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6,000 miles a year vs. heart attack

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6,000 miles a year vs. heart attack

Old 07-17-17, 10:11 AM
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pdlamb
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6,000 miles a year vs. heart attack

You might think that bicycling 6,000 miles each of the last 8 years would be sufficient to prevent a heart attack, or myocardial infarction(MI). I did. I was wrong. But I’m lucky, I’m here to tell about it.

Actually, it’s worse than the 6,000 miles per year. I’ve averaged over 6,000 miles per year forthe last 11 years, including a cross-country ride with my daughter in 2009. I cheered all the articles that said “Fat doesn’t mean unfit,” because it meant I didn’t have to change much. And according to my doctor, whom I visited last fall, I had a 12% chance of a cardiovascular event over the next 10 years, which I took to mean I only had a 1.2% chance of one this year, so I could take off those pesky extra pounds over the spring and summer and reduce that chance even more. That sort of thinking was comforting. And foolish, in the “This night your life is required of you” kind of foolish.


Bicycle commuted one day, and sometime after supper I collapsed with a 99% blockage of the LAD -- colloquially known in cardiac circles as “the widowmaker.” My wife couldn’t turn me over, so she called 9-1-1. The EMTs got to me quickly and started CPR, then hit me with the AED, and got me to the ER. I had superb care that located and stented the blockage at the top of the LAD, where it had stopped most blood flow to half ofmy heart. The next day, when they tried to bring me out of induced hypothermia, I coded and was shocked something like 15 times before my heart rhythm was stabilized. (Fortunately I was on a ventilator, drugged up but good, and therefore completely out of it, so I don’t remember any of that.) I got medication, and went through physical therapy and cardiac rehabilitation.



My cardiologist told me cycling saved my life. I’m grateful for that, but I have to wonder if cycling also contributed to my arrogance that let things get that far. I can’t control the fixed risks (age, sex,and family history); cycling took care of physical activity and I’ve never smoked, but I blew off the other modifiable risks as under control:
Cholesterol: Hey, I’ve lived with elevated cholesterol for20 years
High blood pressure: It only got up to borderline high thisyear
Obesity and overweight: No problem, remember I cycled a lot?
Diabetes: Blood sugar was OK, and if HbA1C was creeping up, it was still below the diabetic threshold
Diet: Standard American Diet, less some red meat (more chicken than pork and beef) and cut out most French fries. See, I changed something, it must be good!
Drugs: Naw, I don’t want to risk muscle soreness from a statin, or lower my heart rate with a beta blocker. How will that be good for my climbing?



Nothwithstanding that three cardiologists wanted me to be their patient because I’m still relatively young and in pretty good shape (fora cardiac patient!), recovering from this has been a bear. Starting with needing two naps every day, then walking around the block before needing a nap, and seeing my long bikeride drop from 50 miles the weekend before my MI to 6 miles, riding up and downa deserted street with my wife watching from the car with a cell phone in her hand, my endurance and capacity for exercise were diminished greatly. My diet improved, rapidly and forcibly, by necessity. No extra salt, red meat no more than once a week, low fat (no fried foods, butter, or cheese is pretty tough when you goout to eat!). I still miss the taste andtexture of a doughnut, the flavor of a rack of ribs, or the simple pleasure of adding salt to a dish that desperately needs it. But while I miss those, I also miss the extra30 miles I used to ride as a routine every weekend, and cycling in the country this spring that I lost, and the carefree riding without worrying that I was pushing too hard.

All the changes (mostly diet, weight loss, and medication) have had a positive effect. How would your doc respond to a 64% decrease in LDL? Or decreases in total cholesterol and triglycerides of about 50%? If youhad my cardiologist, he’d say, “That’s good.” Lose 25 pounds? “Keep withit.” Full stop. But he was smiling, both because I was alive and in his office, and because I had made (and continue to make) the changes tostay alive.

