CigarettesA broken heart.  Shoveling snow.   Being a weekend warrior.   Eating like a pig, no offense to pigs.  What do these things have in common?  They all have the potential to cause a heart attack.  They could kill you. 

“But wait!” you may say.  “I exercise.  I have a good diet.  Gosh darn it, I’m heart-healthy!”  And that, with the use of prescription medicines, if you need them, is the best way to take care of your heart, says cardiologist Curtis Rimmerman, M.D., of the Cleveland Clinic, who also contributes to a blog called Health Essentials for that institution.   

But even so, he adds, there are some things that can trigger a heart attack.  All of them relate to sudden stress on the heart.  He categorizes them as the four “Es” – Exertion, Exposure to cold, Emotion, and (over) Eating.  (Shoveling snow could fit into three of these four categories, by the way; four if you also actively hate it as you lift each heavy shovelful.)

Sudden or overexertion.  The thing about exercise is, you need to ease your way into it.  Aerobic exercise means your heart works harder, causing you to take in more oxygen.  It is important, Rimmerman says, not just to hurl yourself into an activity that will leave you gasping for breath and have your heart working overtime.  Slowly build up your strength and endurance.  Some bad examples:  Playing a vigorous game of basketball or football if you’re not used to it.  Deciding, since you used to bench-press 150 pounds in your twenties, that this is a good weight for you to start with now that you’ve got that new gym membership, and forcing yourself to do it.  Spending your weekend doing heavy lifting of furniture or books or anything, if you haven’t done hard physical labor in years.  Sudden heart stress has even been known to happen after too much exertion in the bedroom.   And again there’s the classic example:  Shoveling snow. 

Ride the HorseCold Weather.  When it’s cold, your arteries constrict.  This raises your blood pressure.  Add intense physical activity, and your heart could feel the strain doubly.   Every year, Rimmerman says, more than 11,000 people go the hospital with problems related to snow-shoveling.  Most are orthopedic issues – oh, my aching back! – but 7 percent are cardiac, and many of those cardiac events are heart attacks.

Extreme emotions.  Maybe it’s a sudden, fierce surge of happiness; maybe it’s acute grief.  Both extremes, happiness, and sadness, can affect the heart’s electrical impulses, and both can set off a heart attack.  Rimmerman explains that this is because of the body’s “involuntary and sudden increase in heart rate and blood pressure brought on by a surprising event.”  Have you ever heard of someone dying, and then very soon afterward, someone close to that person has a heart attack or dies, as well?  The risk of having a heart attack is greatest within the first 24 hours after a loved one dies, but it remains higher than normal for a month, Rimmerman says. 

A subset of this is would be a category called “having a short fuse:” A 2002 Johns Hopkins study of more than 1,000 physicians, published in the Archives of Internal Medicine, found that young men whose knee-jerk response to stress is anger have three times the normal risk of developing premature heart disease.  In the study, such men – whether they vented their anger or bottled it up – were five times more likely than calmer men to have an early heart attack, even if they didn’t have a family history of heart disease.  Their short fuse was the risk factor.   “In this study, hot tempers predicted disease long before other traditional risk factors, like diabetes and hypertension, became apparent,” reported Patricia Chang, M.D., lead author of the study.  “The most important thing angry young men can do is get professional help to manage their tempers, especially since previous studies have shown that those who already have heart disease get better with anger management.

dirty handsEating a huge meal.   A Harvard-led study at the 2000 American Heart Association’s Scientific Sessions found that eating an unusually heavy meal can increase the risk of a heart attack by about four times within two hours after eating. That was the first time that this, by itself, had been proven as a risk factor.  “We hope that the results of our study will help convince people to be more cautious about eating exceptionally heavy meals, especially for people who have coronary artery disease or have suffered a previous heart attack,” said the study’s lead author, Francisco Lopez-Jiminez, M.D.  The investigators asked nearly 2,000 men and women about what they had eaten just before their heart attacks.  Of these, 158 said they had eaten a heavy meal within 26 hours before the heart attack, and 25 had eaten a big meal within two hours before the heart attack.

