Preventing Heart Attacks: Lessons from the Road
Road accidents and heart attacks share a common anatomy. Both are a result of a cascade of events. Recognize those events and take timely action.
I remember feeling peaceful, like the moments just before you fall asleep. Then, everything went dark. Not sure how long it lasted, but I was awakened by commotion - a bright light above my head, and a bunch of people talking in high pitch tones. I heard “Cut the seat..!”. Then it suddenly dawned on me that I was in an auto accident. I could now taste some blood on my lips and couldn’t move my left leg. Within minutes I was securely strapped in a helicopter with EMTs monitoring my vitals. The next couple of days were a blur. I was extremely fortunate to have survived with only minor injuries.
Anatomy of a Road Accident
Accident analysis (see picture above, ref: Hollnagel) looks at events and conditions that led to the final outcome. Highways are designed with barriers to either prevent an accident or protect people from the consequences of one. Preventive barriers such as speed limits, rumble strips, reflectors and banked turns are in place to help drivers regain control in case of an abnormal situation, while protective barriers such as seat belts, airbags, highway dividers and crumple zones are in place to mitigate the severity of an accident. One of the reasons I avoided serious injury in that terrible accident was because the vehicle I was driving was equipped with seat belts and airbags.
Since that time, I’ve tried to understand the role of human factors in an auto accident. In some studies, 94% of auto accidents are attributed to human error. One scenario could be driving late at night when there may be multiple external factors - visibility, glare, weather, road conditions - at play as well. In such a situation, if you start to feel drowsy, you may hit the rumble strips on the side of the road and be able to regain control. In more severe situations, you may find yourself in the grassy patch past the rumble strips or even hit the barriers in the median. You might still be able to regain control and recover with no damage but you could sustain major damage to the vehicle or to yourself. Many do not survive such accidents.
Heart Attacks - The Accidents on the Road of Life
While road accidents are responsible for millions of deaths worldwide every year, heart attacks remain the leading cause of death. They bring thousands of people into emergency rooms every day. Even more concerning is that multiple studies have now indicated that the risk of cardiovascular disease in young adults is on the rise. Even though deaths due to heart disease have been steadily declining over the last decade, the data hides the real problem - incidence of heart disease is actually on the rise and expected to reach alarming levels by 2060. Where are we going wrong?
Risk Factors Underlying Heart Disease (see reference)
Through scientific studies and research, we have been successful in identifying both the modifiable and non-modifiable risk factors behind cardiovascular disease (see graphic above). The INTER-HEART case-control study noted that 90% of first heart attack cases are due to modifiable risk factors. This is significant because these are the risk factors that are in our control, which means cardiovascular disease is largely preventable. The health care system also has many barriers in place (such as regular checkups, consultation, drugs etc.) to help us control the onset of chronic illnesses that can lead to cardiovascular disease.
Anatomy of a Heart Attack
The anatomy of a heart attack, therefore, looks a lot similar to that of a road accident. An unhealthy condition (such as hypertension or pre-diabetes) can be brought under control through lifestyle intervention. However, if left unchecked, it can progress into a chronic condition which, if undetected or untreated, can lead to a heart attack. There are, of course, emergency interventions such as stents and bypass surgery, but success of those depends largely on timely access to a quality health care facility.
Recognizing the Signs of Trouble
The key to prevention is to empower people to stay in control of their health through proper knowledge of the functioning of the human body, and the impact of food, nutrition, sleep and physical activity on their long term health. I realize that not everyone may find this topic to be terribly exciting. Most of the knowledge in this area that we have acquired is encapsulated in our family traditions and habits. At a minimum, we need to be prepared to recognize the signs of trouble when they manifest, and gain the knowledge about the right corrective action to regain our health. This requires us to seek advanced training on health and nutrition in-keeping with the latest scientific evidence, and to create the right social environment that would support us in adopting healthy habits.
Most of us don’t realize what we are missing until we hit the rumble strips for the first time in life. This could be something in your comprehensive metabolic panel, such as your LDL-C, that isn’t quite right. Your doctor may look at the numbers and ask you to modify your lifestyle (better diet, more exercise etc.) to get you back on track. The next time, you may hit the rumble strips due to your HbA1C or blood pressure. Your doctor may advise more physical activity and less refined carbs. A few years later your LDL-C may have crossed the threshold and you may be prescribed statins. You, my friend, have now crossed the rumble strips and are in the median! If you fail to get this situation under control, you could experience an adverse cardiac event and end up with a stent in your artery. Or, worse, you could experience bypass surgery or organ failure.
