6 lessons from an Ironman athlete with a family history of heart disease

Robert “Skip” Culler is living proof that you can be athletic, incredibly fit and still at serious risk of devastating heart disease. As is often the case, family history can be key.

Culler’s mom had a stroke at 53. And when his dad had open-heart surgery at 54, Culler, then 35, considered that a wake-up call. He scheduled an appointment with Dr. Zan Tyson, the Novant Health Heart & Vascular Institute - High Point cardiologist who’d been caring for his folks. ​(His full name is Archie Tyson, Jr.; that’s how he’s listed in Novant Health’s directory.)

Now 54, Culler has been going to his heart doctor every few years ever since. When he hit 50, he began seeing Tyson annually. It’s fortunate for him and his family (wife, Nicole, and three children) that he’s been proactive about his heart health. A CT scan late in 2023 revealed a serious blockage.

Here are 6 heart-health takeaways from Culler’s experience.

1. Know your family's heart history. ​

“We grew up hearing about people in my family who’d had heart disease,” Culler said. “It goes all the way back to my great-grandfather. My grandfather, who I was very close to, was 68 when he had his first heart attack.”

Culler – a former competitive swimmer who’d always enjoyed skiing and snowboarding – knew exercising, eating right and not smoking were just part of the equation. So, he established a relationship with Tyson before any sign of trouble.

“Being fit doesn’t reverse your genetic history,” Tyson said. In the back of his mind: Jim Fixx, who wrote “The Complete Book of Running” died at 52 from a heart attack while out for his daily run. An autopsy revealed atherosclerosis blocking three coronary arteries.

2. Be proactive with your heart health.

Culler saw his parents’ cardiologist as a preemptive measure.

“I wanted to start a conversation,” he said. “We got a baseline of my heart health. Dr. Tyson said everything looked good and that I could wait another five years before returning. Every five years, I’d go back, get checked, have labs done. Because we were tracking my numbers, Dr. Tyson could see that my good cholesterol – while still a good number – was getting worse.”

Eventually, Tyson recommended medication to help control Culler’s cholesterol. “I don’t like taking meds,” Culler said. “But if it helps my heart, I'll do it.”

3. Get moving, and keep moving.

Culler hasn’t slowed down in middle age. At 50, he began doing Ironmen triathlons. He also invested in a heartrate monitor and wears it when working out.

Culler started with Half Ironmen, which involve running (13.1 miles), swimming (1.2 miles) and biking (56 miles) a total of 70.3 miles over seven hours or more. (In a full Ironman – considered one of the most grueling one-day sporting events in the world – athletes cover 140.6 miles in 14 hours and up. They swim 2.4 miles, bike 112 miles and run 26.2 miles.)

He didn’t even own a bicycle when he started training. “I had a recumbent bike at the time,” he said. “I started pedaling on that initially. And, I started out walking and slowly built up to running.”

Exercise is imperative for heart health. But Tyson said exercise alone isn’t enough: “It doesn’t make you immune to heart disease.”

4. Listen to your body.

At a full Ironman last November, Culler had completed his swim and bike ride and was about halfway through his run when he “felt depleted – with no energy left.”

It was a surprise, since he’d been training for a year and felt ready. But he didn’t push himself to finish. He said, “My body told me to stop.” Fortunately, he had an already-scheduled appointment with Tyson the next week.

5. Listen to your health care team.

Tyson recommended a cardiac CT scan (with calcium score) to see if there was a blockage. The scan showed a 70% blockage in the largest coronary artery – the left anterior descending artery, sometimes called the “widow-maker artery.” A second test showed the blockage was closer to 90%.

Culler needed angioplasty, the surgical unblocking of an artery or blood vessel. Tyson performed the outpatient procedure – and inserted a stent to open the artery and restore normal blood flow to his heart – on Dec. 19 at Kernersville Medical Center’s HVI lab.

“The process was easy,” Culler said. “I was awake the whole time and talking to the doctor. I went back to work the next day.”

Tyson said Culler could’ve had a heart attack had he not been checked and had the stent put in.

6. Manage stress.

Culler is a fourth-generation furniture designer whose deadline-driven job can be stressful. Twice-weekly yoga helps him deal with the pressure that often accompanies his work. “I’ve done it for years, and I'm religious about it,” he said.

Culler isn’t focused on his race times. “At 54, my goal is just to finish,” he said. He’s currently training for a half Ironman in May. Later in 2024, he’ll ride in a 475-mile charity bike ride on the Blue Ridge Parkway and do another half Ironman. And, he’s planning a robust 2025 race schedule. ​

The triathlete encourages others to see a cardiologist.

“I think it’s important to establish a relationship,” he said. “You then have an advocate, someone who knows your history. I told the guys I train with to make an appointment because heart disease is so prevalent. I mentioned my family history, but in a light way. I don’t want them thinking: ‘Oh, I don't have a family history, so I don't need to go.’”

Culler’s proactive measures are welcome reassurance for him and his family. “Staying on top of my heart health just makes me feel better,” he said.

Learn more about taking care of your ticker at the American Heart Association’s website, heart.org.