8/26/2026
I have been sharing my thoughts on Eric Topol's Super Agers: An Evidence-Based Approach to Longevity since August 14. Before I move on from this book, I want to mention something from Chapter 5, Cardiovascular Disease, that is very relevant.
A few days ago, I read about the widely discussed death of Chen Mao (陈毛), a 57-year-old amateur marathon runner from Dazhou, Sichuan, China.
According to reports, Chen died in his sleep on the morning of August 14, 2026, reportedly from acute myocardial infarction. (凤凰网)
What makes his story so shocking is how an exceptionally fit person suddenly died.
Chen began systematic long-distance running at age 50. Over the following seven years, he accumulated more than 30,000 kilometers of running and earned nearly 100 race medals. His best times were an impressive 2:55 for the full marathon and 1:21 for the half marathon. He also did strength training and was known for his muscular physique, disciplined lifestyle, and reportedly low resting heart rate of around 44 beats per minute. Reports also say he did not smoke or drink. (凤凰网)
As recently as August 13, the day before his death, he was still discussing training and race plans with other runners online. (Sohu)
Why has his death attracted so much attention?
Because it challenges an assumption many of us carry:
If someone looks extremely fit, performs at a high athletic level, and lives a disciplined lifestyle, surely his heart and arteries must be healthy.
But those are not necessarily the same thing.
1. A strong body does not necessarily mean healthy coronary arteries
Chen's muscular physique and exceptional running ability tell us a great deal about his physical conditioning. They do not, by themselves, tell us whether he had coronary atherosclerosis.
This is precisely what struck me when I looked at the coronary atherosclerosis data I wrote about yesterday.
Atherosclerosis can begin surprisingly early in life and progress silently for decades. A person can be physically fit and have no obvious symptoms while plaque is developing inside the coronary arteries.
That is an uncomfortable distinction:
The muscles we can see are not the same as the arteries we cannot see.
2. Excellent endurance does not make someone immune to cardiovascular disease
Exercise is one of the most powerful tools we have for healthy aging. Nothing about Chen Mao's story should be interpreted as an argument against exercise.
Quite the opposite.
But excellent athletic performance should not be mistaken for a shield against cardiovascular disease.
A low resting heart rate, strong muscles, fast marathon times and impressive endurance are all signs of physical conditioning. They do not completely eliminate other cardiovascular risk factors, including age, LDL cholesterol, blood pressure, diabetes, smoking history, family history and other factors.
This distinction becomes increasingly important as we get older.
3. Atherosclerosis can remain silent
One of the frightening characteristics of coronary atherosclerosis is that it may develop without any symptoms.
A person can feel completely normal while plaque is silently accumulating inside the arteries.
A heart attack does not necessarily mean that the disease suddenly appeared that day. In many cases, the underlying process may have been developing for years.
When an unstable atherosclerotic plaque ruptures, a blood clot can form at the site and suddenly obstruct blood flow to the heart muscle, producing an acute myocardial infarction. That is one possible mechanism behind a sudden heart attack.
Exercise is generally protective of cardiovascular health. But exercise is not a guarantee against cardiovascular disease.
4. The real lesson for us
What I take from Chen Mao's story is:
Don't confuse fitness with immunity.
Exercise that we should! But as we get older, especially if we undertake vigorous endurance training, we should also pay attention to cardiovascular risk factors and appropriate medical evaluation.
Know your blood pressure, your blood sugar, your family history, your risk, your cholesterol—and, when appropriate, your ApoB or other cardiac markers that your doctor recommends. Pay attention to symptoms.
And if you are planning intensive endurance training, particularly in middle age or later, discuss your cardiovascular risk and what screening is appropriate with your doctor rather than assuming that excellent fitness makes testing unnecessary.
Yesterday I wrote about coronary atherosclerosis in young people. The heart attack like Chen's may happen at 57, but the underlying disease process may have started decades earlier.
The most important lesson I take from Chen Mao's tragic story:
Don't be blinded by athletic performance, a low resting heart rate, or a lean and muscular physique. They may be signs of "fitness"—but they are not necessarily healthy coronary arteries.
And the broader lesson from Super Agers is even more important:
Healthy aging is not just looking healthy. It is preserving health at every level—especially the parts of our bodies that we cannot see.
