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Child measuring his height

The Short End of the Stick

By Eric Van De Graaff, MD June 14, 2010 Posted in: Heart Health

Just when you thought it couldn’t get any worse.  As if it weren’t bad enough already that you spent your school years being picked dead last for basketball teams and that you always had to crane your neck upward to look into the eyes of your prom dance partner, or that you had to put up with that diabolically catchy Short People song getting stuck in your head, the world now comes along and deals one more injustice to those of you who of challenged vertical stature.  Just last week the Associated Press reported the findings of a study out of Finland that allegedly demonstrates a 50% higher risk of death from heart disease among short people as compared to their lengthier counterparts.

That’s right: not only are you short, but you’re short and doomed.

The researchers reviewed and pooled the findings of 52 previous demographic studies and were able to show that persons under 5’3” are one-and-a-half times more likely to keel over from a heart attack than those over 5’9”.  It wasn’t a bit reassuring that the authors of the study had absolutely no explanation for why diminutive people tend to have hearts with limited warranties.  The best they could do was to smugly remind short people to go out and engage in some form of (presumably non-basketball) exercise.

Tuula Paajanen, the study's lead author, of Tempere University Hospital in Finland, said short people shouldn't be alarmed about the findings.

"Height is only one factor (among many) that may contribute to heart disease risk," she said. Paajanen recommended people focus on other things like not smoking, eating a balanced diet and exercise. "Those are easier to change than your height."

Another European expert (not associated with the study) provided similarly helpful advice:

"We don't want to scare short people, but perhaps they should be extra cautious about their lifestyle," said Borge Nordestgaard, a professor of genetic epidemiology at the University of Copenhagen.

Those among you who will never hope to have a clear view at a movie theater or change a light bulb without a stool have already suffered enough injustice.  You’ve been told that tall people are happier, wealthier, more popular, and are even more likely to win an Academy Award.  Now, to make matters worse, the tall crowd doesn’t have to watch their diet or exercise as much as you do in order to stave off a visit the cardiac ward.

What’s the link between stature and risk of cardiac death?  I don’t know, but here are a few possibilities:

    • In the history of humankind, height among various populations has been an indicator of nutrition.  We’re taller these days than were our ancestors of the Victorian age, mainly because we do a better job of getting three square meals a day and eating our leafy greens.  Good nutrition generally means a better chance of survival.  But does this really apply to our present world where my shorter friends have the same access to Whole Foods that I have?
    • Perhaps evolution has played a part.  Tall cavemen enjoyed a diet of apples, peaches, and other healthy foods that come suspended in the treetops, while their more compact counterparts had to subsist on starchy subterranean tubers and the atherogenic red meat of a downed mammoth.
    • Do tall people give their hearts a better daily workout by simply standing up?  The heart of a Yao Ming has to work harder to circulate blood the full length of his 7’6” towering frame than does the heart of a Hervé Villechaize (who, despite his diminutive stature, seemed to be the only one on the island capable of reliably spotting the plane).


    • What if it has more to do with the care the patient receives after he has his heart attack?  A tall person clutching his chest and collapsing in a crowd is more likely to attract the attention of a CPR-trained bystander than is a tiny person.


A more plausible scenario is that this whole line of logic is flawed.  The science of statistics can be easily twisted into a world of smoke and mirrors.  Retrospective analysis of the sort described above can come up with some pretty murky findings and if you spin the data just right you can pull almost anything you want out of a large enough data pool.  If you creatively churn the numbers in any sizable database you’ll find that persons with the last name starting with the letter V are more likely to die of food poisoning, karaoke mishaps, leprosy, accidents involving livestock, toenail fungus, infected paper cuts, or errant golf ball shots.  Does that mean anything?

Another possibility is that short people indeed have more heart disease, but that the reasons for this are so multifactorial as to render the relationship entirely unhelpful.  Can we truly cut the risk of cardiac death among smaller people by simply making them run more and eat less?  Perhaps the relationship resides entirely elsewhere and following the recommendation of more vigorous diet and exercise would have no more impact in this population than in any other.

Besides, in the end it all equals out anyway.  Taller people are more likely to die from breast and prostate cancer, injuries, and endocrine abnormalities.  Short people tend to survive periods of hardship better than taller individuals.  And, of course, don’t forget the whole issue of lightning strikes.

So, short people everywhere: while you may still harbor resentment about sitting the bench during basketball games, don’t lose too much sleep about this supposed predestined failure of your cardiovascular system.  After all, you know what lack of sleep will do to your heart.

Eric Van De Graaff, MD
Eric Van De Graaff, MD

Eric Van De Graaff, MD is a Heart & Vascular Specialist at CHI Health Clinic.

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