In November 2022, AMA member Steven Lome, DO, ran a half marathon in Monterey, California. While he has always felt honored to work as a cardiologist and use his training to help others, he never thought those skills would come to use during a half marathon. But they did.
At mile three, a runner collapsed in front of him—cardiac arrest. Dr. Lome started CPR and runners around him called 911. An automated external defibrillator (AED) arrived in about six minutes and the rhythm was ventricular fibrillation, a fatal arrhythmia unless a person gets defibrillated quickly. One shock and the runner’s normal heart rhythm was restored. He had a coronary artery blockage, which ended up being fixed.
After the patient was in an ambulance with paramedics, a somewhat frazzled Dr. Lome kept running to finish the race. As Dr. Lome crossed the finish line, he threw his hands in the air to celebrate only to witness another runner collapse in front of him. The runner had no pulse. Dr. Lome started CPR again and within one to two minutes, a race volunteer brought an AED. It was another fatal arrhythmia.
“Both runners had no prior history of heart disease, but they both did have a family history of heart disease,” Dr. Lome said, noting that “neither of them had seen a cardiologist or been tested in the past, so it was new and quite crazy that it happened twice in one race and right in front of me both times.”
Since the half marathon, both runners have already agreed to run again next year with Dr. Lome who was reunited with them on NBC's “Today” show.
In an interview with the AMA, Dr. Lome discussed his experience, what to keep in mind to be a healthy runner and how to prevent cardiac arrest or a heart attack.
AMA: Is this something you can be aware of going into a race?
Dr. Lome: Certainly, there are some warning signs. If somebody was feeling more short of breath than they should or had abnormal chest pain symptoms, those are always symptoms that somebody should get evaluated by their physician, especially prior to doing something like a half marathon or a marathon. But honestly, there are frequently no symptoms.
They say the first symptom of heart disease in about one out of three patients is sudden cardiac arrest, which is what happened to these two individuals. Retrospectively talking to them, neither of them had any major symptoms. One of them had some minor sharp shooting chest pains, but not anything that was legitimately, potentially heart-related symptoms. So, they didn't have any warning signs.
What somebody needs to be aware of if they feel good, they have no symptoms, but they have risk factors for heart disease—say a strong family history, diabetes, a previous smoking history, high blood pressure—then certainly before doing something as strenuous as a half marathon, the person should discuss it with their physician and ask if there are any other precautions to take such as should they do an EKG before the race or a treadmill stress test to make sure that the heart is OK to do something like a half marathon or marathon.
It’s about being aware of symptoms and discussing with the physician if you have risk factors for heart disease. But, honestly, a healthy person with no risk factors at all, usually we don't recommend any type of specific screening prior to an event like this. Everybody should see their doctor yearly to make sure their blood pressure is checked, know their cholesterol numbers and have a mindset of prevention for heart health because of course, a situation like this, a lot of people rightfully so are giving big time credit to knowing CPR and the quick action of defibrillators and advocating that the whole public learn CPR and how to use defibrillators.
However, even more powerful than learning CPR and how to use a defibrillator is preventing cardiac arrest from happening in the first place. So, everybody trying to have a good mindset to take control of their own health and focus on healthy habits that can prevent them from even being at risk of a cardiac arrest or a heart attack or coronary blockage in the first place is super important.
AMA: What are some steps that people can take for heart disease prevention?
Dr. Lome: It's all based on guidelines. As a cardiologist, the guidelines I tend to follow are the American Heart Association and the American College of Cardiology. Exercise is important despite this being two runners having cardiac arrest during an event. Exercise is good for your heart if you do it the right way.
Unfortunately, on some of the social media posts there are comments from people saying: Well, this is why I don't exercise. No, that's not the right mindset. The exercise component to heart health is maybe about 20% of being healthy. Eating healthy is about 80% of heart health. And of course, some of the other obvious things like don't smoke cigarettes.
But in regards to the exercise, the formal recommendation in the American Heart Association guidelines for the primary prevention of cardiovascular disease is to get 30 to 60 minutes a day, five days out of the week of moderate intensity aerobic exercise. And if you’re really busy and don’t have that much time, you are allowed to cut the time in half and make it vigorous intensity exercise. So, 15 to 30 minutes a day, five days out of the week of vigorous intensity aerobic exercise.
