You Can’t Outrun Your Genes

By John Marsh, Editor & Publisher

“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.”

Update: Four years on since writing this, let me give you a quick update as of early 2016. The season after I first started taking a statin, I set all my still-current PRs for the “benchmark” rides I’ve done many times, the Rome (Georgia) century (flat to rolling) and Six Gap, a mountain century that includes 11,000 feet of climbing. And as of my last annual physical, last June, my total cholesterol was 125, and my LDL was 62; both of those are as low as I can ever remember.

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John Marsh is the editor and publisher of RBR Newsletter and RoadBikeRider.com. A rider of “less than podium” talent, he sees himself as RBR’s Ringmaster, guiding the real talent (RBR’s great coaches, contributors and authors) in bringing our readers consistently useful, informative, entertaining info that helps make them better road cyclists. That’s what we’re all about here—always have been, always will be. Click to read John’s full bio.