The Trap of Moderation
Six years ago, I was put on a continuous positive airway pressure (CPAP) machine for life. It is the most commonly prescribed device for treating sleep apnea, but it is debilitating even though the sleep quality improves significantly. I was a vegetarian for most of my adult life and by all means lived a life of moderation. Ah.. moderation - a topic for another blog! Doctors always told me I shouldn’t worry, which was reassuring, even though some of my markers were out of whack. I was a heavy snorer for most of my adult life, just like my dad, and didn’t think much of it. But the diagnosis of acute obstructive sleep apnea (OSA) was a wake up call for me. It just didn’t seem right that I should be expected to wear that contraption on my nose every night for the rest of my life, for no apparent fault of mine! I was a seasoned, well-trained driver, or so I thought, and yet my vehicle was out of control. I had failed to detect the early warning signs and take control of my health. I was also not warned that OSA together with my other markers (which, mind you, were mostly within acceptable ranges) might be indicative of metabolic distress.
In 2020, when the world receded into the living room due to the deadly COVID virus, I found time to evaluate my personal health trajectory. At this time, a few of my peers and classmates started experiencing cardiac issues and a couple of them unfortunately did not survive. My mom was someone who followed a very health-conscious lifestyle, and yet succumbed to a sudden heart attack at 68. In retrospect, she had hit the rumble strips a few times but we failed to recognize and act promptly back then. It took me another year to realize and then become convinced that I was headed towards a metabolic cliff, despite a moderate life-style. I became motivated to find out what I was doing wrong and why the health system was unable to help me avoid that cliff. I did not want to end up in the hospital with a heart attack at a young age. I was determined to understand what modifiable risk factors I had, and how I could manipulate them to reduce my risk.
How Do You Prevent Chronic Illnesses?
Prevention of diseases is obviously not a new topic. Far from it. But along the way, mostly in the last 60-70 years, the wheels of the collective health care machine have turned more towards screening, diagnosis and treatment. This approach is adequate only for acute illnesses, and this fueled the belief that we could somehow conquer chronic illnesses the same way - by developing therapeutic and pharmacologic cures and administering them after the emergence of symptoms or a diagnosis of the illness, much like what the airbag and seat belts in your car accomplish. The advancements made in screening, diagnosing and treating modern day chronic illnesses are necessary and they do save lives, although some have questioned whether the costs are worth it. They have definitely increased lifespan, but have they increased healthspan at all?
Further, treatments for atherosclerotic, metabolic, neurodegenerative diseases and cancer have mostly been developed independently - a mindset that is a carry over from the era of antibiotics and vaccines. Only recently, developments in network biology and systems biology have enabled a better understanding of the richness and complexity of the biological world inside us, leading to a holistic view of the underlying pathologies that drive disease over the long term. This, coupled with the research into the true impacts of epigenetics on gene regulation, a deeper appreciation of the important role of the 38 trillion bacteria that line our gut, and the understanding of the critical role of micronutrients in disease prevention has given rise to a whole new set of tools in the fight against chronic illnesses. However, a commitment to leverage these tools in a systematic manner to reduce the incidence of chronic illnesses is sorely missing in health care. Methods for early interventions, such as food and nutrition, are still in the experimental stages of clinical practice and therefore their implementation is left up to the individual. If you were to rely only on screening it would be like driving with your eyes closed and relying solely on active safety technologies warning you of impending trouble! It would be a dangerous ride.
During my own health journey, I found out that most of my training about how to live a long and healthy life was outdated. We have learnt so much in the last 20-30 years about how the body converts our food to energy, how toxins in the environment affect our health and how the complex biochemical systems in the body keep us healthy or can make us sick. But we are living according to old paradigms, are victims of our complex social conditioning regarding food, and are at the mercy of commercial interests in the food and pharma industry. More on these in a future blog!
Whether it is driving on the road or life, in the face of our changing environment and new discoveries, we need to learn new skills (for instance, watching for those blind-spots in the rear-view camera, connecting the different metabolic markers), update our knowledge of the systems that we depend upon (the human body, food, gut bacteria, the changing rules of the road) and, finally, take responsibility for our own health.
Key Takeaways:
Prevention is about paying attention to signs of distress as early as possible. Don’t ignore what your body is trying to tell you.
Understand the underlying causes of chronic illnesses - they are all connected.
The human body is remarkably resilient. It is never too late to start your journey of recovery.
Take responsibility for your health. No one else will. Ask questions, find trusted sources of information and keep learning. The good news is that we are living in an era where all the information you need is readily available.
About me
I am an engineer, problem solver, devoted husband, proud father, caring brother and loving doggy dad. Professionally, I have worked in the US automotive industry for more than three decades, a majority of which were in the development and testing of safety related technologies like anti-lock brakes and driver-assistance systems. After watching a lot of my friends and colleagues struggle with chronic illnesses, and some succumbing to them in the prime of their lives, and noticing my own health deteriorate for a while, I decided to apply my problem solving mindset to my own health. Surprisingly, I was able to find solutions that are simple, effective and long lasting. I am now passionate about continuing on this journey of learning how to prevent and reverse chronic illnesses. This blog is an attempt to share my learning with others who are curious, in a language that is simple. I invite you to follow along as I write about these topics, and to share your own experience.
A great read and analogy! Thanks for sharing.
Excellent article! I really like the analogy of a car accident and driving your car with your eyes closed. That´s exactly what most people do with their body by consuming unhealthy food. Looking forward to reading the next post ...