LCFC #2: An athlete's heart shouldn't break. Did mine?
Plus: A thought on the weightloss drug Wegovy
Yes or No
If the doctor finds something abnormal, do you want to know?
It was the only question I had initially skipped while filling out a research study participation form. It was 2011. I was racing triathlons, and I had spotted the study scrolling through Duke’s volunteer research study database. The research question struck me: why do most triathletes die specifically during the swim leg of the swim, bike, run race?
Sitting there in the bowels of Duke University Hospital, I carefully printed my name, described my health history and then went back to the question I had skipped. I could circle no, the doctor won’t find anything anyway, I thought. But if the doctor won’t find anything, why not just circle yes.
I did.
About 20 minutes later, I was lying on my back with electrical wires attached to my chest and a young man squirting cool gel on my skin, then pressing a thick wand on my left pectoral muscle. It was like on TV, when a doctor does an ultrasound of a pregnant person’s belly and then gives them a picture, a sonogram. Only this wasn't my belly. It was my heart. Amazed that I could see my own blood-pumping organ, I peppered the sonographer with questions. He calmly answered them.
Then, silence. Minutes seemed to tick by.
“Umm, I am going to get a cardiac fellow. Are you ok to wait?” the sonographer said.
“Yep,” I replied.
Silence, again. I stared at the ceiling tiles counting the black specks, marveling that I’d just seen my heart, and certainly not having the wherewithal to be worried.
Then, the sonographer returned. With him was a cardiac fellow, a doctor wanting extra training in treating heart troubles. The fellow introduced himself, and said he’d be taking a look at the images of my heart. Wand back on my chest, the men spoke almost inaudibly.
“I’d like to run an extra test, would you be ok with that?” the fellow asked.
“Yes. What is the test?”
It was painless. They’d shoot saline, a saltwater solution, through an IV into my vein and watch the air bubbles in it work their way through the chambers of my heart.
In went the saline. What seemed like seconds later, there were a few mmmms.
“The bubbles are moving too fast. I’d like to refer you to a cardiologist for further testing,” the fellow said.
He explained that there could be a few reasons the bubbles traveled too fast, a hole in my heart, for instance. I could not continue in the study, he said, but he urged me to go see the doctor he recommended.
Stunned, I said yes, I would.
The men left. I wiped the goopy gel from my chest with a worn, scraggly towel and pulled on my bra and shirt. After collecting a card with the name and number for the doctor I needed to follow-up with, I took the long walk past Duke’s chapel, around the traffic circle planted with pansies to my office at the edge of the college campus.
Was my heart truly broken?
I’d have to wait a few weeks to know for sure, so too will you. More next newsletter.
Switching gears, here’s a thought on the weight loss drug Wegovy and heart disease.
Wegovy has been making headlines lately. Curious about the buzz, I read a few of the stories. Here’s the gist, according to NPR’s Allison Aubrey: The injectable drug is for people with obesity. These people also have high blood pressure or high cholesterol—both risk factors for heart disease.
The active ingredient in the drug, semaglutide, is also used, at a lower dose, in the diabetes drug Ozempic. Recent FDA approval for Wegovy for children, along with decreased supply of semaglutide, the ~$1,400 monthly cost of Wegovy (typically not covered by insurance), inequities in access to the drug and the effects of going off of it have driven media interest, generating those headlines.
My question: In the long run, how could Wegovy and other weight loss drugs in the pipeline address the statistics I cited last time?
Again, nearly half the adult population has heart disease, that’s roughly 127.9 million people. 700,000 in the United States die each year. And: We spent more than $200 billion each year on doctor visits, medicines and “lost productivity due to death” related to heart disease, the CDC reports.
Being obese may directly damage the heart, at least one study has shown. And, people with obesity cannot always control their weight with a healthy diet and exercise, other research suggests.
Since extra weight and heart damage seemed inextricably linked, could Wegovy and other drugs like it reduce the risk of heart disease?
Yes, early data suggest. There’s a clinical trial called SELECT, which stands for Semaglutide Effects on Cardiovascular Outcomes in People With Overweight or Obesity, asking the exact question I posed. And there have been studies of studies, or meta-analyses, that do indicate these weight loss drugs lower the risk of death from cardiovascular disease. We’ll have even more data when the SELECT trial finishes in September.
If the drug lives up to its promise, its cost could prohibit use as a standard preventive medicine. Quick math suggests treating 100,000 million people with Wegovy for 12 months at $1,400/month would be more than a trillion dollars each year; far above the $200 billion spent annually on cardiovascular disease right now.
If the price comes down as more weight loss drugs enter the market, and they have limited side effects, it seems like we could use them as a possible prophylactic. We would most likely need insurance companies and the public to get onboard with this treatment, and whether that will happen, given the stigma associated with being overweight, is unclear.
We don’t have all the answers.
But, just like I checked yes in 2011 and set myself on a medical adventure, the use of Wegovy and other drugs too is an evolving story, one I’ll follow and provide updates on in the future.