Anatomy of a heart attack, Part 3: Risk factors and the French Paradox

This is the third in a series about experiencing a heart attack and recovering from one.

People say such silly things! For example, here is a list of silly — by which I mean awful — things people have recently said to me:

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  1. One out of four men who live through a heart attack will die within the following month. (True)
  2. This is the worst rat infestation I’ve ever seen. (True)
  3. You look great! (Nope)

For heart-attack survivors, these are all unpleasant things to hear. For this particular heart-attack survivor, that last one is the worst. I’m a balding, pear-shaped 51-year-old. I don’t look like Brad Pitt with my shirt off. Or with my shirt on. There are a lot of miles on this engine, some of them clocked over bumpy terrain.

It makes me question why anybody — particularly my family and friends, none of whom are delusional — would say I look great, especially with an exclamation point on the end.

“You look great!” contains an unspoken comparison between the real you and the expected you. What it means is: “We thought you would be in bed wearing an afghan, trembling and breathing through your mouth, yet here you are. Huh.” They expect you to be ashen-faced and moaning in discomfort, not out on the street walking around like a normal person.

I know they’re trying to be kind. Nobody knows what to say to people who have almost died of something, anything, from heart attacks to peanut-butter-sandwich-induced anaphylactic shock. I get it. I don’t know what to say to myself, either.

When Statistics Canada thinks you will die

In Canada, the average age to suffer a heart attack is 71. I was barely 51 when my attack, uh … attacked. This means, if you do the math, at the same time my heart gave out, some 91-year-old guy keeled over. Let’s call him Joe. Ninety-one seems like a pretty good run to me, and while I bear Joe no ill will, I think it would have been a little more fair for him to suffer an attack at, say, age 76, which would have given me a statistically and personally significant extra 15 years.

My point is that I might not actually know how averages work. And finally, there is nothing about heart attacks that, on average, is fair.

For example, despite women suffering only 35 per cent of all heart attacks, more women die from heart attacks than men. According to a 2016 report by the American Heart Association, 26 per cent of women who suffer a heart attack will die within a year, compared with 19 per cent of men. The gap widens with time: Five years after suffering a heart attack, almost half of women die, compared with 36 per cent of men. Nobody knows why.

Of course, it’s not just gender that is unfair about heart attacks. It’s also where you happen to live. According to three seconds of internet research, the death rate per 100,000 people due to coronary artery disease varies quite a bit by country. The top 10, by which I mean the bottom 10, are as follows:

  1. Turkmenistan 411.10
  2. Ukraine 395.73
  3. Kyrgyzstan 388.11
  4. Belarus 362.19
  5. Uzbekistan 325.43
  6. Moldova 322.26
  7. Yemen 298.84
  8. Azerbaijan 295.11
  9. Russia 292.00
  10. Tajikistan 271.42

Unless I am missing something important, the data strongly suggest against living in a country whose name is nearly unpronounceable and might not be an actual country, at least not according to what I remember from eighth-grade Social Studies class.

Happily, Canada appears much farther down the list, at number 172 (55.36 deaths per 100,000 people), while our friends south of the border are more death-by-heart-attacky, at number 130 (86.89 per 100,000). Last on the list is South Korea, ranked 183 with just 30.76 deaths per 100,000 people).

Obviously, the South Korean diet of deep-fried chicken dripping with sweet, mercurochrome-red yang-nyeom sauce influences cardiovascular health in mysterious, but powerful, ways. Mmm-mmmmm.

Statistics Canada says that heart-attack rates in our country vary widely among provinces, ranging from 169 per 100,000 people in British Columbia, to 347 per 100,000 in Newfoundland and Labrador.

What’s true for provinces is also true for cities. New data from the Canadian Institutes for Health Information show that the rate of heart attacks in Canada’s lowest-income neighbourhoods is 255 per 100,000 people, compared with 186 per 100,000 in the most affluent neighbourhoods. That’s a noteworthy 37 per cent difference, and proves the old adage that money might not buy happiness, but neither does poverty.

Which brings me to the French and, specifically, to what is known as Ze French Paradox. This phrase was coined by French epidemiologists in the 1980s, when they observed the low coronary-heart-disease death rate in France, despite the high intake of dietary cholesterol and saturated fat. Basically, the French drink a lot of wine, eat a lot of cheese and olive oil, smoke too much and sit around, while people in other countries eat vegan garbage, count carbs, go to the gym every 10 minutes and die like flies.