Why didn’t I change all this a year ago? If my weight, BP and lipid profile had been then what they are now, my risk of a cardiovascular incident (heart attack orstroke) would have been 4.5%, instead of 12%. Put simply, I couldn’t be bothered.

As Ben Franklin wrote, “Experience keeps a dear school, but fools will learn in no other.” I had to learn the hard way. Maybe you won’t haveto do that.

And I’m glad to be back on the bike! The statin isn’t as bad as I’d feared, I haven’t had any muscle aches I can attribute to the statin. I’m building up slowly, and hoping to complete a couple of brevets next spring.

tl;dr? If you don’t want a sudden, drastic lifestyle change, make appropriate gradual changes now.

Start paying attention to your heart now, while you can makea difference.


Check out https://www.heart.org/HEARTORG/Conditions/My-Life-Check---Lifes-Simple-7_UCM_471453_Article.jsp for changes to consider.


Talk to your doctor. If he says it’d be a good idea to start youon a statin, do it while you can!


Last edited by pdlamb; 07-17-17 at 10:17 AM.
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Old 07-17-17, 10:29 AM
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Glad you came out of all that in one piece!

I dunno why these are not the standard of care ... IMHO, they should be:

Computed Tomography Angiogram (CT Angiogram)

Family history, age, weight, bloodwork ... all of that is information used to essentially guess at the state of your cardiac arteries. The way I look at it ... why guess when a simple non-invasive test can give you a much better estimate of your cardiac health. I know one guy (bad family history and overweight) who was on statins for years, had the test, and his doc promptly told him to stop the statins ... he didn't need them.

Most insurance doesn't pay for it, but it doesn't cost much more than a decent set of wheels.
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Old 07-17-17, 11:56 AM
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Fat, skinny, "normal". It can happen to anyone regardless of the amount of cycling. I lost a friend back in '98. He was only in his 50s. Lean guy who rode thousands of miles/year. Dropped dead of what was believed to be a massive heart attack less than 2 miles into a club ride. He was thin but had a not-so-healthy diet. (I saw the stuff he ate. Lot's of fatty, cholesterol-ladened stuff.) On top of that, he was fearful of doctors and finding out what they might find, so (I was told) he never had things like his cholesterol checked. The crazy thing is that he widow dies in her sleep a few years later, apparently of a heart attack. If I were his one of kids, I would be getting my cholesterol checked monthly.
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Old 07-17-17, 12:12 PM
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When it comes to recovery from an illness like a heart attack, I would rather be the person who is in reasonable shape from having exercised regularly than the couch potato in dire shape.
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Old 07-17-17, 01:01 PM
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Originally Posted by Biker395 View Post
I dunno why these are not the standard of care ... IMHO, they should be:

Computed Tomography Angiogram (CT Angiogram)

Family history, age, weight, bloodwork ... all of that is information used to essentially guess at the state of your cardiac arteries. The way I look at it ... why guess when a simple non-invasive test can give you a much better estimate of your cardiac health. I know one guy (bad family history and overweight) who was on statins for years, had the test, and his doc promptly told him to stop the statins ... he didn't need them.

Strangely enough, I missed my CT scan while I was in the hospital. The cardiologist who put the stent in told me mine was a soft plaque rupture -- it wouldn't have showed up on the CT, because the plaque hadn't hardened by incorporating calcium. So if I'd had the scan 2 days before the MI, instead of scheduled for 2 days after, I'd have been scored clean -- a false negative, as it turned out.
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Old 07-17-17, 01:04 PM
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Good post PDlamb. Maybe it wil prevent a dangerous episode for someone. Woody Allen said "Confidence is what you have before you understand the problem".
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Old 07-17-17, 01:19 PM
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pdlamb,

I too am guilty of the misconception that because I bike 50-100 mile per week I am somehow "protected" from a bad cardiac event. Which has led to less than adequate attempts to control my weight. As I get older and I see many friends of mine have cardiac events I realize every day I wait to change my lifestyle is another day closer to my event.

