Heart health, women and the limits of exercise


I want to talk to you about my friend Anne, who was 61, kind and capable, modest and fit. Anne passed away suddenly this month from a bolt-of-lightning heart attack, which is why I want to talk to you about my friend Anne and heart health and the solace – and limits – of exercise.

Anne and I met when our children joined the same sweet, crunchy elementary school, its curriculum more idealistic than clear-eyed about childhood. (Sample lesson: You and Jade each have two cookies. How many will you have after you share with Tristan and Isabelle?)

Anne and I bonded over our shared cynicism about our offsprings’ willingness to share cookies and our mutual interest in being outdoors. In the following years, we began regularly hiking and mountain biking together, in combination with various squads of spouses, friends, children and dogs. In 2017, with another friend, we trained for a half marathon, their first, my fourth. We all finished, and within a hairbreadth of our goal times.

When the pandemic struck, we saw each other infrequently, although we convened on the trails when possible. In between, Anne fervently took to indoor cycling, riding every day, a streak that extended 800 days.

Anne also ate well. She was a marvelous cook. She didn’t drink. After gaining some weight in midlife, she lost it and looked lithe and strong. She never smoked. Her mother lived into her 90s, her father almost as long.

But one afternoon this month, Anne rode her bike, climbed off, and complained of nausea and fatigue. Her right arm ached. Blaming indigestion, she took Tums. They didn’t help. She vomited. Her husband suggested urgent care. She declined.

The next morning, Anne collapsed in their bathroom and could not be revived.

Most of us, as adults, have friends of convenience, friends of happenstance, friends of nice times and occasional get-togethers, and friends of our heart. Anne was a friend of my heart, and her loss leaves me and everyone who loved her bereft, but also confused and mad as hell. It never entered my mind someone like Anne could have a heart attack. It seems also not to have occurred to Anne.

And that is why I want to talk to you about my friend Anne.

Women who exercise still can have heart disease

“Heart disease remains the number one killer of American women,” said Martha Gulati, a cardiologist at Cedars-Sinai Heart Institute, associate director of the Barbra Streisand Women’s Heart Center and president of the American Society for Preventive Cardiology. “When we ask people, they almost always say breast cancer is number one. But women have a tenfold greater chance of dying from heart disease than breast cancer.”

That risk extends even to women like my friend Anne, who are, to all appearances, healthy and in shape. Anne recently began taking a statin to treat elevated cholesterol, but was not prescribed other medications and had no family history of heart disease. She never had covid-19. By my internal calculus, as someone who writes about the health benefits of exercise, Anne should have been safe. She did the right things. She did what I do. She did what I tell everyone to do.

“There is no doubt that, on a population level, physical activity is extremely good for us and our hearts,” Gulati said. “People who exercise, people who are physically fit, those are the people who are most likely to stay alive.”

But, she continued, on an individual level, fit, healthy people can and do develop heart disease, often silently. They can and do die of it, often suddenly. Any of us can be struck by lightning.

Pay attention to symptoms that are new to you

So, I want to talk to you about cardiac symptoms and response, especially if you are a woman, fit and perhaps, like me, considered yourself almost invulnerable.

“Pay attention to any symptoms above the waist, which means above the belly button, that are new to you,” said C. Noel Bairey Merz, the director of the Barbra Streisand Women’s Heart Center.

Sudden, unusual shortness of breath and profound fatigue are common among women experiencing a heart attack, as are chest pain or discomfort, upset stomach, and new pain in the back, neck or jaw, Gulati said.

The classic Hollywood version of a heart attack – clutching your chest and keeling over – is fairly rare, especially for women. More often, symptoms linger and intensify for hours.

During that time, many women cannot or will not believe their hearts could be failing. “If their husbands had those symptoms, they would take them to the ER,” Gulati said. “I always say, if you would take someone else to the hospital with those symptoms, make sure you get yourself there, too.”

This is why I wanted to talk to you about Anne. I wanted to urge all of us, as we set exercise resolutions for next year, to be attentive, to accept our bodies’ limits and respond to its signals, no matter how healthy we may feel and how implausible we may consider any concerns. Do the same for all those you care about.

My last text from Anne was about a wintertime foot race on our favorite, rolling trails. The distance was a bit longer than either of us had attempted lately but Anne was game. It “looks like fun,” she wrote. “A reason to get outside.”

So, on a recent clear, chilly morning, I ran the race with my son and some friends, not for competition or even exercise, but connection, deeper and more substantial, to those I love, the enveloping land, my own thrumming heart, and a dear, indelible friend. Godspeed, Anne.



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