It's STILL About the Plaque, Stupid!

I like About.com. In fact, I use it to keep up on my Spanish. But, just as with Yahoo!, it leaves a lot to be desired in terms of heart health advice. Since I took the time to "go off" on Dr.Margolis at Yahoo! Health, it's only fair I treat the drivel being pushed by Dr. Fogoros at About.com with the same disdain. Such a pity too because he ALMOST got it right.

The good doctor attempts to answer the provocative question, "EBT (Ultrafast CT) Scans - Godsend, or Scam?" in the About.com: Heart Disease section. He actually does a pretty good job explaining everything until he gets to the real meat of the issue; the efficacy of using heart scans to track heart disease. Unfortunately, like many other traditional practitioners, he remains blinded by the hopelessly outdated fixation on OBSTRUCTIVE heart disease.

For many years heart disease theory and practice was centered on treating heart disease like a "plumbing" problem. You simply test the coronary arteries for flow and if it's adequate everything is just fine. If not, you hope you catch it in time and call "roto-rooter." Everything was focused on finding and fixing obstruction to flow. But a not-so-funny phenomenon kept occurring. People would pass their stress test and then die of a heart attack the next day! What the hell?

It is now known that most heart attacks actually occur at sites with no symptomatic or even detectable flow obstruction. Unstable, previously undetectable "silent" plaques rupture exposing their lipid core to blood, a clot forms, and bang, you're dead! The bottom-line is that what you need to know is NOT the amount of obstruction you have but your total PLAQUE burden. A heart scan will tell you this, a stress test or even a catheterization often WILL NOT.

Dr. Fogoros completely misses the point when he laments that a heart scan does not have the power to accurately predict who has an obstruction at any given instant. That is what a stress test is for. It will tell you if you currently have obstructive heart disease and are in imminent danger of dying immediately. However, it will not tell you a thing about what will happen at any point in the future - like tomorrow! A heart scan is the most accurate predictor of your risk for future heart attack.

Here is the bottom-line. Get a freakin' scan heart scan. If your score is zero, throw a party. If it is non-zero find a doc who understands what your risk is, how to determine the root cause of whatever is causing the problem (hint: High LDL cholesterol is not the most common problem), and put together a program to treat your root causes. Get a yearly repeat scan to see if your plaque burden is growing or shrinking. If it has been arrested or starts reversing - again - throw a party. This means your heart attack risk is almost as low as a zero score. If it is growing, you need to be more aggressive in your current program or change it. The key here is that without a follow-up scan you have no idea of what to do next.

So stop worrying about obstructive heart disease (OK, so don't worry quite so much). Focus on plaque burden.

Plaque is Where It's At!


HeartHawk