Predicted or Prevented?
Heart disease is #1 killer of men and women in America.
In the U.S., someone suffers a heart attack every 30 seconds and dies from one every 60 seconds.
The first time your doctor knows you have heart disease...is when you present to the ER with a heart attack...and the most likely outome of your heart attack is death." -- from 'Prevention: The Most Important Treatment of Heart Disease'
Bernie Sander's heart attack could have been predicted and also prevented.
The Preventive Paradox In Amercia: Preventive Cardiac Testing is Not Supported by Medicare or Private Insurance
Ironically, Senator Bernie Sander's Bill 'Medicare-for-All' will not cover cardiac preventive testing. Be aware that I am a staunch supporter of Medicare-for-All. However, Medicare still does not pay for a simple test known as a calcium score which determines if you have heart blockages. I have been an advocate of the calcium score for over 24 years since I started practicing cardiology in Hawaii.
For patients with risk factors for coronary artery disease such as HTN, hypercholesterolemia, diabetes, smoking, family history, a simple calcium score will determine your future risk of suffering a heart attack.
The 2018 AHA/ACC Cholesterol Management Guidelines advocate using the calcium score to determine statin use.
A calcium score costs around $200 dollars in Hawaii, but only around $70 dollars on the mainland. It may or may not be covered by insurance so be ready to cover this cost yourself. It is worth it!
The Calcium Score: An Old, But Useful Test
The calcium score is a decades old test which simply determines the presence of absence of heart disease.
It is superior to cholesterol lab tests, CIMT, LDL subfractionation.
There are far better tests than a calcium score, but it is inexpensive and very easy to do.
Who Typically Gets A Calcium Score?
Presidents of the United States, CEOs, the top 10 earners of any large company, the super-rich, VIPs...people like Bernie Sanders.
This is because the 'key man (or woman)' in a business cannot suffer a debilitating illness as Bernie Sanders just did.
So the difference between the average person and the richest person in the country is $70 dollars? Sadly...yes.
Cardiac Prevention for the Asymptomatic Patient
For Men over 45 and Women over 50 with intermediate pre-test likelihood for CAD perform a calcium score. A calcium score is not for patients with bypass surgery, stents, younger patients, or those who are at low risk for CAD.
If the calcium score is >0, be referred to a cardiologist.
Follow the recommendations I outlined for cholesterol management.
The very same stratification tools used to determine if you require a statin are the basis of preventive evaluations.
Summary:
If Bernie Sanders had performed a calcium score last year, a stress test would have been performed, and his stents placed electively.
His cardiologist would have aggressively lowered his risk factors and performed more frequent surveillance testing.
If Bernie had performed a calcium score 20 years ago, he would not have needed coronary stents or suffered an MI.
More Info:
To learn more about the benefits of a calcium score, read any of the attached links.
To learn more about why Americans do not do more to prevent heart disease, read my book.
Stay Healthy!
Gregg M. Yamada MD FACC
Disclaimer: I hope you find my medical blogs to be educational, pertinent, interesting, and thought provoking. The information provided is educational and should not be taken as medical advice. I am a doctor, but I am not your doctor. Please schedule an appointment with your doctor to discuss these issues and to determine what is right for you.
© 2019. Gregg M. Yamada, MD FACC. All rights reserved
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