uciflylow

If anyone here has had heart attacks. Did they happen eventhough you have been riding for years? Did you start riding after the heart problems started?

I quit smoking, took up riding and lost 60 lbs. to help avoid heart problems. Surley I'm not wasting my time. I love to bike and I won't quit untill I'm forced to!

fujibike

No heart attacks here but I'd say you're moving in the right direction to avoid one.

Rich Clark

It was after I stopped riding and got out of shape that my heart problems developed. It's a common story.

The most recent findings tend to indicate that almost all cases of coronary artery disease (CAD) are caused by poor lifestyle choices, not genetics. This certainly tallies with my own experience and that of the patients and professionals in the field that I've talked to.

If you've returned to a healthy lifestyle without actually suffering a cardiac event, there's a pretty good chance you won't -- although if you haven't had a a cardiac workup and you're a middle-aged male who was once overweight and smoked, you probably should.

I had several years of heart problems (and other serious health issues) that developed after I let myself get sucked into the suburban-dad-with-career pit.

But in the last few years I've succeeded in actually reversing the CAD (as well as controlling my diabetes without medication) through cycling and diet.

So no, of course you're not wasting your time. What a silly idea!


RichC

uciflylow

I thought not. I am a medical lab tech and I have been used as a test subject for the ultra sound machine that checks your heart and they said " I have a very good heart".
I have my blood preasure into the normal range now. My HDL is twice as high as before and my other lipids are better also. My resting HR was 54 this morning, it was around 78 less than 2 years ago.

Most of all I feel GREAT! I just got back from a little ride and I feel like crap if I don't get to ride atleast every other day.

My goal is to drop another 40 lbs. by the spring.

miamijim

I'll have to agree with most of this. A vast majority of heart disease is due to lifestyle but much of it is due to old age. With the average lifespan in the upper 70's its double what it was 100 years ago. Thats twice as long for disease processes to work. Whats important is to watch your risk factors, diet, smoking exercise etc. Something you should have done, if this is bothering you, is to have a very thourough cardiac workup. I had a 12-lead EKG done not to long ago and gave me peace of mind to know it was OK. The 'ultrasound' machine you've been tested on is nice for diagnosing congenital defects or valvular disease but it does nothnig to diagnose coronary artery disease. Keep exerciseng, keep losing weight, have a stress test, see your cardiologist and WEAR A HEART MONITOR!!!

Jim.....cardovascular perfusionist

Hunter

Rich,
I dot mean this in a negative way. However "recent studies" what exactly is this? Just over the past few months BRAIN did stories of avid cyclists well known in the industry droppiong dead while riding from heart attacks. One was a former trainer of Lance. I remember another well known runner named Jim Fixx while running dropped as well. I do not think these studies took people such as this into consideration. I also do not think their lifestyle choices were all to conductive to heart failure. If so thre would not be so many people posting here.

miamijim

Yes and no and heres why. Lets say you have a 75% blockage of one of the main coronary arteries, you eat like pig, smoke, and dont exercise. Now you assume a healthy lifestyle. I'm going to say your now at greater risk for a heart attack. If you dont do anything strenuous...i.e. your a couch potato your cardiac demand is almost always constant so that vessel with only 25% flow is flowing enough to get you up a flight a stairs. Now you start exercising. At first that vessel is flowing enough because you only walking around the block. What do you think is going to happen when you get yuor heart rate up and try to pedal up a small hill?? That vessel will no longer be able to supply your myocardium with the increased demand for oxygen. Your now going to have chest pain, if you lucky you wont have an MI.

CHEST PAIN is similar to the muscle pain you get climbing a hill. The pain you feel in your legs is a result of lactac acid build-up which is a result of not supplying enough oxygen to the tissues. The tissues become ISCHEMIC. When this occurs certain enzyme levels in your blood elevate. If the levels are within a certain range within a certain time after the onset of chest pain you've had heart attack. If a cetain enzyme is elevated you've had a myocardial Infarction (MI).

ISCHEMIA...a lack of proper oxygen delivery to the tissues. Either caused by to much demand for oxygen or lack of proper oxygen delivery. Regardless its an im-balance in supply/delivery. Tissues can become ischemic without causing injury. If and injury occurs to the tissues you have had a MYOCARDIAL INFARCTION. Once na infarction thats it....in most cases the tissue is permanently damaged.

