DARE TO BE 100. PRICE OF BIG ARTERY

Huffington blog DARE TO BE 100

THE PRICE OF A BIG ARTERY

December 13 2017

As a premed student at Williams College in 1950 I wrote my biology honors thesis on arteriosclerosis. This choice made sense since I was headed for a medical career and heart disease was our number one killer.

Heart disease is a misnomer however, because it is really artery disease that leads to the heart disease that is the primary issue. The heart muscle gets its blood from three small arteries that emerge from the aorta and deliver the life sustaining blood to the heart muscle. When one or more of these arteries gets plugged up, known as a coronary artery occlusion, the involved heart muscle yells, like a finger with a tight tourniquet. This pain is known as angina. Continued lack of blood leads to a myocardial infarction or heart attack. The heart is a pump and any compromise in its blood supply poses a huge threat to survival.

Bernoulli’s principal says that the flow-through any tube varies directly with the diameter of the tube multiplied to the fourth power. Thus any change in the size of the bore becomes a huge survival issue.

One of my most precious medical reprints is called Mr. Marathon. It was published in the New England Journal 50 years ago, and told the story of Clarence Demar, one of the legends of the running world. He ran the Boston Marathon dozens of times and won it several times. Clarence died in his 70s of colon cancer. Paul Dudley White, Eisenhower’s cardiologist, arranged for an autopsy. The article reproduces pictures of his coronary arteries. They were huge like garden hoses.

This important finding went largely unnoticed.

It remained in my memory bank however, so that when I became involved in the Western States 100 mile trail race I pondered what the arteries of these super athletes looked like.

I recruited 12 of them and within several months my Cath Lab Stanford buddies performed coronary arteriograms on them. I was at the Cath table when the dye was shot in. Splash! “My God, we’ve killed him”.

But he was fine, and we went on to report our findings in the medical journal Circulation, “Coronary artery dimension in long distance runners.” Demar confirmed and extended.

Exercise enlarges arteries, WOW!

Our Stanford study has now been repeatedly confirmed. Its message gave me a jolt. At age 40 I started to run slowly and awkwardly, but determinedly. I have now run 45 marathons including Boston 2013, BOMB, but I will still on Heartbreak Hill when the blast hit. Yet now

I am almost 88 years old and have big arteries. No statins for me.

But I have had to reacquaint myself with my cardiology colleagues because two years ago I started to fibrillate, my heart was beating asynchronously, and I didn’t like it. All advisories preached different pills. I hate pills and don’t trust their long-term effects.

Gloriously, one of my Stanford colleagues is Sangiv Narayan, premier ablationist, who a year ago inserted his wires into my groin and teased them upstream into my heart where he found the irritable focus and singed it, so that my heart is now behaving itself . My running habit had remodeled by heart so that the conduction fibers had become tented and erratic. Now thankfully restored and optimistic.

A regular heartbeat with big arteries. Who could ask for anything more?

But what if I had not begun running? I would have joined the millions burdened with the threat of little arteries. But who cares what your cholesterol is if your artery is an inch across? Millions of people have had coronary artery surgery costing billions of dollars, $100,000 per encounter is a reasonable estimate.

The heart is a muscle. Use it. Grow big arteries. Save our national treasury from unnecessary drain.

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