokes like a furnace, eats like a hog, carouses like a buck, and is nonetheless 85 years old?' By the same analogy, you may once in a while drive from San Francisco to Los Angeles at 120 miles an hour and still get there--but don't bet on it. Maybe suicide doesn't work the first time around, but try again; the odds get better."