Rich Clark

Hunter and miamijim, please note that I was specifically discussing CAD, and not other cardiac problems that may cause heart failure.

miamijim, I agree with what you're saying, which is why I also suggested that a cardiac workup is a good idea for someone returning to exercise after getting out of shape. However, even after an MI that causes tissue death, revascularization can and does occur, and the CAD itself can be reversed. The heart can be strengthened, and even someone with 25% tissue damage can become fully fit again (as I know from personal experience).

Hunter, here's a report on a recent study indicating that lifestyle-related risk factors are likely to be the overwhelming cause of CAD. There may have been other sorts of heart problems that led to the deaths of those athletes, and there are always exceptions (90% may be an overwhelming majority, but it's not everyone; yet's it's a mistake to pick an exception and try to generalize backwards from it).

"Most people with heart disease do have at least one risk factor

"Reported by Susan Aldridge, PhD, medical journalist

"An analysis reveals that the vast majority of those with heart disease have been exposed to at least one known risk factor.
Allthough it is known that diabetes, smoking, high cholesterol, and high blood pressure increase the risk of heart disease, it is commonly believed that many heart attacks occur for other reasons. There could be genetic factors, say, or risk factors still be to discovered.

"However, a new analysis from researchers at Northwestern University, Chicago, now reveals that conventional risk factors do play a major role in heart disease. They looked at three major studies of risk factors and heart disease and found that where fatal heart attacks were concerned, 87 to 100 per cent of those affected had at least one risk factor. For non-fatal heart attack, the figures were slightly lower, This suggests that heart disease may be more preventable than previously realised. If you want to avoid having a heart attack, a healthy lifestyle is a great investment.

"Source
Journal of the American Medical Association 19th August 2003"

RichC

miamijim

Rich, a majority of the patients we operate on do in fact have at least one of the risk factors you mention. One risk factor you failed to mention is old age. Its just like anything other plumbing, with time your going to get build-up in the pipes. You say that coronary disease is reversable. In what way are you reffering to? Coronary revascularization? Ballon Angioplasty? Coronary endarterectomy?

Revascularization of an area that has had an MI occurs as soon as the oxygen supply/demand ratio has been corrected. The trick is to keep the tissue from becoming ischemic again. The tissue can recover from the damage but its realtive to the extent of the infarct and how soon intervention takes place.

Rich Clark

I mean without surgical intervention, or in addition to it.

When you look at a CAD patient's tapes, you can see lots of plaque deposits. They'll ballon and stent the worst ones, but there will still be a Number of deposits -- 50, 60% blockages -- that they'll leave alone because too much intervention is risky.

Most patients eend up coming back to the cath lab eventually to get those repaired, if they're lucky enough to avoid bypass.

But sometimes those blockages can be seen to reduce, or even disappear, in patients that truly change their lifestyles. The plaque goes away, revascularization takes place, the heart muscle strengthens, and the patient is in bettr shape than he was before the initial MI. Dean Ornish has documented a number of these cases, and while I don't follow a regime as extreme as the one he espouses, I've experienced similar results, as confirmed by a cardiogram done about two years ago.

I can't argue with old age being a statistical risk factor, but I'm not quite ready to accept it as causal. I don't think there's enough data. But people from cultures that generally get a lot of aerobic exercise, eat low-fat diets, and don't smoke do tend to die of other things, and there's some evidence from autopsies that CAD isn't a factor as it is in First World cultures.

And it can't be controlled anyway, so I'm not going to worry about it!

RichC

bandaidman

ther are many risk factors for CAD (atherosclerotic)...and many are genetic

hypertension, diabetes, elevated cholesterol, being male or old, obesity, cigarette smoking being the biggies...family history is also included in a risk stratification by most physicians

when one discusses risk factors one must remember that the "risk factor" concept does not neccessarily imply direct causation...ie you can have bad diabetes and cholesterol and not have any coronary disease...other people will have no risk factors and have terrible disease...there is still a lot more to learn

the three that have the clearest predictive value for having an increased risk of atherosclerosis are high blood pressure, high cholesterol, and smoking.

saying it another way....modifying these 3 factors will most likely benefit the patient and his coronary arteries



yes a healthy lifestyle helps

sometimes the way you were made also has an influence

Rich Clark

I think this is turning out to be dangerous thinking. That's what I was glad to see the results of the Northwestern study indicating that genetics is a much smaller contributor than we've been fooling ourselves into believing.

There a re a lot of people who will use an excuse if it's offered to them. For years, there's been this prevailing "wisdom" that half of all heart attacks were caused by inherited factors... that half of the patients would have had the MI even if they didn't smoke, overeat, constantly lose emotional control, never exercise, etc.

