Editor’s Notes: Both my column and our Health Matters column today focus on heart health, cholesterol and cycling. I hope these pieces serve as a reminder that we should all take our heart health seriously and be especially mindful of any predisposition you might have to heart-related health issues.

As November 24 is Thanksgiving Day, we will not be publishing an issue that day. Enjoy spending time with your family!

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“You can’t outrun your genes.” I heard this mantra from my doctor every time I saw him over the past three years for my annual physical. It was his blunt way of recommending that I get a coronary calcium scan to check for any plaque buildup in my coronary arteries.

I knew instinctively that he was right, but I was determined to ride -- and fight -- as hard as I could to outrun my genes, anyway. And I did not relish taking a test that could brand me with the disease that took my dad’s life -- and both his brothers’ -- at fairly early ages.

I fought the good fight -- working as diligently as possible on my diet, losing weight, taking fish oil, riding and training as much as I could. But as of three weeks ago, my genes officially won the battle. Now, like an estimated 25 million others around the world, I’m taking a statin drug to control my cholesterol. And I’ll be taking it for the rest of my life.

Mine is a story that probably rings true with many cyclists of a certain age -- and a certain genetic make-up.

The Scan Told a Different Story

I am in most respects the picture of health for a 47-year-old. At 5’10” (1.78 m), I weigh about 163 (73.9 kg). My blood pressure is normal. I have no risk factors other than family history. Heck, I even have a normal cholesterol level. Granted, it was slightly elevated a couple of years ago, but I managed to bring it down, back to the accepted normal range, at my last physical in May. My total cholesterol then was 183, and I had dropped my LDL, or bad cholesterol, by 25 points in a year, down to 99.

I quietly rejoiced at my short-term victory, having beat back my cholesterol level through diet and exercise alone -- despite my doctor telling me it couldn’t be done. Feeling like the time was right, I finally relented on the coronary CT scan and had the test done in June.

“You can’t outrun your genes. You just can’t,” he repeated to me in a phone call to give me my test results. He delivered the sobering news that my score of 50.5 meant that I had coronary artery disease -- that curse I had hoped and prayed to avoid forever. Specifically, my score falls in the middle of the 11-to-100 range that confers a diagnosis of mild to moderate atherosclerotic plaque burden. (Click the links for further information about coronary calcium scans, and how they’re scored.)

Translation: I have some plaque in my left anterior descending artery, but it’s not enough to cause any problems -- as long as I make sure that no further plaque is allowed to form. And, to best accomplish that, my doctor told me, I needed to bring down my LDL to 70. He gave me three additional months to see what more I could do with diet and exercise alone. I was to have a follow-up blood test in October.

Don’t Slow Down

Meanwhile, I rode my normal summer “schedule.” That is to say, as much as possible, throwing in a bunch of fast organized rides in the area, a race for good measure, lots of training miles with buddies, and multiple hill repeats on my favorite training hill, aptly named Silver Hill. My summer culminated with 530 miles in eight days on the California Coast Classic in September, on which I felt and rode great. Honestly, I’ve never been stronger on the bike.

Still, when I was retested in October, my cholesterol had increased a bit, to 196 overall, and my LDL had risen to 111 -- as if to prove the point that I had reached a plateau, and no amount of riding or diet-watching was going to help me stave off the inevitable. Yes, my genes had finally caught up with me.

In his office after drawing my blood, my doc pulled out one of those sectional models of an artery and showed me how my plaqued-up artery looked. But he reassured me that it was indeed a moderate amount of plaque and does not affect me at all. When I asked him about hitting a heart rate of 191 on a recent super-hard ride with some buddies, he said that, too, should be of no concern, that my heart is otherwise healthy. Finally, he said the same of the 40 mg daily dose of Simvastatin that he prescribed for me.

“Go ride like you always do,” he said. It was the first thing he’s told me in a while that I enjoyed hearing. And I plan to, pardon the pun, take it to heart.

