I was discussing James Gandolfini’s death with a friend. She says that Gandolfini is reputed to have eaten a very unhealthy meal consisting of fried food and foie gras a few hours before his fatal heart attack. She says something similar happened to a family member of hers – an older gentleman had foie gras and had a (mild) heart attack a few hours later.
My friend is very bright but has trouble understanding that you cannot necessarily generalize from two incidents. She believes that eating fatty foods like foie gras can trigger immediate heart attacks. Any truth to her claim?
Many people eat fatty foods; few have heart attacks. Also, do we know when Gandolffini died? Was it immediately after he had his last meal? He was also obese and likely had other risk factors.
My understanding is that a large fat intake (from a single meal) does immediately affect the concentration of fatty acids in the blood. This can put temporary additional pressure on the heart, and could potentially contribute to a heart attack where underlying problems exist.
Yes, eating a heavy meal, especially one high in fat, increases the risk of a heart attack by up to 4 times for several hours after eating. Something to think about next Thanksgiving.
Possible, but as your first cite states, some of the most potent stressors to the heart (i.e. heart rate increase, adrenalin levels) are even more pronounced after a high carbohydrate meal. So, maybe it’s not the fat content of the meal so much as its size.
In some sense, yes. Remember, too, that people who have a history of eating large high-fat meals may be among the most predisposed. If so, then it’s not too unlikely that when they finally do have their heart attack, they will have recently eaten such a large, high-fat meal.
Out of curiosity, why do you consider an increase in heart rate and catecholamines more of a problem than the prothrombotic response and inhibition of vascular reactivity that are specific to high fat meals? My WAG would be the opposite, that the clot, the dysfunction of the endothelium, and the lack of coronary artery relaxation are much more significant proximate factors than a slightly greater heart rate and BP. Hypercoaguability, provasocontriction, and platelet activation by enothelial dysfunction seem like bigger deals as triggers for an acute event to me than does getting heart rate up a bit. But that is just a WAG.
In any case, yes, the op’s friend’s sense of it is correct. In those who are at risk for a fatal cardiac event (a group that might be habitually eating large meals with lots of fat and refined carbs) eating a large meal consisting of lots of fat and refined carbs could be a trigger for an acute coronary event. It stresses the heart, increases the risk of plaques rupturing, increases the risk of a larger clot forming bith by its effects on clotting factors and on the platelets, decreases the chance of the coronary vessels relaxing enough to keep enough blood flow going, and a host of other factors that add up to an aute event in an at-risk individual.
A medical person told me recently if you took the blood of somebody some optimum time X after supper bad meal Y, you could actually SEE the difference in the blood. Something along the lines of Paula Dean had dropped by and put some butter in there.
Because heart rate and contractile state (the latter a function of catecholamines, in large part) are the major determinants of myocardial oxygen consumption.
ETA: Plus catechols also induce a prothrombotic state as well as causing vasospasm.
For those who are interested, this classic paper by Don Zilversmit from 1979 and cited over 1400 times since, puts forth and summarizes the argument for a concept complementary to that of this thread, i.e. the idea that your blood vessels may be being damaged each time you eat, and that the more fat there is in a meal, the more damage may be done to your vessels after consuming it.
Phrased somewhat more precisely, he was making the case that the process of atherosclerosis is augmented and promoted after a meal (“post prandially”). On the other hand, the OP is about one of the major *consequences *of atherosclerosis, heart attacks.
Basically, it introduced a new paradigm - that the chronic disease called atherosclerosis may actually occur acutely, by small steps, several times per day (or at least may be accelerated acutely several times a day). D’ya follow?
Yes, thank you for the links. I admit I am a bit surprised. I had always thought that occasional pigging out on fatty food was pretty much harmless; that the danger was from doing it frequently and regularly for years.
Yes, hopefully the study authors did a statistical analysis to rule out this possibility. And of course there is always the problem of self-reporting. I would think a lot of people don’t want to admit to themselves or others that they pig out on fried food a few times a week.
If he had indeed recently done cocaine, then yes. The factors include: the presence of atheroscerotic plaques (and what type they are) - that’s the slowly progressive bit; the demands on the heart - the heart rate and contractile function that Karl alludes to - which would be impact by a big meal, especially one high in refined carbs, and by cocaine; and factors that cause the plaque to rupture (beyond the nature of the plaque) at that time and a clot to form at that point at that time - most impacted by those hypercoaguable, platelet activation, and endothelial dysfunction factors.