And that gave a lot of those folks all the excuse they needed not to change, to blame their genes and not themselves.

Family history doesn't necessarily mean genetic predisposition. Usually it means a family history of eating lots of sausage and a house full of cigarette smoke. My father was a diabetic, but he was also an alcoholic. Certainly those things are risk factors for me (for becoming a diabetic or an alcoholic), but mostly because we learn how to behave -- and what to eat -- from our parents.

I'm not denying the existence of genetic predisposition as a possible contributor in some cases of CAD. But I'd like to see it de-emphasized, because it's too convenient an excuse. Most people can avoid CAD -- and Type II diabetes -- by making intelligent choices. And although it's harder, these diseases can be controlled and even reversed by taking personal responsibility for one's health and making those same choices.

RichC

uciflylow

What will this do for me?

I would also like to share what my old mentor pathologist told me when I was just wet behind the ears. He came here from Cuba due to the political climate and his first jobs where doing autopsies on mental health folks. It was his firm conviction that heart diease was caused mostly by stress. He said he had never done an exam on one of these patients that had heart diease and atributed it to the total lack of stress. I don't know how true this is, but he swore to it.

miamijim

WEAR A HEART RATE MONITOR!!!!

Wearing a heart rate monitor is relevant to supply/demand of oxygen. As heart rate increases cardiac output (how many liters of blood per minute) your heart pumps, increases to a certain point. Once your heart rate reaches a certain level CARDIAC OUTPUT DROPS. Now, if your body needs a certain amount of blood flow (oxygen carrying capacity) and your heart rate enters the zone in which cardiac output drops you've just exceeded the supply of oxygen. That is a heart attack. A monitor will keep you in your target zone.

PTCA...ballon angioplasty....its not that intervention is to risky. Occlusions in vessels do not become hemodynamicly significant untill there is a 50% blockage or more. If you ballon or stent something like that your treating something that doesnt require treating. Vessels become operable/treatable when blockages reach 70-80%. The same holds true for the carotid arteries in your neck.

How many references do you want to verify genetic pre-disposition? Do you want the one from my friend who had bypass at the age of 40? When his blood pooled in his chest and in my heart lung machine you clould see the lipids glistening in the blood. High cholesterol or lipids at the age of 20 when you have a healthy diet is a genetic pre-disposition.

uciflylow

I thought a heart attack was when one of the vessels supplying blood to a portion of the heart became occluded and shut off the oxygen to that part of the heart! This muscle dammage is how an ECG picks up a heart attack, when a certan area of the heart muscle stops firing. Also when the cells of the heart die this is where the enzymes that the lab picks up come from, not just because you exceded the oxygen supply your body was asking for.
I thought when my cardiac output droped below what my skeletal muscle system was begging for is what causes me to get dropped on the hills by fellas in better shape than myself. I was under the impression a heart monitor was so I can train more effectively, not avoid a heart attack.

miamijim

uci, I wasnt to clear with that.....if your bood supply to the heart muscle isnt delivering enough oxygen to supply the heart muscles demand you have a heart attack....

a heart monitor can help you train train more effectively by getting you in your maximum cardaic output zone and it can keep you from having a heart attack by preventing you from exceeding that range....

On hills you get dropped because your muscles use all of the oxygen being supplied to them not because your cardiac output decreases....your leg muscles become ischemic...the burn you feel is acid build-up..this is just like having a heart attack except its in your legs.....chest pain/leg pain....basicly the same

You are right about the enzymes and EKG changes...just remember you can have EKG changes due to ischemia (lack of oxygen) without damaging the heart muscle (infarction)

You do not need to have occlusions in any of your coronary arteries to have a heart attack...without 'getting into it' if you have severe aortic stenosis (a tight aortic valve) and your blood pressure drops your heart muscle can get ischemic and you have all the symptoms of a heart attack....because you just had one...

DnvrFox

If old age is a risk factor for a heart attack, it seems the only remedy for this one particular risk factor is to commit suicide at a younger age so you won't die of a heart attack.

Listing "old age" as a risk factor seems absolutely silly and oxymoronic to me. Old age is a natural and inevitable progression. To me, a "risk factor" is something over which I might have some control. I have no control over my age.

Also, in regarsd to Jim Fixx and other intense athletes, I do believe that there was a study sometime back on free radicals and the damage they inflict and that they are more often produced by folks involved in intense physical activity.

Rich Clark

One more time, because I refuse to be painted into a corner: I'm not suggesting that there are no genetic factors that can contribute to heart disease. There's good data that something like 2 or 3% of lipid disorder cases are inherited, and that certainly sounds like your friend's sad situation.