Serious Business

But I know the diagnosis -- as I’ve always known about my family history -- is serious business. I am, as my doctor puts it, a “plaque maker.” I’ve been trying to outrun my genes for a long time. Along the way, though, I’ve had regular check-ups to monitor my health, and I certainly will continue those.

Sure, I’ve now had to come to terms with the fact that I need some help in the form of the statin that I take. But I am determined to continue what’s helped me strengthen my cardiovascular system, lose weight (30 pounds in the last decade), remain otherwise healthy and enjoy life more since I took it up in earnest -- road cycling. I intend to speed up, not slow down.

I’ll keep you posted on my 3-month follow-up blood test, at which time we’ll see how well the statin works at lowering my LDL to the goal level of 70. In the meantime, I urge you to monitor your heart health and, especially if you have risk factors, including family history, get regular checkups. My doctor says cholesterol levels are 80% genetically determined. And I now fully understand his mantra: “You can’t outrun your genes.”

Enjoy your ride!

John Marsh

Editor & Publisher

Comment

We’re pleased to announce the launch this week of a totally new look and much easier navigation flow for RBR’s eBookstore.

You’ll notice an immediate difference, as all of our eArticles and eBooks are now arrayed as “book covers” to make it quick and easy to scan available titles. Simply click on the book cover for a detailed description of that title.

In addition, we’ve added new categories, including New Releases, Best Sellers, Seasonal Training (in which titles will change with the season), and Member Favorites to the existing list of targeted categories (Training, Skills, Nutrition, etc.).

You can also click on the author’s name to see all titles by that author -- a great way to find additional eBooks and eArticles from the authors whose works you enjoy.

In short, we hope the changes will make it easier for you to browse this great resource and find eBooks and eArticles that best meet your needs. I encourage you take the new eBookstore for a spin. I’m guessing you’ll find titles you weren’t even aware of.

Tip!  RBR eBooks and eArticles make great holiday gifts for your fellow cyclists. Each purchase is a downloadable PDF that can be printed or emailed to your cycling friends. (Please remember, though, to buy a fresh copy for each friend -- no matter how many downloads you have left. We can’t allow our eBooks and eArticles to be shared: We’d be out of business, and so would the authors.)

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Great New Premium Member Benefit!

We’re also happy to announce a new partnership with the League of American Bicyclists that provides RBR’s Premium Members a 15% discount on the price of any membership type with the Bike League. (That’s a savings of $6 on an annual individual membership!)

To take advantage of this opportunity to save money while supporting one of the premier cycling advocacy organizations, simply access the code on the Premier Member Welcome Page when you log in on the RBR website (it’s highlighted in yellow -- you can’t miss it).

This is yet another example of the numerous benefits of a Premium Membership, which nets you a 15% discount on all eBooks, eArticles and logoed gear in our Marketplace -- as well as granting you access to 200 Product Reviews, our entire Newsletter archive (over 500 issues), and another several hundred pages of exclusive Tech, Training and other Premium content. A Premium Membership can easily pay for itself in cost savings alone.

Most importantly, Premium Memberships help underwrite and support the weekly RBR Newsletter. Without our Premium Members, RBR would not exist.

We’re very thankful to our Premium Members and will continue to look for ways to add value to our Premium Membership.

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Coach John Hughes is back from his recent speaking and consulting trip to China. He graciously agreed to share his experiences with us on of the state of cycling in the world’s most populous country.

Coach Hughes’ Observations:

I spoke at the International Conference on Cycling and Health in Shanghai and consulted with government officials, educators, coaches and riders at Sports Institutes in four northern cities. The Conference and tour included experts from Masaryk University in the Czech Republic, Harvard, the University of Illinois and several Chinese institutions.

I lectured on Effective Training for Cycling: Varying the Intensity. The slides are on my website here.

