Runner Down

George Spears used to tell his kids that the human heart has only so many “ticks” and when it’s used them all—well, to apply a metaphor the avid marathoner might have approved— its owner’s race is over. By that reckoning, Spears approached his own mortal limit at about nine o’clock on Sunday morning, October 1, during last fall’s Twin Cities Marathon. He had passed the six-mile mark on the south side of Lake Calhoun when, according to witnesses, he faltered and fell forward on his face. He was treated at the scene and rushed to Hennepin County Medical Center, where he was pronounced dead.

The Twin Cities Marathon involves more than 8,500 runners, 5,000 staff members and volunteers, and 250,000 spectators and follows a famously scenic, serpentine course that begins at the Metrodome in downtown Minneapolis and concludes 26.2 miles later below the Saint Paul Cathedral on the edge of downtown St. Paul. Given the dimensions of the annual event, not to mention the level of concentration of serious runners, it’s not surprising that Bradley Huckle had no idea that Spears had gone down on that sunny autumn morning. Huckle didn’t know about his own heart attack until the next day, when he woke up in the intensive care unit at Regions Hospital with virtually no knowledge of anything that had transpired during the previous thirty-six hours.

Spears and Huckle didn’t know each other, though they had run in some of the same events prior to last year’s TCM. Spears was an inner-city social worker with a wife, seven children, eight foster children, and several grandchildren. Huckle was the president of a $200 million suburban bank, divorced, and a single father of an eleven-year-old boy. All things considered, the two men had little in common except their middle age (Spears was forty-nine, Huckle forty-seven), a deep-seated passion for running long distances, and—presumably—the sturdy, healthy hearts they needed to take their bodies to the borders of endurance.

But Spears and Huckle would unwittingly figure in a flurry of local news stories that sent a chill through Twin Citians of a certain age. Even those who couldn’t care less about marathons took notice. The question abruptly and uncomfortably on many minds was the obvious one: How could two comparatively young, reportedly experienced, fit, and rigorously prepared runners suffer a heart attack while participating in their chosen sport? Aren’t heart attacks what happen to persons who are not so young, fit, or well-prepared when they exert themselves?

So why did their heart attacks—in medical terms, myocardial infarctions—happen? Were there warnings? And, maybe more to the point for most of us, what do those MIs say about the threat to others in the prime heart attack years—forty to sixty for men, sixty and up for women—even, or especially, those who eat righteously, exercise religiously, and visit their doctors regularly?

A marathon is not for the faint of heart, nor the flabby or infirm, much less the obese and hypertensive. Showcases of physical fitness and mental steel, hundreds of marathons around the country challenge the world’s best competitive distance runners to cover the standard 26.2 miles in under three hours. (Mbarak Hussein and Marla Runyan won last year’s Twin Cities event with times of two hours and fourteen minutes and two hours and thirty-two minutes, respectively.) For most participants, finishing the course in less than four hours would be a significant achievement, requiring discipline, focus, and countless hours of preparation,  Still, though grueling in the extreme, marathons—in part because they’re run by marathoners, a self-selected cohort of  people in peak condition—have rarely been fatal.

William Roberts is a St. Paul–based physician who specializes in family and sports medicine. Not a marathoner himself, he’s worked with the Twin Cities Marathon since its inception in 1982 and has been its medical director since 1985. Roberts recalls that thirty years ago, during the early years of the modern popularity of the sport, some expert was loudly quoted as saying that no one who trained for and competed in a marathon could possibly have a heart attack. “That’s since been disproven,” Roberts says with a wry smile. Just not, historically, very often.

Roberts and Barry Maron, a  Minneapolis doctor, have collected records from the TCM and the annual Marine Corps Marathon in Washington, DC, dating back three decades. Among almost 442,000 finishers between 1976 (the Marine Corps event’s first year) and 2004, there were a total of nine heart attacks, five of them fatal. That breaks down, at least in these two annual races combined, to a decidedly undaunting rate of 1.1 fatalities per 100,000. What’s more, the ratio of fatalities to total heart attacks has decreased over the past ten years, an improvement Roberts, Maron, and others attribute to the increased presence of medical personnel and automatic external defibrillators that nowadays are as visible along race routes as cheering loved ones and water stops.

For several years, there were no reports of heart attack deaths during American marathons. Then, for a reason or reasons that no one seems able to explain, 2006 proved to be a weirdly lethal year, at least by marathon standards. In 300-plus U.S. events, seven racers died: two in Los Angeles, one each in Chicago, San Francisco, Washington, DC, and Tucson, and one—George Spears—in the Twin Cities. Finally, in early December, The New York Times made marathon MIs an official national concern with a long story under the bannered question: Is Marathoning Too Much of a Good Thing for Your Heart? Pointing out that marathon fields have grown by 80,000 runners during the past six years, the Times quoted the Marine event director saying that, “statistically, maybe, it was inevitable.” But the paper also cited a pair of fresh and extensive studies—one from Boston, the other from Duisburg/Essen in Germany—that suggest that runners’ coronary artery systems in “some baffling way” may be damaged during the long runs. While no one was advocating that distance runners hang up their Asics, the scientists were at least raising some disconcerting questions.

Inevitably, the unsettling news brought forth the iconic ghost of Jim Fixx, the most famous marathon fatality since Pheidippides—who dropped dead after running twenty-two miles with news of the Athenian victory at Marathon in 490 BC. Fixx, even nonmarathoners remember, was the guy who literally wrote the book on the manifold benefits of running and died practicing what he preached, while running alone along a Vermont country road, in 1984, at the age of fifty-two. When Fixx died, every couch potato in America raised his Bud and said, “I told you so,” while hard bodies who had followed Fixx’s lead felt a shiver of confusion and doubt.

What many people overlooked was that Fixx was running from heart disease. His father had died of a heart attack at the age of forty-three, and Jim himself had been fifty pounds overweight and a two-pack-a-day smoker when he started running at thirty-five. Thus the pertinent question was not  “Did running kill Jim Fixx?” It was “Would Jim Fixx be alive today if he had simply embraced his genetic inheritance and bad habits and not started the obsessive running—or did he live as long and as well as he did (nine healthy years longer than his father) because he staved off his fate by running?”

On October 1, closer to home, the collapse of two like-minded strangers struck the same fears, raised the same issues, and reminded the rest of us that what we don’t know about our hearts, which is plenty, could kill us.