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STUDENT DISPLAYS CASE STUDY ON 70.3 TRIATHLON RELATED FATALITIES AT BOSTON CONFERENCE OF SCIENCE
Majority heart related and in the swim
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the aorta does not and should not dilate
on this thing. in my imagination i could imagine an athlete like dave scott bored and ported, like a late 60s big block. that it either dilates through training or, if thatās not a thing, that it just starts 4.5cm or 5cm and thatās part of why certain athletes are just good.
that would be pretty easy to test. of course i take your word as gospel on this. but has this been tested? as in, have really good athletes, from say middle distance runners up, or cyclists or swimmers, had their aortas measured? either as an absolute measure or a width as a function of height?
Are you onto a hypothesis of sorts?
Didnāt Normann Stadler also having a descending Aortic aneurysm ?
Caused by racing at that level or is it a pre selection of physiological attribute that makes these humans good at the limit this sport.puts them thru?
Iāve hesitated to jump in on this discussion since Iām still pretty traumatized butā¦ Eight months ago (Oct 2023) I lost my 67 year old husband to an ascending aortic dissection that happened while we were riding bikes in Mammoth Lakes, CA. Actually, we were riding road e-bikes because Iād lost a kidney 10 months prior and we decided it was time to back off. He was a long time Masters cyclist who focused on time trials and was at one point 3rd at Masters Nationals in the competitive 50+ age group. Was it the 40+ years of high level endurance training? I donāt know. Heād had a stress echo three months prior (July 2023), where it was discovered he had a bicuspid aorta valve and a very slight dilation of 4.08. Apparently the dissection was not aneurysmal in nature. There were no warning signs - we set out on what was going to be a 30 mile ride that he decided halfway through he wanted to extend to 40. He was a little whiny about pain 
so Iām sure he would have said something if thereād been any chest/back pain leading up to this.
Is there a lesson for endurance athletes in this? I donāt know. I donāt know what we could have done differently, other than not being in Mammoth when it happened. My understanding is that 60% of dissections fall below the 5.5 surgery criteria. I trust his cardiologist (Monty, if youāre reading, it was the cardiologist at LA Cardiology whom Dr. Cannom referred me to when he retired), who was shocked and went back to review the stress echo but didnāt see anything he or we could have done differently; I really donāt think he was saying that just to cover his ass. What I can say is that I wouldnāt wish the pain my husband went through then and the pain Iām going through now on my worst enemy - we were together for 35 years and very happily married for almost 32. I didnāt see this coming. I would just encourage people to be cautious and proactive. It may not have changed anything for us, but maybe it will for someone else.
(sorry, way too long already, I know) I was looking at some of the work of Dr. Lars Svennson at Cleveland Clinic and did see this, but donāt really know what to make of it. It looks like just incidental/anecdotal findings at this point. From this podcast in 2021:
Lars Svensson, MD, PhD:
āI have seen it with golf, rare, but it can happen if itās enlarged aorta. Swinging a baseball bat, chopping wood with an ax. Now, thatās not a sport necessarily, but itās exercise. Interesting in the literature, thereās actually quite a lot of patients who have dissected with cycling. I donāt have a good explanation for that. Swimming, particularly crawl or freestyle, as itās called, seems to occasionally and Iāve seen patients dissect with that. Basketball is another group of patients that weāve obviously also even seen that related to players on the field. Rowing machines seem to have some risk. That has been documented also. And so those are some of these sports that we know of, that there is some risk of aortic dissection.ā
That is the worst possible outcome I am so sorry it happened to your husband. I canāt think of anything useful to say but thank you for sharing the story.
Iāve hesitated to jump in on this discussion since Iām still pretty traumatized butā¦ Eight months ago (Oct 2023) I lost my 67 year old husband to an ascending aortic dissection that happened while we were riding bikes in Mammoth Lakes, CA. "
truly, truly terribly sorry for your lossā¦
some things in life are unpredictable and sometimes very bad things happen despite doing all the right thingsā¦and yet, those words and thoughts do not help offset the lossā¦Iām glad you had 35 years togetherā¦cautious and proactive are good pieces of advice
condolences to you-
Thank you for sharing your expertise with us. We appreciate it!