--- My talk was targeted at recreational and amateur competitive riders. I’ve written an eArticle for RBR (Intensity Training for Cyclists) on the importance of varying the intensity both by type of workout as well as season of the year. These concepts were new to Chinese recreational riders. Coaches and competitive cyclists understood the general concepts; however, because of the language barrier I couldn’t tell how detailed and current their knowledge is. In Nanjing it appeared that riders train and compete all year rather than taking a periodized approach of base training, then a build phase and then peaking.

--- In Nanjing I visited the gym while cyclists were working out. They lack both the most current equipment as well as knowledge of how to develop the most power. I demonstrated plyometrics, as well as squats, going down slowly and then exploding upward on each rep.

--- Shanghai, with 23 million people, is the largest city in the world. The other cities ranged from 4-10 million. The streets are very congested and smoggy, and some commuting riders wore facemasks to filter the air. In Shanghai in particular, it’s very difficult for riders to get out of the city to open roads to train.

--- The universities are researching significant topics such as why MTB riders have greater bone density than road riders. However, China lacks sophisticated facilities to test competitive riders for lactate threshold, V02 max, etc., and to optimize bike fit.

--- In Nanjing, we ate in the athletes’ cafeteria, which had excellent food: vegetables, fruit, rice, noodles, fish and fruit juice rather than soda. However, McDonalds, KFC, Starbucks, and the like are popular with younger Chinese, who tend to eat less healthy than the traditional diet.

--- With increasing affluence, there are more cars and many more battery-powered ebikes. Historically, most commuting was by bicycle; now 75% of the cycle traffic is ebikes and only 25% pedal bikes. Although ebikes pollute less, disposal of their lead batteries is a long-term pollution problem.

--- The Chinese are very concerned about advancement. They spend almost all of their time studying to get into a good university, and then study to get a good job, and then work hard to advance. They use ebikes because they are faster, which leaves more time for work.

In one study of China’s elite workforce, almost 90% knew what they should do for their health -- but only 6% exercise regularly.

--- Prof. Zhu from the University of Illinois showed statistical trends demonstrating that the U.S. population is becoming more obese, with attendant health issues such as diabetes, hypertension, etc. This parallels a decrease in manual labor as well as an increase in the use of labor-saving devices, ranging from cars to escalators to dishwashers. He suggested that simple changes in activities of daily living can make a significant difference in obesity.

I very much enjoyed the opportunity to coach in China and learned an amazing amount about physical activity in a country like that. We were treated as honored guests, and I’d welcome an opportunity to return.

Comment

Coach John Hughes earned coaching certifications from USA Cycling and the National Strength and Conditioning Association. He enjoys coaching riders with a variety of goals and fitness backgrounds. For more information, visit www.coach-hughes.com. Coach Hughes is the author of 8 RBR eBooks and eArticles.

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After last week’s Women on Wheels column focused on the issue of osteoporosis and bone health in women cyclists, an RBR reader with the tag noibn suggested on the Comments page that we re-run a newsletter article from 2007 on osteopenia for our male readers.

It was a great idea, so here it is:

Osteopenia? If you're not familiar with the malady, just think of it as the stage between healthy hard bones and osteoporosis -- the debilitating loss of bone density.

Osteopenia isn't unusual for men whose main sport is bike riding or any other low-impact activity. Despite cycling's wonderful benefits for cardiovascular fitness and leg strength, it's been shown to work against bone health.

Researchers at the University of Missouri are the latest to find that male cyclists are significantly more likely to have osteopenia and, therefore, a greater risk of fractures. The study will appear in an upcoming issue of the journal Metabolism.

Most men don't realize the risk and, the study notes, most doctors don't either. They almost never check men's bone density, even after one is broken.

And yet the National Osteoporosis Foundation says that osteopenia affects nearly 12 million men in the U.S. and another 2 million have developed osteoporosis.

The Missouri researchers tested competitive male cyclists and runners. They found that 63% percent of the cyclists had osteopenia of the spine or hip, compared with 19% percent of the runners. The big difference is attributed to the fact that running is a high-impact, weight-bearing sport while bike riding is neither.

