1: “What proportion of heart attacks occur in people younger than age sixty-five?”
That was the question Dr. Allan Sniderman asked Dr. Peter Attia at Dulles Airport in 2014.
“I guessed high,” Peter writes in his terrific book Outlive.
“One in four,” he responded.
He was low. Way low.
“Fully half of all major adverse cardiovascular events in men (and a third of those in women), such as heart attack, stroke, or any procedure involving a stent or a graft,” he writes, “occur before the age of sixty-five.
“In men, one-quarter of all events occur before age fifty-four.”
Whoa.
“But while the events themselves may have seemed sudden, the problem was likely lurking for years,” Peter notes.
2: Heart disease is a sly, slow-moving, stealth-like killer.
Which is why Peter takes such a hard line on it.
He writes: The “myth that we need to confront is the notion that cardiovascular disease primarily strikes ‘old’ people and that therefore we don’t need to worry much about prevention in patients who are in their twenties and thirties and forties.”
While our risk of heart disease “events” increases steeply in the second half of our lives, “some scientists believe the underlying processes are set into motion in late adolescence,” Peter writes, “even as early as our teens.
“The risk builds throughout our lives, and the critical factor is time.”
It is important to understand how heart disease evolves and advances so we can implement a strategy to slow it down or stop it.
“Back when I had an office, pre-COVID, I kept a clutter-free desk,” Peter writes, “but one book in particular was always there: Atlas of Atherosclerosis Progression and Regression, by Herbert C. Stary. It will never be a bestseller, but in the field of cardiovascular pathology it is legendary.”
Why did he keep it on his desk?
Because it is “a highly effective tool for communicating the seriousness of this disease to my patients, thanks to its lavish and gruesome photographs of arterial lesions as they form, develop, and rupture.
“All taken of the arteries of dead people, many of them in their twenties and thirties.”
By the time Peter had finished sharing the gruesome photos, “my patients would often have this kind of harrowed expression on their faces, as it they’d just leafed through a coffee-table book documenting their own death.”
3: One of the critical points Peter makes is that heart disease starts early.
If we “are reading this and are older than fifteen or so, there is a good chance we already have some [plaque] lurking in our arteries,” he writes
“Yes, I said ‘fifteen’ and not ‘fifty’—this is a lifelong process and it starts very early.”
Peter shares autopsy data of young people who died from various causes like accidents, homicides, or other noncardiovascular causes: “As many as a third of sixteen- to-twenty year olds already had actual atherosclerotic lesions or plaques in their coronary arteries when they died. As teenagers.”
His point?
“It’s not as if they were about to have heart attacks,” Peter notes. It’s that heart disease starts early and moves very slowly.
And we need to start early to fight it.
More tomorrow.
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Reflection: What surprises me about Peter’s research regarding heart disease?
Action: Talk to my Primary Care Physician about Peter’s work.