Paul Dudley White, MD, Chief of Cardiology at Harvard Medical School and the physician caring for President Eisenhower in 1955 when he suffered a massive heart attack, commented that “a heart attack after age 80 is an act of God but a heart attack before age 80 is a preventable event”. What have we learned since 1955 about heart care that can maximize the chances that your career, and beyond, is free of a heart attack, stroke, bypass surgery or coronary stent?
The most common health detour to successful career and retirement plans occurs with the sudden closure of an artery to the heart or brain causing a heart attack or stroke. This may be fatal or just result in disability. Life can change in seconds, yet the problem was progressing for years. How were years of decay missed? My book, Dead Execs Don’t Get Bonuses, makes the case that dead executives, lawyers, dentists, accountants, judges and even doctors, don’t get vacations, attend weddings, or see children graduate college. What can be done to make the words of Dr. White over 60 years ago a reality in 2018?
Ask for a coronary artery calcium scan (CACS)
Consider this. At age 50 a health care provider says, “we need to schedule your colonoscopy, and if a woman, a mammogram”. Yet, the #1 killer of executives worldwide, atherosclerosis, is not tested for by an examination that directly looks at arteries (a stress test NEVER shows arteries). A provider could and should add that “we need to schedule a CACS so we know if you are developing any silent calcified heart arteries” A CACS is a CT scan of the heart that takes under 1 minute, uses no dye or needles, has a very low radiation exposure like a mammogram, and costs about $100. It is the only way to actually see heart arteries in a painless and simple manner. The CACS score should be zero. Even a slight elevation in the CACS raises the risk for heart attack and a multitude of other diseases of aging like dementia and deep evaluation by a preventive cardiologist assessing risks, lifestyle, stress with advanced testing.
Ask for a carotid intimal-medial thickness (CIMT) scan
A CACS is an amazing advance in identifying silent aging of heart arteries but it requires calcification to be abnormal. There is also a pathology called soft plaque that may threaten health and identify sick arteries. A CIMT is a 20-minute ultrasound of the neck that uses advanced software measurements to examine carotid arteries for both soft and hard plaque. The CIMT also measures the thickness of arteries, another sign of aging. The biggest drawback of the CIMT is finding a quality center that offers it.
Ask for advanced labs.
In my view, it is unacceptable to have the same lab studies you had for the last 30 years as there have been major advances in laboratory testing. I suggest asking for the following tests:
Advanced lipid profile: Rather than giving you a calculated LDL cholesterol level, advanced panels measure LDL particle number and size, which are more predictive of future heart and stroke events. Two people with the same cholesterol levels can have widely different particle and size measurements, making for very different risks.
Lipoprotein (a): This is a genetic form of cholesterol that’s elevated in about 20% of those tested. It’s rarely drawn even though hundreds of research studies indicate that if it’s high, the risk of heart attack and stroke skyrocket. It runs high in many families that have been decimated by heart disease.
Homocysteine: This amino acid is produced by a process called methylation. It can injure arteries when elevated. It may be due to a genetic defect in the MTHFR gene, which is easily measured. It can be treated with methylated B-complex vitamins.
Inflammatory markers: The middle of the word inflammation is flame and it means the immune system is turned on and trying to deal with some kind of disorder, often dietary. The best-known test is the hs-CRP, but there are at least five others I measure in my practice, like MPO and oxidized LDL. If you want the cutting edge, a new panel called the PULS score is available.
TMAO: This is a newly described marker of heart and kidney health that’s elevated after eating meat- and egg-heavy diets with an altered gut microbiome. It has been shown to cause heart and kidney damage, and is associated with worsened prognosis.
apoE: This is a genetic marker related to cholesterol metabolism that is measured from a blood sample. For the unlucky few that inherit a pattern called apo E 4/4, the risk of heart disease AND Alzheimer’s Disease is high and may have an onset 20-years earlier than average.
Never leave an ER without a complete evaluation
If you do not pay attention to your heart risk and if you skip the CACS and CIMT you might end up in an emergency room. Don’t go to an urgent care clinic and always go to a full emergency room as it may save your life. DON’T GO HOME without a thorough evaluation. Ask for “serial” cardiac enzymes that are repeated two or three times, every four to six hours. Ask for repeat ECGs to compare to the one done on arrival. Finally, ask for a definitive test before discharge. This may be a treadmill stress test with echocardiography (no radiation) or nuclear imaging (radiation). In some ERs, the advanced coronary CT angiogram (CCTA which requires iodine dye injection) may be available. This is by far the most accurate way to be sure your arteries are clean before discharge.
Although many years have passed since 1955, the focus on learning CPR and having defibrillators in gyms misses the main point for a successful career and life: the early identification, prevention and reversal of the silent disease that chokes off our vitality. Executives that are alive do get bonuses and vacations which is much more fun.
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