When you stuff yourself and your body begins the task of digesting what you just put into it, it releases many chemicals, such as norepinephrine, into the bloodstream.  This can cause your heart rate and blood pressure to rise.  Your heart works harder.  Higher blood pressure can act as a power-wash of your arteries, causing chunks, or plaques, of cholesterol to break loose and to form a clot.  This, in turn, can block a blood vessel, cutting off blood flow to the heart – triggering a heart attack or stroke. 

In addition to too much food, too much alcohol, drugs, or even caffeine also can trigger a heart attack in people who already have some heart disease.  Here’s a sad example:  In 2013, “Sopranos” star James Gandolfini died at age 51 after eating a decadent meal, including a lot of foie gras and two big orders of fried prawns with  mayonnaise chili sauce.  He washed it down with four shots of rum, two Pina Coladas, and two beers.   A few hours later, he had a massive heart attack.   

The lesson here?  You can’t help some things, like excessive grief.  But what you can do is try to start off with as clean a slate as possible.   Eat some stuff that’s not fried, not covered in cheese, not fatty, and not bad for you.  Eat some fruits and vegetables.  Try to exercise regularly; you don’t have to climb mountains or run marathons – start by walking.  Walking is good.  Don’t drink a lot of alcohol all at once.  Remember, moderation in all things.  And if you have a problem with anger or stress, get some help dealing with it.  Your heart will thank you.

©Janet Farrar Worthington

railroad manED and Low T:  Dont Just Treat the Symptoms!

Part One of my series with Johns Hopkins Urologist Kevin Billups, M.D.

 If you have erectile dysfunction (ED) or low testosterone, and you go see a doctor about it, that’s good:  Because in both cases, there’s probably something else going on.

I recently interviewed urologist Kevin Billups, M.D., Director of the Brady’s Men’s Health and Vitality Program at Johns Hopkins Medical Institutions, who has treated thousands of men with these problems.  “These are symptoms that will get a man interested in seeking help,” he says.  But they’re generally not the only things he ends up treating. “The first thing I do is point out that these problems don’t occur in a vacuum. There are reasons why you have this.”

The first thing I do is point out that these problems don’t occur in a vacuum. There are reasons why you have this.

If you are a man between the ages of 40 and 50 and you have ED, growing evidence suggests that you could have nearly a 50-fold increased risk of developing heart disease over the next 10 years, Billups says.  “It’s a group we’re really looking at.”  He believes many of these men need a more aggressive workup, “not just with the standard stress test,” which he sees as more of a fitness test, but with a coronary CT scan to look for coronary plaque.  “You can get a coronary cat scan now for $75.  I’ll be very honest when I talk to these guys.  I’ll say, ‘Your insurance may not cover this.  But if you turn out to have plaque in any of these arteries, I will manage you differently.”

Let’s just take a moment here to note that if you have ED and you just take a drug like Viagra or Cialis, you probably aren’t doing yourself a favor.  “Treating that one symptom without finding the underlying cause would not be a good idea,” says Billups.  “Here’s my biggest concern:  When a guy has ED, that may be a symptom that will actually get him to come to a doctor,” and that’s an opportunity to improve his overall health.  “If you just get medicine, that will mask the real problem in a number of men.  Then you’re just pushing everything back.  So this 40-year-old guy who’s having problems, maybe the medicine will fix what he cares about,” and the man has a heart attack several years later that might have been preventable.

What else could be going on?  “We do a very thorough evaluation to find out,” looking for, in addition to cardiovascular risk factors, diabetes or pre-diabetes, chronic sleep problems, urinary problems, and prostate problems.  Billups refers many of his patients to general urologists, primary care physicians, sleep specialists, or preventive cardiologists for further testing or more aggressive treatment when needed.  “We’re offering very integrated, multidisciplinary care.”

Billups, who sees patients from all over the country, estimates that more than half of his patients are self-referred; many have seen his website: menshealth.jhu.edu or one of his videos addressing key issues related to men’s health.  The website features 25 short videos of Billups talking about specific symptoms — any one of which might get a man through the door of the doctor’s office, where Billups then goes on to treat the whole patient. “Yeah, I’ll treat your ED, but what else do you have going on?”

Update: Kevin Billups is now on the faculty at Meharry Medical College in Nashville, Tenn.

©Janet Farrar Worthington