Early vascular disease of Olympian Paavo Nurmi despite a healthy lifestyle | European Heart Journal

Lifelong exercise, non-smoking, and a healthy diet form the strong and evidence-based corner stone of cardiovascular disease prevention. Yet, atherosclerosis can exist despite an extremely healthy lifestyle, robust appearance, and lack of symptoms; the heterogeneity of cardiovascular disease is often forgotten. Therefore, the life of distance runner Paavo Nurmi, who won five gold medals at the previous Summer Olympic Games in Paris in 1924, illustrates that conventional risk factors do not tell the whole story of cardiovascular risk.

Athletes and vascular disease

Press and social media often spark discussions about cardiovascular disease risks, prompting questions such as whether a healthy diet and activities like going to the gym or jogging might offer better prevention against heart attack or stroke compared with drug treatment. Even in secondary prevention, where combining medications with lifestyle is vital, it can be difficult to persuade patients to adhere to the advice that a healthy lifestyle and preventive medication are complementary, not alternative approaches to prevent heart attack and stroke.

The dramatic collapse of Christian Eriksen in the middle of a UEFA Euro 2021 soccer match made many people wonder how a top athlete can have a heart attack. Shouldn’t it be efficiently prevented by regular exercise? Moreover, a recent study published in this Journal, focusing on middle-aged adults, revealed that lifelong participation in endurance sports does not necessary provide protection against coronary plaques.¹

Hero of the Paris Olympic Games in 1924

These superficially unexpected observations—and also the Olympic Games again in Paris—reminded us of the medical history of distance runner Paavo Nurmi (1897–1973),^2,3 who in 1996 was selected as the greatest Olympian athlete ever by TIME magazine and in 2012 was named among the first 12 athletes to enter the IAAF Hall of Fame (International Association of Athletics Federations; since 2019, World Athletics). In 1925 alone, the New York Times published over 70 articles about him.

Nurmi’s Olympic journey began in 1920 at the Antwerp Summer Olympic Games, where he won gold in the 10 000 m run and cross-country and silver in the 5000 m run. He dominated the scene further with simultaneous world records in the mile, 5000 and 10 000 m runs, a feat unmatched since. His Olympic success continued in Paris in 1924 and Amsterdam in 1928, culminating in a total of nine golds and three silvers, a record unbroken until swimmer Michael Phelps in 2008. Nurmi with his flowing running style was well known in Europe and even became a household name in the USA during the 1920s,⁴ with epithets such as ‘The Flying Finn’, ‘The Phantom Finn’, and ‘The Finnish Running Marvel’. After his athletic career, Nurmi became a highly successful businessman and real estate contractor, and he also coached runners.

Healthy lifestyle of Paavo Nurmi

From the medical viewpoint and the current emphasis on a healthy lifestyle, Paavo Nurmi is exceptional. As seen in his bronze statue (Figure 1, created by sculptor Wäinö Aaltonen in 1925 and depicting him running in front of the Olympic Stadium in Helsinki), he was lean and, of course, exercised a lot. Moreover, he was a lifelong non-smoker and leaned towards a ‘vegetarian’ dietary pattern. The business world can be stressful, but Nurmi was self-confident and not easily shaken by challenges. He has been quoted as saying ‘All that I am, I am because of my mind’. The genetics and familial history of Nurmi concerning cardiovascular disease is obscure, but he nevertheless originated from Western Finland, which, according to Keys’ Seven Countries Study, had lower prevalence of cardiovascular disease than Eastern Finland.⁵

Nevertheless, early vascular disease

Despite all these genetic and cardiometabolically low-risk characteristics, Paavo Nurmi experienced his first myocardial infarction at age 61 years.6 He recovered promptly and returned to business, but 10 years later, he had a stroke which left a permanent handicap and tremor in his left arm. His heart disease progressed despite the best contemporary medical care, and after a respiratory infection in the autumn of 1973, he died at the age of 76.

Besides his height (174 cm), weight (65 kg), and consequent healthy body mass index of 21.5 kg/m², exact numerical data on Nurmi’s clinical and possible genetic risk factors are unfortunately not available. Yet, his cholesterol and blood pressure have been stated to be ‘normal’. Of note, in the 1960s, plasma cholesterol level below 7.0 mmol/L (270 mg/dL) and blood pressure below 160/95 mmHg were considered to be within normal limits in Finland. So, according to current definitions, Nurmi might have been hypercholesterolemic and have hypertension, corresponding to his age peers having cardiovascular disease in the Helsinki Businessmen Study cohort⁷ and in business life possibly predisposed to second-hand smoking. Furthermore, the ‘vegetarian’ diet may not have excluded high-fat dairy products or high natrium intake.

Personalized medicine needed

The take home message of the life of Paavo Nurmi is that in primary prevention of cardiovascular diseases, a healthy lifestyle resulting in a robust appearance is not always enough. Cardiovascular disease is heterogeneous, and conventional risk factors are not the whole story. Risk assessment must be personalized, and risk modifiers, e.g. inflammation markers, lipoprotein(a), and coronary artery calcium scoring, may better reveal risk and existence of subclinical disease.⁸ Furthermore, physicians and health professionals must effectively communicate to patients that adopting a healthy lifestyle and preventive medication are not mutually exclusive options but rather complementary strategies.^8,9 However, even with existing genetic risk healthy lifestyle is still important and beneficial.¹⁰

PS. While battling illness in 1968, and despite harbouring strong criticism towards the medical field, Paavo Nurmi founded a foundation aimed at funding research into cardiovascular diseases. His initial contribution was significant: two townhouses and one million Finnish marks. Consequently, Nurmi’s legacy helps to battle cardiovascular diseases to this day.

Declarations

Disclosure of Interest

T.E.S. has had various cooperations with companies (incl. Amarin, Amgen, Novartis, Orion Pharma, and Sankyo) marketing cardiovascular drugs. P.T.K. has had various cooperations with pharmaceutical companies (Amgen, Amarin, Raisio Group, Roche, and Sanofi) marketing dyslipidaemia drugs. M.K. declares no conflict of interest.

References

Published by Oxford University Press on behalf of the European Society of Cardiology 2024.