Dr Bart Olechowski MD MRCP DM

CAN YOU BE FIT AND STILL HAVE A HEART ATTACK?

Absolutely. Fitness is powerful. But fitness isn’t immunity.

As a cardiologist who loves exercise, one message I regularly emphasise is that being physically fit doesn’t make you immune to coronary artery disease.

We know exercise is one of the most powerful interventions for cardiovascular health. A study of over 122,000 patients published in JAMA Network Open demonstrated a strong association between higher cardiorespiratory fitness and lower long-term mortality (1).

But here’s the interesting paradox.

Research published in Circulation found evidence of coronary atherosclerosis in some highly trained endurance athletes, despite their otherwise favourable cardiovascular risk profiles (2).

More recently, the Master@Heart study, published in the European Heart Journal, found that lifelong male endurance athletes had a greater prevalence of coronary plaques than healthy non-athletes (3).

The significance of the above findings are uncertain and importantly, more plaque does not necessarily mean more heart attacks, and these observational findings do not establish that endurance exercise causes cardiovascular events.

So what’s the takeaway?

You can run marathons, have an impressive VO₂ max and look exceptionally healthy, yet still have elevated LDL cholesterol, high blood pressure, raised lipoprotein(a) or underlying coronary disease.

My advice?

1. Keep exercising — the cardiovascular benefits are overwhelming.

2. Know your blood pressure and cholesterol.

3. Consider checking lipoprotein(a) at least once in adulthood.

4. Understand your family history of premature heart disease.

5. Never ignore exertional chest discomfort or unexplained breathlessness.

The goal isn’t simply to perform well today. It’s to protect your heart for decades to come.

Have you ever thought about your cardiovascular risk factors despite feeling fit and healthy?