Are we done here?

Les' doctor consulted me because his CT heart scan score had increased 40% from 893 to 1259 over 18 months.

Judging by his appearance, Les was a 59-year old guy trapped somewhere in the 1980s. The only reason he'd undergone two heart scans was from the prompting of his wife, who was quite savvy.

Among the steps we took was to have Les undergo a stress test. I explained to Les and his wife that stress tests are effective tests of coronary blood flow, but not of plaque. Therefore, there was somewhere around a 25-35% likelihood of an abnormality that suggested poor flow in one or more portions of the heart.

Les passed his stress test easily. A bricklayer, Les was accustomed to heavy physical effort. "Are we done here, doc?" Les asked. Les' wife raised her eyebrows but, to her credit, kept quiet. She'd obviously been here before.

I explained to Les that having normal coronary blood flow was just one aspect of the issue.

"But I don't need a stent, right? I don't need a bypass. I already take Vytorin. So I need a cheeseburger once in a while. So what! Who doesn't? What else is there?"

I continued. "Les, with a normal stress test, there's no denying you still have lots of plaque in your heart's arteries. The risk to you is that one of these plaques will 'rupture,' sort of like a little volcano erupting. Of course, it's not lava that flies out, but the internal contents of plaque. When that happens and the contents of plaque get exposed to blood flowing by, a blood clot forms. That's a heart attack.

"With a 40% increase in your score over 18 months, you are, in fact, at substantial risk for such a plaque rupture. Unless you're fond of hospitals and the thought of heart procedures, then we need to address that part of the issue."

So it went. Step by step, with the quiet, strong support of Les' wife, we uncovered 7 additional causes of his heart disease. It wasn't the easiest process for us, but we did manage to educate Les on the simple steps he needed to take to 1) correct the causes of his coronary plaque, 2) how to use foods and stop fanning the flames of his plaque, and 3) how to live with this nasty specter hanging over him.

Now, if we could only transform Les into an optimist . . .

Comments (4) -

  • Anonymous

    7/28/2007 12:15:00 AM |

    I'm curious what those "7 additional causes of his heart disease" were.

  • Dr. Davis

    7/28/2007 1:32:00 PM |

    These refer to the lipoprotein sorts of abnormalities we commonly uncover, e.g., small LDL, IDL, VLDL, deficient vit D, etc.

  • Anonymous

    8/25/2007 2:40:00 AM |

    I am interested in learning what you prescribe for lessening plaque rupture. My score was 1229 and I also easily passed an echocaridogram. I am doing all
    I can to correct the deficiencies from my lippo testing
    but what I fear most is plaque rupture. Currently I am
    taking 2000 mg omega3s and 10mg Mevacor as prevention. I was taking an ACE inhibitor but discontinued 2 weeks ago as my blood pressure has stabilized for the first time in 14 years.
    Any thoughts you may add would be appreciated.
    Gene Mc

  • Dr. Davis

    8/25/2007 2:52:00 AM |

    Hi, Gene--

    I'm afraid that our approach is too lengthy to cover in this blog.

    I would invite you to participate in the conversation on the website. The entire website is, in fact, devoted to answering your question.

    I will stress to you that, given your current regimen, an increase in heart scan score is virtually guaranteed unless you take appropriate action.