The solution for us cyclists is to integrate weight-bearing exercises into our fitness programs. This could be weight training, cyclocross, running, hiking, basketball, tennis, even jumping rope -- you get the idea.

Tip!  Guys, ask your doc to arrange a DEXA scan, a bone-density test. Your medical insurance will probably pay for it, and it doesn’t hurt a bit. Take corrective action now if you’re trending toward osteopenia. If studies on women can be applied to men, a 1% increase in bone density reduces the risk of fracture by as much as 5%. If you are found to have osteopenia, you may need to take one of several prescription drugs (Actonel, Boniva and Fosamax are among them) to help add bone density.

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Only weeks ahead of his Nov. 21-24 doping hearing before the Court of Arbitration for Sport in Lausanne, Switzerland, Alberto Contador was in the news again -- he got married.

The three-time Tour de France champion married his girlfriend of 10 years, Macarena Pescador, in his hometown of Pinto near the Spanish capital on Saturday.

Contador faces a two-year ban if the CAS rules in favor of the UCI and the World Anti-Doping Agency, which appealed the decision by the Spanish Cycling Federation to clear Contador of doping charges. He was found during a test administered during the 2010 Tour de France to have Clenbuterol, a banned substance, in his system. He allegedly ingested the Clenbuterol through meat he ate during the Tour.

Overheard:

--- “What they’d (GreenEDGE) like me to do is finish at the end of May, so that would be after the Tour of Cali, then go with the team to the Tour de France and scout the finishes. I’d go ahead of the team -- either leave really early in the morning or go the night before -- and scout the last 10K of the stage and then re-ride the last 5K, re-ride the last 3K again, then do the last 2K and 1K again so I know it perfectly. I can relay all that information to the guys in the bus during the team meeting by phone before they start so they’ve all got a clear picture of what the finish is. I can tell them about each corner so they know exactly what is coming before they get there, and that’s a little advantage.”

-- 39-year-old Robbie McEwen, who will keep a full race calendar for the Australian team GreenEDGE through May of next year before retiring to the role of “scout” for the team.

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--- “It’s been my best year to date. As much as two years ago was a breakthrough in the Tour de France (a 4th place finish with Garmin), this has been a real breakthrough year for me in terms of consistency at the top in the big races. That’s been the biggest thing and I guess being considered a hitter or contender whenever I go to a race is something I’ve always wanted to achieve.

“So in that sense of what we want to achieve next year -- which is going as high up as we can at the Tour de France -- it’s a confirmation. I guess the biggest thing for me this year was never dwelling too much on the successes I had and instead be always looking forward to the next target. I think that’s continuing right now -- we’re already looking towards next year and planning for it -- and not resting on any laurels.”

-- Team Sky’s Bradley Wiggins, who had a strong 2011 season, winning the Criterium du Dauphiné and finishing third at the Vuelta a España -- after crashing and breaking his collarbone in the Tour de France. He says the 2012 Tour will take precedence over the London Olympics, with the goal of a final podium spot in mind.

Comment

Answer at Question of the Week, where you can also find an archive of previous poll results.

Highlights of your responses to last week’s Question:  Do You Use a Heart Rate Monitor for Training?

-- 36% said “Absolutely. I wear it on every ride to keep tabs on my zones for training.”

-- 22% said “Yes. It is the best way to gauge my effort and stay under LT.”

-- 19% said “Sometimes. I wear it when I plan to do interval training and climbing.”

Comment

Question:  I'm a first-year racer and bought my current bike a year ago from a friend for $400. It weighs 22 pounds and has a triple crankset. To lighten this bike, where would I get the best bang for my buck: wheels, fork, frame or drivetrain? Or do I need to bite the bullet and invest in a whole new bike? -- Scott P.

Coach Fred Matheny Replies:  A dozen or so years ago we thought a 22-pound bike was light and anything under 20 pounds was so gossamer as to be scary. Now the standard has changed so much that 15-18 pounds is the norm for high-quality road bikes (and a bigger pile of money can buy you a ride as light as 13-14 pounds).

