Medicine / Cardiology
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The young and healthy are not immune from heart disease.

April 14, 2007

Charles Vasey, MD



It is likely that the millions of twenty-something readers of NYJSM.com may consider themselves immune from heart disease. Sadly, with the possible exception of "The Vasey Show" himself, immortality eludes us all. There are however several cardiovascular conditions that may affect the younger generation (which to me is now almost all generations), some of them not even self-induced.

A leading cause of sudden death among those in their 20s and 30s surprisingly is not something they caught from (INSERT NAME of PROMISCUOUS CELEBRITY HERE), it's conventional atherosclerotic heart disease. Coronary artery disease has been reported to account for 24% of sudden deaths in individuals under the age of 30. Identifiable risk factors, including smoking, elevated cholesterol, hypertension, family history of sudden death and high blood sugar can markedly increase the risk of dying suddenly from a myocardial infarction. . Smoking not only costs thousands of dollars a year, but the development of coronary artery disease is virtually inevitable. It would seem to be common sense that giving up cigarettes and pursuing a blood pressure check and several simple screening blood tests, including a measure of cholesterol and blood sugar, would be wise. Sadly, wisdom seemingly evades the young and potentially threatening but reversible conditions may be unrecognized.

Surprising to many, the heart itself may become infected by bacteria, a condition called infective endocarditis. Of those who become infected, 20% will not survive. Among those at risk are individuals with congenital heart valve abnormalities, most commonly an aortic valve with two cusps rather than the usual three. One to two percent of the population are born with bicuspid aortic valves and are at risk for infection, particularly in the case of intravenous drug use. Gather your closest thousand friends around you (actually only "the Vase" has that many close friends); 10-20 are at risk for endocarditis. The presence of a bicuspid valve can generally be detected by a physician listening to the heart (cheap) or by an ultrasound of the heart (expensive), also called an echocardiogram. A screening exam by a physician should suffice.

Cardiovascular risk is not exclusive to intravenous drug use. While cocaine may not be as ubiquitous as it was during my Studio 54 days (I never really had Studio 54 days- they were nights as best as I can recall, admittedly sometimes leading directly into days), it has not I suspect totally disappeared from the recreational drug menu. It remains in fact the second most commonly used illicit drug, after marijuana. Among males between the ages of 18 and 45, as many as 25% of heart attacks are the result of cocaine use. In the first hour after cocaine exposure, an individuals risk of suffering myocardial infarction increases 24 fold (that's a lot). It would appear to be wise to avoid cocaine whenever possible.

In summary, no one can safely ignore the threat of cardiovascular illness. I would suggest that the billions of readers of "TheVaseyShow.com" (an exponential increase in the number of hits anticipated after this is posted)
1. have your blood pressure checked
2. have your blood sugar and cholesterol screened
3. find a sympathetic health care professional/ student to listen to your heart (perhaps TheVaseyShow.com, himself)
4. avoid cocaine and intravenous drug use and if at all possible,
5. stop smoking.
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