Another heart attack

Quoted post said:

Originally posted by Spider1977
From Procycling news (5 Jan 04)

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Former Motorola, ADR and Tulip sprinter Michel Zanoli died of a heart attack in his home country of Holland on December 29. The Dutchman, who retired from the pro peloton in 1997, was just 35.

Zanoli first came to prominence in 1986 when he won the world junior road championship. He turned pro with ADR in 1989, moved on to Coors Light the following season and took the biggest win of his career in 1991 with a Vuelta stage victory for Tulip. He won the USPRO Championship that same year, before spending one season with Motorola in 1992.
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Starting to lose count of the number of road cyclists who have had heart attacks recently. If these are drug induced (I'm not saying this one was) - is a modest professional cycling career really worth it? Or is there a physiological reason that some road cyclists can acquire through training and racing work?

If he retired in 1997, this means it has been 6 years and a few months since the season ended. Perhaps a better question is what was he doing during that 6 year time he had off. Did he gain a lot of weight? Did he take up smoking? Drinking? Did he fail to exercise? Each of these is a big risk factor for a heart attack, except failing to exercise which by itself is probably low or moderate risk. I suspect that many pro riders who quit training after they retire gain weight very quickly due to their enormous appetites and a severe decline in activity.

I'm with you on this question. I want to know the whole truth about his and all the other riders' early deaths. As you suggest, maybe there is some kind of weakening of the heart from all the riding. Maybe there is a way to prevent this from happening to other riders when they retire.

I guess years of road racing are just too hard on the body? (well of course there is more detail to it than that, but what is it exactly?)
I would really be interested in documented info about this.

From cyclingnews.com

Hennie Kuiper remembers Zanoli

The death of ex-Dutch professional Michel Zanoli was a sadly premature end for a man who was just 35 years old. Zanoli died on December 29 of heart failure, and was cremated last Saturday, January 3. Zanoli's former Motorola team director Hennie Kuiper remembered him in an interview with Dutch newspaper De Telegraaf.

"Michel was a guy who was always looking and fighting for recognition. In one way or another, he always had difficulty staying in line. He could not completely live for the sport. As a rider I'd say that he had qualities. I remember a Vuelta España where he was pretty much unbeatable. Unfortunately we had to make him leave Motorola in an unpleasant manner. In front of the cameras, Michel hit Phinney, who was an institution in American cycling. Jim Ochowicz couldn't do anything then but sack Zanoli. I'm afraid that since he stopped he often had problems."
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I wonder what was meant by that - "since he stopped he often had problems." Does this suggest something contributed to his heart attack? It's sad that some elite sportsman have no "life" after retirement - perhaps there should be programs in place to allow these people to have a sense of worth after they retire from competition at the highest level.

This is happening for AFL footballers in Australia.

Dagnabit, I just read somewhere that pro riders need to remain active after retirement in order to prevent things like this from happening.

The story read that their hearts (like any other muscle that is used excessively) grow larger and become accoustomed to being used. When the racing stops, the heart still wants to pump excess blood, but if it's not being tested, then there's a good chance for trouble.

I'll look for the article tonight and post what I find.

Well, it doesn't make sense to me that the heart would have problems after such a career simply because it is used to being exercised. If the exercise is dicontinued, I would think the heart would shrink back down a bit just like your quads do after not riding for a while, and still pump normally. I mean, it is a muscle like any other, and I don't ever recall hearing about bodybuilders losing the ability to move simply because they are no longer lifting. I would imagine that the heart attacks (if not just a genetic defect) are a result of pushing so hard for so many years, that a chronic problem is developed, and then a few years down the road...boom. Either that, or an ex-pro decides to get back on the bike after 6 years of not riding and thinks he can still climb that 1000 ft hill at 190 bpm like he used to...and then has a heart attack. Of course, I am no cardiologist. Do we have a doctor in the house? Wait, what am I thinking...doctors don't have time to ride a bike.

