Running Doc’s advice for runners with heart problems

running30s-1-webDear Running Doc:

In April 2013 I had a heart attack. My cardiologist doesn’t like the idea of me running a marathon. I’m 54, and all my blood work and stress tests are OK now. But I have three clogged arteries: one at 40 percent and two at 30 percent. What do you think?

— Gene C.

Gene, I feel your pain being told not to run. And this is such a good question given the heart attack of Alberto Salazar at age 48 that all in the running community talk about.

As I’m sure you’re aware, Alberto is known throughout the world as the charismatic runner who won three consecutive New York City Marathons (1980-1982) and a 1982 Boston Marathon. He set six U.S. records and one world record. His having a heart attack in 2007 and needing coronary artery stents for clogged arteries invites the questions: Should someone with coronary artery disease run? And is running really good for you or in any way protective? All the Jim Fixx questions return!

What some people may not realize is that Jim Fixx, even though he was a runner and died at 52, survived nine years longer than his father, who died of a heart attack at 43. Apparently Mr. Fixx had a cholesterol level higher than 250 and deferred getting a stress test, even at Dr. Ken Cooper’s recommendation. An autopsy revealed blockage in Fixx’s three main arteries of 95 percent, 85 percent, and 50 percent.

The tragedy of exercise-related death is fortunately a rare occurrence that may strike young, asymptomatic, and seemingly healthy athletes. Well-known examples besides Jim Fixx include the deaths of basketball players Hank Gathers and Reggie Lewis and, more recently, Minnesota Vikings tackle Korey Stringer. Such incidents have increased the awareness of exercise-related death, raised questions about proper pre-participation screening for athletes, and prompted studies into the incidence and causes of exercise-related death.

The risk of exercise-related death has been studied. The statistics make our answers quite clear:

— In studies of the risk of death in marathons, it has been estimated that one death would occur in 50,000-88,000 marathon finishers.

— In a study I published with Dr. Steve Van Camp in 2004, we found that the risk in distances between 10K and half-marathon was significantly lower: 3.1 deaths per million finishers.

— There has been reported one sudden cardiac death per 4,000-26,000 active men: 56X greater risk during exercise in sedentary men; 5X greater risk during exercise in active men

— The risk of having a heart attack is 1/year for every 2,000-2,500 asymptomatic men: 107 X greater risk with exercise in sedentary men; 2.7 X greater risk with exercise in active men; 19 X greater risk with exercise in diabetic men.

My cardiology friends with an interest in exercise point out that the key points to understand are the duration and severity of exercise. Many older (>50 years) runners have undiagnosed coronary artery obstructions. Stress testing will only diagnose the severe lesions and not the mild and the moderate (<70 percent) obstructions. All plaques, severe or not, have the potential to rupture and cause a heart attack. The exact cause is not known but it is believed that exercise can be a factor. This does not mean that exercise is not beneficial. It definitely is helpful, but is not without some risk.

Runners are more at risk during the hour or so a day they train and are particularly more at risk if they run marathons, as the time out there with an elevated heart rate increases. But the remainder of the day, all cardiologists agree, they are much less at risk than the general population and can actually extend and improve their lives and lifestyle.

As there is no PROVEN benefit to marathon running in preventing heart attacks the general advice by exercise-savvy cardiologists is to exercise, but with caution, always paying attention to your body, and seeking help should there be any form of chest discomfort (not necessarily PAIN) that occurs with effort. The long duration of a marathon (four hours or more for the average older runner), may be too much of a stress on obstructed arteries. If despite this, the decision is to run a marathon, it should definitely be after a stress test; use the aerobic threshold heart rate as a cut-off for effort.

That said, Gene, if you think I am going to contradict your cardiologist who has had the benefit of doing a complete history and physical, you need a “check-up from the neck up”…lol. There is no way for me to tell you if your cardiologist is right or wrong in your particular case. Questions that you should ask:

1. Is he/she “Board Certified” by the American Board of Cardiology?

2. Is he/she a runner? Interested in running and exercise? Has he/she ever volunteered at any running event?

3. Is he/she a member of the American College of Sports Medicine?

4. Can you exercise at all? Is there something about your condition that won’t allow for any exercise? Does he/she recommend some sort of activity? What kind?

5. If running is OK, how long may you participate? And if yes, in what heart-rate range? Now may be the time for a heart-rate monitor.

6. Are you a candidate for stents to open up those clogged arteries?

If you are not happy with those answers, you may want to find a local cardiologist who can answer these questions to your satisfaction. But be careful: Doctor shopping for the answer you want may be dangerous. The answer you want to hear may be recommended by the least smart doctor!

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source: Daily News by Lewis G. Maharam

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