Twelve minutes. That's how Matias Escobar lay on the ground without a pulse while lifeguards performed CPR on him after his heart stopped last October. Moments earlier, this healthy 38-year-old man had collapsed from a heart attack while running the final leg of the New York City Triathlon.
Escobar suffered a heart attack with a completely blocked coronary artery (STEMI), considered the most lethal of heart attacks. “He is called the widow maker. They told me that less than 2% of people survive,” Escobar told the program in an exclusive interview that aired on May 30.
Against the odds, Escobar survived and after spending several days in the hospital, and having a splint inserted into his coronary artery, he made a dramatic recovery. But this near-fatal heart attack left the healthy triathlete and his doctors wondering what happened and what signs they may have missed.
Escobar has been running for over two decades and has competed in many triathlons and Ironman races. When he suffered the heart attack in 2023, he described himself as the epitome of health. He had a healthy diet, felt no stress or anxiety, did not smoke, and rarely drank alcohol. A checkup before the competition indicated that he had normal blood pressure and cholesterol levels.
In fact, Escobar had no obvious risk factors. His heart attack was unexpected and inexplicable.
More young people suffer heart attacks with fewer warning signs
Doctors say Escobar is part of a growing trend of young, apparently healthy adults suffering sudden cardiac events.
“In general, 10 to 20% of people who come with heart attacks do not have obvious, traditional risk factors,” explained Dr. Deepak Bhatt, director of Mount Sinai Fuster Heart Hospital.
Conventional risk factors for a heart attack include high blood pressure, high blood sugar or diabetes, high cholesterol, being overweight or obese and smoking, Bhatt said. These factors lead to 80% of heart attacks, she added.
Although research shows that there are increasingly more patients with heart attacks who are young, healthy adults, who did not present these risks.
Now, Bhatt and a group of doctors at Mount Sinai are tracking patients like Escobar to find out if there are other risk factors they're not noticing or different ways of thinking about heart attacks.
“There are definitely more young people arriving with heart attacks, there is data to support this. What is causing them is more controversial,” Bhatt explained.
One possible explanation is that these risk factors are not being identified in young patients; for example, someone who is healthy and young is not going to routinely check their cholesterol or blood pressure.
Another reason is that doctors may not be considering behaviors or qualities that may increase the risk of heart attacks because they are not typically considered risk factors, Bhatt said.
These include smoking marijuana, using cocaine, and having a larger waist circumference. “It probably has to do with the obesity epidemic, but, I hate to say it, there's also more substance abuse these days,” Bhatt said.
Another potential clue is inflammation, which appears to be a common denominator, in these young patients.
“What causes most heart attacks is plaque in the artery, and inflammation can cause the plaque to act and rupture, causing a blood clot that, if large enough, will block the artery,” Bhatt explained.
“Inflammation can be a good thing if you have an infection, you want to have a fever and have the inflammation clear the infection,” he continued. “I'm talking about lower inflammation, which seems to predispose to heart attack and stroke risk. There are indicators to see it.”
Look for clues in a patient's history
At the hospital, Escobar's doctors dug deeper to find out what they might have missed and “to understand why a young man like him, so healthy and athletic, could arrive in such serious condition,” said Dr. Serdar Farhan, an interventional cardiologist. at Mount Sinai Hospital and Escobar doctor.
Escobar not only had a heart attack but suffered the most lethal one. A STEMI causes a complete blockage of the main artery that supplies oxygenated blood to the heart muscle, according to the Cleveland Clinic. “This (artery) supplies about 60 to 70%. That is why he is called the widow maker,” Farhan said.
Escobar described it as “immediate, you don't have any kind of warning (like) 'oh, my arm is starting to hurt, I have chest pain, or I feel dizzy,' it's just sudden. “It is a sudden death.”
Upon further investigation, doctors found that Escobar had signs of inflammation, including high levels of C-reactive protein, which is secreted by the liver in response to infections or inflammation. However, it is not clear whether this marker was elevated before his heart attack or for how long. It could have increased later, something that happens in many patients, Farhan explained.
It's not entirely clear what causes inflammation in healthy patients like Escobar. Doctors also found that the triathlete had elevated cholesterol levels when he was young.
“At that time the cardiologist did not define it as a risk. It was a point in the data that he should lower, but I was not diagnosed with anything,” Escobar said, adding that he was able to lower his cholesterol naturally with diet and when the heart attack occurred his levels were normal.
“Was it a risk? It matters what your cholesterol is today, of course, but also how long it was high before and how high, that determines how much plaque (you have) even if it's been very well controlled,” Bhatt said.
High cholesterol can cause fatty deposits to build up in blood vessels that can rupture and cause a clot, leading to a heart attack, according to the Mayo Clinic.
“(They told me) what happens to athletes, if (you have) cholesterol in your veins, it doesn't matter how healthy you are,” Escobar said.
Reduce the risk of heart attack in young people
Experts insist that it is important for doctors and patients to be aware of potential risk factors for heart attacks and to have routine checkups.
“I think that's the most important message: know what the risk factors are and know your numbers. Everyone should know (how far away) their blood sugar, blood pressure, waist circumference and bad cholesterol are. Those are vital key signs,” Bhatt said.
People can reduce their risk of heart disease by eating a healthy diet full of fresh fruits and vegetables, grains, and limiting red meat. Also exercise for at least 30 minutes a day, get enough sleep, and manage stress, Bhatt emphasized.
The Mount Sinai team of researchers is currently working on a project to investigate trends in younger patients, as doctors become more aware of cases like Escobar's and gather more information. They hope to have a better understanding of what are considered “risk factors” to save more young lives.
Today, Escobar is recovering. This husband and father of a 2-year-old child maintains a vegan diet and remains active. From there he is already preparing for the New York Triathlon.
“I thought a lot about it. Initially I didn't want to do the same race that basically killed me, but I think I should,” Escobar said, adding that he won't let fear stop him.
