Heart Disease In A Marathon (PHYSICIAN!) Runner
 

Wonder if he followed the SAD diet?

Web address: http://www.sciencedaily.com/release...70315091100.htm


Source: University of Maryland Medical Center
Date: March 18, 2007
More on: Heart Disease, Fitness, Cholesterol, Stroke Prevention, Workplace Health, Today's Healthcare

Heart Disease In A Marathon Runner: Is Too Much Exercise A Bad Thing?
Science Daily — Doctors at the University of Maryland Medical Center had a mystery on their hands. A 51-year-old physician colleague who looked the picture of health—no cardiovascular risks, a marathon runner who had exercised vigorously each day for 30 years—had just flunked a calcium screening scan of his heart.

The patient had expected a score indicating a healthy cardiovascular system. Instead, the images indicated a high score: a build-up of calcium in his coronary arteries put him at high risk for blocked blood vessels and a possible heart attack.

The mystery was all the more intriguing because his resting blood pressure and fasting cholesterol levels, the usual measures of cardiovascular health, were in the normal range.

In the March 1, 2007, issue of the American Journal of Cardiology, the researchers say this is the first case, to their knowledge, of advanced coronary calcification in an otherwise healthy middle-aged male marathon runner who lacked traditional cardiac risk factors and had no symptoms of heart disease.

The researchers conclude that the physician’s intense, long-term exercise regime, coupled with a predisposition toward a type of hypertension, contributed to his cardiovascular disease. "In this particular individual, we think that oxidative stress was an important contributor," says the study’s senior author, Michael Miller, M.D., director of preventive cardiology at the University of Maryland Medical Center and associate professor of medicine at the University of Maryland School of Medicine. "But we also found that this individual has exercise-induced hypertension, which I think is vastly under-diagnosed."

Oxidative stress is a byproduct of the normal cellular metabolism of oxygen. It refers to cell, tissue or organ damage from a class of molecules associated with oxygen metabolism, including unstable molecules called "free radicals." Oxidative stress plays a role in many heart, lung, blood and sleep disorders, including atherosclerosis, or hardening of the arteries, hypertension, heart failure, asthma and sleep apnea.

To help gage the impact of oxidative stress on the patient’s cardiovascular system, his doctors evaluated the response to exercise of the endothelium, the lining of his arteries. An ultrasound device was used to measure what is known as flow-mediated vasodilation. It shows how well the endothelium responds to a sudden increase in the flow of blood through an artery in the upper arm. The endothelium in a healthy vessel typically dilates or expands during this test to accommodate the increased blood flow, while an impaired vessel constricts or narrows.

The patient's blood vessel dilation was normal before exercising. But after exercise, vessel constriction occurred immediately and showed no improvement after an hour. To put this response into perspective, the researchers administered the same exercise/blood vessel response test to a group of ten men whose mean age was 41. The vessels of these men initially constricted, but improved significantly one hour after exercise.

Several weeks later, the patient was given vitamins C and E just before exercise and was tested again for endothelial response. These vitamins are known as antioxidants and may protect cells from free radical damage. This time, the test revealed a partial reversal of the blood vessel constriction after one hour, and normalization after two hours.

"As he took the vitamin C and vitamin E, you could see improvements in his brachial arteries," says Dr. Miller. "We recommended that the patient take these vitamins before he runs."

With half the mystery solved, the research team explored another possible cause of the calcium buildup—elevated blood pressure. Hypertension can cause artery walls to thicken and the endothelium to narrow. This narrowing can promote the formation of fatty plaque deposits in artery walls. The plaque, from cholesterol and fats, can eventually harden or calcify.

Although hypertension did not seem to be a risk factor for this patient, exercise is a major factor in his life. So, the researchers turned to a treadmill stress test to measure his blood pressure during exercise. At the start of the treadmill test, his baseline blood pressure was normal, 118/78 millimeters of mercury (mmHg). He was in such great shape that it took 20 minutes to reach high blood pressure levels, and this happened only after the treadmill speed and incline had been raised. But by the end of the test, his blood pressure had soared to 230/78 mmHg. A check of several of his previous treadmill tests indicated a similar rise in blood pressure.

