Being physically fit does not necessarily make a person protected against heart disease.  A few examples in recent years proves this: Earlier this year, Bob Harper, 51, fitness guru and host of the show Biggest Loser, lay unconscious for two days after suffering from a massive heart attack.  In 2007, legendary marathoner Alberto Salazar, 48, had a heart attack in which he was technically dead for 14 minutes.  Back in 1984, Jim Fixx, a leading spokesperson for the health benefits of running, died at the age of 52 from a massive heart attack while running alone on a Vermont country road.

Unfortunate events like these should be a wake-up call to the fact just because one is physically fit does not guarantee zero chance of having atherosclerotic coronary artery disease (ASCAD) which can lead to a potential heart attack or myocardial infarction (MI).

Know your family history for heart disease

A common thread each of these men shared was each suffered from ASCAD which is the leading cause of cardiovascular morbidity and mortality in the developed world.  Another powerful risk factor each had was a strong family history of heart disease.  One of Salazar’s grandfather’s died from a heart attack at age 52 and the other at age 70, also from heart disease.  Even Salazar’s father had at least two heart attacks.  Fixx’s father died of a heart attack at age 43.  Bob Harper’s mother died from a heart attack.

Having a positive family history is defined as having a father who had an MI before the age of 55 and a mother before the age of 65.  If both parents have what is called prematurity of coronary heart disease (CHD) of having a heart attack before age 50, this increases the risk for descendants almost sevenfold.  The Framingham Heart Study database has found that the highest risk for offspring was a maternal history of premature CHD. 

But doesn’t being physically active help prevent heart disease?

A major risk factor for developing heart disease is physical inactivity.  Regular inactivity accounts for up to 30% of deaths from CHD worldwide.  There is overwhelming evidence supporting the benefits of exercise in reducing the risk of having a heart attack.  These benefits include lowering blood pressure, decreasing blood coagulation, improving blood lipid levels, improving lung functioning, helping maintain a healthy body weight and reducing the risk of type 2 diabetes. 

So it can be unsettling when very fit, young and well-trained athletes have a major heart issue.  It would be assumed that their physical activity would have greatly reduced their risk of a heart attack.  Research has suggested that a cardiac event during physical activity may not be directly related to the exercise but more likely is associated with an underlying cardiovascular problem commonly associated with ASCAD.  The exercise itself was the stressor that precipitated the heart attack in these athletes who had undiagnosed and unstable underlying ASCAD.

How to prevent heart attacks in people with a strong family history

Individuals with a strong family history of heart disease should be aware of their enhanced risk of having a heart attack.  It does not necessarily mean they will have one but they do need to be on guard and take precautions as much as they can to reduce their risk.

The steps these individuals can take are as follows – keep in mind, everyone should be following these steps regardless of a family history of heart disease or not:

·      Have a good medical knowledge if your relatives, including parents, grandparents, aunts, uncles and siblings, have any history of heart disease.

·      When having a physical, be sure to let the doctor know if heart disease is a strong risk factor in your family.

·      Patients with a high-risk family history should be referred to a physician who is trained in identifying heathy individuals who may be in danger of an imminent heart attack.

·      Mayo Clinic research has come up with a new blood test to help identify patients at risk for a heart attack.  The blood test analyzes plasma concentration of ceramides, a class of lipids highly linked to ASCAD.  Individuals with high levels are 3 to 4 times more likely to have a heart attack compared to others with low levels. 

·      Individuals can follow a heart-healthy lifestyle which is the cornerstone of cardiovascular disease prevention.  Modifiable risk factors that can be controlled are reducing LDL cholesterol, smoking cessation, diabetes control, achieving and maintaining a healthy body weight and consuming a Mediterranean-style plant-based diet.

·      Healthy eating has a substantial role in reducing a significant portion of deaths from heart disease.  Researchers have found those eating a diet lacking in healthful foods such as nuts, vegetables, fruits, whole grains, and yet high in salt and trans fat contribute to more than 400,000 deaths from heart and blood vessel disease in the U.S. in 2015. 

·      Exercise is still important but does not provide immunity against a heart attack in people with underlying ASCAD and could possibly trigger an event.  It is strongly advised for anyone with ASCAD or a strong family history of heart disease to discuss with their physician on safe recommendations on physical activity.