Cleveland Clinic Cardiac Specialist Talks About TV Fitness Guru Bob Harper's Heart Attack: Could It Have Been Predicted?

FEBRUARY 28, 2017
Caitlyn Fitzpatrick
primary care, family medicine, internal medicine, cardiology, hospital medicine, heart attack, myocardial infarction, coronary heart disease, Bob Harper, The Biggest Loser, exercise, diet, fitnessEditor’s Note: The news broke on February 27 that 51-year-old Bob Harper, “The Biggest Loser” reality show host and personal trainer, had suffered a heart attack two weeks earlier while working out at a gym in New York City. Harper reportedly was transported to a hospital and was unconscious for two days, spending a total of eight days in the hospital. It’s also been reported that Harper’s mother died of a heart attack a while back. MD Magazine asked Steven Nissen, MD, a cardiologist at Cleveland Clinic in Ohio, for more insight on myocardial infarctions in fit, seemingly healthy people. (His answers were edited for space.)

There have been other cases of athletes, such as marathon runners, who seemed to be in a great shape then had heart attacks. Can these cases ever be predicted?

You can to some extent. The reality is that a heart attack in an athlete is not at all unusual and being physically fit by no means eliminates the risk. There’s risk calculators and they all take various risk factors into consideration and calculate a risk score. The one I use is the Reynolds Risk Score.
In Bob Harper’s case, it’s been reported that he was unconscious for two days following his heart attack – does that give any indication of how severe it was?

A heart attack can cause anoxic brain injury, or total lack of oxygen to the brain. In cardiac arrest, therapeutic hypothermia protects the brain and those people are typically kept unconscious. However, it’s unknown if that was done in Harper’s case.
How do genetics and family history come into play with cardiac arrest?

Family history is a fairly powerful risk factor. One disadvantage with the ACC/AHA guidelines is that they do not include family history as a risk factor—because they were never designed to do so. That’s why I use the Reynolds Risk Score, it includes family history.

Physicians tend to be particularly eager in people with family history to do everything they can to prevent myocardial infarction. With Bob Harper, all of that information isn’t available to the public.
Do healthy men or women have greater risk of spontaneous heart attack?

Sudden death and age-adjusted rate with myocardial infarction is slightly higher in men. Coronary heart disease is the leading death in men and women, but men are more like to have it at any age than women.
Is recovery different for patients who have a heart attack based on their health prior to the event?

With most health conditions, patients are more likely to do better if they were healthy and physically fit before the event. A couch potato who has a heart attack is almost always going to have a longer recovery.

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