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What Men Need to Know
I don't belong here. That was Brian Bishop's first thought when he awakened in the cardiac intensive care unit at the hospital near his home in Pelham, New Hampshire. Sure, he was overweight-okay, very overweight. But he was just 28 years old and had never been seriously ill. Yet there he was, surrounded by frail patients at least four decades older.
The night before, Bishop had felt achy and dizzy. He figured it was just the flu, but when he started shaking uncontrollably, he called 911. When the doctor in the emergency department told him he was having a heart attack, Bishop was incredulous. "I grabbed him by the lapels and said I didn't believe him. I was too young!" The head of cardiology set him straight. "He told me, 'It's really up to you whether you want to live or die,' " Bishop recalls. "That got my attention."
Bishop was wheeled into the OR, where surgeons inserted a small mesh tube called a stent to open his blocked artery. The operation saved his life, but what happened to him is everyone's nightmare: the patient with no family history of heart disease, whose first symptom is a massive heart attack.
According to the American Heart Association (AHA), at least half of the people who die suddenly from coronary heart disease each year had no clue they were sick.
That fact has led to a widespread misconception: that half of all heart attacks strike out of the blue. Not true, insists cardiologist Jennifer Mieres, MD, a spokeswoman for the AHA. A 2004 study of more than 29,000 people found that at least 90 percent of first heart attacks could be attributed to well-known problems like high cholesterol or diabetes. "If you look closely," says Dr. Mieres, director of nuclear cardiology at New York University School of Medicine, "you'll almost always find a risk factor that was undiscovered, ignored, or not adequately treated."
That was true for Bishop. A jock in college, he'd piled on 80 pounds from eating on the run, not exercising, and working 24-7 during Boston's commercial real estate boom in the early 2000s. When he finally had his cholesterol checked, after he almost died, his numbers were off the charts. His so-called bad cholesterol, or LDL, was over 200 mg/dl (the riskiest category starts at 190), while his artery-clearing HDL cholesterol was 18 mg/dl (for men, 40 or above is optimal).
Bishop was unaware of his risk because he hadn't been to a doctor in years. Men are much more likely than women to skip checkups, says cardiologist J. James Rohack, MD, president-elect of the American Medical Association (AMA), so they miss out on screenings like cholesterol tests. "We see it every day," says Stephen Nicholls, MD, a cardiologist at the Cleveland Clinic in Ohio. "Men have risk factors that they're unaware of, and then they suffer a premature heart attack."
Bishop was young for a heart attack victim (while men tend to develop heart disease 10 to 15 years earlier than women, they don't enter the red zone for heart attack risk until age 45). But he was otherwise typical of a man heading for cardiovascular calamity. He had a major gut, for instance. Males tend to collect fat around their middles, which is much more dangerous than the pear-shaped pattern common among women. "Fat cells in the belly do more damage because they release fatty acids and other substances that travel directly to the liver," says Dr. Rohack. Indeed, a man with a waist bigger than about 40 inches is twice as likely to die prematurely as a man whose waist is less than about 34 inches, a study of more than 350,000 people found last year. (For women, a waist of more than 35 inches is a red flag.)
Bishop also snored. That trait, much more common in men, isn't just an insomnia-inducing nuisance for their spouses -- it often signals a dangerous condition called sleep apnea. People with the disorder (two thirds of them male) stop breathing for 10 to 30 seconds or more at a stretch during sleep, up to 400 times each night. The loss of oxygen kills off brain cells in regions that regulate blood pressure, says Ronald M. Harper, PhD, a neurologist and sleep apnea expert at UCLA's David Geffen School of Medicine. That can trigger hypertension or wide swings in blood pressure, which can lead to a stiffening of blood vessels.
Still, if men are more likely to be stricken with heart disease-at least until age 65, when women catch up-they have an advantage when it comes to dealing with the problem. Lifestyle changes (adopting a healthy diet, getting out for regular exercise, avoiding tobacco, losing weight) are the first line of defense, even if drugs are needed too. And once men make up their minds, experts say, they shed excess pounds more easily than women, thanks to a faster metabolism.
"I threw out everything in my kitchen-cookies, crackers, packaged foods-and started reading labels," Bishop says. He and his wife began walking a mile every night with their dog; then he added an hour, then two, on a stationary bike. In a little over a year, he dropped 112 pounds and trimmed his waist from 49 inches to less than 31. Today, four years after his heart attack, he regularly competes in triathlons. He's on only a low dose of a statin drug, but his bad cholesterol is down and the good kind is up. So is his outlook. "After my heart attack, I thought my life was over. I was afraid to walk around the block in case I gave myself another heart attack," he says. "Knowing what to do changed my life. This isn't rocket science-people just need to be motivated."
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