Widowmaker
I have personally done hundreds and hundreds of stress tests and have ordered hundreds more but no longer. You can learn a lot from stress tests … the heart rate and blood pressure, and how they change with exercise. Whether exercise causes irregular heart beats and your exercise tolerance are both important markers for heart trouble. Unfortunately, one of the most important things I want to know is how much blockage you have before you actually keel over and the typical stress test is lousy at that. The stress test isn’t abnormal until you are probably in need of a stent or bypass. The stress test only turns abnormal when you have a lot of blockage. Look at Tim Russert the TV anchorman who passed a stress test yearly and yet died of an unsuspected heart attack – (and of course he was on statins for years!).
Well there is a new test in town and it’s called the Cardiac Calcium Score. It’s not really new. -The test has been around for over a decade but I did not trust it the first few years as it had no track record and we had plenty of other tests to check the heart. I now have enough information and experience to recommend the test to my patients.
Not everyone needs a Cardiac Calcium Score test. If you already have known heart disease or you are a young person aged 20-30 who has no reason to suspect heart disease this is not a test for you. If you are trying to decide whether you need a statin drug this would be a good test to guide your decision.
The test consists of a quick CT scan. No needles or dyes are used. The CT scan measures the amount of calcium in the coronary arteries. It is not a direct measure of the amount of blockage but it’s very clear that the more calcium the more buildup and the worse your prognosis. If you have a normal heart you will have a calcium score of zero. Having a zero score means that your risk of having a cardiac event in the next 10 years is less than 1 in a thousand. I like those odds. The higher the score the more likely you are to have a cardiac event in your future. Investigators followed over 15,000 people over almost 15 years and there is a reliable gradient … the higher your calcium score, the worse off you were. After collecting this de-identified data, the investigators tracked the status of all participants through the National Death Index, (a central computerized index from the National Center for Health Statistics). The investigators followed the patients for a mean of 14.6 years. A score of 0 equals very low risk … 3% in this study. A score of less than 100 equals a 9% risk of an event in the next 15 years. A score between 400 and 1,000 equals a 21 percent risk and a score over 1,000 gives you a 28% risk of an event in the next 15 years. So a very low score 3% risk … a high score almost a 30% risk of actual all cause mortality not just heart attack.
Until now if we wanted to estimate your heart disease risk we would use calculations based on your age, sex, blood pressure and cholesterol levels, whether you are a diabetic or a smoker, etc. Your doctor is supposed to use this calculator to determine if you need a statin or not. Unfortunately the calculation is not that accurate and instead of guessing based on some calculations you can spend $125 dollars and find out exactly where you are on the spectrum. We can find heart disease much earlier with this test and we can guide your medications accordingly. Furthermore, and more importantly, we can reinforce changing your diet to possibly reverse your heart disease which no statin has ever been able to do. If your cardiologist tells you there is nothing you can do for heart disease except take a statin … you should retire him.
There is a growing body of literature from Drs. Gundry, SInatra, McDougall, Rogers, Ornish, Hyman, and Barnard to name just a few prominent physicians who have demonstrated reversal of heart disease … opening up arteries with changes in diet. Ivor Cummins documents all the risks and benefits in the youtube video Avoiding and Resolving Modern Chronic Disease.: https://www.youtube.com/watch?v=2IU-33EucMc
Also the video The Widowmaker is available for free on Youtube and explains the benefits and history of the Cardiac Calcium Score.: https://www.youtube.com/ watch?v=NSPcuGjstN4
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Need further proof? How about the fact that since 2006 NASA does this test on all the astronauts and if they don’t have a perfect score of zero they are released from the program for space. Also I am told that every President since Bill Clinton had his “surprise” bypass operation gets this test done as well. If it’s good enough for NASA and the White House why isn’t it a good test for you?! It’s a cheap test as far as medical tests/costs go and I think it’s a great test to help patients really see where they are on the heart disease spectrum and adjust their diets and meds accordingly. Remember, statins will not save you … changing your diet will! It’s been shown over and over again and has even convinced Medicare to cover the Dean Ornish Program. It’s a terrible shame that we don’t have this program in Upstate New York but that’s another column.
Until next month … get well … stay well.
(ed. Readers can listen to Dr. Joe Barry’s radio show “Your Health Matters” airing Sunday afternoons at 12:00pm on WSYR 570)
