005 - The Marathon Runner With a 95% Widowmaker Blockage (And Zero Symptoms) | ClearCardio

Welcome to Clear Cardio's Prevention is Power podcast, where we help you take control of your health and protect your future. I'm your host, J.D. Enright, and today we're diving into a topic that will challenge everything you think you know about heart health. Because here's the shocking truth: just because you're fit doesn't mean you're safe. Every day we see marathon runners, personal trainers, and health-conscious individuals blindsided by heart disease. They feel invincible because they work out, eat clean, and don't have any symptoms. But inside, something deadly could be developing, completely undetected. Joining me today is Dr. John Osborne, a Harvard-trained cardiologist with nearly 30 years of experience in preventing and treating heart disease. Hi, Dr. Kahn. Dr. Osborne, welcome back to the podcast.

Thank you, JD. Always a pleasure.

Yeah, it's great. So really, I mean, seriously, you see these fantastic marathon runners and bodybuilders and Pilates experts and trainers, and they're in this great shape, but you're telling me that the mirror lies.

Yeah, let me give you 2 stories. I want to put a personal face on this. 2 stories that were, for me, were remarkably educational. Great.

All ears.

All right. 33-year-old guy had flown, had flown cargo planes and all that, big planes, heavies, as they call them, for the Air Force, right? And by this point, he was actually— he had done that, Put in his time. Thank you for your service, and then was flying for American Airlines.

Oh, so he's a commercial pilot?

He's a commercial pilot.

Okay. Okay. I'm getting nervous already.

Yep. Well, yeah. Well, both of these stories have great endings.

Okay. Good.

Good. Okay.

Good.

So when I first saw him, 33 years old, no symptoms, no chest pain, no angina, no bad habits. By the way. Ironman triathlete, ripped. Okay, 7% body fat, no blood pressure. Again, no bad habits, no smoking. Yeah. No blood, you know, no, you know, looked to be absolutely fit, completely fit guy. The reason he came to see me is he had a really bad family history of heart disease. Okay. And he said, yeah, you know, when, when I was in the Air Force, The flight surgeon said, geez, your cholesterol is pretty high. You better start doing diet and exercise. Well, remember, he has 7% body fat, triathlete, eats perfectly, no bad habits.

Ideally doing everything he should be doing.

Everything I would ask anyone to do.

Got it.

So the long and short of this was, now this is a while back. Long and short, at age 33, he needed 5-vessel bypass surgery.

Oh my God. 5-vessel. So that's when they cut you open, split your entire frame, go in there. They call it the zipper scar, don't they call it that?

Yeah.

So wow, major surgery. A lot of people don't survive that actually, do they?

Nowadays? Yeah. I mean, it definitely has a mortality rate.

Okay.

He got through that and that was great. As it turns out, his LDL cholesterol was 250, which is very, very high. If your LDL cholesterol is above 190, you're in the 95th percentile. That is, your LDL cholesterol is higher than 95% of people in the population.

Wow. Mine was like 260. It's 40 now, but—

Yeah. Well, of course.

Thanks, Steve.

And we caught this and took care of you so that you'll never have to look forward to being a member of the zipper club, right?

That's right.

So the other thing too is he also had another form of inherited cholesterol called Lp. We'll do a show on that, but it's a completely 100% genetic form of cholesterol. It is not picked up or detected on a standard cholesterol or lipid profile.

Okay.

It occurs in about 20% of people with heart disease. It is a really nasty bugger. We do have some tools that can modestly lower it. The good news is in the pipeline, we have tools, drugs, that will be able to lower it by 85% to 100%. So very exciting.

CareCredit does that test though, right?

Yeah. Oh, absolutely.

Got it.

So because this is the hidden cholesterol, the hidden deadly cholesterol, We check it in everyone, right? If it's normal, it'll never be high. End of story. You check it once.

Most times you go to a cardiologist, they don't check that.

They don't even know what Lp is.

Okay, good to know.

It's spelled L-P little a. Oh, got it.

Fair enough.

But anyway, that's the value of being also a cardiologist and a lipidologist, because we're dweebs and nerds about all that. Anyway, so he had 2 of those bad things going on. That netted him bypass surgery at age 33. Now here's the good story. That was 20 years ago. He had his bypass surgery. We got all his cholesterol down, fixed him up. He's never had another event, no problem since then. I don't think he ever will. And now his LDL is, you know, about the same as yours. In fact, I did see there's a little substory. I did see him a couple years. Well, as I saw him, he was telling me, yeah, I got a daughter. Well, again, these are genetic High cholesterol issues, right? This is a function of passing on the bad gene. He had a daughter; she was in high school at this point, so young. We checked her, right? She's healthy, looks perfect, right? We checked her. Yeah, her LDL looked just like dad.

