Heart attacks are not just something that happen to older men

At 44, Raul Rio considered himself a fit man.

He is an avid cyclist who maintains a healthy weight by eating nutritiously. Though he had borderline high cholesterol and blood pressure, neither was enough for him to be prescribed medication. He never thought he would suffer a heart attack.

He did.

In March, while on a long-distance fundraising ride, the Bike MS: Breakaway to Key Largo, Rio began to feel “weird.” He pulled his red and white Trek Madone to the side for a refreshment break. Having caught his breath, he took off again, only to find he was falling farther behind. At the 61-mile marker, uncharacteristically out of breath, feeling pressure on his left arm and shoulder and a radiating pain in his chest, he stopped.

Paramedics were called. Quickly they administered an IV, fed him some aspirins and ran an EKG. The pain only increased.

“It got so bad, I thought I was going to pass away,” Rio recalled. “When the chopper airlifted me to Kendall I thought, ‘Oh, I’m flying to heaven.’ ”

Not quite. At Baptist Hospital’s emergency room, Dr. Dean Heller, a Baptist interventional cardiologist, performed a minimally invasive stent procedure that opened a clogged artery.

“They saved my life,” Rio said. “I’m lucky to be here.”

His case goes to show that a heart attack can happen even to men who don’t fit the typical profile of “a heart attack waiting to happen.” And Rio’s case, Heller said, isn’t that unusual.

“Even though he was young and fit and doing all the right things … he had certain sub-traits, borderline hypertension and high cholesterol, that were enough to put him in danger,” Heller said.

Even as fatalities from heart attack have decreased over the past three or four decades, a result of improved medical care, the incidence of heart attacks has remained fairly stable. Heart disease remains the leading cause of death for men in the U.S., accounting for one in every four, according to the U.S. Centers for Disease Control. And half of the men who die suddenly of coronary heart disease have no previous symptoms.

Many men — and Rio admits he was one of them — tend to believe that a heart attack is something that happens to older men. But in fact, heart problems are not uncommon in younger men. Heart disease is the second most common killer of men between ages 35 and 44, second only to accidents.

While the average age for a first heart attack in men is 65, as many as 10 percent of all heart attacks occur before age 45 — mostly to men. Coronary artery disease is the predominant reason for these cardiac events.

“There are a lot of components to heart disease and for younger men genetics is an important one,” said Dr. Randy Katz, chief of emergency medicine at Memorial Regional Hospital in Broward. “So is lifestyle. Though you can modify lifestyle, as a society we’ve done a poor job of controlling that.”

While some heart attacks in younger men can be traced to inborn abnormalities of the coronary arteries, many of the cases of heart disease can be blamed on lifestyle, including commonly known risk factors: smoking, obesity, diabetes, high blood pressure, high total cholesterol and low HDL, or “good” cholesterol. A study of more than 3,500 men found that a man who has none of the six has only a 5 percent risk of developing cardiovascular disease by 95. But a man with two or more risk factors has a 69 percent probability.

Public education of the danger in flirting with these risk factors has helped. Smoking, for instance, is down. Obesity, however, is not, which can also lead to diabetes and cholesterol problems.

Younger men, Katz added, also “tend to have symptoms they ignore. When they experience something, they dismiss it or don’t recognize it.”

Yet, as Rios’ case proves, getting immediate medical attention is truly the difference between life and death.

“Men more than women are more likely to be in denial of the symptoms,” said Dr. Robert Myerburg, professor of medicine and physiology at the University of Miami Miller School of Medicine. “They tell themselves, ‘Oh, I’ll check this out in a couple of days’ and then dismiss it.”

Bad move. Time is of the essence in treating heart attacks. New guidelines for treating STEMIs — the acronym for ST Segment Elevation Myocardial Infarction, or the most severe type of heart attack — were updated in December 2012 by the American Heart Association and the American College of Cardiology. The national guidelines detail the best treatment plan that doctors should follow, and include a rule of thumb: The time between first medical contact to when a doctor opens a blocked artery should be 90 minutes or less.

But the best guidelines and medical care can prove useless if the patient doesn’t seek immediate medical attention. Even for those who survive a heart attack, quick treatment means less damage to the heart muscle.

Rio is certainly aware of that.

“All my friends are shocked that this happened to me,” he said. “But if it had to happen, it was at the right place at the right time. The paramedics told me that two more minutes and I would’ve died.”