The Heart of the Matter

While hiking outside of Denver last spring, one of my firm’s patients noticed a light, fluttering sensation in her chest, followed by pain in her jaw, nausea and a cold sweat. Her next 75 minutes consisted of an ambulance ride, an EKG and admittance to the cardiac catheterization lab, where she underwent a rescue angioplasty and stent placement for an occluded coronary artery.

This medical event surprised her—and all of us at WorldClinic. Our patient, who was just 25, had had a normal cardiac exercise stress test just two years before, and her only obvious risk factor was that her father had had his first heart attack at 57—but he was a chain-smoker. Could we or our patient have done anything differently to see this coming?

It’s an important question because, the statistics show, most of us will die a cardiac death. The enemy of all good cardiac blood flow is plaque, a mix of calcium, cholesterol and proteins that attaches to the wall of coronary arteries. Hypertension, diabetes and physical inactivity eventually enlarge such deposits to the point that they compromise blood flow. In advanced cases, the artery wall with the plaque may rupture, exposing torn collagen and plaque to passing platelets and thus triggering a clot. The result is usually an immediate and total occlusion of the artery.

Though the exercise stress test has been a good way to assess our patients’ risk for a heart attack, it is not foolproof. There are better cardiac screening tests out there that we don’t hear about very much because most health insurance plans don’t cover them. But those willing to pay for these tests should talk to their doctors about having them.

01. High Sensitivity CRP

This blood test reveals how much plaque you have throughout your vascular system. If your plaque level doesn’t change, you aren’t enlarging the plaque burden you already have. If the value increases over time, you are heading for trouble.

02. Cardiac Myeloperoxidase (MPO)

This test reflects your risk for the rupture of unstable plaque, which occurs when a cholesterol pocket in the wall of your coronary artery is large enough to spontaneously burst into the artery itself, causing a heart attack. In the case of the patient above, the results might have tipped us off that she was at major risk.

03. PLAC Test

Like MPO, but through a different mechanism, the PLAC Test is very good at assessing whether you are vulnerable to a high-risk plaque rupture.

One or two of these biochemical blood tests can be combined with cardiac calcium scoring (an X-ray of your heart) or a carotid artery Doppler (an ultrasound of the carotid vessels in your neck), minimally invasive exams of your vascular anatomy that show how much plaque is in your coronary arteries. Along with the results of the blood tests, they provide information that can tell you whether the situation is likely to worsen. You and your doctor can then sort out key issues related to your lifestyle and whether statins (a controversial class of cholesterol-lowering medication) might make a positive difference in your future.

Pay particular attention if the results show that you have obvious plaque and an elevated MPO or PLAC Test. If so, you are at a much increased risk for a serious event. Anyone with such results should be under the care of an attentive physician and have a deliberate but aggressive program to stabilize and arrest plaque formation. Though such a program may involve major changes in areas such as diet, stress management, exercise and blood pressure/blood sugar medications, the return on investment is, quite literally, your life.

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