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Jay Neugeboren

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HDL and Sudden Death: The Heart Has Its Reasons

Posted: 05/28/2012 2:16 pm

The pairing of two lead articles in a recent "Health" section of The New York Times -- one reporting that those of us with higher levels of HDL (so-called 'good' cholesterol) have "no significant decrease in risk of cardiovascular disease," and the other reporting that a popular antibiotic, azithromycin may cause 'abnormal, potentially fatal, heart rhythms" -- constitute a sobering reminder that when it comes to disease (heart disease in this instance) what we do not know remains greater than what we do know.

When it comes to disease -- what causes it, how we know it's there, and what may ameliorate its often deadly designs on us -- mysteries abound. Thirteen years ago, at the age of 60 -- without any conventional symptoms or risk factors -- two of my three major coronary arteries turned out to be 100 percent shut down, and the third major artery, the LAD (Left Anterior Descending Artery, the so-called 'widow-maker') was more than 95 percent shut down -- and my life was saved by emergency quintuple bypass surgery. I had never smoked, I exercised regularly (swam a mile a day, played tennis and full-court basketball), had no family history of heart disease, and had normal blood pressure, and better-than-normal levels of cholesterol (both 'good' and 'bad').

I had, however, for two months prior to the surgery, been concerned about some shortness of breath I experienced, if intermittently, while swimming, and by an unfamiliar, sporadic pain -- more like a burning sensation -- in my back, between my shoulder blades. When my family doctor suggested I have a check-up with a cardiologist, the cardiologist performed an echo-cardiogram and diagnosed 'a viral cardiomyopathy.' But he saw no urgency in my situation.

At the same time, I had been talking regularly with a childhood friend, Richard Helfant, who was a cardiologist in Los Angeles, and had been Chief of Cardiology at Cedars-Sinai Hospital in Los Angeles. When I told him of the viral cardiomyopathy diagnosis, he shouted into the phone, "It's not viral, goddamnit -- I want you in the hospital as soon as possible."

He had made an accurate diagnosis from 3000 miles away because, as he later explained, he knew me, and thus could place my specific symptoms in the context of my full story. What the cardiologist who had misdiagnosed me had done was to pay more attention to tests and numbers and, thus, to forget that I had told him about the pain between my shoulder blades, which symptom -- referred pain from the heart -- was inconsistent with a diagnosis of viral cardiomyopathy.

A year later, when my friend and I had a happy reunion in California, and I was, again, expressing my thanks to him, he smiled. "Let's face it," he said, "you and I wouldn't be sitting here today if you hadn't gone to high school with the right guys."

And just this past week, I attended a memorial service for a mutual friend of ours -- I had known him since kindergarten, and the three of us had gone to high school together in Brooklyn -- who had had open heart surgery within the past year, but who, during his stay in the hospital, had contracted a deadly MRSA infection (methicillin-resistant staphylococcus aureus). When the infection spread and, over a period of months, did not respond to treatment, our friend underwent surgery again to replace an infected aortic valve and (the surgery less than successful) he never regained consciousness.

Surely, as our two stories indicate, the element of luck -- of good fortune or bad fortune -- plays a large, mysterious part in our destinies. But we want answers; we want to be able to defeat, or forestall, a definitive visit from the Angel of Death and often believe the source of doing so resides in data -- in those numbers that researchers, doctors, and pharmaceutical firms keep inundating us with. But as the news this week about 'good' cholesterol not being so 'good,' and the popular antibiotic azithromycin raising the risk of sudden death, confirm, it is best to take such ever-changing numbers, and the recommendations and diagnoses that flow from them, with a healthy dose of skepticism. "The heart has its reasons," as Blaise Pascal noted nearly four centuries ago, "of which reason knows nothing."

 
 
 
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