Heartbreaker

Fit or not, it's time to wise up and listen to your ticker. It could be headed for an untimely failure.

WE ALL KNOW SOMEONE LIKE JIM, a guy in his late twenties who exercises hard and, as a result, thinks he can get away with eating anything he wants. He chases a four-hour mountain-bike ride with a pepperoni pizza and a pitcher of beer. With his concrete quads and thoroughbred lungs, Jim is hyperfit, which is why he doesn't hesitate to order a slab of carrot cake for dessert. "I'll burn it off tomorrow," he smirks.

heart health

But he's wrong—perhaps dangerously wrong. Like many other outdoor athletes of his generation, Jim is overlooking a tenacious enemy that will linger inside him long after he sweats away the calories. One that, without a change in diet, will grow even more worrisome as he exercises into his thirties and forties. And someday, when Jim appears to be in prime middle-age condition, it just might kill him. The culprit is arterial plaque—a by-product of high levels of low-density lipoprotein (LDL) cholesterol, which lurks in foods rich in saturated fat. Over years of après-sport cheeseburgers and Saturday-morning doughnut runs, this plaque builds up on the walls of arteries and hardens. Left unchecked, it will gradually strangle the flow of blood to the heart—or even break off during a routine workout and fatally block an artery.

That's exactly what happened to Ed Burke. Three years back, Burke—the renowned Colorado Springs–based exercise physiologist who consulted on the training programs of cycling legends Greg LeMond and Lance Armstrong—dropped dead, at 53, from a plaque-induced heart attack during a lunchtime bike ride. But plaque isn't the only exercise-related heart stopper. Last May, 47-year-old Ed Sheehan, former world-class marathoner and onetime Harvard track coach, died from an arrhythmia-related coronary while running. Frankly, there wasn't much Sheehan could've done. Whereas Burke, by heeding his symptoms—mysterious fatigue and chest pain—and seeking treatment, might have prolonged his life.

Burke's condition was first identified in a 1975 study published in the medical journal Angiology. It took subsequent studies, published over the last ten years in The Journal of the American Medical Association, among others, to confirm that rogue plaque is the leading cause of exercise-related coronaries for athletes and the general population. Unfortunately for baby boomers, the first generation to embrace lifelong exercise, this is a frightening irony. Most of us assume that workouts lead to healthy hearts. But for a heart plagued by plaque, exercise itself can be deadly.

There are no statistics to precisely track incidents like the one that killed Burke, but cardiologists make it clear that his fate is not unique—and that thousands of athletes are at risk.

"I predicted this would be a problem back in the 1980s," says cardiologist Paul D. Thompson, head of the Athletes' Heart Program, at Connecticut's Hartford Hospital. "With more people continuing to exercise later and later in their lives, the danger increases."

And it's not just middle-aged jocks who should worry. According to Thompson, anyone over 30 is liable to face a blocked artery if they don't eat right. Pair that with hereditary factors and the risk of an untimely demise jumps, no matter how fit you feel.

But facing facts now can give you the best chance of running strong into old age. It's never too late to lower your risk of a heart attack. Done right, you can actually improve your odds of avoiding heart disease. "If you aggressively address the situation," says Thompson, "you can lessen the damage."

The Pumphouse Plan

heart health

THE PUMPHOUSE PLAN
We're not asking you to eBay your gear and take up shuffleboard, of course. Cardiovascular exercise will always play a part in heart health. The risks mount, however, when you ignore the other elements of the equation: diet and genes. They can put your ticker on the fritz. David Cannom, a cardiologist at Good Samaritan Hospital in Los Angeles who specializes in athletes with heart disease, says, "The vast majority of coronary failures are preventable if you know what to expect."

»THE MEAL DEAL
Take a survey of what you eat, then slash from the list those foods that are high in LDL cholesterol, which cardiologists have increasingly linked to sudden cardiac death. "Five years ago, we considered an LDL cholesterol count of 110 safe," says Cannom. "Now we want to see it around 70." To lower that number naturally, adopt a nutrition program that's low in saturated fats (see "Heart Smarts," next page).

»FAMILY MATTERS
A history of heart disease among your immediate relatives effectively doubles your chances of dying suddenly and can lump you into the same risk group as smokers and those with high blood pressure. Ed Burke's family, for example, had a history of bad hearts. His parents had each suffered a coronary, and two of his brothers had undergone bypass surgery.

»LISTEN TO YOUR BODY
If you suffer from indigestion, lightheadedness, blackouts, or abnormalities in your heart rate—especially during exercise—see your doctor. You may be in need of a maximal treadmill stress test, which will reveal any reduced flow in the arteries. If you pass the exam but the symptoms persist, you should submit to more-invasive testing—namely, catheterization, which allows a doc to peer inside the coronary arteries, thus improving the chances of catching a potentially fatal problem in time for countermeasures, such as a regimen of cholesterol-lowering drugs, like Zocor or Lipitor, or beta-blockers, which prevent the heart from overexerting. Extreme cases may call for cleaning the clogged artery, inserting a stent to prop it open, or performing a bypass.

Following all three components of the plan should keep your pipes clean for years. "Avoiding a heart attack is like investing in the stock market," says Paul Thompson. "You keep paying into it day by day for a long-term gain."

Heart Smarts

heart health

HEART SMARTS
As tempting as it is to stick to a business-as-usual-diet—i.e., eating whatever you want whenever you want—don't give in. If you're over 30, poor nutrition may be your undoing, regardless of how fit you are. To keep your ticker clean, healthy, and strong, follow the decade-by-decade guidelines below, compiled with help from the American Heart Association and cardiologists Paul D. Thompson and David Cannom. Hopefully, you'll live to celebrate it.

»IN YOUR TWENTIES Limit your intake of saturated fats—found in whole dairy, fried foods, and fatty cuts of meat, to name a few—to 7 percent or less of total calories, and stay away from trans-fatty acids, which are used as preservatives in many packaged foods and may actually raise LDL cholesterol levels. // Check your cholesterol and blood-pressure levels at age 21. // Stay lean with help from a five-day-a-week, 30-to-60-minute cardiovascular workout.

»IN YOUR THIRTIES Stick with the same plan from your twenties. // Have your cholesterol checked every three years. // If your LDL cholesterol number surpasses 100, Cannom recommends considering a cholesterol-reducing drug to help lower that number.

»IN YOUR FORTIES Cannom suggests a maximal treadmill stress test in your early forties, to see if there's any blockage developing. // Check your blood pressure and cholesterol every two years. // Thompson advises taking 81 milligrams (a baby dose) of blood-thinning aspirin daily.

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