Lipids are snapshots in time; heart scans are cumulative

12. August 2006 William Davis (0)
Let me paint a picture. It's fictional, though a very real portrait of how things truly happen in life.

Michael is an unsuspecting 40-year old man. He hasn't undergone any testing: no heart scan, no lipids or lipoproteins. But we have x-ray vision, and we can see what's going on inside of him. (We can't, of course, but we're just pretending.) Average build, average lifestyle habits, nothing extraordinary about him. His lipids/lipoproteins at age 40:

--LDL cholesterol 150 mg/dl
--HDL cholesterol 38 mg/dl
--Triglycerides 160 mg/dl
--Small LDL 70% of all LDL

At age 40, with this panel, his heart scan score is 100. That's high for a 40-year old male.

Fast forward 10 years. Michael is now 50 years old. Michael prides himself on the fact that, over the past 10 years, he's felt fine, hasn't gained a single pound, and remains as active at 50 as he did in 40. In other words, nothing has changed except that he's 10 years older. His lipids and lipoproteins:

--LDL cholesterol 150 mg/dl
--HDL cholesterol 38 mg/dl
--Triglycerides 160 mg/dl
--Small LDL 70% of all LDL

Some of you might correctly point out that just simple aging can cause some deterioration in lipids and lipoproteins, but we're going to ignore these relatively modest issues for now.)

Lipids and lipoproteins are, therefore, unchanged. Michael's heart scan score: 1380, or an approximate 30% annual increase in score. (Since Michael didn't know about his score, he took no corrective/preventive action.)

My point: If we were to make our judgment about Michael's heart disease risk by looking at lipids or lipoproteins, they would'nt tell us where he stood with regards to heart disease risk. His lipids and lipoproteins were, in fact, the same at age 50 as they were at age 40. That's because measures of risk like this are snapshots in time.

In contrast, the heart scan score reflects the cumulative effects of life and lipids/lipoproteins up until the day you got your scan.

Which measure do you think is a better gauge of heart attack risk? I think the answer's obvious.
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Money, money, money, money

Money, money, money, money

3. October 2007 William Davis (3)
I've been asked the question numerous times:

Why aren't heart scans more popular?

First, let me qualify by saying that heart scan have indeed grown in popularity over the past decade. I think the real question is:

Given the enormous usefulness of CT heart scanning to detect hidden, asymptomatic coronary atherosclerotic plaque, why haven't they more readily been incorporated into conventional medical practice?

That's easy: There's no money in it.


Say, for instance, your doctor orders a heart scan and somehow receives a $1000 for the test. Scan centers would be scanning 100 people a day, falling over themselves to do scans.

This would be similar to a heart catheterization. Order a catheterization, do 30 minutes of work, and get $1000. Or, order a nuclear stress test. Depending on how its done and where, $1800-4000 is paid by the insurer.

Order a CT heart scan and how much is paid to the doctor? Usually nothing. At most, a nominal fee might be paid if the doctor reads the scan.

With heart scans, there simply is no big payoff.

We learned the implications of this situation 10 years ago when I was trying to help my friend, Steve Burlingame, the owner of Milwaukee Heart Scan. (I am NOT and NEVER WAS an owner.) Steve was trying to let everybody know about this great new $2 million dollar heart scan device in the Milwaukee area.

The first few years were tough for Steve: Carrying the substantial expense of this device while doctors essentially gave the technology the cold shoulder. It simply did not fit into the financial equation. Why change the way things were, particularly when there was virtually no financial reason to do so? To counter this, Milwaukee Heart Scan followed the model many other scan centers have followed and marketed directly to the public.

I see this as yet another example of why people need to take control of health care away from doctors and hospitals, the current controllers of the system who are providing a disservice to the public they are supposed to be serving. These institutions, for the most part, serve their self-serving financial interests, not your health interests. It's the same equation that drives food manufacturers to make more and more processed carbohydrate foods that they sell for substantial markups, not green peppers and cucumbers that make little money.

I regard heart scans as among the greatest self-empowering tools in health ever conceived. It was that way in 1997; it remains that way in 2007.
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Comments (3) -

  • Anonymous

    10/3/2007 5:41:00 PM |

    I personally get the word out on how heart scans are superior to regular cholesterol testing in predicting future heart health to family and friends.  Honestly many times I'm greeted with skepticism, "if a CT scan is so great, why hasn't my doctor recommended one?"  When that happens, your blogs are a wonderful tool to me in convincing them of there importance.    

    Many place doctors on a very high pedestal, too high I believe, and so in this case I find it bad that doctors do not make money on CT heart scans.  I do not have anything against people making money in an honest manor and if it takes some cash to change a few more healthy care providers’ ways on heart scanning, I'm in favor of it.

  • JoeEO

    10/3/2007 7:41:00 PM |

    Dr Davis,
    You are creating an "Army of Davids"! The phrase is from a book written by Glenn Reynolds (aka Instapundit.com ). The premise of the book is that "a society that's rich and free will have citizens who-entirely on their own-develop a wide range of skills."

    That is what we are doing here (and at Trackyourplaque.com) we are learning to manage and diagnose and treat our various lipid profiles and tracking our levels of coronary artery disease (plaque).

    I think I mentioned this in a post on typ's member forum, but I still can't understand why every person in the US who is taking a statin is not also taking niacin. If the your sites didn't exist I doubt I would have found out about the HATs study until I had a coronary event (if then)

    Now I am empowered (it is a little scary!) and have the ability to find out detailed information about my condition and the ways I can address that condition thanks to you Dr Davis!


    We live in amazing times...


    Peace

    Joe E O
    P.S. Here the whole title from Amazon.com:
    An Army of Davids: How Markets and Technology Empower Ordinary People to Beat Big Media, Big Government, and Other Goliaths (Hardcover)
    by Glenn Reynolds (Author)

  • Dr. Davis

    10/3/2007 8:30:00 PM |

    Thanks, Joe. It is an exciting time for immense change.

    Would you recommend Reynolds' book?

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