'Extreme' Exercise, Atherosclerosis, Coronary Artery Calcium Score — “Exercised, The Science of Physical Activity, Rest and Health”
re: Magnesium Intake Is Inversely Associated With Coronary Artery Calcification
re: Can an Extreme Endurance Athlete Have an Early Heart Attack? CT Coronary Calcium Scan, HDL Cholesterol, LDL Cholesterol, Statins, Atherosclerosis, etc
The passage below in Exercised caught my attention, because it applies so closely to my own situation, with a quantitative CAC score of 159*.
* The sum of calcium in different areas of the heart added together for a score seems in and of itself a dubious metric that should be challenged as scientifically non-rigorous.
by Daniel E Lieberman.
When he turned 65, Ambrose “Amby” Burfoot decided to get a thorough heart checkup. By any standard, Burfoot counts as an extreme exerciser. Prior to walking into the doctor’s office on that day in 2011, he had clocked more than 110,000 miles of running and had raced more than 75 marathons (winning the Boston Marathon in 1968), not to mention countless shorter races. As the much-admired editor of Runner’s World who writes frequently about the science and health implications of running, he also knows more than most people on the planet about the benefits and risks of running. But he wasn’t prepared for the bad news he received from his doctor. On the scan of his heart were many bright shiny spots in the coronary arteries that supply blood to the heart. These calcified plaques can can a heart attack if they block an artery. Because plaques contain calcium, which shows up nicely on a CT scan, doctors routinely score plaques by their calcium content: a coronary artery calcium (CAC) score. CACs above 100 are generally considered cause for concern. Burfoot’s CAC was a staggering 946, which according to other studies, put him at more risk than 90% percent of men his age(24).
Burfoot left the doctor’s office terrified by his CAC score. “Driving to my Runner’s World office 10 minutes later, I felt lightheaded, dizzy. My palms left a damp smear on the steering wheel.”. Burfoot however was otherwise totally healthy with excellent cholesterol levels and no other evidence of heart disease, and it turns out that he is hardly unusual for an extreme athlete and probably shouldn’t be worried. For some time, doctors have noted that competitive runners have CAC scores greater than 100 and assumed these patients were at elevated risk for heart disease(25). But these risk estimates are based on non-athletes and do not take into consideration the size and density of the plaques, the size of the coronary arteries around them, or the likelihood that the plaques will grow, detach, or do anything else that would cause a heart attack. An alternative evolutionary perspective suggests that plaque calcification is one of the body’s normal defense mechanisms, not unlike a fever or nausea. And when researchers look more carefully, they find that dense coronary calcifications commonly found in athletes like Burfoot tend to differ from the softer less stable plaques that are indeed a risk factor for heart attacks. Instead, they appear to be protective adaptations—kind of like Band-Aids—to repair the walls of arteries from high stresses caused by hard exercise(26). On massive analysis of almost 22 thousand middle-aged and elderly men found that the most physically active individuals had the highest CAC scores but the lowest risk of heart disease(27).
Burfoot’s CAC score scare is a characteristic example of how fears about high doses of exercise tend to be based on poorly understood risk factors rather than actual deaths associated with those risk factors. Another example is the so-called athlete’s heart. Endurance athletes like Burfoot tend to have enlarged, more muscular chambers of the heart that allow each contraction to pump more blood. One consequence is a low resting pulse (40 to 60 beats per minute). Because these big, strong hearts at first glance resemble the dilated hearts of individuals suffering from congestive heart failure, worries persist that too much exercise causes pathological expansion of the heart. Big was thought to be bad. But the superficial similarities in heart size between athletes and those who suffer from heart failure have different causes and consequences. Apart from potential arrhythmias (especially atrial fibrillation), there is no evidence that a big strong heart poses any health risks(28).
Stay tuned for more on these and other worries about the effect of too much exercise on the heart and other orgains, but even if new concerns emerge, overexercising will never be a major public health problem. That said, high levels of exercise still impose an underlying paradox. As we have repeatedly seen, regular exercisers, including those who engage in extremes, are less likely to die young than non-exercisers, but very physically stressful activities like shoveling snow after a blizzard or running a marahot do increase the risk of sudden death(29). These deaths, however, mostly occur because of an underlying congential condition or acquired disease, and without exercise some of these individuals might have died even younger(30). You might be more likely to die while running than watching a marathon, but training for the marathon likely adds years to your life.
WIND: none of this proves anything. But the severe faults of mainstream non-scientific-false-assumption-minimal-data take on athlete cardiovascular health should be obvious to anyone able to think clearly.
The cardiologist I visited had no knowledge of CAC scores in athletes (I asked), or athlete’s heart (I asked). Or much of anything (I asked) except the dogma he had learned 30 years ago in medical school. I consider him one of the worst examples of assembly-line paint-by-numbers medicine I have ever encountered. Run for your life with such doctors.
I am in the same situation as Burfoot, only with a CAC much lower (a bit over 100). And yeah, maybe I will have a heart attack in 3 years—shit happens. But my cardiac stress test showed absolutely no impairment and before my current ongoing long-haul COVID ordeal, I had de facto hundreds of such stress tests over a decade, and absolutely no impairment up to 14252' elevation either, at max heart rate in an intensely hypoxic environment! Yet doctors as a rule reject such compelling counter-evidence, preferring to rely on the false idol of “data”— the intellectual malpractice of applying epidemiological statistics for an individual, in turn based on finding only what your preconceived notions look for. As a group they are far worse at probability worse than someone trained to think about data (eg economists, statisticians, etc). OMG. Exceptions are there of course, but it is also true that most health care organizations steadily beat-down the doctors that trend to be creative and free thinkers.