Wow!

So we actually started her on drugs.

How old was she?

She was about 18 when I saw her.

18.

Yeah. So we actually started her on drugs.

Okay.

Got those numbers perfect, and. She will never catch up to dad with respect to needing the zipper club.

So preventive. Yeah, that's so important.

Isn't that great?

That's amazing. Yeah, and these drugs are well tolerable. Yeah. Oh yeah, medications.

Yeah, yeah. No, it's incredible.

Yeah, that's so that's two. Those are two scenarios there, right?

So I got one more quickly. Okay. Forty-five-year-old guy wants to run a marathon. He's training for a marathon again. Looks perfect, healthy, blah blah blah. Did have a family history of heart disease. So again, respect what has happened to mom, dad, brothers, sisters, aunts, and uncles.

I'm starting to see a theme here. That's how important this is. So when you see these phenomenally athletic, svelte, beautifully bodied people, or you don't even have to be ripped and all that stuff. So imagine if you're not even that and you're like me or like the average person who's pretty good shape, but they're not like super athletes. But you got these really, really fit people. It doesn't necessarily matter, right? You could have this genetic situation going back.

Absolutely.

And that's the key.

And feel fine.

And feel fine. And feel—

not only feel fine, feel amazing.

Yeah.

Right?

Wow.

Until you don't. So, remember, right? Family history of balloons, stents, bypass surgeries, heart attacks, strokes. That's all plaque. If you have that in your family, Listen up, because we've always been told.

Yeah, we've always been told. I've always been told. I know most of our listeners have always been told that you diet, you exercise, you know, you lose weight, you look great. Yeah, those are those are important things. Yes, those are all really important things.

Absolutely.

However, what I'm hearing here is yes, and right, you need to know you can control what you can control. Yeah.

There's certain things you can't control and you can't eat or exercise them off.

Okay. So everybody at a certain age— well, I heard there was an 18-year-old girl, but that's okay. But everybody specifically say over the age of what?

40 is a great place.

Okay. So we'll start there.

Let's just say you have a horrible family history or whatever. Well, you might do what we were talking about earlier, but I would say for everybody, I think it's a great Number to keep in mind. Yeah, right. 40, let's, let's start getting serious about this.

So is that something you do? So when they come into Clear Cardio and they meet with Dr. Osborne, and they come in, and let's just say gentleman or, or a young lady, 40 or over 40, and, you know, they're in great shape, you know, there's not the obvious risk factors like, um, high blood pressure, um, over, you know, having a lot of visceral fat. Diabetes, smoking, a lot of alcohol abuse, things like that. If they come in and they look great, they don't have all this, but you find out that they do have this disease, right? They have plaque in their arteries, arterial plaque, i.e., heart disease in this case, and they're at risk. And you see that there's a genetic factor to that. What do you do then? Do you recommend that they bring in their siblings?

Oh, I do. I always take a very good family history. I want to know, Mom, dad, brothers, sisters, aunts and uncles, and of course, your siblings, even down to your kids, right? Sometimes nieces and nephews, right? Because they all can carry some of these adverse genes that can dramatically increase your risk.

Yeah. So, Dr. Larsen, we're talking about how you can look in the mirror, look fantastic, have no symptoms, go to doctors, get stress tests. You're a world-class athlete, but you still should come out and see you and Clear Cardio Because you need to really look under the hood. Okay? So, I'm looking at a graphic here. Can you explain to our audience and myself what this graphic is all about?

Sure. You know, I think when people think of exercise or activity, right, they think the more is better. What we found out, and this is fairly recently, is that that's not necessarily true. Okay? What I'm showing you is this great graphic that shows, with respect to the benefits, health benefits of prevention of cardiovascular disease, even modest amount of exercise translates to reductions in weight, blood pressure, diabetes, cardiovascular risk factors, lower rates of atrial fibrillation, that's AF. It's not what you think that is, it's atrial fibrillation. Sorry.

Yeah.

Coronary, you actually improve blood flow to the heart. In fact, I've seen some really highly tuned athletes that have heart disease, They'll show up and we'll do the scan, complete blockages of vessels.

Wow.

No symptoms, no chest pain, no angina.

World-class athletes.

Oh yeah, yeah. I mean, just amazing.

Professional athletes.

Complete blockages of the blood vessels. What has happened is, yes, they do have plaque. It starved off the vessel, but slow enough that the other blood vessels in the heart could pick up the slack. Pick up the slack, right?

Yeah, yeah.