An extra 3-4 pounds won't penalize you much on flat courses, but on long climbs you'll lose about 2 seconds per mile for each extra pound of bike (or body) weight. That's not a lot if you're on a group ride or out training by yourself, but it could put you off the back in races.

The most cost-efficient way to get a significantly lighter bike would be to buy a new one. This way, you can get a lighter frame, a carbon fork with a carbon steerer tube, lighter wheels and higher-end (and therefore lighter) components.

If you keep your current frame but replace the triple crankset with a double and buy lighter wheels, it will make a difference you can feel. After that, replacing components would pare more weight. But when you finished, the bike still wouldn't be super-light because of the frame, and you'd have spent a large portion of the price of a new and better bike.

Another advantage of buying a new bike is that your old one can become your winter bike for training on wet, gritty roads. For this type of riding a little extra weight isn't a problem. Some riders even like lugging extra poundage up hills, believing it makes them stronger.

Comment

I ask because it’s not uncommon for seatposts to slip down over time. I’ve had this happen on my bike and didn’t realize it. I didn’t feel it as it was happening. And, it wasn’t until my riding buddies mentioned that my seat looked low that I checked it and found that it had indeed dropped a full half inch.

As I ride around and spot other cyclists, I look at them, too. And I’ve noticed, like my friends did, that there are a lot of too-low seats out there. I see too-high ones once in awhile. But the low ones are easier to spot and more common, I think.

Too low a seat is a problem because it can cause knee pain, or even injury, fairly quickly, especially if you climb hills or push the pace. It also reduces your pedaling efficiency, since you aren’t able to use the full power of your legs. And, as the seat drops, the distance to the handlebars changes, possibly causing back or neck discomfort or pain as well.

Tip: With winter already here for some of us, you may be planning to ride indoors on a trainer. It’s even more important to have the right seat height on a trainer because you’re more likely to sit in one position for extended periods, which can lead to injury faster if your seat’s not right.

Know your seat height

The easiest way to be prepared to check your seat height is to mark it or memorize it. That way, you can routinely check your seat with a tape measure or look at your mark. Some riders put a wrap of electrical tape around the seatpost to mark it. Black electrical tape blends in well with many seatposts and can hardly be seen. It’s also there if you ever need it for any on-the-road repair. But if tape clashes with your seatpost, or you simply don’t want a piece of tape junking up your baby’s looks, a line or dot from a Sharpie marker will last a long time, too.

I also memorize my seat height measurement, taking it from the top of the seat to the center of the bottom bracket. These two reference points are relatively easy to measure from.

Tip: Because I’d like to have a permanent mark, too, I know it’s tempting to want to scratch or notch your seatpost to mark it. But don’t do it because it will likely damage your seatpost and may even cause it to break. Maybe you’re lucky, though, and exactly four fingers fit beneath the seat. Something like that would be a nice gauge if it works for you.

Resetting your seat height

If your seatpost is marked or you know the measurement, it’s simple to raise it if you’re home with your tools. If you notice it on a ride, as long as you have the right wrench and have it marked, you can raise it right there. If you only know the measurement and don’t carry a small tape measure, you can ballpark it with the steps that follow, or look for an old mark since a post that has been in one spot for a while usually leaves some line or blemish on it.

Tip: Hopefully, when you try to raise your seat it will move easily. (In next week’s Tech Talk, I’ll explain some of the ways to remove frozen seatposts.) To prevent a seatpost from freezing, make sure it’s lubricated. If it’s steel or aluminum, use grease. For carbon seatposts and frames use what’s called “carbon assembly paste,” which is made just for carbon and has grit in it because plain grease would allow the post to slip.

Finding the right seat height

If you’re not sure exactly where your seat was, here’s an easy way to find the optimum height. Do it on a trainer or indoors in a doorway and have a friend or your spouse help. Put on your cycling shorts and shoes, mount your bike in the trainer or place your bike in the doorway, get on and hold onto the doorjamb to support yourself. Have your helper stand behind.

