1: When he was in his mid-thirties, Peter Attia realized he knew how he would die.
It was shortly after becoming a father for the first time when it struck Peter: “All of a sudden, the awareness of my own mortality crashed over my head like a rogue wave, coming out of nowhere on one of my long swims,” he writes in his terrific book Outlive.
Peter was five years old when his Uncle Francis, his father’s favorite of eight siblings, died of a sudden heart attack at forty-six.
“Another uncle suffered a fatal heart attack at forty-two, while a third made it to age sixty-nine before his heart killed him,” Peter writes, “which is perhaps more typical but still way too young.”
He had known about his uncles his entire life, but the implication of their stories suddenly became clear.
“Forty-two seems really young to keel over from a heart attack,” he reflects.
Even though Peter’s cholesterol profile was favorable, he ate well, had never smoked, had normal blood pressure, and rarely drank alcohol, he knew he was still at risk.
“Globally, heart disease and stroke,” Peter writes, “represent the leading cause of death, killing an estimated 2,300 people every day in the United States, according to the CDC—more than any other cause, including cancer.”
And it’s not only men who are at risk: “American women are up to ten times more likely to die from atherosclerotic disease than from breast cancer (not a typo: one in three versus one in thirty),” he notes.Â
“But pink ribbons for breast cancer far outnumber the American Heart Association’s red ribbons for awareness of heart disease among women.”
Before his realization, Peter, like most thirty-six-year-olds, rarely thought about heart disease.
“Why should I have?” he recalls.
He considered himself an athlete. He was a long-distance swimmer and had recently swam twenty-one miles from Los Angeles to Catalina Channel.
His heart had worked “steadily for more than fourteen hours, like a Mercedes diesel engine purring along smoothly inside my chest, he notes, “I was in great shape, I thought.
“But I was nevertheless worried, on account of my family history. So I insisted that my doctor order a CT scan of my heart,”
2: That decision would change his entire outlook on life.
The CT scan was calibrated to find calcification in his coronary arteries.
“The results showed that I had a calcium ‘score’ of 6,” Peter notes. “That sounds low, and in absolute terms, it was; someone with severe disease could return a score well over 1,000.Â
“But for someone age thirty-six, it should have been zero. My score of 6 meant that I had more calcium in my coronary arteries than 75 to 90 percent of people my age. As I dug deeper into the pathology of this disease, I was dismayed to learn that it was already fairly late in the game.”
Because calcium scores are a predictor of future risk and a metric representing historical and existing damage.
“And I was already off the charts,” he writes. “I was only in my midthirties, but I had the arteries of a fifty-five-year-old.”
Despite being a long-distance swimmer, Peter was overweight and borderline insulin-resistant, two significant risk factors for heart disease.
“Yet because my calcium score was ‘only’ 6, and my all-important LDL (“bad”) cholesterol was ‘normal,’ the medical advice I received was—wait for it—to do nothing.”Â
3: Peter’s situation perfectly highlights the difference between the way traditional medicine is practiced, what he calls Medicine 2.0, and a new approach to medicine he calls Medicine 3.0.
With Medicine 3.0, the goal is “not to patch people up and get them out the door, removing their tumors and hoping for the best, but rather to prevent the tumors from appearing and spreading in the first place,” he writes.
Rather than treating the heart attack after it occurs, the goal is to avoid that first heart attack.
After getting the CT scan results, Peter realized he was not on a good trajectory.
He committed himself to do something about 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.
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