Thank you for sharing your experience..... it is a wake-up call for me. Time to take care of myself.
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Old 07-17-17, 01:20 PM
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My doctor put me on statins. They made my muscles ache. My doctor said to take CoQ10 for that. That stopped the muscle aches. It also gave me a little more energy. I used the extra energy to start riding a bike. A year later my cholesterol was improved, so my doctor took me off statins. That was 5 years ago and my cholesterol is still good. I still get it checked every year. My diet is pretty bad.
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Old 07-17-17, 01:27 PM
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Originally Posted by indyfabz View Post
Fat, skinny, "normal". It can happen to anyone regardless of the amount of cycling.
It can, but it usually happens to people with the usual risk factors.

@pdlamb's message is

1. Don't ignore the risk factors and
2. Regular exercise improves survival and recovery rates if it does happen to you.
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Old 07-17-17, 01:36 PM
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Originally Posted by DiabloScott View Post
It can, but it usually happens to people with the usual risk factors.
True. My friend apparently chose to not find out if he had the usual risk factors. He was great ride creator. We still run his crowning achievement--New Hope, PA to Brooklyn, NY--in his memory.
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Old 07-17-17, 01:44 PM
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Looing just at cycling mileage can be deceptive. Slow and easy all the time is similar to walking around the block. We need time where the HR is up, breathing is rapid, and sweating takes place.

If someone isn't doing that now, it's also important to build up intelligently.
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Old 07-17-17, 05:44 PM
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Originally Posted by pdlamb View Post
Strangely enough, I missed my CT scan while I was in the hospital. The cardiologist who put the stent in told me mine was a soft plaque rupture -- it wouldn't have showed up on the CT, because the plaque hadn't hardened by incorporating calcium. So if I'd had the scan 2 days before the MI, instead of scheduled for 2 days after, I'd have been scored clean -- a false negative, as it turned out.
I'm not an MD, but I think getting the CT angiogram with contrast improves that issue.

Still ... that is frightening, and a good lesson for everyone. Thanks for sharing!
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Old 07-17-17, 06:01 PM
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Good job on surviving an MI and then cardiopulmonary arrest! Keep riding but, yes, work on the things you had neglected before.
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Old 07-17-17, 06:06 PM
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You can't out ride a bad diet. I also believe that unless a genetic heart condition involves a resultant deformity the co relation with heart disease and family history is due to inherited diet rather than inherited genes.
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Old 07-18-17, 11:06 AM
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Is it correct that you were doing everything your doctor(s) advised with the exception of the statin, or was your weight also a concern? Sorry if I missed that. There seems to be more fear of statins here in the US than in the other developed countries. Maybe that's one of the things that contributes to health being worse here than in most of our peer countries.
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Old 07-18-17, 11:16 AM
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One of mt best friends and riding buddy died of a heart attack at age 64. He raced mountain bikes with me and did crit racing often. I would hate to guess how many miles he rode but he rode daily and had been for years. One day he was out training for the senior olympics and he had a bad virus. He rode one of our regular routes, about 40 miles, and when he got home he had the heart attack. It can happen to anyone. I miss him, I was in the best shape of my life riding with him.
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Old 07-18-17, 06:20 PM
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Well I'm very glad that you came out of it okay. I had a similar experience a little over 2 years ago. Woke up feeling like I was coming down with a chest cold. I did an hour workout with my coach at the gym (because it was a Tuesday and that's what I did on Tuesdays). Then I showered and went to work still feeling a little funny. By noon it had progressed to feeling really lousy, so I drove home. On the way I somehow decided that maybe this wasn't just a cold or flu and that maybe I didn't really know what it was. So I turned around and headed for the hospital. A few minutes later I was unconscious and in full arrest. Three bystanders saw the crash and stopped to help. Fortunately they all knew CPR and were able to keep me alive while they waited for EMS. I spent 7 days in the hospital and a few months recovering.

