Pistol Pete Maravich may have possessed the highest scoring average in the history of college basketball, but his fatal heart attack after a pickup game at a Pasadena church was a classic case of death far more common in young American men than most people would like to believe, doctors say.
Preliminary autopsy results, released Wednesday afternoon, indicate that Maravich succumbed to a kind of early, apparently undetected, blockage of the arteries supplying blood to his heart, a common syndrome that increases eight-fold as a cause of death in men after they turn 35.
A Clean-Living Vegetarian
Maravich, the former Atlanta Hawks, New Orleans and Utah Jazz and Boston Celtics superstar who was said to be a nonsmoker, nondrinker, clean-living vegetarian, was 40 when he died Tuesday.
While sudden death among celebrity athletes like Maravich and runner Jim Fixx, who collapsed and died while jogging in 1984, attract national attention, cardiology experts agree such cases are far from rare. Rather, they are high-profile examples of a type of death that is as unsettlingly common as it is sudden and unexpected.
"My patients this morning were all asking me, 'What's going on?' " said Dr. Paul Thompson, a Brown University expert on sudden-death heart attacks, in a Wednesday telephone interview. "And I told them that I liken what happened to Maravich to being in the stock market.
"We believe exercise reduces the risk of (heart disease). We also think the stock market makes you money, but when you're putting your money down, you're taking a risk. You also take a risk while you're exercising.
"If you have only one hour to spend alive, you should go to bed, but if you have a lifetime of one hours, you don't want to spend it physically inactive. You buy stock because you accept the risk because you are looking for long-term gain. The same thing is true of exercise. You're looking for longevity."
Turning Point at 35
In fact, American Heart Assn. statistics indicate that age 35--not later demarcations like 50 or 65--may be the most telling turning point in increased risk of sudden heart attack deaths among American men.
In 1985, the last full year for which figures are available, men between 25 and 34 had suffered the most common type of catastrophic heart attack--myocardial infarction--at a rate of 2.9 seizures for every 100,000 men. But for men 35 to 44, the rate jumped to 23.9 per 100,000.
Nationwide, in 1985, only 618 men between 25 and 34 died of such heart attacks, while the death toll for those in the next decade of life increased to 3,738. Heart attacks in women in the same age brackets are rare. For recreational athletes 40 and older, said Dr. Jere Mitchell of the University of Texas Southwestern Medical Center in Dallas, this reality makes it all the more important to warm up carefully before exercise and to unfailingly engage in "warm-down" behavior after, in which loads on the heart are gradually--not suddenly--reduced.
"If you start suddenly, you can have an arrhythmia and if you suddenly stand still and stop, your heart vessels are still very dilated and you can have a drop in your blood pressure," said Mitchell, a former chairman of the heart association's task force on exercise and heart disease. "If you have any obstruction in your coronary arteries, that is when you can have a (catastrophic alteration in the heartbeat pattern and) sudden-death event."
While being in good physical condition and maintaining a regular exercise program continue to be seen as clear-cut advantages in preventing heart problems, medical experts emphasize that coronary artery disease and its often sudden, fatal consequences can occur in active and former world-class athletes as easily as in ordinary people. For people Maravich's age, sudden death is the most common first sign of heart disease.
"We know that professional sports certainly does not immunize a person from coronary artery disease," said Dr. Ronald McKenzie of Centinela Hospital in Inglewood. "There are risk factors that professional athletes share with the general population. One of them is simply being male."
Maravich had been resting at court side when the four-on-four pickup game stopped, according to Jim Dobson, another player.
'I Feel Great'
"I asked how he was feeling," Dobson said, "He said, 'I feel great.' He turned around, took one step and he fell and hit the ground hard and never moved. It was like the sound of flesh against a hard floor."
As Maravich may have done, potential victims often deny, even to themselves, that warning signs are anything to worry about. Those signals could lead to the early diagnosis of a problem.