Michael Finley

"The Working Heart"

Reprinted from his "What Ails You?" columns for Twin Cities Business Monthly

© 2003 by Michael Finley

Heart disease can drop you like a baked potato
with bacon and cheese and extra sour cream.

Have your employers wished you a Happy Heart Day lately?

They should, if they like money. Companies have a lot invested in keeping you alive and ambulatory, so they can reap the dividends of your mind. But the road to the mind passes through the heart.

After all, one person in four suffers from some form of heart disease: high blood pressure, clogged arteries, angina, congestive heart failure, heart attacks or strokes. Heart disease kills 1 of every 2.4 people, often in their 40s and 50s, and often without any symptoms to tip them off to the threat.

More harrowingly, nearly all American workers in their 30s and older, unless they are lifelong vegetarian yogis, have some degree of arteriosclerosis.

Think of the lost productivity, the lost training, the lost expertise. When employees are falling like flies, it's not the outfit down the street that's your competition; it's the cemetery.

Heart disease should therefore be a line on your organization's balance sheet, alongside salaries, wages, and commissions, because it consumes financial resources the way stressed-out middle managers consume onion rings.

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You're In Charge

"When I see businesspeople in my practice at Mayo, I ask them, 'Does your business run itself?'" says Thomas Kottke, a cardiologist at the Mayo Clinic in Rochester and director of CardioVision 2020, a grassroots community cardiovascular health initiative in the Rochester area.

Your body's no different than your business, Kottke says. "Your business stays on track by utilizing controls like accounting and goal-setting. You need to do the same thing with yourself, keeping track of what you eat, how often you exercise, what you weigh every day."

"A big misconception that people in their prime have is that they won’t get [heart disease], or if they do get it, they will be rescued by surgery or drugs or angioplasty," says Russell Luepker, head epidemiologist and professor of public health at the University of Minnesota in Minneapolis. "What they don't know is that two-thirds of heart-related deaths in the Twin Cities occur outside hospitals. Half [of those who die] have no knowledge of having heart disease."

And everybody has it, just about. Autopsies on soldiers fallen in the field, young men barely into their 20s, confirm that arteriosclerosis, caused by cholesterol clogging the arteries leading to the heart, is ubiquitous.

Eat or Be Eaten

"The reason we're in such trouble is because we have bad habits from antiquity," says Kottke. "Deep in our brains we feel it's a good thing to sit and eat whatever is available, because for 100,000 years that was true. People didn’t have enough to eat, and had to exercise dawn to dusk to get food. We lived in fear of being eaten.

"Today it's completely reversed. Food [expense], as a fraction of income, has fallen from 40 percent in 1928 to 11 percent today. Food is practically free. But we pay to get exercise," Kottke observes. "The thing we should fear today isn't hunger, it's the food we enjoy—all those burgers, and fries, and chips. Our world is upside-down, and it's no wonder we've adapted poorly."

How can you tell if you’ve made the necessary transition? Excess weight makes the heart work harder. To take pressure off your heart, you need to lose some of that weight. Look down, Kottke says. If you are a guy and have an unobstructed view of your belt, you've adapted successfully to the abundance of food. Otherwise you are among the 30 percent of the adult population that is—prepare to wince—obese.

Losing weight is just one piece of the puzzle, though. To understand all the risk factors, a history lesson is in order.

A Brief History of the Heart

The heart is really a 20th century invention. Physicians knew hearts were important, and they had stethoscopes to eavesdrop on them. But it was not until the invention of the electrocardiograph machine (EKG) in 1902 that we were actually able to chart what the heart was doing.

The EKG changed everything, according to Bruce Fye, president of the American College of Cardiology, professor of medicine and the history of medicine at Mayo Clinic, and author of American Cardiology: The History of a Specialty and Its College. For the first time, the EKG gave doctors and researchers direct insight into the workings of the heart, its rhythms, palpitations, and quirks.

Then in 1929, German cardiologist Werner Forssmann inserted a narrow tube into his forearm and jimmied it all the way into his right auricle, where it squirted a load of tracer fluid. Forssmann then X-rayed himself, and beheld for the first time the flow of blood through the chambers of the heart. Heart catheterization became an invaluable tool in understanding the heretofore hidden organ.

