Both my children have had coughs and colds last week, despite the nice weather, and I get the distinct impression this is their body’s way of saying they need a break. They’ve had exams, lots of sports fixtures, and are knackered. Summer holidays are around the corner, and I’m also very much looking forward to some time off. Whatever your age, modern life just seems so busy all the time. Too fast paced. Never enough down-time. We are, of course, architects of our own problems, and I’ve never been good at doing nothing. I’ve always thrived on working really really hard, all the time. Even when I’m not at my day job in Bournemouth hospital, I’m working hard on my fitness, my family, my blog, my business. I used to always go on adventure holidays, but these days sitting in the French countryside somewhere, going for paddle on a river, visiting the wonderful food markets to get delicious local ingredients for dinner is perfect!
I digress! I’ve had quite a few older athletic patients in my clinic this last week, and there are a few learning points that I wanted to write about. Firstly, it’s my observation that when I meet older athletes, rarely do they think of themselves as such. Sadly, the bar in the UK to be considered athletic is rather low – you don’t need to do much to be above average. The most important statistic for today is this – if you are in the top 2.5% fittest (as measured by a formal VO2 test) of the population for your age, you have a 5x reduction in all cause mortality compared to the bottom 25%. Let me put this another way, your risk of dying in the next year is 500% less than an unfit person. No medication, supplement, diet or anything else can get close. Now you may read that and think, ‘there’s no way I can get in the top 2.5% for my age’. Look around you next time you are out and about, or even when watching tv. Two thirds of adults are obese. A relatively small amount of training, and could you get into the top third fittest for your age? If so, your risk of dying of any cause is 300% less. Even if you are unfit, the gains to be had by improving are phenomenal. Remember also, these stats are above risk of dying, I’m not even going to touch on the quality of live improvements…
Sounds amazing, and it is amazing. There is a paradox here though with respect to the heart: coronary artery disease.
1 in 2 male runners over the age of 55 have coronary artery disease, and 1 in 5 have ‘significant’ disease, with a narrowing in an artery of >50%. In one study of middle aged (average 55 years) sportsmen, nearly all of whom had a low conventional heart risk score, only a third had what I would call normal heart arteries. In another, 44% of athletes had coronary plaque compared to only 22% of non-athletic controls.
When we assess plaque with a CT scan, we look to see if it is ‘hard’ or ‘soft’. Typically athletes are more prone to the hard, calcified sort. This could be due to a number of factors: altered blood flow down the coronary arteries, inflammation, genetics, diet, performance enhancing drugs, raised blood pressure, mechanical stress on the heart, altered biochemistry.
The fact is, fit people have more coronary artery disease than controls. But does that matter?
We know that in the general population, the more heart artery disease, the higher the likelihood of heart attacks and strokes. However, the more active an individual is, the risk of these endpoints reduces considerably. To put it another way, if you already have coronary disease, on average, the more you exercise, the less likely you are to die compared to a similar individual who also has heart disease but is inactive.
Age is of course the biggest risk factor for nearly all health issues – heart attacks, strokes, dementia, cancer. We can’t stop getting older, but we can improve how we age, and with it our risk of many of these awful conditions.
Back to my patients. I think it comes as a bit of a surprise to people who have often led a lifetime of good habits to find they have furring up of their coronary arteries. It is often then a rather nuanced discussion to reassure people that despite that fact, their outlook is often very favourable, and they should not stop exercising. The key is knowing if that plaque is there to begin with. I have told myself for some years now that I will have a CT to look at my arteries when I turn 50. I turn 47 in 2 weeks, and am definitely re-thinking that arbitrary age cut off. I’m pretty sure I would be in the top 2.5% of the population for my age in terms of fitness, but even in the 45-49 age group, a quarter of patients have some evidence of coronary furring up on CT! Compare that with the 40-44 age group where it is less than 10%. Whilst I feel in great shape, maybe there’s something going on under the hood?! I think this is one for me to ponder on holiday, but rest assured I’m still be working out whilst I’m doing it! Clearly all these numbers are based on scientific studies, and whilst give us a guide, should not be used to take decisions on your own health without personalised advice. If if have questions, please see your own doctor, or get in touch and I’ll certainly help if I can.
For this week’s research study, I spotted a interesting paper which looked at the impact of physically demanding jobs on heart disease. Not uncommonly I see patients who don’t do much exercise, but are very active in their jobs so the perception is they don’t need to bother. That makes sense to me intuitively, and so I was quite surprised to read the findings. Check out the video to find out more.