To find seat height, place your heels on the pedals and pedal backwards. You’ve found the optimum seat height when your legs are completely extended at the bottoms of the pedal strokes with your heels on the pedals. Have your helper watch for rocking hips, the sign that the seat is too high. Now, when you’re actually pedaling, you’ll have the perfect bend in your knees.

This is a great way to find a starting position. If it feels too low or high, adjust the seat up or down -- but only slightly -- to fine-tune the adjustment.

Tip: There are many high-falutin’ calculations you can perform to figure out your seat height, but this simple legs-fully-extended-with-the-heels-on-the-pedals method is quick, easy and almost always very close to perfect.

Comment

Jim Langley has been a pro mechanic and cycling writer for 38 years. At RBR he's the author of Your Home Bicycle Workshop and moderator of the technical forums on the Premium Site . Check his "cycling aficionado" website at http://www.jimlangley.net , his Q&A blog and updates at Twitter. Jim's streak of consecutive cycling days has reached 6,513.

You’re comfortable and competent when your usual group of 3 or 4 buddies decides to hammer into a headwind in a single paceline. All of you know the rules and you’re confident that no one will mess up. But now you're going to ride with a big group from a nearby city. You've heard stories of their fast double pacelines and echelons. You don’t feel confident just jumping in.

Same with joining the fast-moving pacelines that form in century rides. And your secret dream is to race -- but race packs look so disorganized and helter-skelter that you’re intimidated. How does anyone survive in all that mayhem?

It’s easy to ride with a couple of like-minded friends. But it gets more complicated when you’re with a big group of people you don’t know, maybe fighting a strong crosswind. And in a racing pack or the random groups that dominate centuries, it often seems like there are no rules at all.

That’s not true, of course -- big groups operate according to the same principles as small, single pacelines. Only the specifics are different. So let’s look at how to handle these advanced group ride techniques. This week we’ll cover double pacelines and rotating double pacelines. In Part 2 next week, we’ll cover echelons and racing packs.

Double Pacelines

A double paceline is an excellent technique for maximum speed. And with a slight modification they're great for leisurely-paced conversation, too. Here's how:

Form a double line and roll along side-by-side at a moderate pace, chatting with your partner.

The lead pair pulls for several minutes. When they're ready to relinquish the front, the rider leading the left line pulls off slightly to the left and the rider leading the right line drifts to the right.

As the 2 riders soft pedal, the double paceline comes up between them. The former lead pair drifts back along their respective sides of the line and latches on behind the last pair of riders.

Remember, as the 2 riders drift back, the formation becomes 4 riders wide. This is why a double paceline should only be used on low-traffic roads or on a wide shoulder.

Want to go faster? Stow the chatter and have each lead pair take hard, short (30-second) pulls. You’ll fly.

Rotating Double Pacelines

Double pacelines can go even faster if they rotate and the lead riders don’t spend much time on the front.

Form 2 parallel lines like just described. However, the 2 front riders don’t pull off in the same manner. Instead, one line moves slightly faster than the other, and no one dwells on the front. That is, the riders in one line are moving forward while those in the other line are dropping back. It might be easier to picture by explaining it as a long oval rotating counter-clockwise. The “faster line,” on the right side, is moving forward, with every rider working hard until he or she reaches the front. At that point, he or she simply rotates to the left and joins the left side, and then begins rotating back through the left side of the line.

Suppose you’re in the middle of the faster line. Follow the rider directly in front. When she gets to the front of the line, she’ll stay there only until she’s safely ahead of the front rider in the slower line. Then she’ll carefully cross over to the front of that line and reduce her speed about 1 mph by soft pedaling.

Now you’re on the front of the faster line. Don’t linger. Keep your speed steady until you can do exactly what she just did -- slide over as soon as you’re in front of her in the slow line, then reduce speed.

