A prominent attorney who lives in my neighborhood was recently found dead in his bed. He was 49 years old with no history of heart disease. He died from a heart attack. His teenage kids found him and performed CPR, but he was cold and long-gone by then. (Imagine the profound psychological trauma to this man's children.)
A close friend of the attorney told me that he'd passed an annual physical just two weeks earlier.
This sort of tragedy simply should not happen. It is easily preventable. Let me reiterate that point: This man's tragic death was easily preventable.
Of course, hospitals make use of stories like this to fuel fear that brings hordes to their wards for procedures. Would this man have required a procedure to save his life, had his heart disease been diagnosed at his annual physical? Not necessarily. In fact, had it been properly detected, say, a year before his death, all that would have been necessary is an appropriate prevention program.
The enormous growth in cardiovascular procedures nationwide has led many of us to believe that such procedures have an impact on mortality. This is simply not true. In fact, mortality benefits of procedures are questionable except in the midst of acute illness (e.g., unstable chest pain symptoms or heart attack). In fact, recent studies like the COURAGE Trial have even cast doubt on whether coronary stent procedures provide any benefit when stable symptoms of coronary disease (stable angina) are present.
Don't be falsely reassured by passing a physical. A physical does almost nothing to screen you for heart disease. An EKG, stress test, and cholesterol panel is standard fare in most physical exams. As the experience of this unfortunate attorney attests, these "standard tests" represent a lame excuse for heart disease screening. EKG's are helpful in the midst of acute illness, or if a heart attack has already occurred. A stress test is a test of coronary blood flow, reduced only in the most advanced phases of coronary heart disease when sufficient atherosclerotic plaque to block blood flow has accumulated-but may be entirely normal for years before blood flow is reduced, and may be normal even in the days preceding a heart attack. Cholesterol panels identify potential risk for coronary heart disease, but do not detect the disease itself. If our attorney had an LDL cholesterol of 150 mg/dl at his physical exam, what could have been done differently to have averted this tragedy? (By the way, the average LDL cholesterol of some suffering a heart attack? 132 mg/dl-virtually the same as the average person without heart disease. I can't tell the difference, can you?)
My unfortunate attorney neighbor most likely had a 30% "blockage" that did not block flow, but ruptured and closed an artery off sometime during the night when he died. A stress test even on the day of his death would likely not have predicted this. Nor would an EKG or an LDL cholesterol of 150 mg/dl.
Is there is any test that can hope to uncover the coronary atherosclerotic plaque that signals potential for such catastrophe? Yes. That's what the heart scans you may have heard about do: they detect silent coronary plaque, even before blood flow is reduced and detectable by stress testing, before symptoms appear, and with greater certainty than, say, high cholesterol.
Had my attorney neighbor undergone a heart scan, a score of at least 400, if not >1000 (normal is zero), would likely have been uncovered, and appropriate preventive action could have been taken. (Not necessarily heart procedures, but effective preventive strategies that reduce risk of heart attack and death from heart attack.) The conversation could have centered around the strategies to correct the patterns that triggered his plaque and how he could try and reduce his score.
A heart scan would have uncovered this man's disease easily, unequivocally, safely. It would not have necessarily required a heart procedure. It certainly would not have lead to CPR or psychological trauma to children from witnessing the death of their father.
Published On: March 17, 2008