But other factors are more slippery. Are some people genetically predisposed to higher percentage of body fat? Yes, apparently, maybe so. Does that mean those people can't avoid having their tendency end up causing a heart attack? Absolutely not. Maybe that have to work hearder than some other people, but that's the hand they were dealt.

Indeed, that's what the research into the genetic factors that contribute to heart disease is focusing on: enabling people to identify their particular genetic risk factors so that they can take the necessary steps to obviate them.

But those are the same steps everyone should take anyway. Diet. Exercise. Stress reduction. Not smoking. You don't really need to know that you're genetically predisposed to accumulating abdominal fat to know that you need to take steps to lose weight. And for some people, knowing that would just become an excuse for not trying.

RichC

1oldRoadie

See "1OLDROADIE"

Or to translate "shut up, ride, when it happens - ride, when it won't stop happening - wait till it kinda stops, then RIDE!

Make love as often as you can, love your kids and parents, insult a teen for something to do...and enjoy the day God has given you!!

Max

The life span is so high now mainly to the successes in the containing the infectious diseases.

Please, note that this is the life span of the generation, which grew up in the first half of the twentieth century, when the ecology was close to perfection.

No one has the slightest idea what the life span of the generation, which was born in 60s, or 70s, etc. will be.

The Aids, cancer epidemic (pollution), obesity may cause the life span decrease significantly.

But we will know it only in some decades.

The current life span figures are exploited nowadays as an argument against the environmentalists, but this life span does not reflect the dangers of pollution and climate change, as we will see the results of these calamities decades later.

Commuting by bicycle, however, reduces the risks of pollution, loss of bio-diversity, and climate change. And if done by the large number of people, it will contribute to the improvement of health.

uciflylow

1oldRoadie, I'm with you!

I'm hoping to not be dropped on the hills next summer, by dropping 40lbs. of lard by the side of the county roads around here over the rest of the summer, fall, and winter.

Is a heart rate monitor going to help you that much unless you push yourself to the point of chest pain? I may look into getting one if it will help me push harder. Mostly what I have to keep in check is how hard I push my muscles and tendons and practice good form.

Looks like I'm moving in the right direction, I'll just keep on strokin!

Rich Clark

I think it depends somewhat on why you're training, but I find my HRM quite useful in maximizing the amount of time I spend "in the zone" when I'm riding. Since for me aerobic fitness is the training goal, I try to stay around 75-85% of my maximum heart rate pretty much all the time.

Of course, you have to know what your max rate actually is, and that has to be tested empirically. In other words, you have to go there. It's another worthwhile reason to get a cardiac workup including an exercise stress test. If you've been overweight, out of shape, a smoker, then determining your MHR by climbing a hill until you fall over and then checking your pulse (if any) is probably not the best strategy!

I'm continuously surprised by how frequently my perception of how hard I'm working doesn't match my heart rate. It's always lower than I think it is when I'm riding into a headwind, for example, and I have to push harder to get it higher. On the other hand, I can be cruising along on the flats feeling relaxed and enjoying the breeze when the damn thing starts beeping at me.

RichC

miamijim

Rich has hit the heartrate monitor concept.....if you wait untill you have chest pain its too late. Remember a heart rate monitor will serve at least the following two functions..1. it gets you 'in the zone' as Rich has noted to maximize your workout and 2. it will keep you from going 'overboard'. Its important not to let your body use more than your heart can supply...staying within you target zone will limit what you body uses because you'll take it easier when you hit the upper rate alarm.

Supply and demand.... keep the balance in your favor.

late

I didn't use my HRM once this year. Guess I ought to start using it; especially now that I'm training harder than I have in years.

LaFlore

This is an interesting discussion.. I've always known that a HR monitor is a useful tool for helping one get 'in a zone' to maximize training, as well as for possibly detecting the onset of overtraining (i.e. low heartrate per perceived effort). I still occasionally use one for both these reasons, as well as for pacing in TT's or on long climbs.

However, the idea that one should use one to consciously hold back to keep from overtaxing the heart is a new one (to me). Did I read that right? I mean, I purposely forego using a HR monitor in criteriums because I don't want to know how sky-high my HR is! I was always under the impression that acid buildup in the legs would be a limiter well before the load on the heart reached dangerous levels. Or does this only apply to folks with known heart conditions?

This year I've relied more on RPE than on a HRM in my training - and I've had better results.

Go easy on me, I'm clueless in this area.. but always willing to learn something new.