- The Washington Times - Monday, September 12, 2005

More people under 50 at risk

ave Livingston’s cellular phone was ringing when he arrived for work one recent day. It was early, but shoppers already were circling the Raleigh, N.C., lot where he manages a luxury-car import business.

The day was starting to crank up, but Mr. Livingston, manager of Olde Raleigh Motors, didn’t care. He was just glad to be alive.

Just a month before, 40-year-old Mr. Livingston had suffered a heart attack.

“Heart attack, age 40. The two just don’t go together,” Mr. Livingston says. “That’s an old person’s problem.”

D.C.-area cardiologists, however, say heart disease is showing up in younger and younger patients.

“We’re in the middle of an obesity and diabetic epidemic,” says Dr. Patricia Davidson, cardiologist at Washington Hospital Center in Northwest.

Obesity leads to diabetes, high blood pressure and high blood sugar and, in many instances, is associated with higher bad cholesterol levels, Dr. Davidson says. Obesity and lack of exercise, along with smoking, can lead to low levels of good cholesterol, she says.

“The bad part is, many people may be expecting the classic symptoms,” Dr. Davidson says. “They can have shortness of breath and fatigue, which they may assume is due to weight or lack of exercise. … They may have what we call silent heart attacks. Because they are so young, doctors may not pay attention to their symptoms.”

Blood vessels may start to show signs of lifestyle damage at an alarmingly young age, according to a study released in 2000 by the University of Buffalo. Arteries of obese 9-year-olds are measurably stiffer than those of their peers, although proper diet and exercise can correct the problem, the study says. Still, by the mid-30s, stiffening of arteries that started in childhood can progress to hardening of the arteries, characterized by the buildup of plaque that can result in a heart attack.

Nearly a quarter of the U.S. population — 64 million Americans — has cardiovascular disease. Many of those heart attack victims, such as Mr. Livingston — as much as 40 percent nationwide — have no symptoms, according to the American Heart Association.

The North Raleigh resident is a young man with a bright future and a loving family — wife, Tracy, daughters Savannah, 3, and Rachel, 6. Like thousands of others, he had ignored the possibility of a heart attack even though his body was trying to tell him something was wrong. He also had a family history of heart disease that warned of catastrophe.

For a month, Mr. Livingston had been suffering a burning sensation in his chest. He had convinced himself it was reflux. At night when he played tennis, he had to stop and rest or the burn would come back. When he picked up his 3-year-old and held her above his head, his chest burned again.

He should have been worried.

“I wanted to go on my vacation to the beach and feel good,” he says. His doctor suggested a stress test, but Mr. Livingston was too busy. He went to the beach.

The burning continued.

By the time he returned, Mr. Livingston was experiencing increasing pain. On July 29, he headed to his doctor, who gave him a stress test. While on the treadmill, Mr. Livingston had a heart attack. He was rushed to the hospital, where he had an angioplasty and a stent inserted to hold open his clogged artery.

At 6 feet 4 inches, Mr. Livingston had played basketball in high school and then in college. Over the years, however, his exercise routine had slowed; he weighed 230 pounds and he smoked now and then. Add to that his family history — a mother who died of heart problems at age 50, a brother with heart problems and a grandmother who died with heart disease.

Heart attacks begin in the blood supply to the heart muscle. The heart gets its blood supply through small coronary arteries that are about the diameter of a strand of spaghetti. Shut off one of those strands, and a piece of the heart muscle dies. A sedentary lifestyle coupled with a diet high in saturated fat and processed foods builds up deposits of fat and cholesterol in the artery walls.

By age 50, the arteries are coated with plaque like a pipe with gunk built up in it. Even healthy people have plaque, but healthier lifestyles help limit the amount. With no warning, it can rupture, clot and stop the flow of blood to a part of the heart.

Although there is no official national tally for the ages of heart attack victims, medical personnel say they are seeing more young people with heart problems.

Tom Harrison, coordinator for the cardiac rehabilitation program at Rex Hospital in Raleigh, works with about 45 cardiac rehabilitation patients a day. About eight of those are younger than 50, Mr. Harrison says.

Mr. Livingston began the program there recently, but like most cardiac patients, he is adjusting to working the exercise into his busy schedule. Insurance typically covers about 36 visits. Most patients go three times a week for 45-minute sessions. In addition, they get nutritional and emotional advice. In between, they swap stories with fellow patients and establish a consistent routine for recovery.

Last week, Mr. Livingston’s work and family issues pulled him in several directions as he struggled to be consistent in making his class — but he is determined.

“Today, I had a good day,” Mr. Livingston says. “I’m looking forward to the next time.”

Mr. Harrison says his younger patients usually do well.

“When you’re young, you don’t think about these things,” he says, “but once they get over the initial shock — ‘This can’t be happening to me’ — they do great.”

Bethany Kelly, now 50, was 49 when she had a heart attack. Mrs. Kelly has several risk factors for heart attack — diabetes, smoking and lack of exercise — but she says stress has been her biggest problem.

Over the past 15 months, Mrs. Kelly, who heads up volunteer services at WakeMed Cary Hospital, has suffered the deaths of her mother, her father-in-law, a godchild and her two dogs. Her father also required medical care.

After completing the rehab program at WakeMed, giving up all but one cigarette a day and working out regularly at a gym, the Wake Forest resident says she is on the right track.

The shadow of having a heart attack at a young age never leaves, however.

When asked if she’s feeling well, Mrs. Kelly answers: “Great.” After a long pause, she adds, “But I keep waiting for the other shoe to drop. I am feeling great. But I was feeling good the day before I had a heart attack, too.”

NEW YORK TIMES NEWS SERVICE

Washington Times staff writer Shelley Widhalm contributed to this story.


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