They go on to say that adding two days of resistance strength training also has heart disease prevention benefits as well. So, that's the exercise component. But again, that's 20%. The guidelines say diet is the most important part. And the way that they word it is they recommend a plant-based diet or a pro-vegetarian Mediterranean-style diet. So Mediterranean style, but less meat. Not completely vegetarian, but maybe only two to four servings of meat per week.
That was based on a big clinical trial where they studied the Mediterranean diet and it prevented stroke when people followed a Mediterranean style diet, but did not prevent heart disease, except in the cohort of patients who were either complete vegetarian or near vegetarian. Then there was heart disease reduction with the Mediterranean diet.
AMA: What are the keys to exercising that patients should keep in mind?
Dr. Lome: No. 1, you have to really ease yourself in slowly. The common thing that happens is everybody signs up for the gym Jan. 1. They go too hard, they do too much, they mentally burn out, they physically burn out and can get injured. It’s so important to ease yourself in, take it slow, and do not increase the amount that you do by any more than 10% per week.
Regarding running, if you start running a mile a day, five days out of the week, the next week, only do 1.1 miles a day. Don’t go to two right away, that’s too fast. And then the next week, 1.2, 1.3, slowly work your way up. It’ll only take a couple of months and then you’ll be doing a lot more and it’ll give your body time to train, to adapt, to prevent injury. And it also helps to prevent mental burnout as well.
And the No. 2 super important thing that I tell patients is you must choose a type of exercise that you love because if you don’t enjoy it and you don’t love it, you’re not going to do it for very long. Willpower only gets you so far. So, join a group—a running group, a walking group or whatever—listen to music, make this your excuse to watch Netflix while you’re riding a Peloton bike.
Whatever it is, just make sure you love the exercise that you do because exercising for one month isn’t going to give you much heart health benefit.
AMA: Is it also important to eliminate processed foods and ultraprocessed foods?
Dr. Lome: Absolutely. I should rephrase that statement to a whole food, plant-based diet, meaning unprocessed, plant-based, because people think of beyond burgers and impossible nuggets and those types of things. But those are considered to be ultraprocessed, not what the guidelines are referring to. So, the proper terminology is whole food, plant-based diet.
The way I always explain nutrition to my patients is I say food comes in three categories. Category No. 1 is processed foods. No. 2 is animal-based foods. No. 3 is unprocessed, plant-based foods. And the rules to healthy eating are eliminating processed foods. We don’t say reduce. We say eliminate. It’s kind of like when somebody is smoking cigarettes. We don’t say smoke fewer cigarettes. We say don’t smoke any cigarettes. You don’t need to smoke cigarettes to live. Any amount is bad for you.
It's the same thing with processed foods—you don’t need either to live. Any amount is bad for you. They’re very addictive, just like cigarettes, and should be eliminated. That’s where a lot of Americans have misconceptions. They say everything in moderation, right? Well, no. Things that are bad for you should be zero, which includes processed foods.
The only exception to that is technically oils of any kind. They’re considered processed. Olive oil and maybe canola oil are healthier types of oils or lower in saturated fats and have a lot of research to say that they are the healthiest types of fats to use. When you need cooking oil or you want to flavor something up, use olive oil because it is the better type of processed food to use.
So, rule No. 1 is to eliminate processed foods. Rule No. 2 with animal foods is to reduce it down to 10% or even less of the calories you eat. And whatever animal based food you eat, keep it low in fat, so avoid red meats and processed meats, which are very high in fat. Any dairy products should be low fat too. Then rule No. 3 is dramatically increase the unprocessed plant-based foods.
AMA: What else is important to know?
Dr. Lome: The most important thing is prevention. It's great to learn CPR and how to use defibrillators—everybody should do that. But we shouldn't lose focus. Heart disease is predominantly preventable—probably around 90% preventable through proper lifestyle—and so running is good for you.
Eating as plant based as possible is also important and spreading the message. In my career, this is one of the biggest things I've always done, which was trying to advocate for a healthy lifestyle. I have a nonprofit organization—pbnm.org—where we have thousands of members and are getting people to eat healthier.
People are getting sicker and developing more problems or using more medicines and surgeries when really the solution is not finding more pills or developing more surgeries. It's in prevention and keeping people healthy.
