Last post, I wrote about the advisability of getting your heart checked out if you’re past 40, heading towards intense physical activity, and have been sedentary for a while. Straining or tearing something is a bummer and what my posts have focused on, but clutching your chest and calling 911 is a different level of health problem entirely. Getting a cardiac clearance may seem silly if your planned activity is walking or yoga, but it’s not so ridiculous before taking your intensity into the red zone.
But what if you’re not planning on playing superhero?
A recap of key observations:
First, heart disease is really common. Of all the tracked causes of death, blocked arteries feeding key organs like your heart (heart attack) and brain (stroke) rank in the top 5 causes of death in the U.S. year after year. There’s a pesky little coronavirus that’s constantly mutating and competing for a top spot, but heart attack is still #1. You may not know anyone who’s died from a lightning strike, but pretty much guaranteed you know someone who’s had a heart attack. And if one had to bet money on what you’d keel over from…
Second, the process behind it — narrowing of arteries — is a progressive process, starting in your teens or 20s. If you allow the factors that cause it to proceed unchecked, the older you become, the narrower your arteries get. This is true even if you’re not planning on intense physical exercise: we all have to kick it up a notch once in a while, carrying something heavy or navigating stairs, and most folks will have their heart attacks or strokes while not exercising.
Third, the factors contributing to blood vessel narrowing work their dark magic via compound interest. I’ve written about the eighth wonder of the world in positive terms, but the acceleration of change building on previous change can work against you, too. Blood pressure that is “just a little high,” or cholesterol that’s “only 10 points off,” or an A1c that’s just “a few tenths of a point above the cut-off” may not seem like much, but they add up when taken together. And like a retirement plan that yields “just a few percentage points higher” than your old plan, they definitely add up over the decades.
Fourth and finally, relying on the absence of symptoms is so linear in thinking, when the process is non-linear. You try to balance something on a scale by putting weight on the other side, the needle in the middle starts to ease towards the center. You add a tiny bit more weight, the needle creeps a tiny bit more toward the center. A final bit more, the needle gets right to the centerline, done. That’s a linear phenomenon: a bit of input gives you a similar, predictable output.
Non-linear is eating a chili cheeseburger and fries and thinking it’s no big deal because nothing bad happens. You make it a regular thing, and still nothing happens. You ignore your BP, and still nothing happens…until one day you “suddenly” end up in the ICU.
We’re used to judging life based on what we see and feel, but heart disease happens at another scale and timeline altogether. And boy, does it ever happen.
Everything biologic is complex
Let’s get this out of the way: in case it isn’t clear, real boats rock, none rock harder than living systems, and human systems rock the hardest of all.
We like neat stories with 2 or 3 variables (protagonist, antagonist, supportive sidekick), but our bodies have thousands of interweaving variables, defying simplistic understanding. And your variables have different settings than mine.
The 4 observations above add-up to an undeniable conclusion: heart attacks comprise THE major risk to your longevity as you round the corner past 50. Not cancer (#2), not accidental injury (#4), not stroke (surprisingly that’s #5), and not even COVID-19 (#3, yippee). But that’s the conclusion — the punchline, so to speak — after a buildup of numerous factors over time.
It’s natural to want a simple explanation, but simple does not mean easy, and as Einstein famously said, explanations should be as simple as possible, but no simpler.
It’s hard to just give it to you straight
Eat what you want, just in moderation is too danged simple.
I’ve gained 20 pounds during the pandemic, so I need to work out more is just wrong.
Don’t I get credit for giving up smoking? is an understandable question, good on you, but we knew about this 40 years ago, you are very late to the party, my friend.
I need to lose weight is a proper goal, but obesity is a sign of the true underlying causes, like sedentary living, poor nutrition, and unchecked stress.
BP, cholesterol, smoking, diabetes, and stress are last millennia risk factors; the modern list also includes apolipoprotein B, LDL particle number, Lp(a), AM insulin level, hemoglobin A1C, and possibly highly sensitive C-reactive protein. For a start.
Depending on your situation and presence or absence of symptoms, a doctor may also be thinking about imaging studies, stress testing, hormone levels, food sensitivity and leaky gut lab work. And I haven’t even started to furrow my brow yet.
The math gives us a clue
If I’m doing the arithmetic right, the top 5 causes of death in the U.S. account for a little over 60% of the registered deaths in 2020, or about 3 out of 5. That may or may not sound impressive to you, but it impresses the hell out of me: barring the new kid on the block (COVID-19), it’s the same hit parade with heart attack always being in the lead. Out of all the myriad ways we can shuck our mortal coil — the National Center for Health Statistics tracks 113 that it boils down to 51, including slipping in the bathtub, dying in a hospital, succumbing to pneumonia, bending a car around a tree, losing the battle against any and all cancers, suicide, dog bites, birth defects, swimming pool mishaps, getting shot, Alzheimer’s — heart attack still comes out King Of The Hill. Year after year.
And you can do something about it.