Risk factors for death don’t always tell the whole story

Friday, Jan. 5, 2018 9:13 PM

Dallas McCarver, a superstar body builder, who looked like a normally-pigmented Incredible Hulk, died on Aug. 22 at the age of 26.

McCarver, aka “Big Country,” had plenty of risk factors for an early death: He had coronary artery disease, and his heart was twice the size it should be. He had a dangerous ratio of fats in his blood. Other members of his family had died of heart disease at an early age. And to achieve and maintain his physique – over 300 pounds of muscle – McCarver took a boatload of steroid and non-steroid hormones.

The medical examiner certified that McCarver’s death was caused by his enlarged heart and coronary artery disease and that his steroid use was contributory – a reasonable determination.

Fans weren’t satisfied. Comment sections in online media reports are filled with arguments about why, exactly, McCarver died.

Most of the contentiousness revolved around the role of steroids. Do they cause death or not? If they do, are all users at risk or only those who are particularly vulnerable? “If your family has a history of heart disease, becoming a 300 lb. freak is not a smart idea,” one person wrote.

Others were unwilling to blame McCarver’s inherited physiology. “At 26, you don’t just die due to heart disease because it runs in the family,” another reader observed.

My professional experience tells me that family history is a pretty good predictor. I’ve autopsied several people with family histories of heart disease who died in their 20s and 30s. But the reader is right that a family history is not a cause of death. It’s just a risk factor.

Listing risk factors on the death certificate instead of pinpointing a specific cause of death is common practice because it’s impossible to sort out various factors’ relative contributions or single out one of them.

Smoking, obesity and a sedentary lifestyle predispose people to an early death, but some fat, cigarette-puffing couch potatoes live long lives. There’s no way to predict which couch potato will die and which one won’t. There’s no way to say that one particular risk factor made death inevitable. There’s no way to assign percentages of blame.

My dad has been overweight for most of his life. He was trim and handsome when he graduated from high school, but in his wedding picture, he’s only slightly less hefty than Jackie Gleason. That’s because Grandma cooked all his favorite meals before he left the nest.

Mom wasn’t the cook my grandmother was, and she took some of Dad’s weight off, but not enough. Dad has always eaten his salads with plenty of dressing and his vegetables with plenty of butter. He prefers red meat well-marbled with fat and eats plenty of that, too.

Dad has high blood pressure and coronary artery disease. About 10 years ago, he had a quadruple coronary bypass. He takes medicines to control his pressure and the ratio of fats in his blood.

Dad’s cardiologist disapproves of his weight and diet. During a routine physical examination, the doctor – a native of Thailand who speaks with a fairly heavy accent – poked a rigid forefinger into Dad’s jiggly belly. “Eat!” he said with a scowl. “All you think of is to eat. You look just like Pillsbury Doughboy.”

The scolding had no effect.

Dad will be 93 in April. He’s still spry and sharp, and he mows 2 acres of lawn every week. And Dallas McCarver died at 26. You never know.

Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003-12. She now lives in Florida and Maryland. Email her at