GOOD LUCK to Dave with his Surgery & recovery!!! I hope he can discover some of the root cause possibilities of these heart/vascular problemsā¦why does Dave have these problems but Lou Hollander & Hiromo Inada (both in their 90ās) do notā¦or at least did not in their 70ās??? Genetics??? Environment??? Environmental factors include: training, stress, sleep, diet & nutrition. Genetic factors include mesenchymal genetic abnormalities (aneurysm tendencies, possibly dilatation at valves tendencies which can cause regurgitation). Combination factors include genetics exacerbated by environment (excess stressā¦mental & physical, diet, etc.). Again to emphasize, why Dave & not Lou and/or Hiromo??? I am not sure we yet have the ability to answer this yet.
Apparently in early June. Wishing this legend a speedy recovery!
GOOD LUCK to Dave with his Surgery & recovery!!! I hope he can discover some of the root cause possibilities of these heart/vascular problemsā¦why does Dave have these problems but Lou Hollander & Hiromo Inada (both in their 90ās) do notā¦or at least did not in their 70ās??? Genetics??? Environment??? Environmental factors include: training, stress, sleep, diet & nutrition. Genetic factors include mesenchymal genetic abnormalities (aneurysm tendencies, possibly dilatation at valves tendencies which can cause regurgitation). Combination factors include genetics exacerbated by environment (excess stressā¦mental & physical, diet, etc.). Again to emphasize, why Dave & not Lou and/or Hiromo??? I am not sure we yet have the ability to answer this yet.
Again to emphasize, why Dave & not Lou and/or Hiromo??? //
I doubt we can answer that particular question, but I can for certain tell you that between Dave and those two, there was a world of difference on how they did our sport. They are not in the same category one would use when beginning a studyā¦
Is Daveās training level the difference or is it some other factor or combination of factors (genetics, diet, sleep, etc.)??? I am not sure we can presently know.
To ASSUME this is an overtraining problem is jumping the gunā¦overtraining as THE cause or contributory cause is a HYPOTHESIS, however, it might be due to or contributed to by other issues (under-recovery, genetics, diet, stress, etc.)ā¦to my knowledge, we just donāt know at this time. Training for a full IRONMAN (Lou in his 80ās and Hiromo presently at 91) IMO (my best GUESS is) likely requires HIGH volume (I might GUESS pro-like volume though I do not know Hiromoās present volume OR Louās volume when he was in his 80ās) as each of the 3 sports will require a considerably longer time period to complete than if they were 30 or 40 years younger AND their adaptive responses are blunted at an older age.
An initial study might include ALL older athletes (those with AND without problems) and their training volume (present & lifetime) to see if there were a relationship AND at what volume AND should attempt to exclude other confounding factors such as sleep, diet, stress, particular genetics, etc. BTW I seem to always hear about this in menā¦what about womenā¦does this occur less frequently in women AND if this occurs less frequently in women then WHY??? Lots of questions here & again I would GUESS we do not have a definitive medical answer to these yet. Since I race as a 73 yr. old & do high-volume training, I would be interested in studies on this.
To ASSUME this is an overtraining problem is jumping the gun//
Who is assuming that, not meā¦And I dont know the answers, but it does appear that the high level competitors seem to have more heart anomalies as a % of their cohort. Now you have put up two guys you asked about, but that really does nothing to further this conversation. Because you have two old guys that have survived all of what they did before, seemingly unscathed. But what about all the others along the way that trained like pros, guys like Joe Bonness? It is easy to see who survived the gauntlet, but so many of those that fell off on the way are forgotten. In the pro ranks it is astonishing the level of heart anomalies, and almost no one escapes them eventually as we have just seen with Dave and Scottā¦
As to the women, there are dozens with pacemakers now from the old pro ranks, and many others retired from heart issues. Is it less than the men as a %, I dont know that, not sure anyone does. But in age group athlete deaths, it certainly leans way more to the men dying in the swims. So probably something there, either physiological or mental. But for sure they are not immune to the heart issues we talk about here.