And they never had heart attack damage. Chest pain and angina, but they had such extensive disease, they already blocked off a vessel, right?

Wow.

But by exercising, again, we'll talk about moderation, all that, we can improve the blood flow to the heart. I also have people that have blockages, and they always say, can I exercise? I say, absolutely, right? You can't kill yourself. We'll talk about that here in a moment. But moderate exercise and regular exercise literally can improve the blood flow to the heart and actually redistribute blood flow, even from areas that are blocked.

Got it.

In fact, exercise, rehab, and all that, particularly in patients with heart failure— leading cause of heart failure is you have a heart attack and damage your heart— literally has been shown to lower the risk of mortality.

Oh, fantastic.

And it says here, increase functional capacity and prognosis of patients.

What is CAD?

C-A-D? CAD is coronary artery disease.

Okay, fair enough.

Yep. So that's why we recommend for cardiovascular health, plus reduction in the risk of diabetes or treating diabetes and blood pressure, that 150 minutes a week of moderate to vigorous exercise, or about 30 minutes most days of the week, or 30 minutes 5 days a week or so.

Okay. That's what you and Clear Cardio recommend.

That delivers huge benefits. What's interesting is, If you look at some people, so your marathon runners, your people that like, or the 100-mile ultramarathons, or, you know—

It amazes me, by the way.

Yeah, right?

Yeah.

There is a limit. So this is a U-shaped curve, means that there is benefit going to a certain point, and then if you overdo it, the risk goes up. So what this is showing—

No kidding.

Oh, absolutely. So in fact, we know—

So those crazy, like, ultramarathoners and all that, their risk goes up.

It does.

Wow.

Oh yeah. So in fact, if you do CT scans, basically clear cardio on these individuals, you will find many of them have extensive coronary artery disease, right? Never smoked, no bad habits, all the usual stuff. But we know, and we've seen that, we've seen that particularly in marathon runners, because there's a lot of marathon runners, and those were the people you'd think, you're free and clear, right?

Yeah, they're going to live forever.

Yeah. In fact, speaking of marathon runners and a caution, Literally, the guy in the 1970s who literally wrote the book on aerobics and running, right, was a guy named Jim Fixx. Jim Fixx wrote the book on aerobics, big deal back then. And he did this, he got involved with running and aerobics because he had a horrible family history of heart disease. So he figured if I am a runner, do aerobics—

More is better.

More is better. I'm going to live forever. Well, here's the bad news. The reason you probably don't know Jim Fixx, unless you are a little bit older or around the '70s— Or Google him. Or Google him, right? Is Jim Fixx, at age 52, died by the side of the road of a massive heart attack. He felt that he could exercise away his risk and his family history. He couldn't. And he died by the side of the road with sudden cardiac death at age 52.

So genetics plays a major role in this.

Major role, right?

And then overexercising makes it worse. And overexercising.

So if you— 12 METs, so this is a way that we just use to quantify a degree of exercise, right? So this is metabolic equivalents.

Okay, that's what MET means? That's what METs mean. Metabolic equivalents.

So 12 METs is basically if you're running full out, hard as you can on a treadmill, so I mean really putting it out, you're sweating and all that, you're probably pushing about What about heavy lifting, like bodybuilders and stuff?

Yeah.

And again, different levels of exercise. One is isometric, that's weightlifting or resistance training. The other is more aerobic. But we can use the lingua franca, the Rosetta Stone of METs to sort of make equivalent weightlifting versus aerobics, right? They're different. But the answer is, If you go above about 12 METs, you increase the risk of cardiovascular events, right? Sudden cardiac death, et cetera, is greater if you routinely push yourself above 12 METs. And the reason is, you can imagine, I mean, the heart's an organ, it's a muscle, right?

Yeah.

You can begin to outstrip the capacity of that muscle, and you can get fibrosis of the heart. You can develop cardiomyopathy. We know NBA players, football players, et cetera, but their hearts enlarge. Now, to some degree, that's compensatory for exercise, but there is a limit. If you push past it, you begin to get fibrosis, that is scarring in the heart. You can develop atrial fibrillation. So you can see here, atrial fibrillation, AF, is better with moderate exercise, goes up fivefold if you push past it. Yeah.

Oh, what a crazy graphic that is.

Yeah.

That's amazing.

So exercise, yes, it's great. Do it regularly in moderation, but be careful. If you're pushing it, do not think that that is the—

This is so counterintuitive. I bet to me and I bet all of, or most of our listeners, because it just doesn't fit for certain. The facts are the facts. So what I'm hearing—

So you can drown in the fountain of life.

