What the President’s Physical Exam Results Can Teach Us About Heart Health
While cardiologists have debated the finer points of the President of the United State’s recent health report, his yearly check-up is raising awareness of heart disease risk indicators that can help gauge risk over time.
Among the more common risk factors, the President’s body mass index (BMI), 29.9, puts him in the overweight category and his LDL cholesterol level, which rose from 94 mg/dL to 143 mg/dL during the last year, is considered borderline high for someone without heart disease. Both are risk factors for heart attacks and stroke.
A less traditional yet non-invasive way of measuring risk actually looks at the coronary arteries. A multi-site National Institutes of Health study found that coronary artery calcium was a significantly better predictor of heart disease than other diagnostic tests. The study showed that the presence of coronary artery calcium was associated with cardiovascular events, regardless of the levels of other risk factors and even among individuals with no risk factors.
President Trump’s coronary artery calcium (CAC) score merits attention. His calcium score rose from 34 in 2009 to 133 in 2018. CAC scores of 100 or higher mean an individual has plaque present in the coronary arteries and a much higher risk of a heart attack than indicated solely by his cholesterol level and other risk factors. The higher the CAC score, the more plaque is present.
Calcified plaque indicates that heart disease has been present long enough for an inflamed lesion to heal and calcify. The CAC score is like the tip of an iceberg, whereas the soft plaque is what’s under the surface. What’s really dangerous is the soft plaque, and experts estimate that there is approximately four times as much soft plaque present as hard, or calcified, plaque.
When soft plaque ruptures, it’s similar to having a pimple inside the artery that breaks open. The body responds by forming a clot to heal the lesion, but if the clot is large, it blocks the artery off completely, quite suddenly, and can cause a heart attack or sudden death.
The presence of calcium in the arteries of the heart is an excellent measure of the presence of what is called “subclinical” atherosclerotic disease and leaders in cardiovascular prevention now would equate these CAC scores to a coronary disease risk equivalent…
Based on the results of his heart risk tests, the President is being prescribed a higher dose of the statin he takes to lower his cholesterol. In patients with coronary disease, lipid experts recommend that LDL cholesterol levels be less than 70 mg/dL. He has also been advised to take up a regular exercise habit to improve his heart health.
In general people who are ages 40 to 65 and have any of the following risk factors are candidates for cardiac calcium scoring: Smoking, a family history of heart disease, obesity, high cholesterol, high blood pressure, or diabetes. Large equipment is required to obtain a CAC score but simple blood and urine tests that are readily available can help determine where patients fall on a spectrum of risk.
Are your behaviors contributing to an increased risk of heart attack? Is there evidence of the possible presence of disease that shows up in blood and/or urine tests? Do you have elevations in vascular-specific markers of inflammation that indicate an active disease process is present?
Inflammation testing offered by the Cleveland HeartLab provides additional ways to take stock of your heart’s health and point you to targeted interventions for lowering the risk for dangerous cardiac events. For more information, go to KnowYourRisk.com.