PUBLISHED 09/07/2007
In an effort to educate other runners about the risk of heart attack, Alberto Salazar allowed his cardiologist to speak publicly about his case. Dr. Todd Caulfield, M.D., is the medical director for interventional cardiology research at Provident St. Vincent Medical Center in Portland, Oregon, and first met Salazar on the morning of the athlete's heart attack. Coincidentally, Caulfield had just finished his first marathon (Vancouver, 3:53:22) seven weeks before treating Salazar.
You can't eliminate all risk factors
Salazar had a lot of risk factors: a family history of coronary disease, and high blood pressure and high cholesterol, both of which were being controlled with medications. Being male is a risk factor, too. "Those are the things that got him into this situation despite his history as a world-class athlete," says Dr. Caulfield. "Even when you control for heart-disease risk factors, they still persist as risk factors. You can't completely mitigate against them."
You can't make heart disease disappear
Salazar's right coronary artery was about 70 to 80 percent narrowed, reports Dr. Caulfield. "We opened it up, put in a stent, and got great results," he says. "His heart hasn't lost any of its pumping capacity." The doctor expected Salazar to return to his usual activity and routine, and says his long-term prognosis is excellent. That said, Dr. Caulfield cautions that Salazar's heart has suffered. "He's got scar tissue, and he's got moderate coronary disease in his other arteries," says Dr. Caulfield. "This is a chronic condition."
The right meds matter
Salazar was already taking medications for his blood pressure and cholesterol, but Dr. Caulfield prescribed a more aggressive regimen and added a blood thinner. The doctor instructed Salazar to return slowly to his usual exercise, by walking first before he begins running. "He'll come into our rehab center for an exercise stress test in a month," says Dr. Caulfield, "so we can see how his heart reacts when he goes up to about 80 or 90 percent of his full effort."
Pay attention to small changes
As a runner, you give yourself a sort of poor man's stress test nearly every day, says Dr. Caulfield. "Any time you feel a new symptom that decreases your exercise capacity to the point where you can't do as much as you're accustomed to," he says, "call your physician, and say, 'Something is wrong.' You can't run through heart disease. We saw that mistake with Jim Fixx."
Your fitness does make a difference
According to Dr. Caulfield, Salazar's heart attack was "quite small," and his conditioning did help him. "If he hadn't been so active and fit and taking good care of himself," says Dr. Caulfield, "he might have been one of those guys who has a heart attack in his 30s instead of at 48."
