Despre boala de inima

Most heart attacks are asymptomatic. A stress test doesn't tell you your risk for a plaque rupture as you had. The false confidence of passing a stress test is due to the erroneous idea that heart attack risk is primary from arteries narrowing over time and then symptoms showing on exertion, such as on a stress test. As with you, a plaque rupture doesn't fit this model.

Many cardiologists will tell you nothing can be done and they wait until symptoms show up or an event like yours to do a procedure such as stent or bypass. They make a lot of money on procedures. When reimbursement goes down, the NYTimes reported, cardiologists do more procedures.

Your doctor should have had you have a heart scan to establish a baseline (the $400 calcium score type not the CT angiogram scan the NYTimes rightly just ran a good article condemning, though it wasn't clear on the proper use of the different, cheaper scan). A follow-up scan a year later would have shown how fast your plaque was progressing, usually 15-30% annually. Russert had one calcium heart scan that put him in the highest risk >90% for his age, not a moderate risk as has been reported. He didn't have a follow-up scan. It is the recent plaque that is most unstable and likely to rupture. Other factors such as low HDL and high triglicerides and inflammation markers would have given you more data on risk of rupture.

Cardiologists, many commenting on Russert and including his doctor have claimed there's not much you can do even having a heart scan showing plaque progressing year after year. Here is where current cardiology is killing people.

Statins appear to have some stabilizing effect on plaque and they get prescribed easily--drug company marketing has been very effective and the drugs have a clear effect on your LDL (a bad cholesterol). But LDL and total cholesterol scores aren't the most important factors. You do want LDL to be much lower than the norms if your plaque is progressing rapidly. More important are your HDLs (good cholesterol that lowers your risk the higher the score is) and triglycerides (small, nasty fats that are worse than LDL. You can get a test to see how much of your LDL is small vs. large--cardiologists don't order it though it tells you your risk even if LDL is low. Most LDL tests are estimates that can underestimate the amount as well--a direct LDL, which usually requires the doctor to specify it on the order is much more informational. So what raises triglicerides and lowers HDL--a high carbohydrate, low fat diet does, especially lots of refined carbs such as breads (even whole-grain), rice, french fries, and anything with high fructose corn syrup. Beer is full of maltose, a fast-absorbed sugar, and alcohol, while raising HDL, raises triglicerides too.

— Phil Key, Redwood City, CA