Quoted post said:

Originally posted by memphiscyclist
Well, it doesn't make sense to me that the heart would have problems after such a career simply because it is used to being exercised. If the exercise is dicontinued, I would think the heart would shrink back down a bit just like your quads do after not riding for a while, and still pump normally. I mean, it is a muscle like any other, and I don't ever recall hearing about bodybuilders losing the ability to move simply because they are no longer lifting. I would imagine that the heart attacks (if not just a genetic defect) are a result of pushing so hard for so many years, that a chronic problem is developed, and then a few years down the road...boom. Either that, or an ex-pro decides to get back on the bike after 6 years of not riding and thinks he can still climb that 1000 ft hill at 190 bpm like he used to...and then has a heart attack. Of course, I am no cardiologist. Do we have a doctor in the house? Wait, what am I thinking...doctors don't have time to ride a bike.

Yeah! We can say a lot of things that make sense and seem logical, but we really need to have more data to evaluate what is happening here. I would like to see a comparison of heart attack deaths in ex cyclists compared with the general population to see if there is any greater risk of such an event for a retired cyclist than for a member of the general public. Who knows, maybe the heart attack rate in ex cyclists is significantly lower than in the general population, and we simply hear it louder when one of them dies. Most of the time, when someone who is not a celebrity dies of a heart attack at a young age, all you see is the obituary, and it usually doesn't say how they died. It might say where to send donations, but the cause of death is usually left out. The fact that we are not being told about it doesn't mean it isn't happening just as much or more in the general population. I have a feeling it will be a higher risk in the general population, upon reflecting on the distortion in the media based on celebrity status. I hope someone doubts me and brings some solid evidence proving me wrong. This might lead to saving a few retired riders' lives.

http://www.procycling.com/news_main.asp?newsId=4843

Go to this link to read about 10 heart attacks in cyclists in the last 6 months ranging in ages from 16 to 35 years. The magazine is looking for feedback from us about our thoughts on the matter.

I think there is something a bit fishy. Sure some people are probably prone to heart attack and the extra workload due to cycling may predispose them to problems. But I am not aware of such a high number of these problems in other similar sports such as triathlon, rowing, swimming, running etc. especially at the elite level.

Quoted post said:

Originally posted by Spider1977
http://www.procycling.com/news_main.asp?newsId=4843

Go to this link to read about 10 heart attacks in cyclists in the last 6 months ranging in ages from 16 to 35 years. The magazine is looking for feedback from us about our thoughts on the matter.

I think there is something a bit fishy. Sure some people are probably prone to heart attack and the extra workload due to cycling may predispose them to problems. But I am not aware of such a high number of these problems in other similar sports such as triathlon, rowing, swimming, running etc. especially at the elite level.

I looked at that site, and I count 6 people they list as having died within the last 12 months. One of those is a rider who is a 16 year old amateur. To compare these figures with others or the general population, you need to know how big is the size of the group we are looking at. Clearly, this reporter is not looking only at the pros. He is looking at the amateurs as well. The size of this entire group is probably well over a million riders. Although it is unfortunate that these deaths have occurred, I still am not so sure that this is so unusual.

Reporters often play to our fears and try to get a reaction out of us. I felt the same way when I started reading these accounts. Now I'm not so sure that one reporter after another is just jumping on a publicity bandwagon. I would like to know more facts and hear comments from cardiologists and sports physicians on this matter.

It's not unheard of for young people to have heart failure. I know of one guy who was in my high school class who later, while a 19 year old collegian, caught an intramural football pass. He caught it with arms outstretched and in a diving motion. He hit the ground after he caught it, and never got up. He was dead of heart failure. He had no prior history of heart trouble, and didn't take drugs. He didn't even drink, and he was an athlete--a good one.

I work as an actuary and I can tell you that the empirical
indicies show that within the male population of 1st world countries, between the ages 20-35 years, the statistical chance of
coronary/cardiac death is 1/5000 per annum.
(see my post about Professional Cyclists dying young).
As a cyclist myself, I feel that the verdict 'natural causes' for cardiac/coronary death in seemingly fit, young men, is not valid.
Taking the general probability in the adult population (1/5000),
it is inconceivable that the rate of deaths within our sport can be
systematically attributed to 'natural causes'
Given the rate of medical checks for professional cyclists, no doctor would allow a cyclist to participate if he/she had cardiac
irregularities.
Therefore, it is safe to assume that those who have/are competing in our sport have/had healthy hearts/blood pressure
while they were competing.
It is likely that perhaps some deaths can be attributable to 'natural causes'.
However I humbly submit that, given the rate of increase in cardio-failure within the professional ranks, these deaths could not have resulted from solely natural causes.