Yeah, I get it. No, that's crazy. So what I'm hearing is, if you're over 40, men and women, you need to come and see Dr. Osborne or a preventive cardiologist who understands what we're doing. Come to Clear Cardio, meet with us, because whether you're a world-class athlete or You have tons of risk factors and symptoms. You need to come in. You're all basically the same, because you never know whether it's genetically based or what have you, right? Or environmentally based or just lifestyle-based.

There's an amazing number of factors. I always like to think, we can think in 1, 2, 3, maybe 4 dimensions, right? Try to think in 10, 13, 20 dimensions, right? And an unbelievable array of variables that can be good, bad, or ugly for the heart. It is impossible to solve that, but we don't have to because we look under the hood.

We have the technology.

The technology—

Looks under the hood and can tell you yes or no. Do you have it?

Unequivocal.

Or do not. So that's important.

Absolutely.

To look beyond that.

So another one, the 45-year-old guy training for a marathon. As he was training, he started passing out. That's weird, right? Again, guy's perfectly healthy as far as anyone knows. So now, this is a long time ago, right? So we did something we don't do anymore. We did a stress test.

Okay.

This is a long time ago, but again, very eye-opening, right? We do the stress test and he looks great. He's doing fantastic. Gets pretty far into the stress test, kind of what you'd expect him to do when he's training or doing his marathon that he wants to do. And suddenly, He goes into a heart rhythm called ventricular tachycardia. What that is, is the heart rhythm that precedes sudden cardiac death.

Oh my goodness.

So he goes into this heart rhythm, his heart suddenly goes to about 200 beats a minute, he starts feeling dizzy and lightheaded and goes, yeah, that's the feeling I've been getting.

Wow.

So—

Wow.

Next thing, we put him in the CT machine. Again, this is a long time ago. Nowadays, we wouldn't even bother. He goes to the CT initially, but we put him in the CT machine. Yeah, he's got a 95% blockage in his widowmaker.

Wow.

No symptoms.

Yeah.

Except he got dizzy.

Yeah. He had a ticket to the death train.

Right. And again, as an aside, when we do stress tests, we are basically pushing you to, you know, when you're about to die, right? Never a good idea.

Never a good idea.

That's why stress testing again, not useful. But anyway, it was an interesting story. Again, eye-opening. Yeah, we got him fixed up, taken care of. He's been fine since then.

So what's the moral of this story, Dr. Osborne? What would you say our our our viewers should what should they take away from this? You know, people that are watching this, you know, they're going to think, hey, I've been working so hard. I look great. I eat well. Da da da. I mean, what would you say to them right now?

You know, I'm always going to say, we've talked about it before, we got to look under the hood, right? You know, you may have a Ferrari, it may look amazing, polished, gorgeous, sound great, and, you know, it could have an engine that's just about ready to fail, right? Or you have no oil in the crankcase, right? It's going to be a bad outcome, yeah, right? You got to look under the hood, and the way to do that is The CleerCardio way, I'll say, which is cardiac CT angiography, our CAT scanner, the donut of destiny, I call it, combined with cutting-edge aortic— cutting-edge AI. And we will know 100%. No, could be, maybe, possibly. It's there, it's not, end of story.

And you're in and out in what, an hour?

A few minutes. Yeah. The scan itself is really just a few minutes. And, you know, And then we go over all the results. But yeah, I mean, it's quick, easy.

Yeah, I've been watching this, I've been watching the news and watching these world-class athletes, people you would never imagine, just dropping dead of heart attacks and strokes. And you wonder why. And so, here's why, because no one's looking under the hood. They're not taking the time. They're looking at them in the mirror.

The surface looks great. So they say beauty is skin deep, ugly is to the bone, right? Well, obviously joke, but just because you look great on the outside doesn't mean that there could be something really terrible and ominous and particularly life-threatening going on on the inside. The only way to know is you got to do the Cleer Cardio way. That's it.

Well, that's great. Thanks for coming out, Dr. Osborne. Really appreciate the time with you again. Those of you who've been watching myself, J.D. Enright, and Dr. Osborne with Clear Cardio, if you have any questions at all, or you're one of those people who think that, you know, you're in great shape, you've been eating right all this time, you may not have any symptoms at all, but you're in that age range, you're 40, 45, and going on that, we highly recommend you reach out to Clear Cardio. You can go to clearcardio.com. That's clearcardio, spelled C-L-E-A-R-cardio.com, all one word, clearcardio.com. And just reach out and get on a call with us and get on a call with Dr. Osborne, and let's take care of you. Let's find out once and for all what's going on under the hood.

Absolutely.

Thank you for joining us for another podcast here at Clear Cardio. Have a great day.