French researchers, who I should probably point out are French, compared coronary-heart-disease deaths per 100,000 men, ages 35-64 years, in France and Great Britain, and found the following shocking differences:

  • Glasgow (U.K.) 332
  • Belfast (U.K.) 280
  • Lille (northern France) 89
  • Strasbourg (northeastern France) 80
  • Toulouse (southwestern France) 53

Understandably, this annoys the British, who like a good smoke and pint of lager just as much as the next nation with loads of football hooligans. Numerous studies have since looked into possible explanations for the French Paradox, and many possible mechanisms have been identified, including the effects of drinking on blood lipids, endothelial function, coagulation, inflammation, glucose metabolism and gene expression. But what it all really comes down to is: Heart attacks are totally unfair.

Good news, everyone!

The good folks at Cardiac Services B.C. say “the good news” about heart attacks is that about 90 per cent of premature heart disease can be prevented. I’m sorry, I misplaced the quotation marks. I meant to put them around “the good folks.” This is because those people also say health behaviours such as physical activity, diet, tobacco and alcohol use are modifiable risk factors — dubiously implying that changing these behaviours will change your risk of heart disease.

That might all sound reasonable to you, but the key word to look at in the previous sentence is: risk. Risk, as you know, refers to the probability of encountering danger and doom. Probability is a kind of math, and therefore not to be trusted, especially because everybody thinks they understand the rules of probability. They do not.

For example, despite whatever lucky-number system you think you invented, you are never, ever going to win the 6/49 lottery. To be clear, it’s not going to happen. And that meat-raffle winning ticket that was so close to your number? No it wasn’t, probability-wise. When you yell out “Soooooooo close!” at the Legion hall on Friday night, you are embarrassing yourself and lending credence to the Cardiac Services B.C. people, who also want you to:

  • quit smoking
  • maintain a healthy body weight
  • eat a healthy diet
  • lower high blood pressure
  • properly manage diabetes
  • reduce blood cholesterol
  • reduce stress

OK, OK, those are all good things to do. My beef is that I did all of those things, and I still suffered a heart attack due to extreme coronary artery disease. Well, I did some of those things. For sure, I thought about doing some of those things. But in my case (and also in your case), there’s nothing you can do about non-modifiable factors to prevent the risk of a heart attack. Factors such as genetics, age, gender and ethnicity. Those things are just the luck of the draw, and no, luck is not a real thing, probability-wise.

Exercise, that broad class of activities that makes you sweaty, out of breath and unbearably smug, is said to help you live longer and reduce the risk of dying from heart disease by up to 50 per cent. By “said to help” I mean that everybody says it. I used to say it.

When I had my heart attack, I had just returned from a three-week cycle over the back roads and through the jungles of Central America, up and down volcano slopes in the 35C heat and 10 billion per cent humidity, if I correctly remember the state of my underpants.

My point is that we all know that exercise is good for us. Our bodies were designed and built to be used, not sat on the couch to binge-watch Netflix shows.

When I make this point to friends and family, they usually say something along the lines of: “Dave, no more about your underpants, please.” Besides, the other thing that we all know — but pretend we don’t know — is that eventually our hearts will stop. Your heart is one day going to stop. I’m sorry about this little bit of unpleasantness, and if it is of any comfort, you might die of something else first, which will lead to your heart stopping.

This is not an existential argument for eating that second doughnut, nor for never exercising because why bother if you’re going to die anyway? I get it. I have a daughter, so I have more than a passing familiarity with living with a profound sense of disorientation, confusion and dread in the face of an apparently meaningless and absurd world.

Despite the knowledge of our own end, we carry on because that is how life works, and it turns out that life works better when we exercise. It’s one of those quality, not quantity, things. So get off the couch and do a little exercise every day. Walk a ball. Kick your dog.

Come over to my house and we’ll go for a stroll around the neighbourhood together, talking about the old days when our hearts were going to beat forever and existential dread had no place in our lives.


Cardiac Services B.C. —

The series

Part 1: 'Every part of me felt really awful'

Part 2: 'Exceptional medical talent' at Royal Jubilee hospital

Part 3: Risk factors and the French Paradox

Part 4: Stress test and a sweaty gym visit

Part 5: Grow up and eat your vegetables

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