Heart attacks and sudden death: are you at risk?

Fred was a mildly overweight, 38-year-old male who decided to take up short distance jogging, so he joined a local running club. Running was a new activity for him but he did not obtain a doctor clearance to begin. Fred's mother and father both had heart disease. He died on a club run; one heart artery was nearly 100% blocked.

The media contains stories of people that may have died a premature death during exercise. Jim Fixx's demise and last year's incident in the Staten Island Half-Marathon reached national media levels. There are more deaths locally, such as on Fred's Virginia-based team, which has lost two members on short training runs in the last 10 years.

There are decades worth of research in support of physical activity as an essential component of reducing the risks of heart disease, stroke and a host of other life-threatening illnesses. It is important to remember that coronary artery disease took the life of Jim Fixx, not exercise. On the contrary, running most likely prolonged his life. The rate of sudden death in previously healthy, middle-aged runners is about seven of every 100,000 exercisers per year. In younger people, it is even lower because they typically don't have coronary artery disease. Nevertheless, every runner--and previously sedentary people in particular--should take steps to ensure they are not at increased risk due to family history or other factors.

From these strange examples of sudden death in otherwise healthy runners, we can learn that the real questions are: Am l at higher risk than the general population my age? How can my risks for heart disease be discovered, and what can l do about them? The answers are relatively easy to obtain now, thanks to extensive research. Pooling all of the cardiac risk assessment tools together reveals seven major risk factors. (Note: Diabetes has recently been elevated from a risk factor to a heart disease equivalent. Obesity greater than a body mass index (BMI) of 30 is clearly a risk, even if indirectly as an indicator of other risks. Optimal BMI range in low-risk people is 20-25.) The seven major risk factors are:

1. Smoking

2. High Blood Pressure

3. High Cholesterol (including high LDL and/or low H DL).

4. Age (men over 45, women over 55)

5. Family History (a male relative under age 55 with heart disease, or age 65 for female)

6. Diabetes

7. Obesity

Every adult would be wise to identify their risk factors for heart disease, either formally with a risk assessment tool, or at least by simply totaling their number of the seven major risk factors. Discussing your risk with a physician may lead to cardiac testing and treatment that could save your life.

(The Physician & Sportsmedicine, 2002, Vol. 30, No. 11, pp. 23-29; JAMA, 1982, Vol. 247, No. 18, pp. 2535-2538)

Dr. Mendel is a family physician and the former medical director of the Marine Corps Marathon.

Online Tools for Assessing Risk:

www.americanheart.org/presenter.jhtml?identifier=3003500

http:/hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof

For General Info on Risk Factors:

www.lipidhealth.org/content/helpfulresources/fact_pdf/FctAbt_riskfact ors.PDF