The 1950s were a time of extraordinary advances in heart health, several occurring here in Minnesota.

During the midpoint of the twentieth century, improvements in cardiac care came fast and furious. The National Heart Institute was founded, to serve as a clearinghouse for new knowledge about the heart. Here in Minnesota, scientists began to get their first understanding of the importance of serum cholesterol. Also here in Minnesota, biomedical engineers like Earl Bakken of Medtronic created devices that could modulate heart rhythms (pacemaker) and others that could restart a heart that had crashed (defibrillator).

Coronary care units were created to provide care for heart patients. Thrombolitic agents were developed to bust up clots that cause heart attacks and strokes. Angioplasty and bypass surgeries improved the throughput of blood to the heart. People learned how to do cardio-pulmonary resuscitation and saved thousands on the spot.

How significant were these advances? One quick measure is the evolution of history of White House heart emergencies. Franklin Roosevelt died in 1945 because no treatment existed at that time for malignant hypertension. A decade later, the only treatment for Dwight Eisenhower's heart attack was five weeks of bedrest. In our own era, Dick Cheney has survived three heart attacks plus a quadruple bypass. People are talking about a second term, and beyond that, who knows?

Short-Term Risk Factors

Despite these technological advances, however, heart disease remains Killer One. Everyone with plural brain cells knows what the long-term risk factors of heart disease are—smoking, overeating, not exercising, high blood pressure, high cholesterol, diabetes. Overcoming any of these can be Herculean.

But there are short-term risk factors too, according to Luepker: letting stress get to us, blowing our tempers with our loved ones or the fellow in the next lane, coping with the challenge of doing the work of two people in the wake of downsizing. You wonder what Tim Pawlenty's arteries are like right now, or Tom Ridge's.

Truth is, controlling and monitoring ourselves, and employing basic good sense represents a far more powerful survival strategy than relying on surgery and fancy machines.

Cigarette smoking remains the biggest single risk factor for sudden cardiac death. Smokers carry two to four times the risk of nonsmokers. Also, smokers who have a heart attack are more likely to die -- and die immediately. If you haven’t quit smoking yet, right now would be a good time.

Even healthy habits can bring us down, however. Jogging is listed as a high-risk activity, as is having sexual intercourse. Not that we shouldn’t tackle these pastimes with vim and conviction. Just, be mindful that they ask a lot of the only heart we have.

Then there's diet. We know we have to rely more on water-based cuisines, involving more fruits and vegetables, and less on the fat-based cuisines, the meat and dairy and fried "comfort foods" that will be small comfort to your widowed spouse and kids.

Now many businesses are recognizing the value of encouraging healthier eating and getting lots of exercise. Becker Furniture, of Becker, Minnesota, replaced coffee pots and doughnuts with fresh-squeezed juice and fruits in break areas, and encourages workers to exercise when there's a lull in the workday. Employees work better and it shows up on the bottom line in another way, too: While other companies face 15 percent to 18 percent annual increases in health insurance premiums, Becker's went up only 2.1 percent in 2001.

What To Do

The hardest part in all this is to breach the wall of denial. We need to accept that we probably already have heart disease, even if we feel fine. Waiting for a warning is no good. "Too often," Luepker said, "the warning signal is waking up dead."

So we have to change. Think of it as an act of entrepreneurial far-sightedness, of seeing around the corner. "Sure, it's hard," says Kottke, "but life is hard. Sixty percent of the population has managed to lose 10 pounds or more, so it can be done.

"Look at me," he adds. "I love to eat, and I eat well. Yesterday, I had raspberries and bananas and OJ for breakfast. For lunch, I had a salad with sourdough buns, no butter. And I had a terrific supper at W. A. Frost: gravlax, mussels, and salad. Instead of cheesecake, I ordered espresso. Does that sound like I'm depriving myself?"

Of course, Kottke writes it all down—every meal, every mile on the exercise bike, every pound, every day. Boring? Possibly. But what if it buys you 20 years of healthy life?

"I've got a snappy ending for your story," Kottke says, printing the headline in the air with his hands:

When your retirement account is ready for you, will you be ready for it?

"Well," he says, "I liked it." 

 
Michael Finley