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Salazar's heart attack should alert all runners

If elite endurance athletes can have heart problems, we all can

By Brom Hoban
AMERICAN-STATESMAN CORRESPONDENT
Tuesday, July 10, 2007

We're conditioned to think that elite endurance athletes, capable of seemingly inhuman efforts — like running a marathon at a four minute, 54-second per-mile pace — are immune to heart disease. It's a reasonable assumption. Anyone with such a powerful cardiovascular system should be the last person to have a heart attack, right?

Unfortunately, that's not the case.

When Alberto Salazar collapsed from a heart attack while coaching at Nike's campus last week, it sent ripples of concern through an entire nation of runners. While folks were wishing the three-time New York City and former Boston Marathon champion a speedy recovery, a question lurked: If a lean, fit, 48-year old former American marathon record holder (2:08:52) could have a heart attack, couldn't any runner?

Salazar was not one of those athletes who let himself go after he retired, piling on the pounds and becoming a couch potato. After running on the Town Lake trail with local runners in 2004, he told a crowd at RunTex that he still ran and worked out almost every day, just not at a competitive level.

Although it's too soon to put all of the pieces together for a decisive reason why someone like Salazar would have heart troubles, one fact looms large. He told doctors at the hospital that he had a family history of heart conditions.

The good news is that Salazar is on the mend and is making a full recovery. But Budd Coates, a former 2:13 marathoner and director of employee health and fitness at Rodale Inc. (the publisher of Runner's World), feels that Salazar may have been able to avoid the anguish and expense of a heart attack, had he been more vigilant.

Coates should know. His father died at the age of 48 from a heart attack, and his brother at 41. As a 50-year old former elite marathoner in good health but with a strong family history of heart disease, his health profile is very similar to Salazar's.

"My stomach sank when I learned about Alberto," Coates said. "He's part of the running family. It really struck a chord with me."

Like Salazar, Coates got good genes from one part of his family, but not the other.

"I took my situation very seriously long before my brother died," he said. "I knew that the signs weren't good for me from a hereditary standpoint."

Last year, Coates went in for a 64-Slice CT scan (a cutting-edge, non-invasive heart scan that can alert doctors to otherwise undetectable soft plaque that leads to heart attacks). The results were good, but not perfect. The scan revealed plaque buildup in one artery — something that other tests Coates had taken had missed.

Based on his family history, the doctor wanted Coates to take a statin drug to lower his cholesterol, which was 236 at the time. But Coates had another approach.

"I'm not a statins fan, in the sense that everyone should take it. But I don't think it's for me," he said. "I learned that doctors are obligated to prescribe statins from a legal standpoint, if there is any indication of family heart disease."

Coates decided to be a lot more careful with his diet. He realized that with his current running of "only 45 to 60 miles a week," he couldn't afford to eat as much as when he trained by running 100 or more. And he decided to limit red meat and saturated fats. He also decided to take omega-3 supplements, he said, even though his HDL ("good" cholesterol) is 98.

Coates said that his overall cholesterol is now 203, that he has lost some extra weight and that his race times have dropped as well — he recently ran a four-mile race in 21:24, a 5:21 per-mile pace, which is certainly elite for a 50-year old.

"I'm stepping out on a limb here," he said. "But I think if Alberto had read my article and gotten the 64-Slice CT scan, he would have immediately realized that he had some business to take of."

Coates agrees that it's totally possible that a 25-mile a week recreational runner with no heart disease in his family can be healthier than an elite marathoner who has a family history.

Still, running is definitely on the list of "good" things when it comes to heart disease.

"There's no doubt about it: We are doing some of the right things as runners. But it's not the only thing," Coates said. "You need to limit your alcohol and fat intake. And you need to have a diet that prevents buildup of arteriosclerosis. And certainly, if you have a family history of heart trouble, get the CT scan."