The writer of twice-monthly health columns is a practicing cardiologist, clinical professor at Wayne State University School of Medicine and founder of the Kahn Center for Cardiac Longevity in Bingham Farms. He is an author and has appeared on national TV, including "Dr. Oz" and "The Doctors Show."
By Dr. Joel Kahn
It's Heart Month -- time to reflect and protect the heart.
Let’s say that you are working hard at your career and have goals to provide for your family’s security and to build your future retirement. Nothing can stop you -- you are at the top of your game. Nothing, that is, except a health crisis.
The most likely detour to your plans is the sudden closure of an artery to your heart or brain causing a heart attack or stroke. Your plans change in a second as do those of your career and family. Although the problem was progressing for years, how was it not detected?
I wrote a 2018 book, "Dead Execs Don’t Get Bonuses," to plea with readers to arrange a thorough reality check of your health beyond a cursory annual exam. Here is the list of what to arrange in Heart Month.
Coronary artery calcium scan (CACS)
You turn 50 and your health care provider turns to you and says, “we need to schedule your colonoscopy and, if female, a mammogram." Why no equivalent screening test for the heart, which poses a far greater risk than colon or breast cancer? The CACS is a highly accurate, safe, and available test you should do. A CACS is a CT scan of the heart that takes under 1 minute, uses no dye or needles, exposes you to very low dose radiation, and costs about $100. It is far more accurate for screening than any kind of stress test on the planet. Your CACS score should be zero, and anything higher should prompt you to see a preventive cardiologist to examine in detail your risk factors, lifestyle and stress
Ask for advanced labs -- you're worth it
Dr. Joel Kahn: "Arrange a thorough reality check."
I've had 30-plus years of training and practice and I can tell you that you'll probably have the same lab tests at an annual physical now as you would've in the 1970s when I started training. This isn't just outdated, it's unacceptable considering there have been major advances in laboratory testing. I suggest asking for the following:
♦ Advanced lipid profile: Rather than giving you a calculated LDL cholesterol level, advanced panels measure LDL particle number and size, which are more predictive of future heart and stroke events. Two people with the same cholesterol levels can have widely different particle and size measurements, making for very different risks. You need to know yours.
♦ Lipoprotein a: This is a genetic form of cholesterol that's elevated in about 20% of those tested. It's rarely drawn even though hundreds of research studies indicate that if it's high, the risk of heart attack and stroke skyrocket. There's even a foundation dedicated to educating the public of the risk.
♦ Homocysteine: This amino acid is produced by a process called methylation. It's important for artery and brain health, and when elevated, it may be due to a genetic defect in the MTHFR gene, which is also easily measured. It can be treated with methylated B complex vitamins, and the level will return to normal.
♦ Inflammatory markers: The best known is hs-CRP, but there are at least five others I measure in my practice. If there are elevated markers of inflammation in the blood, a hunt is on for insulin resistance, infections, food allergies, skin conditions like psoriasis, a diet rich in processed foods, central obesity, gingivitis, and sleep apnea, among others. Inflammation can be reduced by addressing these root causes.
Never leave an ER without a complete evaluation
Don't go to an urgent care clinic with chest pain, pressure, tightness, squeezing or compression. Go to an emergency room.
But ERs have pressure on them to turn over rooms, so don't go home without a thorough evaluation.
Ask for serial cardiac enzymes that are repeated two or three times, every four to six hours. Ask for a repeat ECG to compare to the one you got initially. Ask for a definitive test before discharge, such as a treadmill stress test, a CACS or an advanced coronary CT angiogram.
In 1955 President Eisenhower had a massive heart attack and was cared for by Dr. Paul Dudley White of Harvard Medical School. In commenting on his care, Dr. White made this dramatic statement: "A heart attack after age 80 is an act of God but a heart attack before age 80 is a failure of the medical system”.
All these years later we focus on learning CPR and having AEDs in gyms but miss the main point: The early identification, prevention and reversal of the silent disease that chokes off our vitality. We must do better.
