A doctor resolves to cut his heart attack risk

I have a 5% chance of having a heart attack in the next 10 years. That’s not so high, but it’s higher than I want it. Most of that risk is due to my cholesterol and my age. I can’t do anything about the latter, but the former is under my complete control. Cholesterol medications can improve my cholesterol significantly. So can proper diet and exercise. That’s not true of everyone; some people will never improve without medication, but I’ve found that my numbers respond at least somewhat to lifestyle modification.

Around the same time I last checked my cholesterol, my wife was headed to Washington, D.C. to help out a friend at the Marine Corps marathon. Her friend’s brother was a Marine Corps major and was killed in Iraq six years ago. Needless to say, it wasn’t his heart. He believed strongly in what he did, and gave his life for his Marines and his country. His friends and family have honored his memory by raising money for injured Marines and their families, a sad necessity. In my daily work I see preventable death and illness every day, but not the kind caused by rockets and gunfire. I was happy my wife could be in D.C. to help out. I couldn’t be there, but I was at least helping others at home, helping to prevent illness and death.

But like many people who work for a living, I’ve sacrificed a bit of my own health along the way. A colleague of mine, about 15 years my senior, had a major heart attack at work earlier in the year. That scared me.

Last week I was at a party, a fund-raiser for local schools. The hosts have a beautiful home. Everyone looked lovely—on the outside. I knew that many of them had had their own struggles: mastectomies, insulin pumps under their shirts, bypass scars hidden by high-neck blouses, tattoos from radiation therapy. Everyone has a story, if they’re willing to tell it and you’re willing to listen, or even bother to ask.

As I thought about this, I stood and talked to one of our friends there. He’s an avid runner, one of the crazy ones. Like most runners, he’s happy to share advice about running and I drilled him on how to get started, especially with the Midwestern winter coming.

I don’t want to be a cautionary tale, a bugbear people invoke over donuts. I resolved to cut my risks. Many others can’t, but I can. In the process, I can give encouragement to others. I agreed to train for 10K so that I can run with my friends at next year’s Marine Corps Marathon. I made plans to cut out one of my evening shifts to add sanity to my schedule, and to run mostly in the mornings.

I haven’t run in years, and was pretty apprehensive, but so far, so good. The first run felt fine, but for days afterward, my quads and shins were a mess. I couldn’t run again for several days. But I’ve run several times since and I’ve seen clear improvement.

And mornings are beautiful. The cold air is so clear. I walk out and see Orion in front of me. Deer scatter as I head down the road. And it’s quiet.

I hope to hell I can keep this up, for my friends, for my family, and for myself.

“PalMD” is an internal medicine physician who blogs at White Coat Underground.

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Comments

Anonymous
Don’t give up! I know it will be easy to and there will be times when you go on hiatus as it were, but you must get back at it. I’m getting up there in years, too, though still young enough to have grade school kids at home as the older ones head off to college. I struggle a bit with cholesterol. I went from TC of 350 to less than 200 in a year with just diet, supplements, and exercise. I slacked off and it went up to 267, but I’m back on track. I’m going for blood work on Saturday, then I’ll see what kind of effort I need to do.
Once you get into the zone where you feel like something is missing when you don’t run, think about adding resistance exercises (weights) for the upper body. I am not a physician but I am in the industry in other ways (having researched and written, for instance, CME for cardiologists). While running burns fats, the rebuilding process associated with weight lifting I believe also helps the body use up the cholesterol in the blood.
Also, consider the role of carbohydrates in the diet. The role of dietary cholesterol is not as great as it seems. There are about 5 liters of blood in the body — 50 dL. If the recommended level of cholesterol is 200 mg/dL, that makes 10,000 mg in the whole body. That’s a lot to attempt to regulate through avoiding dietary cholesterol since the liver makes cholesterol. If the liver makes cholesterol, two questions are what does it make it out of, and why does it make it at all if one’s cholesterol levels are high to begin with? The answer to the first one is that the liver can make cholesterol out of carbs, and that it will make carbs into cholesterol if there is inadequate cholesterol in the meal that has carbs. So the principle is if you eat 100 g of carbs (a mere 3 ounces) in a cholesterol-free meal, and 99% does not become cholesterol (I do not know how much does, and I don’t know how much cholesterol can be made out of 1g of carbohydrate, this is just an example using numbers easy to work with), then it’s like eating 1000 mg of cholesterol in a single meal. Even if 99.9% doesn’t become cholesterol, that rate of cholesterol production would still make dietary control of cholesterol levels nearly impossible.
My approach is to keep carbs to about 25 or less per meal (they are good only for energy after all, and I still have plenty of energy stored subcutaneously in another form!), eat at least some cholesterol whenever I eat carbs, not deprive myself of protein especially after exercising, and not worry about actual cholesterol consumption as long as I’m being moderate overall. For weight loss, I also watch fats, both animal and vegetable, but protein and non-starchy veggies are free foods.
http://profiles.yahoo.com/u/66NCFAXDWYB7JVNVNLNIUTCUVU Violetta V
“Cholesterol medications can improve my cholesterol significantly.”
Just curious, but by how much you are reducing your risk? 30%? This is an absolute risk reduction of 1.7%. So you are talking a drug which may have side effects even though there is only a 1.7% probability that it’ll help you?
It’s your choice of course….

http://twitter.com/palmd PalMD
Statins for primary prevention is uncertain territory. There is no risk-reduction “cutoff” that I or most docs use. I give my patients info and advice and go over risks and benefits.
For secondary prevention, statins are pretty much a no-brainer.
Niacin is losing more and more face as its outcomes data becomes less encouraging.

Rolf Olsen
I don’t know specifically what my own risk is, but here’s a story to consider: I’m 60 years old and work in communication and marketing at an academic medical center. Exactly 686 days ago, I made a commitment to exercising more and eating less. Every single day, I do 30-60 minutes of vigorous aerobic exercise — most days it’s 45 minutes on the elliptical trainer in my basement “man cave,” plus stretching and some modest weight training. In just less than two years, I’ve dropped 35 pounds and my HDL has gone from 48 (on Lipitor) to 75 with no medication (LDL is 114 and triglycerides 95). Also, after considerable self-education, and consultations with my cardiology team and my family physician, I weaned myself from the three medications (Lipitor, Toprol XL and Lisinopril) that I’d been taking since my own MI on October 2, 1001, more than ten years ago I have one stent in a cardiac artery. My blood pressure is now generally about 124/78 and my resting heart rate is 53. My cardiologists (one recently arrived from a Mayo Clinic fellowship) both advised me to stay on the meds because they would help me “live longer.” Longer than what? I asked. It’s all about the odds and risk factors, I concluded, so continued on the path I’ve chosen and I have no regrets. My decision was based on the notion that I might have another 15-30 years of life, if I make lifestyle changes, including giving up (mostly) my fond and long-term relationship with Ben and Jerry. Do I really want to keep taking these prescription medications for the rest of my life? Will I be able to afford them in my hoped-for retirement, or will I be one of those people making the awful decision to choose food or drugs? Again, I have no regrets. I feel terrific. Since my MI, I’ve never had a single symptom, so I believe I’m on a good path — for me. I know that meds are necessary for some people and I may again fall into that category at some point, but I must also express some cynicism about big pharma and the phenomenon we see in our culture where active drug advertising seems to incite an increase in diagnosis for previously unknown conditions, with the concomitant uptick in prescriptions. Hmm…

A doctor resolves to cut his heart attack risk

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