What Happened to Tim Russert?
Americans were recently taken by surprise at the untimely and sudden death of senior vice president of NBC News and moderator of "Meet the Press" Tim Russert. It was reported that the 58 year old journalist died of "a sudden heart attack." The autopsy found that Mr. Russert had an enlarged heart and significant coronary artery disease.
Were there any clues to suggest his serious heart condition?
Calcium Score
About 10 years before his death, Mr. Russert had a heart scan showing a calcium score of 210. Although some experts use a score of 400 as the benchmark for high risk and would therefore classify Mr. Russert’s risk as moderate, experts who factor in gender and age to determine risk would have classified him at very high risk.
Plaque in the Arteries
Mr. Russert had a stress echo test done a few months before his fatal heart attack that can detect 70% or greater narrowing of the arteries. His test was normal. And yet he died suddenly. No test is yet available to predict whether a plaque is ready to rupture.
Statin Therapy
Mr. Russert was on statin therapy (prescribed medications to lower his bad cholesterol) which did lower his bad LDL cholesterol to 68, the goal recommended by the guidelines. But research shows that two or three out of four people on statins continue to suffer from strokes and heart attacks, or require bypass surgery or stents to relieve their symptoms.
Low HDL & High Triglycerides
Mr. Russert’s HDL (good cholesterol) had risen from the 20’s to 37, but was still below the recommended 40 level. Another signal of his high risk was Mr. Russert’s elevated Triglycerides (high is over 150). Leading researchers look to the HDL-Triglycerides ratio (equal to or greater than 3.5) as an indicator of insulin resistance
(metabolic syndrome) which confers a three-fold increase in risk. Again, Mr. Russert was at high risk.
Take note
Anyone with a high Triglyceride-to-HDL ratio should seek counseling from a practitioner who is knowledgeable about cardiovascular prevention. (This ratio may not be applicable to African-Americans.) This ratio may indicate a need for aggressive therapy to stabilize the plaque, to prevent it from rupturing suddenly with disastrous results.
Increased risk today
Although imaging studies and pharmacology have contributed greatly to our understanding of cardiovascular disease and its treatment, our population is at greater risk than ever.
Why? Because this is a disease of civilization - sedentary lifestyles, fast and over-processed food, a lack of understanding of the roles played by diet and exercise, and/or lack of will to change them, hypertension, smoking, stress and pollution of various kinds. All of these take their toll on our health, starting in childhood.
A new paradigm
The old way of understanding heart disease has changed. It is no longer appropriate to think of cardiovascular problems as clogs that can be roto-rooted out or bypassed and solved. Today we understand that heart disease is a condition which must be addressed system-wide if it is to be treated successfully. |
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