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  • Heart Health Screening for Athletes (and Non-Athletes Too)

    In 2015 we lost our cycling friend Scott Ellis to the silent killer – heart disease – while he was doing what he loved. He was doing the Leadville 100 Mountain Bike Race.  You can read his story here.

    I did a lot of investigation afterwards because his death seemed so impossible. He was relatively young and healthy. He didn’t appear to have any heart disease issues. I learned that the classic warning symptoms of heart disease or an oncoming heart attack may be completely absent or not easily discerned. These may be even more difficult to parse out in an athlete – even for a trained health care professional. A silent killer indeed.

    Just because you are not an athlete does not mean this information doesn’t apply to you.  All of us need to be aware of a disease where sudden cardiac death is the first presenting symptom of heart disease in 50% of those suffering a heart attack or sudden cardiac arrest.

    In the past six months or so I’ve had several people reach out to me about heart health issues, wanting to know if there have been updates to testing recommendations. I am pleased to report that in the 11 plus years since Scott’s death, more physicians are recommending tests that can reveal heart disease earlier.

    If you want to know what you should have tested, a review of the 2026 guidelines for testing from the American Heart Association (AHA) are reasonable place to begin. Then, have a frank discussion with your primary care provider (PCP.) The AHA recommends:

    1. Get normal lipid panels tested annually. If your low-density lipoprotein (LDL, or "bad" cholesterol) is concerning for any reason, know that most normal blood panels have LDL “calculated.” This means it is not measured directly. It is possible to request that LDL be directly measured.
    2. Coronary Calcium Artery Test (sometimes called CT Calcium Scan).  This is the test I think would have saved Scott’s life had he had it done. At time of his death, the CT scan was not widely publicized. After writing the column about Scott, several people have reached out to me to let me know having this done saved their lives, they believe.  
    3. Lipoprotein(a) or Lp(a) is a specialized, cholesterol-carrying particle found in your blood. It is structurally similar to low-density lipoprotein LDL. New guidance recommends that every adult get tested for lipoprotein(a), or Lp(a), at least once in their lifetime. High Lp(a) levels (125 nmol/L or 50 mg/dL and above) are often inherited. Lp(a) levels should be combined with other health measures to assess heart disease or stroke risk and help guide next steps in prevention or treatment.
    4. Apolipoprotein B or ApoB is the primary structural protein found on the surface of potentially harmful, artery-clogging lipid particles in the blood, including low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and lipoprotein(a). Testing for ApoB can help when someone has high triglycerides, metabolic syndrome or type 2 diabetes. These conditions can increase the number of harmful cholesterol particles in the blood, even when LDL cholesterol looks normal. An ApoB test gives a clearer picture of heart disease risk.

    After you have the results of your health markers, consider putting all the numbers into an online risk calculator with your PCP. There are several out there, including:

                    https://tools.acc.org/ascvd-risk-estimator/default.aspx

                    https://www.mdcalc.com/calc/10491/predicting-risk-cardiovascular-disease-events-prevent

                    https://professional.heart.org/en/guidelines-and-statements/prevent-calculator

    The information in this blog is all about “mechanical” heart issues. It is important to also consider electrical heart issues. A recent column in Cycling Weekly noted that Endurance Cyclists Are 2 to 10 Times More Likely to Develop Atrial Fibrillation (AFib). In this column, the key recommendations to detect AFib include:

    ·         Wear a smart watch with ECG capability. These devices can detect AFib, which is a common heart rhythm disorder (arrhythmia) where the upper chambers of the heart beat chaotically and out of sync with the lower chambers. Undetected, AFib can cause stroke or heart failure.

    ·         Monitor your heart rate after hard training days and races. Heart rate should return to normal within about five minutes of ending the session. Sustained or irregular rates warrant investigation with your PCP.

    ·         Get a baseline echocardiogram at age 50.

    It is important to note that laboratory testing is valuable; however, it is equally important to pay attention to how you feel. If something doesn’t seem right with how you’re feeling, don’t brush it off or try to tough it out.

    Pulling all the information together and having a discussion with your PCP will help you decide how best to care for yourself. After all, we want you around for years to come!

     

     

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