Quoted post said:

Originally posted by limerickman
I work as an actuary and I can tell you that the empirical
indicies show that within the male population of 1st world countries, between the ages 20-35 years, the statistical chance of
coronary/cardiac death is 1/5000 per annum.
(see my post about Professional Cyclists dying young).
As a cyclist myself, I feel that the verdict 'natural causes' for cardiac/coronary death in seemingly fit, young men, is not valid.
Taking the general probability in the adult population (1/5000),
it is inconceivable that the rate of deaths within our sport can be
systematically attributed to 'natural causes'
Given the rate of medical checks for professional cyclists, no doctor would allow a cyclist to participate if he/she had cardiac
irregularities.
Therefore, it is safe to assume that those who have/are competing in our sport have/had healthy hearts/blood pressure
while they were competing.
It is likely that perhaps some deaths can be attributable to 'natural causes'.
However I humbly submit that, given the rate of increase in cardio-failure within the professional ranks, these deaths could not have resulted from solely natural causes.

But this seems to support the idea that the number of riders who are dying may be consistent with general actuarial estimates. Wouldn't you agree that there are more than 1 million amateur and pro cyclists in the world? I don't know this for sure; it's just a guess. If there are, this would mean that the number dying of cardiac arrest should be 200 a year (1 mill/5000) in the 20-35 year group. The fact that it is much lower than that (6) for cyclists seems to be an indication that these riders are far less prone to heart attack than the general population. Not all these deaths are of current riders. They are including riders who are no longer competing in these news reports. What I'm saying is that reporters are thrusting information at us to get on the bandwagon and create the appearance of something wrong. This sells newspapers and generates controversy, but perhaps there really isn't anything wrong.

Gtlmn,
The points that you make are vaild of course.
But like another person on this thread said, unless we know the facts, it is really hard to evaluate what caused the recent deaths
in our sport.
My gut feeling is that there is some drug abuse in our sport - nwo whether that can be attributed to the deaths of cyclist, I cannot
definitively say.
I do think that it is suspicious that fit men are dying at a young age.
The rate of death in cycling (from heat failure) is far higher than say other endurance sports.
This is what is bothering me - rowing,skiing, marathon running -
doesn't have the same high incidence of heart failure as cycling does.
I don't want to be derogayory to those who have died, but I think that there is something wrong and whatever it is, is
causing fit men to die prematurely.

Quoted post said:

Originally posted by limerickman
Gtlmn,
The points that you make are vaild of course.
But like another person on this thread said, unless we know the facts, it is really hard to evaluate what caused the recent deaths
in our sport.
My gut feeling is that there is some drug abuse in our sport - nwo whether that can be attributed to the deaths of cyclist, I cannot
definitively say.
I do think that it is suspicious that fit men are dying at a young age.
The rate of death in cycling (from heat failure) is far higher than say other endurance sports.
This is what is bothering me - rowing,skiing, marathon running -
doesn't have the same high incidence of heart failure as cycling does.
I don't want to be derogayory to those who have died, but I think that there is something wrong and whatever it is, is
causing fit men to die prematurely.

It was I who said he wants to know all the facts🙂 . It's true, I do, but I don't find these deaths quite as alarming as I did when I first read this thread. Considering the figures you have cited, I am further relieved. We get alarmed because these are our heroes out there who are dying, but they aren't dying as fast as the rest of the population. If drug use that is a contributing factor, this is actually further relief for me because they know they aren't supposed to be doing that, and that would indicate that it's not the riding that is doing it; it's something else. On the contrary, riding without drugs may improve your odds against heart attack.

