The story is a common one. So common that most of us have had a friend, family member, or loved one who has died of a sudden heart attack.
People ask how it could happen to someone so young and healthy. Someone who exercises regularly, or who had no symptoms at all. The horrible truth is that 50% of the time, the first indication that a patient has severe coronary disease is when they die from a sudden heart attack.
We need to do better, and at Priority Physicians we’re passionate about identifying and treating silent cardiac disease.
Generally speaking, coronary disease presents in one of two ways. The first is when the coronary arteries slowly narrow over time. This is due to cholesterol plaque insidiously building up within the walls of the heart arteries, causing a gradual narrowing.
These patients are pretty easy to diagnose. If you can’t walk 50 feet without stopping from chest pain and shortness of breath, you almost certainly need a cardiac catheterization. Symptoms like this offer a strong indication that your coronaries are at least 70% blocked. That’s the number when down-stream blood flow is affected, and the number cardiologists use to determine whether or not to go in and stent (open up) those arteries. Typically, if you’re at less than a 70% blockage, we’re going to watch your symptoms and treat you medically.
The big problem is that the second way coronary disease presents doesn’t look like this at all. This is especially true in younger patients and in those who have a high risk for coronary disease. Their biggest risk isn’t the slow cholesterol build-up over time. Their biggest risk is that one of the plaques that’s embedded in arterial wall will break open and expose its soft, sticky core to the inside of the blood vessel.
When that plaque ruptures, it blows soft liquid cholesterol into the center of your coronary artery. The body reacts by creating a blood clot. You can go from a 10% narrowing to a 100% blockage in about a minute. Those are the people who die of sudden cardiac arrest. Unfortunately, they also tend to be younger patients who aren’t otherwise on the radar for coronary disease.
Preventing Coronary Disease
There are many risk factors for heart disease. The two biggest are smoking and diabetes. Cholesterol, weight, physical activity level, and family history are all key factors as well. One of the things we’ve learned in the last decade is that the amount of inflammation in your body plays a huge role in your cardiovascular health.
The one common theme among all cardiovascular risk factors is their propensity for increased inflammation. As the inflammation in the walls of your arteries increases, so does the risk of plaque deposition — that is, of cholesterol sticking to the walls of your arteries. Increased inflammation also increases the risk of plaque rupture, which is the leading cause of sudden cardiac death.
Conventional medical practices wait to screen for coronary disease until a patient experiences chest pain or until they develop multiple issues and risk factors. This approach is problematic for several reasons.
First, the traditional medical system isn’t paid to work up asymptomatic patients. For example, there is still no insurance reimbursement for screening heart scans, despite the fact that prices for the scans have dropped to around $50.
Second, the system is unfortunately designed to generate vastly more revenue by putting in stents and bypassing coronary arteries than by identifying asymptomatic patients and treating them early. Medicine is big business, and financial incentives drive hospital priorities and behavior.
In our direct primary care model, our incentives are aligned with what’s best for the patient. Our goal is to do everything we can to keep our patients as healthy as possible. We certainly aren’t financially rewarded the sicker our patients get.
Because we’re outside the insurance market, we will routinely order screening tests we believe are indicated that insurance doesn’t cover. By identifying high-risk patients, we can intervene early and prevent future heart attacks and death.
The Best Ways to Prevent Heart Attacks
Know Your Risk Factors
Not only should you know what your risk factors are, you should also know whether each one is under control. These risk factors include:
- Current smoking or history of smoking
- Cholesterol — Bad (LDL) and good (HDL) levels along with the sizes of these particles
- Blood pressure
- Weight — including your body composition, visceral fat level, and overall percent body fat
- Inflammatory status, including cardiac-specific inflammatory lab markers
- Lifestyle — are you exercising and eating a balanced diet?
- Family history of coronary disease
Know the State of Your Cardiovascular System
Do you have any plaque in your coronary arteries? If you do, is it old, stable plaque that was laid down when your cardiovascular risk factors were more poorly controlled than they are now? Or do you have mostly soft, non-calcified plaque? If so, you could be getting a false sense of security from a relatively low calcium score that doesn’t show the extent of soft plaque burden.
At Priority Physicians, all our patients over the age of 40, as well as some younger patients with higher risk factors, are offered a coronary calcium score. If their calcium score is anything significant, we take a deeper dive and determine whether their plaque is old or new. We can tell the difference with a coronary CT angiogram.
Other than a minimal amount of radiation, the coronary CT angiogram is a very safe screening test. We run the data from that screening through a secondary company called Cleerly, which uses machine learning and AI algorithms to give us a load of specific, useful information about the composition and location of any plaque.
What is the composition of those plaques? Hard, soft, or the most dangerous “lipid lake” plaque with the highest risk of rupture? Based on that information, we can tell how aggressive we need to be with a patient in modifying all their risk factors as well as whether further non-invasive or surgical intervention is necessary.
We believe in the power of information when deciding how to prevent and treat cardiovascular disease. Over the last 20 years, Priority Physicians has been proud to roll out the most aggressive preventative cardiovascular program in the Midwest. More importantly, we’re happy to say that we’ve already saved countless lives by doing so.
Come in for an appointment today. We’ll be happy to speak with you about our focus on preventative care.