On the basis of running duration and intensity, the researchers estimated that the patient spent about 30 minutes a day at a systolic blood pressure above 200 mmHg. This number is well into the blood pressure danger zone and meets one definition of exercise-induced hypertension—a jump of at least 60 mmHg from baseline after exercise.

This finding should be investigated further, says co-investigator Matthew R. Weir, M.D., head of nephrology at the University of Maryland Medical Center and professor of medicine and head of the division of nephrology at the University of Maryland School of Medicine. “Because we know that blood pressure rises during a stress test, we tend not to pay attention to it. We’re more interested in changes in electrical activity and the redistribution of blood during exercise, which could indicate inadequate blood supply to the heart muscle,” says Dr. Weir. “The question

is, should we pay more attention to treadmill-induced changes in blood pressure as a means to identify people at risk for developing coronary artery disease?” Dr. Miller adds another question, "Should we screen all middle-aged individuals who want to participate in an exercise program to make sure they don’t have exercise-induced high blood pressure?"

Unlike cholesterol or triglyceride levels, blood pressure levels fluctuate dramatically throughout the day, depending on a variety of factors such as exercise, emotions and even the time of day. In light of that phenomenon, Dr. Weir says the study raises another issue. "This research indicates that we need a more dynamic measure of blood pressure to truly profile the risk of an individual. We’ve been using casual, at-rest office readings of blood pressure for more than 50 years. It’s not bad, but it’s not the answer." The treadmill is one way to gather a more dynamic measurement, but he says there’s an easier option. "It can even be done at home if you have a blood pressure cuff and someone who can take your blood pressure at peak exercise."

The patient in the study continues to run, but is now taking medications to lower both his cholesterol and blood pressure. Despite his exercise regime, he appears to be in the same boat as millions of Americans who do not exercise regularly. So, is too much exercise a bad thing? The physicians answer to the contrary. "We are not publishing this report to suggest in any way that people should not be exercising. Exercise has stood the test of time as being one of the best ways to modify cardiovascular risk," says Dr. Miller. “But what we’re looking at are improved detection methods for predicting those at risk. Exercise-induced high blood pressure may be a part of that.”

Other authors of the study included Radha Goel, M.D., Duke University School of Medicine, Durham, North Carolina; Farhan Majeed, M.D., Robert Vogel, M.D., Charles Mangano, R.D.M.S., Charles White, M.D., Gary D. Plotnick, M.D., University of Maryland School of Medicine and Mary C. Corretti, M.D., Johns Hopkins Hospital.

Note: This story has been adapted from a news release issued by University of Maryland Medical Center.



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Exercise IMO cannot beat a good diet for prevention of heart disease. I remember at a conference in 2004 that showed an 77~ year old marathon runner who ran 50 miles per week for 30 years, and then showed a CR'd guy 77 years who done CR (diet with lots of veggies, nuts, fruit, olive oil, fish etc...) and the 77 year old had 0 plaque build up. While it looked like the runner was headed for a major heart attack with the blockage seen. I have the pictures here somewhere. Obviously this is just one case, but I would imagine that diet furst, and exercise a distant second in preventing heart disease.
In many studies it has been shown that exercise does NOT stop the rise in blood pressure with age. Whereas diet will have a good chance of reversing high bp and totally prevent it. Although Exercise and a good diet together is probably better.

I know of at least two people who lived near me that ran everyday, showing off their fitness, they looked healthy and ran fast and far... but dropped dead of a heart attack around middle age. I guess most of us know of some person near them that this has happened to.

As my ancient mom used to say, Who know what lurks inside? While it is astounding what we know and can do now compared to forty years ago, the amount yet unknown remains immeasurably larger. All of which is one of my reasons we all need to temper our responses with kindness and no "know it all" attitude.

Although actually I know it all :lol:

Long distance endurance exercise is one of the least healthy things you can do. That's no secret. Massive stress + inflammation, not sure why everyone thinks it's so good.

Long distance running and traditional 'long and slow' cardio have been implicated in heart disease in recent studies, especially sudden cardiac death. To his credit, at least the good doctor was active and experiencing life instead of hobbling himself with a tortuous and unhealthy CRonbie diet that sacrifices mental acuity, sensual enjoyment and vigor for the sake of a few extra months of pathetic, cadaverous life.