And my personal belief is it is not overtraining, because virtually every serious triathlete does that at some point, and most dont end up with heart issues. To me it just feels like an odds thing. If you are a pro, you bump up against those lines more often, and eventually cross them more often than the typical age grouper. It can be a one time episode that does you in, but that could be out of 100ās that you presented yourself with. IT would help explain why pros and elites end up with a higher % of issues, that and the added pressure for them to go beyond their limits from time to time.
And for me this is just not theory, I lived it and I believe I can point to 3 times where I crossed the line and did my damage. It was not overtraining all those years, or all the racing I did, but just a very few instances where I can now look back and see I went way over the line and now pay the price for itā¦And even with those, there were many more where noting bad happened, but once again, just the odds and my throwing so many out there that it had to eventually catch up with meā¦
11 years ago, @ age 64, I became concerned about cardiac issues from multiple years of Ironman training and racing at a high level (40 races, 11KQs, 8 AG wins). I found an article from Australia and Belgium (European Heart Journal, Dec 6, 2011, by La Gerche, Burns, Mooney, et al.) ItĆ¢ā¬ā¢s specific to long-course triathletes, studied pre and post races that showed an increased risk for evidence of cardiac fibrosis who met the following criteria: competing for longer (20 yrs vs 8 years), had greater predicted VO2 max for age, and were older (50+).
They found those with evidence of fibrosis (determined by delayed gadolinium enhancement, (whatever that is) had a LOWER right ventricular ejection fraction ( IĆ¢ā¬ā¢m not a cardiologist, so youĆ¢ā¬ā¢ll just have to accept that as a measure of cardiac function) than those without. The article suggests the gold standard for determining if there is right ventricular injury is a cardiac MRI,
My conclusion is that years/decades of high level endurance training does constitute a cardiac risk. In 2013, I wrote a little post about my own theories about this, wonāt repeat here, just link: http://bikrutz.org/triblog/?p=1140
Anyway back to The Man , Dave. What an inspiration. I wish him a speedy and full recovery.
Your following statement is a good hypothesis:
āAnd my personal belief is it is not overtraining, because virtually every serious triathlete does that at some point, and most donāt end up with heart issues. To me it just feels like an odds thing. If you are a pro, you bump up against those lines more often, and eventually cross them more often than the typical age grouper. It can be a one time episode that does you in, but that could be out of 100ās that you presented yourself with. IT would help explain why pros and elites end up with a higher % of issues, that and the added pressure for them to go beyond their limits from time to time.ā
Some one needs to test this with a studyā¦assuming heart problems are due to any one factor and this factor projects (might project) to a general population (triathletes) is a hypothesis without a definitive answer. Evidence exists, which is why there is a hypothesis, but the answer has yet to be clearly defined. Complicating this is the fact humans are difficult to test vs say rats. Rats have a shorter lifespan so an answer can be obtained more quickly. Rats can be purchased with essentially the same genetics so genetic factors are minimized. Verified, identical diets can be given or different diets can be given to different groups with the knowledge no rat is ācheatingā on their dietary reportingā¦Humans are just harder. BUT rats are NOT humans. Additionally, unless one can test a pharmacological remedy, a researcher might find funding difficult.
We know, for example, human longevity varies from country to country. For example, Japan ranks 3rd (84.95 years) on the longevity list & the USA is 47th (79.74 years). IMO, (my best GUESS is) this is pretty poor given the financial/economic advantages the USA hasā¦but the general population does not seem to care about this. The point is there are differences and the reasons need to be brought to light. BTW do triathletes live longer than the general population?? There is so much I/we do not yet know. Just some thoughts.
https://www.worldometers.info/demographics/life-expectancy/
** BTW do triathletes live longer than the general population?? //**
Well being that Dave and myself were among the first few dozen triathletes ever, that theory will have to wait for a bit to be testedā¦There are of course old age group triathletes who started later in life, but that probably just goes into an old fitness study of longevity for now.
