Can athletes over 50 who continue to train hard, increase their chances of heart attacks?
I received a link the other day from a friend who knows I run on a daily basis. I opened it believing it might be information on a new local race, or perhaps a new training tip, but instead the link sent me a story entitled, ‘Lifelong Runner Has Heart Attack and Dies While Competing in Yesterday’s Marathon.’ Along with it he wrote, ‘Is all that running you’re doing really a good thing?’ For the record, that’s not the first time I’ve been asked that question, nor is it the first time I’ve heard about an athlete dying in competition due to a heart attack. And while I appreciate his concern, being an athlete and having a heart attack is not a cause and effect relationship – far from it. Yet this is a real concern for many athletes, especially as we get older. What exactly are the risks? The purpose of this article then is to talk about what a heart attack is, the reasons why it can occur, and what things you can do to decrease the risk of having one.
According to the Mayo Clinic, a heart attack (also known as myocardial infarction) occurs when blood flow to the heart becomes blocked. Typically, this blockage occurs when the arteries in our heart become narrowed by a buildup of fats, cholesterol, and other plaque-forming substances that collects in a part of the artery that had previously been damaged. A piece of this plaque can then break off and travel through the arteries, until it becomes lodged in yet another part of the artery that has been narrowed because of plaque (this blockage becomes known as a clot). The blockage then interrupts blood flow, preventing the muscle from receiving oxygen, which results in damage and destruction of the heart muscle.
There are many factors that can increase your risk of having a heart attack. Some of these are under your control; these include diet, exercise, and cigarette smoking. These factors are known as modifiable risk factors because they are under your control. Abstaining from smoking, eating a healthy diet, and getting the recommended amount of exercise are the best ways to prevent cardiovascular disease, as well as many other chronic diseases such as hypertension, dyslipidemia, and diabetes (each of which increases your risk). If you’re an athlete, you’re probably doing all of the right things in these areas to begin with. And that’s a good thing, because it is believed that poor diet, cigarette smoking, and a sedentary lifestyle plays a significant role in the development of cardiovascular disease.
But as the link that my well-meaning friend pointed out, there is a risk. So why might an individual who is healthy by all accounts have a heart attack? There are some commonly accepted views on why athletes experience heart attacks. First, the athlete may have an undiagnosed heart condition such as hypertrophic myopathy (abnormally enlarged heart) or other genetic heart abnormalities. Secondly, sometimes a cardiovascular event occurs when the heart’s electrical system suddenly misfires, causing the heart to beat dangerously fast. Third, strenuous physical exercise can cause damage to the heart. In fact, the American College of Cardiology (ACC) reports that cardiac scarring can develop in predisposed individuals who engage in long-term, high-intensity, high-volume styles of training.
The last reason why athletes could have a heart attack was referenced earlier when talking about genetics. Cardiovascular disease can run in families - this would be known as a non-modifiable risk factor because unlike diet and exercise, it is one that you cannot control. Another non-modifiable risk factor is age; as we get older our risk for cardiovascular disease increases. The last non- modifiable risk factor is gender. Although cardiovascular disease is the leading cause of death for both men and women in the United States, it is more common in men.
So what things can we do if watch what we eat, abstain from smoking, and regularly exercise, but have one of the nonmodifiable risk factors (such as age)?
First, if there aren’t any reasons why you should not exercise, you should continue to do so. According to the American College of Sports Medicine (ACSM), the risk for a heart attack actually decreases in individuals who perform regular exercise. Secondly, it is important to see your health care provider and be aware of physical exams that may be needed as you get older. If you have not done so previously, be sure to share your complete family history with your physician, because as previously noted some heart conditions are genetic. If they are concerned, a series of exams can be performed to evaluate the health of the heart. These include an electrocardiogram (ECG), echocardiography, and maximal exercise testing. (in fact, the ACC suggests that athletes who have experienced cardiac episodes perform these exams as a safety precaution). And lastly, you can be cognizant of the signs of a heart attack. While true that a heart attack may indeed occur suddenly, many times warning signs and symptoms precede the event. Seek medical attention if you experience sudden dizziness, lightheadedness, or pressure, tightness, pain, or a squeezing sensation in your chest or arms, especially if the pain begins to radiate to your neck, jaw or back.
According to ACSM, moderate intensity exercise does not typically cause cardiovascular events in healthy individuals with normal cardiovascular systems. The fewer risk factors you have the better. The best advice is to continue your healthy behaviors to reduce your risk of cardiovascular disease, be aware of the factors you cannot control and discuss those concerns with your healthcare provider and be knowledgeable of the signs and symptoms of a heart attack.
By Yasha and Brian Foster
American College of Cardiology. (2015). The heart of exercise and sports: Don't drop the ball caring for active patients. Retrieved from https://www.acc.org/latest-in-ardiology/articles/2015/03/23/11/11/the-heart-of-exercise-and-sports-dont-drop-the-ball-caring-for-active-patients
American College of Cardiology. (2019). What is sports cardiology? Retrieved from https://www.acc.org/latest-in-cardiology/articles/2019/03/20/12/33/what-is-sports-cardiology
Mayo Clinic. (2019). Heart attack. Retrieved from https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106
Riebe, D. (Ed.). American College of Sports Medicine. (2018). ACSM's guidelines for exercise testing and prescription (10th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.