Annual physical

26. November 2006 William Davis (0)
A judge who lives in my neighborhood was found dead in his bed this week from a heart attack. He was 49 years old. His teenage kids found him and performed CPR, but he was cold and long-gone by then.

A close friend of the judge told me that he'd passed an annual physical just weeks before.

This sort of tragedy shouldn't happen. It is easily--easily--preventable. Had this man undergone a heart scan, a score of at least 400 if not >1000 would have been uncovered, and appropriate preventive action could have been taken. The conversation could have centered around the strategies to correct the patterns that triggered his plaque and how he could reduce his score.

Of course, hospitals make use of stories like this to fuel fear that brings hordes to their wards for procedures. Would the judge have required a procedure to save his life, had his heart disease been diagnosed at his annual physical? Not necessarily. Hospitals and cardiologists would try to persuade you that procedures have an impact on mortality. This is simply not true. In fact, the mortality benefits of procedures are questionable except in the midst of acute illness (e.g., unstable chest pain symptoms or heart attack).

Don't be falsely reassured by passing a physical. A physical does nothing to screen you for heart disease. An EKG and stress test, if included, is a lame excuse for heart disease screening. Remember that a stress test is a test of coronary blood flow, not for the presence of coronary plaque. The unfortunate judge most likely had a 30% "blockage" that did not block flow, but ruptured and closed an artery off sometime in the night when he died. A stress test even on the day of his death would not have predicted this.

A CT heart scan would have uncovered it easily, unequivocally, safely.
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Mr. Salazar: Check your Lp(a)

Mr. Salazar: Check your Lp(a)

9. July 2007 William Davis (8)
Marathon star Alberto Salazar was just released from the hospital following a heart attack and a heart catheterization that led to a stent. The MSNBC version of the report can be viewed at http://www.msnbc.msn.com/id/19653682/.

At 48 years old and holder of several American records for marathon times, Salazar's story is eerily reminiscent of Jim Fixx, who died at age 52 after writing a bestselling book, The Complete Book of Running. Thankfully, Salazar's story has a happier ending.

Fixx died at a time when prevention of heart disease was quite primitive. Lipoprotein analysis was not broadly available to the public, CT heart scans had not yet been invented. Even statin drugs were just a gleam in the pharmaceutical industry's eye.

But not so with Salazar. This Cuban-born marathoner experienced his heart attack at at a time when enormously useful steps can be taken to 1) document the extent of disease with a CT heart scan (the presence of a stent just means that one artery can't be "scored"), and 2) identify the causes of his disease.

I suspect that the fact that yet another marathoner in the limelight will once again prompt the (likely non-sensical) conversation about long-distance running and the increased risk of heart disease. Unfortunately, I fear that the real cause will be left unidentfied and untreated: Lipoprotein(a), or Lp(a).

It's almost certain that Fixx had Lp(a), given the fact that his dad had a heart attack at age 35. Running simply postponed the untreated inevitable.

I hope Mr. Salazar is surrounded by doctors who have his true interests in mind (not just procedural excitement) and ask the crucial question: Why?

The answer is almost certain to be Lp(a).
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Comments (8) -

  • JT

    7/9/2007 11:29:00 AM |

    I know a group of guys that run marathons regularly.  If you asked them why they run, they will tell you there are two reasons; one to prevent heart disease and two to drink beer with out gaining weight.  Special emphasis will be placed on drinking beer.  I was reminded this week of how much the group enjoys their beer when the head of the group CCed me on a letter he wrote to Kroger grocery store pointing out that their Miller beer price is significantly higher priced than Wal-Mart, located just across the street.  If Kroger did not lower the price, well, they might just have to shop elsewhere.  

    I'm going to send them this blog and tell them they can stop running blind.  Today there are tests to determine if you have heart disease.  I'd suggest to them to drink red wine instead of beer, but that might be asking too much.

  • Dr. Davis

    7/9/2007 11:43:00 AM |

    That's great.

    Now we can only hope that their doc's know what to do next if any of them have Lp(a) or other "obscure" factors.

  • Mike

    7/9/2007 5:58:00 PM |

    When (what age) should one have a heart scan and Lp(a) test done if there are no symptoms? What would be the approximate cost to get the recommended testing done and evaluated?

  • traderfran2001

    7/10/2007 4:17:00 AM |

    I am curious as to why you focused on LPa as the likely cause. For example I am a regular runner and my LPa is in the low normal range. Is there something about running that makes LPa abnormalities more likely?

  • Dr. Davis

    7/10/2007 11:32:00 AM |

    Hi,
    I believe that the combination of Lp(a) and marathoners is no more likely than the general population, but it makes for media hype--the apparent contradictions of ultra-fitness and a disease generally associated with poor lifestyle. Lp(a) is, more often than not, the source of the contradiction.

  • John Townsend

    7/20/2007 11:08:00 PM |

    Do you have any advice on a Vitamin C/Lysine regimen? Apparently this combination was recommended (in high doses) by Linus Pauling years ago for cardiac health, particularly in controlling high levels of Lp(a). TIA

  • Dr. Davis

    7/21/2007 1:44:00 AM |

    John--

    I can only tell you that we've tried a number of times only to see no substantial effect.

    The concept has the basis in some real--and very interesting science--but the leap from a "test tube" observation to a "cure" for heart disease and cancer is, to say the least, a big one.

  • Dr. Davis

    7/28/2007 2:52:00 PM |

    Mike--Please see the extensive commentary on these issues on the Track Your Plaque website that this Blog accompanies. You will find an enormous amount of discussion, even in the non-Member, open content section.

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