The oldest guys I know of are Dave, Dean Harper, myself, Tinley, and many that are already dead. 2nd group just behind are Mark Allen, Mike Pigg, Scott Molina, Norman Stadler, Greg Welch, and the others from that generation. And pretty much everyone I mentioned has had a serious heart issue, it really is the unicorn to find an old pro in their mid 60ās to early 70ās that has not had oneā¦
To ASSUME this is an overtraining problem is jumping the gun//
Who is assuming that, not meā¦And I dont know the answers, but it does appear that the high level competitors seem to have more heart anomalies as a % of their cohort. Now you have put up two guys you asked about, but that really does nothing to further this conversation. Because you have two old guys that have survived all of what they did before, seemingly unscathed. But what about all the others along the way that trained like pros, guys like Joe Bonness? It is easy to see who survived the gauntlet, but so many of those that fell off on the way are forgotten. In the pro ranks it is astonishing the level of heart anomalies, and almost no one escapes them eventually as we have just seen with Dave and Scottā¦
As to the women, there are dozens with pacemakers now from the old pro ranks, and many others retired from heart issues. Is it less than the men as a %, I dont know that, not sure anyone does. But in age group athlete deaths, it certainly leans way more to the men dying in the swims. So probably something there, either physiological or mental. But for sure they are not immune to the heart issues we talk about here.
And my personal belief is it is not overtraining, because virtually every serious triathlete does that at some point, and most dont end up with heart issues. To me it just feels like an odds thing. If you are a pro, you bump up against those lines more often, and eventually cross them more often than the typical age grouper. It can be a one time episode that does you in, but that could be out of 100ās that you presented yourself with. IT would help explain why pros and elites end up with a higher % of issues, that and the added pressure for them to go beyond their limits from time to time.
And for me this is just not theory, I lived it and I believe I can point to 3 times where I crossed the line and did my damage. It was not overtraining all those years, or all the racing I did, but just a very few instances where I can now look back and see I went way over the line and now pay the price for itā¦And even with those, there were many more where noting bad happened, but once again, just the odds and my throwing so many out there that it had to eventually catch up with meā¦
Monty, you and your cohort of early pros were guinea pigs in terms of what you put your bodies thru and your health today.
I would be curious to know the relative heart health of pro tour cyclists from your age group cohort from the late 70s and early 80ās. I would imagine that those pro cycles hammered their bodies just as hard aerobically but they did it all none weight bearing . You guys were likely doing printout cyclist volume and intensity but inclusive of time on your feet and many of you kept it up for a long time after your pro days ended but pro cyclists likely did not continue afterwards. I believe Dave Scott was second at Kona at 40 and fifth at 44? Not many pro cyclists go on that long at the top of their sport.
I asked about longer living triathletes because there is some evidence other athletes live longer AND one of the best predictors of longevity is maxVO2 which, as you probably know, is trainable. I agree triathlon is not old enough to determine if there is increased longevity in triathletes.
I replied to your original post because their seems to be a prevailing thought among those posting that over-training/high-volume with intensity-training is highly suspect AND while over-training/high-volume with high-intensity might be suspect (or even highly suspect) this is a hypothesis and not a finding (yet). We already know those on the Standard American Diet (SAD) are likely to die before those in Japan (Japanese Diet) and those in the Blue Zones (Blue Zone Diets) and these differentials probably have nothing to do with triathlon or hard training for many years. Would those you mentioned (all from western cultures) have lived longer without (put-off to an older age) their cardio-vascular issues OR avoided them entirely with a different diet??? Could they still have achieved as much on a different diet??? Does hard training exacerbate dietary or genetic or sleep or stress or other, issues??? All unanswered questions & humans do not seem to like that situation.