I am convinced that my riding was partly responsible for saving my life, even if it didn't save me from having a heart attack. It also meant that my recovery was quicker and more complete. Now I'm back to about where I was. I rode RAGBRAI last year and did 6 of the 7 days (370 miles).

Everyone was shocked that I had had a heart attack, including me. Riding and other exercise strengthens the heart, but does very little for the arteries. I think that science still doesn't really understand what causes coronary artery disease. The only symptom I had before my heart attack was high blood pressure, which we were treating with an ace inhibitor. Cholesterol was on the high end of normal, but still normal. Annual EKGs and one stress test all indicated I was fine.
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Old 07-18-17, 06:36 PM
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Originally Posted by DiabloScott View Post
It can, but it usually happens to people with the usual risk factors.

@pdlamb's message is

2. Regular exercise improves survival and recovery rates if it does happen to you.
Not sure this is true. Anecdotally, the one local cyclist I knew who died of a heart attack was a competive Cat 3 racer, very fit and lean.

Here's a recent relevant news story: Obese patients are 30% more likely to survive heart attack | Daily Mail Online
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Old 07-18-17, 07:15 PM
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Getting my first angiogram (CTA) with the dye on the 26th. I think it'll be fine but one does worry. Did a full hour at 3 beats below my LTHR on Sunday and didn't die, so that gives me hope too. My stress test said I was 25 years below my calendar age.
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Old 07-18-17, 07:52 PM
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Originally Posted by shelbyfv View Post
There seems to be more fear of statins here in the US than in the other developed countries. Maybe that's one of the things that contributes to health being worse here than in most of our peer countries.
There was a statins thread here a few years ago. Feel free to look it up. I for one took them for about a year before I finally told the doc that I'd rather take my chances of dying from a heart attack in 10 years than the certainty that the statins would kill me in a year or two.

As a result of my intransigence, the doc sent me to a cardiologist, who gave me the full stress test. Once they got me up to 145 BPM, I asked if we could try for 180. Doc gave me a disgusted look and made a comment about needlessly wearing out the equipment. Then he tried to put me on statins too. I fired both of them.
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Old 07-18-17, 10:07 PM
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Originally Posted by BlazingPedals View Post
As a result of my intransigence, the doc sent me to a cardiologist, who gave me the full stress test. Once they got me up to 145 BPM, I asked if we could try for 180. Doc gave me a disgusted look and made a comment about needlessly wearing out the equipment. Then he tried to put me on statins too. I fired both of them.
That's great!

I dreaded my first stress test. At the beginning of the test I heard them say the target heart rate was 168, and I stopped worrying. Sure enough, when the doc declared the test was over I said "what do you mean? I'm just getting warmed up!"

Sadly I feel like I can't say "no" to the statins anymore. Even with cholesterol in the acceptable range I developed blockage. Fortunately the statins aren't causing me any serious issues that I don't already have.
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Old 07-18-17, 10:32 PM
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I went through a number of statins until I got one that didn't have side effects. My doc also started me off on a really low dose and increased it from there. I've had no issues.

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Old 07-18-17, 10:41 PM
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I've been on statins for about a year with no problems that I know of. Unless they cause weight gain lol. My cholesterol went from 250 to 150.
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Old 07-19-17, 05:26 AM
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My experience as well. Significant lowering of levels, no side effects. I wonder if this is another of those issues where the people who have the training to understand are of consensus but there is still the perception of controversy since it's now so easy for anyone to have a public platform.
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Old 07-19-17, 05:55 AM
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Originally Posted by shelbyfv View Post
My experience as well. Significant lowering of levels, no side effects. I wonder if this is another of those issues where the people who have the training to understand are of consensus but there is still the perception of controversy since it's now so easy for anyone to have a public platform.

I'm not sure what you're trying to say there; but my take from the thread was that side-effects are much more common than advertised, and the more/harder you work out the more likely you are to have them. The word I'd use to describe mine were "debilitating."
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