Mr. Russert had a heart scan in 1998. Score: 210. What does that mean?
It means that Mr. Russert’s untimely death was every bit as predictable as knowing when the next football season is likely to begin. Heart scans provide a precise, measurable index of coronary atherosclerotic plaque. They provide a level of confidence in predicting cardiovascular “events” that no other non-invasive screening test can match. If his heart attack was predictable, it was also preventable.
Heart scan scores can be expected to increase at the rate of 30% per year without preventive efforts.
Conventional efforts like statin cholesterol drugs usually slow the progression of heart scan scores to 14-24% per year. Let's assume the rate of increase was “only” 18% per year. That would put Mr. Russert's 2008 score at 1101. A heart scan score of 1000 or greater carries an annual—ANNUAL--heart attack risk of 25% per year.
A simple calculation from information known in 1998 clearly, obviously, and inarguably predicted his death. The meager prevention efforts taken by Mr. Russert's doctors did indeed reduce risk modestly, but it did not eliminate risk.
We know that growing plaque signified by an increasing heart scan score is active plaque. Active plaque means rupture-prone plaque. Rupture prone plaque means continuing risk for heart attack and death. Heart attack and death means the approach used in Mr. Russert was a miserable failure.
Yet the mainstream media echoes the mis-information that allows this sort of tragedy to continue. A New York Times article, "A Search for Answers in Russert’s Death," reported:
“Given the great strides that have been made in preventing and treating heart disease, what explains Tim Russert’s sudden death last week at 58 from a heart attack?
The answer, at least in part, is that although doctors knew that Mr. Russert, the longtime moderator of “Meet the Press” on NBC, had coronary artery disease and were treating him for it, they did not realize how severe the disease was because he did not have chest pain or other tell-tale symptoms that would have justified the kind of invasive tests needed to make a definitive diagnosis. In that sense, his case was sadly typical: more than 50 percent of all men who die of coronary heart disease have no previous symptoms, the American Heart Association says.
It is not clear whether Mr. Russert’s death could have been prevented. He was doing nearly all he could to lower his risk. He took blood pressure pills and a statin drug to control his cholesterol, he worked out every day on an exercise bike, and he was trying to lose weight, his doctors said on Monday. And still it was not enough.
“What is surprising,” Dr. Newman said, “is that the severity of the anatomical findings would not be predicted from his clinical situation, the absence of symptoms and his performing at a very high level of exercise.”
While the press blathers on about how heart disease results in unavoidable tragedy, as Mr. Russert's doctors squirm under the fear of criticism, the answers have been right here all along. It sometimes takes a reminder like Mr. Russert's tragic passing to remind us that tracking plaque is an enormously useful, potentially lifesaving approach to coronary heart disease. There are, in fact, a world of additional steps Mr. Russert’s doctors could have taken to have prevented his death not necessarily involving medication or procedures. Just taking fish oil, for instance, sufficient to provide 1200 mg of omega-3 fatty acids (EPA and DHA) could have slashed the likelihood of death by 45%.
Who needs to go next? Matt Lauer, Oprah, Jay Leno, some other media personality? Someone close to you? Can this all happen right beneath the nose of your doctor, even your cardiologist?
Published On: June 18, 2008