Kind regards

I have to say I was surprised at this. And it makes me concerned for my DH. He eats a horrible diet and yet his cholesterol, blood pressure and weight are all "perfect". He thinks it's because he's active. I did tell him about it, he seemed to feel it was an anomally. I felt like it just goes to show that the low cal/low fat diet that I'd bet the good doctor was following was still harming him in spite of the fact he was "working off" the calories/sugar. And he wasn't showing symptoms like many of the people here do. ie cholesterol/blood pressure/weight. His exercise treated the "warning symptoms" but not the problem. Kinda like painting a house full of termites. Looks good. Just don't knock on the door..

Al Sears, MD has a pretty good take on traditional cardio and which biomarkers are effective in the prediction of heart disease. I think it is kebaldwin that occasionally post some of his newletters in the cholesterol and/or nutrition forum with regard to supplement strategies to improving various biomarkers related to heart and recently prostate health.

In his book, "The Doctor's Heart Cure", he goes into ways to improve health, specifically 'heart health, using nutritional strategies (low-carb, a la South Beachish, no suprise), nutritional supplements, and exercise ('low and slow' cardio bad, high intesity interval training good). It fairly well written, detailed and supplies a fair amount of journal papers to back up what he is saying (without making the main text unreadable). Anyway, I 'heart'ily recommnd it! ;)

You can find his website at this link: Al Sears, MD

Kind regards

Well I find this hard to believe. Perhaps they mean cases fully documented in an official medical publication. Decades ago, the popular marathon runner and writer, Jim Fixx, dropped over of a heart attack, astonishing everyone.

Although I've actually run a marathon--you only have to do ONE to make it your claim to fame :lol: --I think distance running is abusive to the body, and something of an obsession for those who pursue it as a lifestyle.

A variety of regular exercises for strength and endurance will keep the body cranking along nicely--along with a healthy nutritional plan. In my case, that would be, now and forever, low-carb, with appropriate supplementation.

It's possible that exercise masks rather than treats warning symptoms. In any event, it appears that additional diagnostic testing is recommended for some of us. Which of us remains to be figured out.

Many diseases progress without symptoms. Which is why we have mammograms, pap smears, prostate tests, and so forth. Go get 'em!

I wonder why the article does not mention the diet of the doctor/runner. I bet that it was low-fat/high carbs.

It is well known that exercise increases systolic blood pressure. Why were the researchers surprized?

From the AHA web site:

This seems to describe the 'problem' that the researchers found.

I also wonder what drugs the doctor/runner was taking. Lots of physicians take statins because they are convinced that it prevents heart problems.

it seems like everyone knows one, that someone that seems supremely fit that dies young. what is considered long and slow cardio?

Running slowly enough to be able to carry on a normal conversation for a few hours.

Almost certainly. If he was low-carbing they'd be telling you that's what killed him.

I would think that it is possible to look fit and thin and still have a preponderance of type B LDL, the small, dense particles that get caught in the endothelium and raise inflammation, as oppsed to type A LDL, which is a larger particle that tends not to get stuck in the endopthelium. Someone could be eating a high carbohydrate diet, burn off all the carbs through intense exercise, and still be damaging his body in ways that have nothing to do with weight gain, such as glycation and suppression of the immune system.

Has anyone noticed that Olympic marathon runners look very gaunt? It is probably caused by constant carbo-loading that prevents the burning of fat for fuel and encourages the body to cannibalize its protein stores in the muscle tissue to produce glucose for fuel when it runs out of glycogen and dietary carbohydrates. Looking fit and thin is not the same as being fit and thin.

Marathon runners require lots of energy, so their calorie intake is probably very high which would confer a higher risk of disease whatever *diet* you are on. Excessive energy intake from ANY macronutrient = increased oxidative stress and increased CVD aswell as many other diseases. If you think you can get away with 4000k/cal a day just because you don't gain weight, you're foolish.

Things about that article that made me laugh:

"Killer" vitamins helped with oxidative stress!
The guy is now taking taking drugs to lower his cholesterol even though his levels are within normal limits.