You seem to know a lot about those in this age category. If the hypothesis of over-training/training-too-much is true then, since we know exercise is generally good for humans, the next question likely is; āHow much is too much?ā
I asked about longer living triathletes because there is some evidence other athletes live longer AND one of the best predictors of longevity is maxVO2 which, as you probably know, is trainable. I agree triathlon is not old enough to determine if there is increased longevity in triathletes.
I replied to your original post because their seems to be a prevailing thought among those posting that over-training/high-volume with intensity-training is highly suspect AND while over-training/high-volume with high-intensity might be suspect (or even highly suspect) this is a hypothesis and not a finding (yet). We already know those on the Standard American Diet (SAD) are likely to die before those in Japan (Japanese Diet) and those in the Blue Zones (Blue Zone Diets) and these differentials probably have nothing to do with triathlon or hard training for many years. Would those you mentioned (all from western cultures) have lived longer without (put-off to an older age) their cardio-vascular issues OR avoided them entirely with a different diet??? Could they still have achieved as much on a different diet??? Does hard training exacerbate dietary or genetic or sleep or stress or other, issues??? All unanswered questions & humans do not seem to like that situation.
You seem to know a lot about those in this age category. If the hypothesis of over-training/training-too-much is true then, since we know exercise is generally good for humans, the next question likely is; āHow much is too much?ā
We have a century of ex pro cyclists to go and study on this . If anyone is in the ātoo muchā category it would be them. But my hypothesis is that non weight bearing nature of that sport allows for more loading over more years without the same long term impact as we could be seeing in ex pro triathletes who have the weight bearing part involved during the highest level of fatigue for the body (at least the in competition part) . The hearts need to pump blood an extra 1.5-2 feet of more vertical in a standing running position versus bent over in aero moving all that volume through more vertical against gravity. Our sport is unique in that pro triathletes are doing this work 8 hrs into a race, not like 2 hrs in like pro marathoners. Thatās a hypothesis on the table here.
** BTW do triathletes live longer than the general population?? //**
Well being that Dave and myself were among the first few dozen triathletes ever, that theory will have to wait for a bit to be testedā¦There are of course old age group triathletes who started later in life, but that probably just goes into an old fitness study of longevity for now.
The oldest guys I know of are Dave, Dean Harper, myself, Tinley, and many that are already dead. 2nd group just behind are Mark Allen, Mike Pigg, Scott Molina, Norman Stadler, Greg Welch, and the others from that generation. And pretty much everyone I mentioned has had a serious heart issue, it really is the unicorn to find an old pro in their mid 60ās to early 70ās that has not had oneā¦
Stadler has just turned 50, and already had to quit in his late 30ās, due to cardiac issues. Possibly Zack and Diettrich are best candidates for this group.
I like the way you think in terms of your hypothesis & probable addāl stress a triathlete gets over a cyclist or runner. A study would also have to account for the addāl confounding factors of diet, sleep, stress, etc. Though more work needs to be done, some work has already been done & erikmulk posted this study: https://www.ama-assn.org/...e-needed-live-longer
The oldest guys I know of are Dave, Dean Harper, myself, Tinley, and many that are already dead. 2nd group just behind are Mark Allen, Mike Pigg, Scott Molina, Norman Stadler, Greg Welch, and the others from that generation. And pretty much everyone I mentioned has had a serious heart issue, it really is the unicorn to find an old pro in their mid 60ās to early 70ās that has not had oneā¦
Thatās a shame that many legends have had/have heart issues. I donāt wish ill will on anyone, but I canāt help but wonder what Lionel is doing to his. The guy seems to empty his tank on every race he does and you have to wonder how many times you can do that before it does some sort of damage. I know that there are pro cyclists that do the same but I agree there must be some compounding effect with running and perhaps swimming.