A Tale of Two Hearts

Meet “Fred” and “Barney,” two friends of mine who were recently compelled by Don’t Die Early to measure their cardiac plaque burden.

Fred and Barney are both in their 40′s. Barney has a few extra pounds around the middle, but with a healthy BMI of 23, Barney’s few extra pounds are nothing compared to the spare tire that most middle-aged men carry around. Barney’s blood pressure, while not as low as it was in his 20′s, is still in the “normal” range, which makes Barney’s doctor very happy.

Fred, on the other hand, has dramatically higher risk of heart attack, according to all traditional cardiac risk factors. Significantly overweight with a BMI of more than twice Barney’s, coupled with inflammation and hypertension, Fred would undoubtedly cause any cardiologist to advise significant lifestyle changes to prevent a heart attack.

Both Fred and Barney recently passed a cardiac stress test with no indication of a cardiac plaque problem and their most recent cholesterol tests were similar: as with most middle-aged men, both Fred and Barney’s cholesterol tests were “unfavorable,” according to current mainstream preventive health guidelines. Both have some family history of heart disease, as well.

This points to a pretty clear picture: Barney could take slightly better care of himself but it’s Fred who needs to take action immediately.

In Don’t Die Early’s chapters on cardiac health, I make the case for going beyond indirect cardiac risk indicators like cholesterol levels, family history, weight, and blood pressure and actually measuring one’s cardiac plaque burden using a simple, inexpensive, non-invasive procedure that involves a few moments in a CT scanner and about the same radiation exposure as a mammogram. The reason I make this case is because traditional cardiac risk factors, while sometimes useful and enlightening, are amazingly inaccurate at predicting one’s true risk of an impending heart attack. According to sources that I cite in Don’t Die Early, the traditional cardiac risk factors that most physicians advocate fail to predict an impending heart attack 90% of the time. That’s right, a 90% failure rate.

To illustrate how traditional risk factor assessment can overlook a cardiac plaque burden, let’s take a look at the results of their coronary calcium scan, a test designed to replace supposition and “risk factors” with a direct measure of their cardiac plaque:

Surprise! It’s Barney, not Fred, who is staring down the barrel at 300 cubic millimeters of cardiac plaque. It’s Barney, not Fred, who has more coronary plaque than 99% of the men his age.

While I have changed the names (and a few trivial details) to respect my friends’ privacy, this is not a fictitious example. It’s a very real example of how traditional cardiac risk markers can fail so dramatically, providing a false sense of security to those who may be a considerable risk for heart attack.

When we think about how often we hear about people having heart attacks not long after obtaining a clean bill of health from their annual physical and cardiac stress test, it’s not difficult to believe that traditional cardiac risk assessment falls very short of predicting heart attacks.

If the traditional risk factors fail so alarmingly at predicting cardiac risk, what should a person really pay attention to? What are doctors who know better looking at to truly gauge a patient’s cardiac health? If I can find a glaring discrepancy like this from among a handful of close friends, how many ticking time bombs are out there, falsely reassured by traditional cardiac testing when their true plaque burden is far more serious? And as you’ll learn in Don’t Die Early, any plaque, not just plaque that forms a blockage, poses a very real risk of heart attack.

And moreover, if a person turns out to be a Barney, not a Fred, what then? How does such  person address, and reduce, the risk of a heart attack?

That, my friends, is only some of what Don’t Die Early is all about.

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