Gntlmn,
I think that you've missed my point.
Cyclists are dying - and we're told that it's from natural causes.
Cyclists shouldn't be dying from heart failure from naytural causes - that's my point !

Let's just revisit the 1/5000 number in the general male population mortality rate from heart failure between ages 20-35.
This statistic is based upon medical records for deaths in the age group,20-35.
The contributory factors to the 1/5000 value are in this order
(1) smoking (cigarettes, cigars, recreational drugs)
(2) Obesity
(3) Genetic/hereditary disposition to heart failure
By far points 1&2 above, on a weighted percentage basis, account
for 80% of the value 1/5000.
Point 3 above accounts for the other 20% of the value 1/5000.
So, smoking and obseity are the reasons why 1/5000 men in the general population die of heart failure between the ages 20-35.

I think that you will agree with me that cyclists, by and large, are neither smokers or obese.
This leaves genetic disposition to heart failure.
I think that it would be stretching credibility to suggest that within
the professional ranks two cyclists (ex-cyclists) would die within
4 weeks of each other because both of them were predisposed to
heart failure (I refer to the passing of Jimenez and Zanoli R.I.P).
Statistically, the likelihood of both of these deaths being due to predisposed heart failure is remote at very best.

The point underlying all of this is that fit people don't die of heart failure between 20-35.
If they do die it is because they were either obese and/or smoking, which causes death by heart failure.
I don't know why cyclists are dying.
What I can tell you is that the rate of deaths in our sport is higher
than the general population and that two of the reasons applicable to deaths of heart failure in the general population
(obesity and smoking) do not (should not) apply to our sport.
Thus, either there are a high number of cyclists with genetic/
hereditary disposition to heart failure, or there is something else
causing heart failure.

Quoted post said:

Originally posted by limerickman
Gntlmn,
I think that you've missed my point.
Cyclists are dying - and we're told that it's from natural causes.
Cyclists shouldn't be dying from heart failure from naytural causes - that's my point !

Let's just revisit the 1/5000 number in the general male population mortality rate from heart failure between ages 20-35.
This statistic is based upon medical records for deaths in the age group,20-35.
The contributory factors to the 1/5000 value are in this order
(1) smoking (cigarettes, cigars, recreational drugs)
(2) Obesity
(3) Genetic/hereditary disposition to heart failure
By far points 1&2 above, on a weighted percentage basis, account
for 80% of the value 1/5000.
Point 3 above accounts for the other 20% of the value 1/5000.
So, smoking and obseity are the reasons why 1/5000 men in the general population die of heart failure between the ages 20-35.

I think that you will agree with me that cyclists, by and large, are neither smokers or obese.
This leaves genetic disposition to heart failure.
I think that it would be stretching credibility to suggest that within
the professional ranks two cyclists (ex-cyclists) would die within
4 weeks of each other because both of them were predisposed to
heart failure (I refer to the passing of Jimenez and Zanoli R.I.P).
Statistically, the likelihood of both of these deaths being due to predisposed heart failure is remote at very best.

The point underlying all of this is that fit people don't die of heart failure between 20-35.
If they do die it is because they were either obese and/or smoking, which causes death by heart failure.
I don't know why cyclists are dying.
What I can tell you is that the rate of deaths in our sport is higher
than the general population and that two of the reasons applicable to deaths of heart failure in the general population
(obesity and smoking) do not (should not) apply to our sport.
Thus, either there are a high number of cyclists with genetic/
hereditary disposition to heart failure, or there is something else
causing heart failure.

You make some good points, and I'm glad you're posting them here. They are very relevant.

Surely there must be a figure for general population death rate for non obese and nonsmoking general public. Is it 1/100,000? If it is, then you might expect 10 deaths among pro and amateur riders in a year. And yet we see far fewer than that.

These are not all current riders either. Bike racers who retire, and who are included as "riders" in these news reports, often put on an enormous amount of weight in a very short period of time. This is a high risk event. It's not only your weight that is a risk factor for heart attacks, but how quickly you have gained it. That's the double whammy some of these retired cyclists are exposed to. So I wouldn't necessarily agree that the riders are not obese; they may not be technically obese, but the rate of weight gain, if excessive, may cause problems that obesity might cause. These would be the retired riders who appear in these news reports.

