Most cardiology patients do not recover like professional athletes

by Dr. Eugenia Gianos

It’s inspiring to see football player Damar Hamlin recovering from what must have been a traumatic cardiac event on the national stage. At just 24 years old, this young man is defying a less than 10% survival rate for an out-of-hospital cardiac arrest after his gut-wrenching experience with the rare “commotio cordis.” It’s nothing short of remarkable. However, it is not common.

From my work as a preventive cardiologist, I can tell you that most patients do not recover like professional athletes. They typically experience limits on their physical and cognitive capacity after cardiac arrest. That’s why it’s so important that we do everything we reasonably and medically can to prevent these types of cardiac events from occurring in the first place.

For many people, a first, understandable response to Hamlin’s experience is that it’s essential to learn cardiopulmonary resuscitation (CPR). That’s a good instinct. After all, CPR can double, or even triple, a patient’s chances at survival when it’s performed early enough.

But that doesn’t have to be our sole takeaway from Hamlin’s on-field ordeal. It can reveal another lesson: We can save even more lives by rewriting our heart health destinies.

We’re trying to do just that in the field of preventive cardiology, striving to make sure that every patient clearly understands their genetic background and the role that lifestyle, and lifestyle change, can play in our heart health and risk. That insight can help us prevent premature cardiac arrest, stroke, heart failure and, of course, death.

If we’re looking to famous people to see more typical causes of cardiac arrest, fitness trainer Bob Harper may be a better example. Harper is the coach from the NBC competition series, “Biggest Loser.” His 2017 heart attack, which occurred when he was 51 years old, was more typical in terms of its cause. It was caused by a blockage in an artery that left no blood flow to the heart muscle and led to an unstable heart rhythm.

Harper’s experience with what is sometimes called a “Widowmaker” heart attack highlights the importance of being aware of our genetic predisposition for heart attack and cardiac arrest. In his case, it was a cholesterol particle that predisposes people both to hardening in the arteries and a tendency to clot made cardiac arrest more likely.

It’s an underrecognized form of premature heart disease that often happens to multiple family members. Harper may have been a professional fitness trainer in incredible physical shape, but he was not able to outrun his family history. His mother had died of a heart attack, a red flag that others in the family also may be at risk.

We have the power change that story. A simple blood test can determine a patient’s baseline risk. We can look for markers of inflammation and conduct imaging studies that reveal the early development of heart-attack inducing plaque.

Abnormal cardiac genetics is like playing poker. You may start the game at a disadvantage but could still win by playing wisely. You also can start with a good hand—that is, good genetics—but lose with poor lifestyle.

We’ve also got some control in the game: 80% of heart disease is preventable, the Centers for Disease Control and Prevention (CDC) says.

Reducing heart disease involves improving exactly what you think it does: diet and exercise. Predominantly plant-based diets help. So does the Mediterranean diet (versus a control diet), which researchers have found lowers the combination of heart attack, stroke and death by 30%. That’s a more impressive outcome than most drug trials.

Fortunately, we also live in an era in which medications, like statins, allow us to reduce our risk and prevent heart attack and stroke. Patients who need help lowering cholesterol are looking turning to treatments that halt disease, including those that regulate and filter cholesterol, and the future may take us to the next level of editing genes that put us at risk. Newer diabetes regimens are helping too, by lowering sugar, promoting weight loss and ultimately reducing cardiovascular risk.

We don’t all need advanced testing or medical therapies, but we all need individualized assessments that include lifesaving details. We want to find out if there’s a family history of early heart disease, which risk factors (high blood pressure, high cholesterol, diabetes, prediabetes, smoking, obesity) are present, and one’s lifestyle habits.

Though I see the devastating impact cardiovascular disease can have, I’m still grateful. We can learn even more lessons from Hamlin’s terrifying story than knowing CPR. We can save lives by understanding our risk, adjusting our choices accordingly and starting much earlier in protecting our heart health. Let’s maximize the potential to rewrite our own stories.

Eugenia Gianos, MD, FACC, FAHA, FASE, FNLA is the director the Women’s Heart Program, at Lenox Hill Hospital and the system director of cardiovascular prevention at Northwell Health.