As other riders come through the fast line and move over, you’ll migrate back to the end of the slow line. When you’re the last rider, slide over to the rear of the fast line and begin rotating through to the front again.

Caution!  Pay attention when you’re nearing the end of the slow line. Don't move over until you've glanced behind to be sure you’re the last rider. If you move over when someone is still back there, you could get tangled up. Even though you know who is behind you in the rotation and you see that rider begins to come past in the fast line, someone may have tagged on from behind. The last rider in the line should announce their presence as you rotate back (a good way is to simply and forcefully say, “last”), but always make a quick check just be safe.

Don’t miss Part 2 in next week’s No Problem, when we’ll cover echelons and racing packs.

Comment

Adapted from Coach Fred's Solutions to 150 Road Cycling Challenges, a helpful eBook especially for cycling newcomers. Coach Fred Matheny is the author of 13 RBR eBooks and eArticles.

Now I know why I’ve been struggling in my indoor trainer workouts: no grapefruit-scented candles.

Soon you will be able to buy $42 grapefruity candles at SoulCycle, a small chain of indoor-cycling studios in the New York City area that is planning to expand to 50 new locations in the U.S. and Europe by 2015.

“Indoor studio cycling is on a roll,” The Wall Street Journal reports. “It’s the latest entry in the ‘boutique fitness’ sector.”

One example, says the WSJ, is the “yoga flavored” SoulCycle, where candlelit stationary-bike workouts feature teachers who emphasize clearing the mind and use yoga terms like ‘chaturanga arms.’” A painted message on the wall of every studio reads, “We aspire to inspire.”

I could slap myself with my non-chaturanga arms for not thinking of this idea first. Take something inherently awful like stationary cycling, dress it up with the trappings of a trendy activity like yoga or Pilates, and presto: People are lining up to pay you $32 apiece to sweat in a crowded room for 45 minutes.

Fortunately, I have a business plan of my own. Coming soon: GreenCycle, the ecological indoor cycling studio.

GreenCycle’s stationary bikes will be hooked to a generator that powers the studio’s lights and sound system (which will play whale mating calls and Occupy Wall Street chants). Not only will customers be participating in a carbon-neutral workout, but slacking off will leave them pedaling in the dark. (Note to potential GreenCycle franchisees: The fitter your customers get, the lower your energy bill goes.)

Each bike will feature catch basins that collect clients’ sweat, which will be recycled into organic, mineral-rich energy drinks sold at GreenCycle’s in-house juice bar. Workout towels, made of fair-trade, locally sourced cotton, will be available for a nominal rental fee.

GreenCycle: We put the green in indoor cycling. 

Comment

If you enjoy reading Scott Martin, the eBook Spin Again contains 181 of his witty, sometimes wacky, and occasionally heart-felt observations on road cycling.

Question: I am 40 years old. For the last 3 years I have participated at local races in my age group. I now train 6-10 hours weekly, and my diet is not perfect but not too bad. At my last checkup my blood test results were: cholesterol, 279, HDL, 54 and LDL, 210. My blood pressure was also high. And an echocardiogram showed a "less than 30% diameter stenosis" in one of my carotid arteries. I asked my cardiologist if I could anything to improve the cholesterol and blood pressure issues but he said given my lifestyle, nothing will change even if I turn vegetarian. (Damned genes). So he prescribed me a daily dose of 10mg Olartan (olmesartan medoxomil) and 10mg Crestor (rosuvastatin). My blood test and pressure results were perfect one month after that. Another issue is that I have an unusually high max heart rate for my age, I regularly go over 190.

My questions are:

1. Is it safe for me to push myself like that?

2. If the answer is yes, are those medicines, or my "condition," affecting my performance?  -- Michalis C.

Dr. Richard Ellin Responds: There are several issues in your questions, Michalis. Let me take them one at a time.