To look at this as a sample of athletes who are currently riding, we would need to eliminate the retired riders, like Jimenez, whose condition and habits are unkown, from the group and see how many we have left. And then we can compare this to the general population rate of heart failure of slim people with no bad habits. The general figure will be a smaller percentage than 1/5000, but it won't be zero. Then we can compare them. I'm still not convinced.

The point I made earlier seems pertinent here. I have not heard of any premature deaths in other sports of a similar nature such as rowing, triathlon, marathon etc. However, this could be because these sports are not as high profile and any deaths don't get reported.

However, there have been cases in athletics. The death of Flo Jo led to a lot of speculation, but I don't think anything was ever proven. Also, I think there have been "premature" deaths amongst weightlifters etc.

In my view, I think that professional cycling, in particular, has been tainted by drugs. I don't think enough has been done to clean up the sport, which is a pity. It is a sport I love, and I trully admire the professional cyclists.

However, I think UCI and other governing bodies have to get really tough on drug use. Otherwise the innocent will be tainted with the same brush as their cheating brethren. Coaches and team managers should be suspended along with riders if a rider is found to be taking performance enhancing drugs. In fact they should be booted out of the sport all together.

Quoted post said:

Originally posted by Spider1977
The point I made earlier seems pertinent here. I have not heard of any premature deaths in other sports of a similar nature such as rowing, triathlon, marathon etc. However, this could be because these sports are not as high profile and any deaths don't get reported.

However, there have been cases in athletics. The death of Flo Jo led to a lot of speculation, but I don't think anything was ever proven. Also, I think there have been "premature" deaths amongst weightlifters etc.

In my view, I think that professional cycling, in particular, has been tainted by drugs. I don't think enough has been done to clean up the sport, which is a pity. It is a sport I love, and I trully admire the professional cyclists.

However, I think UCI and other governing bodies have to get really tough on drug use. Otherwise the innocent will be tainted with the same brush as their cheating brethren. Coaches and team managers should be suspended along with riders if a rider is found to be taking performance enhancing drugs. In fact they should be booted out of the sport all together.

I have heard of premature deaths in other sports. Consider for example, Jim Fixx, who was considered kind of the father of the running craze in America. He died on a training run (I think it was training and not a race) of a massive heart attack, and the doctors said after the autopsy that he should never have been running in the first place. He had congenital heart disease. I can think of others as well, but it seems that drug use with the others, not Fixx, comes to mind--particularly cocaine. Cocaine use has often led to sudden heart failure with athletes.

It's tough to sort out with these reports we hear what is drug related and what is mortality from other causes. All we get most of the time is the fact that they died, they used to cycle, and they are still young. Some are even current cyclists. We need more information, but it seems no one is really motivated to give it. The families, if they know of or suspect drug use, most of the time, I suspect, will not mention it. It would serve the general public much more if they did.

I think you're right about UCI needing to continue to get tougher on drug abuse. I don't know if they have a random drug testing program in place, but I know it works well in the job I do, which is local. All active workers are subjected to random drug testing. This can happen anytime. When you get a telephone call, you have to report to the testing center within I think it's 2 hours (I always go right away) of the call. If you don't, you lose your job for 6 months, even if you're clean. This would be a bit tougher to institute with professional athletes given their travelling all the time. I bet it wouldn't be impossible though. I think it would clean up the sport much more. Then the testing wouldn't be limited to races. It would be an enormous deterrent, if it isn't being done yet; I don't think it is.

Drug use cheats others in a lot of ways. Consider also the actuarial's input above. If an actuarial can show that professional cyclists have a higher death rate (for whatever reason), the insurance company can charge more for health insurance and life insurance. If you're clean, you pay for the increased risk the drug abusers place on the sport. It comes out of your pocket for insurance and also at the finish line.

gntlmn, you are forgetting that the statistic that he brought up was based over a 15 year period, not 1.

Multiply the amount of deaths of heart failure among pros this year by 15.