At what score should I have a heart cath?

This question comes up frequently: At what specific heart scan score should a heart catheterization be performed? In other words, is there a specific cut-off that automatically triggers a need for catheterization?

In my view, there is no such score. We can't say, for instance, that everybody with a score above 1000 should have a catheterization. It is true that the higher your score, the greater the likelihood of a plaque blocking flow. A score of 1000 carries an approximately 25-30% likelihood of reduced blood flow sufficient to consider a stent or bypass. This can nearly always be settled with a stress test. Recall that, despite their pitfalls for uncovering hidden heart disease in the first place, stress tests are useful as gauges of coronary blood flow.

But even a score of 1000 carries a 70-75% likelihood that a procedure will not be necesary. This is too high to justify doing heart catheterizations willy-nilly.

Unfortunately, some my colleagues will say that any heart scan score justifies a heart cath. I believe this is absolutely, unquestionably, and inexcusably wrong. More often than not, this attitude is borne out of ignorance, laziness, or a desire for profit.

Does every lump or bump justify surgery, radiation, and chemotherapy on the chance it could represent cancer? Of course not. There is indeed a time and place for these things, but judgment is involved.

In my view, no heart scan score should autmatically prompt a major heart procedure like heart catheterization in a person without symptoms.
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Oat vs. wheat

Oat vs. wheat

Here's a fascinating 2002 study by Dr. Brenda Davy and colleagues at Colorado State University that examined the NMR lipoprotein differences between a diet enriched in oats and one enriched with wheat. (Davy BM, Davy KP, Ho RC et al. High-fiber oat cereal compared with wheat cereal consumption favorably alters LDL-cholesterol subclass and particle numbers in middle-aged and older men. Am J Clin Nutr 2002; 76:351-358.)

36 sedentary, overweight men (average BMI around 30--obese), aged 50-75 years, were given a diet enriched with either oat bran (as oatmeal and oat bran, providing 5.5 grams of beta-glucan) or wheat (as a hot cereal or Frosted Mini-Wheats), with equivalent calories in each group. All underwent baseline NMR lipoprotein analysis.

Three months later, there were no differences in "anthropometrics" like weight, waist size, or BMI (though there was a trend towards larger waistlines in the wheat group). The NMR lipoprotein analysis was repeated.



Comparison of the lipoprotein changes revealed:

--LDL cholesterol: Down 2.5% with oats, up 8.0% with wheat.

--LDL particle number: Down 5% with oats, up 14.2% with wheat.

--Small LDL: Down 17.3% with oats, up 60.4% with wheat.

--Triglycerides: Down 7.6% with oats, up 22.0% with wheat.



The across-the-board differences between the wheat and oat effects were astounding. In particular, note the extraordinary effect on small LDL particles: wheat triggered a 60% increase.

Similar studies yielding similar results have been conducted elsewhere, including Dr. Ronald Krauss' group at University of California-Berkeley.

Now, this was a study conducted under the somewhat artificial circumstances of a study. But imagine this sort of habitual intake continues, not for just three months, but for years. After all, wheat has expanded and metastasized to all three meals, snacks, every day, 7 days a week in most Americans' diet.

What a wonderfully graphic representation of the undesirable effects of wheat products. When you see Mini-Wheats, Shredded Wheat, whole grain bread, whole wheat bread, whole wheat crackers, Raisin Bran, and the thousands of other wheat-containing products that promise health, run the other way. Grab some oat bran on the way out.

Comments (7) -

  • Anonymous

    8/17/2007 8:07:00 PM |

    Dr Davis,

    I can highly recommend Nairns Oatcakes if you want another, and its quite a tasty  way,  way to eat oats. They replace english muffins and crackers in my diet.

    Best,
    Jim

  • mill

    8/21/2007 10:58:00 PM |

    Dr Davis
    I took fish oil (6/day) and red rice yeast for several months and my cholestral score went up a few points tp 278. I had a CTScan done and have palque (stage 2). I really don't want to take Lipitor etc because of side effects. any suggestions???

  • Dr. Davis

    8/22/2007 2:05:00 AM |

    The Track Your Plaque website, www.trackyourplaque.com, is devoted to answering that question. You're welcome to take a look and see if it's right for you.

  • Anonymous

    11/15/2007 3:55:00 PM |

    My husband and I are both in our
    50's and have incorporated lots of wheat in our diets, which we thought was wonderful for us but now we have our doubts, we feel we had been getting too much! We have switched to oats and reduced our
    gluten intake by 75%. We feel less gasy, bloated and more energy. Any other baby boomers bloated?  
    overwheated in Wisconsin.

  • Kym

    10/11/2008 10:27:00 AM |

    Regardless, both oats and wheat are healthy. One should not stick to just one. Smile

  • Peter

    9/9/2009 9:20:29 AM |

    I started adding lots of oat bran to my oatmeal after you pointed out that it's an excellent cholesterol lower.  I became anemic.  I read that oat bran can interfere with iron absorption, so I discontinued the oat bran and the anemia went away.

  • buy jeans

    11/2/2010 8:45:39 PM |

    Now, this was a study conducted under the somewhat artificial circumstances of a study. But imagine this sort of habitual intake continues, not for just three months, but for years. After all, wheat has expanded and metastasized to all three meals, snacks, every day, 7 days a week in most Americans' diet.

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