First, regarding your cholesterol numbers, there is no question that your total cholesterol of 279 and LDL of 210 are very high. (Optimal total cholesterol is <200, and LDL <130). However, you have a healthy HDL of 54. The relevance of the cholesterol numbers is that it places you at higher risk for cardiovascular disease (plaque buildup and clot formation in the arteries, mainly to the heart muscle and brain).

Just how much this risk is increased is a matter of debate. Certainly, with the added risk factor of hypertension (although of a mild degree, based on the numbers you gave), the concern regarding the high cholesterol numbers is more serious. I presume, by your omission, that you don’t have the other major cardiovascular risk factors (smoking, diabetes, or strong family history).

Many physicians, including myself, use some form of a risk calculator to figure an individual’s specific risk. This helps to stratify people into low risk, intermediate risk, and high risk, rather than just making our own best guess. Perhaps the most commonly used such risk calculator is based on the Framingham study, one of the largest and longest-running studies of cardiovascular disease ever undertaken.

The National Cholesterol Education Program has adopted this 10-Year CVD Risk Calculator as its official method of risk stratification.

Using this calculation tool, your risk of developing cardiovascular disease in the next 10 years is 5%, assuming an average systolic BP of 134, and using the fact that you are already on BP medication. Anything less than 10% is considered low risk. However, with medication to lower both the BP and cholesterol, your risk is much lower. For example, if the Crestor gets your total cholesterol down to 190 (and perhaps it will get it lower), and your BP averages 10 points lower at 124, your risk drops to 1%.

It is important to realize that 5% or 1% are both low risks. The question is really not whether you need medication to lower your risk from 5% to 1%. The question is whether being on medication for cholesterol and BP today lowers your risk when you are 60, 70, or 80 years old. Unfortunately, we don’t know the answer to that, but I think most doctors would say that it likely does lower that risk.

In addition, you have evidence that there is already a plaque in your carotid artery. 30% is insignificant and will cause no symptoms nor increased risk now, but it is a signal that, for whatever reason, your body is laying down plaque in a major artery. Therefore, based on not only your risk factors, but also on the known presence of carotid plaque,  I think your doctor is doing the right thing in recommending that you be on BP and cholesterol medication. Some physicians would also advise you to take an aspirin a day, but that is a topic for another discussion.

That is a very long answer to one aspect of your inquiry, but it is so important for so many people that it’s worth understanding well.Now, let me address the other questions you raised.

Regarding your maximum heart rate, there should be no danger in attaining a heart rate during exercise of 180-190. For training purposes, you don’t need to get it that high, but it’s not an issue if it happens to get that high.

Provided that one has a healthy heart, there is no danger in attaining heart rates in this range, or higher. The risk of attaining higher heart rates is proportional to how healthy the heart is. Only if you have your heart thoroughly checked out by a physician, and it's found to be in excellent health, would attaining a much higher heart rate be safe.

Regarding your medicines, neither should limit your exercise tolerance or endurance. And neither would limit your heart rate. However, Crestor is a statin, and all statins carry a small, but real, risk of causing muscle injury. If you should experience anything more than the usual aches after working out, let your doctor know.

One final note: For those cyclists at any age whose 10-year Framingham risk score is in the intermediate range (10-20%), we sometimes recommend a coronary CT scan, which can help further stratify one’s risk, thereby allowing their physician to make a better judgment about how important risk-reduction is. One can obtain such a scan for about $125 (based on the Atlanta market). Since it is an X-Ray test, it does involve a small amount of radiation but only needs to be done once every several years, at most. Its use is somewhat controversial, but many doctors find the information gleaned from it useful in deciding whether or not one needs medication in order to achieve risk-factor reduction.

Comment

Richard Ellin, MD, FACP, is a board-certified specialist in Internal Medicine who practices in Alpharetta, Georgia. He received his medical degree and completed residency at Emory University, and has been in practice with Kaiser Permanente for 26 years. He is also an avid cyclist.

Health Matters  runs each month in RBR Newsletter. Send us your Health Matters questions by visiting the Newsletters page on our website, and clicking on Health Matters in the right-hand column.

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