HeartCare Frequently Asked Questions
What is heart disease?
What is plaque and what causes it?
What is preventive cardiology?
How do I know if I have the disease?
What can I learn at HeartCare that is not common knowledge among physicians?
What does HeartCare do that is different from what most cardiologists do?
What the difference between advanced lipid testing and the usual blood tests?
What are the non-traditional risk factors responsible for plaque formation?
What about the statin drugs that are prescribed for many people with high cholesterol?
Aren't they sufficient for most people to prevent heart attacks?
What do you recommend in the way of diet, exercise, and lifestyle changes that are
different from what most doctors advise?
I don't eat a lot of cholesterol; why is mine still high?
If I have had a heart attack, why is this kind of treatment necessary?
Why can't I just have a stent or bypass like I did before, if and when I need one?
Do I have to have the advanced blood work and an electron-beam CT scan
before I can see Dr. Wong?
Even if I don't have any family history of heart disease, can I still see Dr. Wong?
If I am happy with my current primary-care doctor and/or cardiologist, can I see Dr. Wong?
What hospital privileges does Dr. Wong have, and where does he admit patients?
What limitations do you have on insurance?
What else is needed if I decide to see you for an initial consultation?
Q: What is heart disease?
A: Heart disease may be congenital or acquired. You can acquire heart disease when fatty deposits called plaque build up inside the coronary arteries. The coronary arteries supply the heart with blood and oxygen. When plaque builds up, the artery can rupture causing a heart attack. The plaque is also known as atherosclerosis. Atherosclerosis is the leading cause of heart attack and stroke.
Q: What is plaque and what causes it?
A: Plaque is a fatty material made up of cholesterol, calcium, and other substances in the blood. High blood pressure, diabetes, or high cholesterol begin to damage the endothelium, a thin layer of cells lining the arteries that keep them toned and smooth, which keeps the blood flowing without obstruction. Bad cholesterol, or LDL, crosses damaged endothelium. The cholesterol enters the wall of the artery. Your white blood cells stream in to digest the LDL cholesterol. Over years, the accumulating mess of cholesterol and cells becomes plaque in the wall of the artery.
Q: What is preventive cardiology?
A: The practice of medicine to prevent heart attack and stroke: first, by diagnosing the genetic and environmental influences that can lead to disease, and second, by treating those factors. The composition of plaque can be changed and plaque accumulation can be reversed.
Q: How do I know if I have the disease?
A: You may not know. Common symptoms are chest pain and pressure, shortness of breath, palpitations and dizziness. However, many people have no symptoms until they suffer a heart attack or stroke.
Q: What can I learn at HeartCare that is not common knowledge among physicians?
A: You will learn how vunerable you are to heart disease through an assessment of your detailed medical history, including a family history. We then order tests specific to the patient's personal susceptibility to heart disease, which can include advanced lipid testing and imaging studies. An individualized treatment program is recommended based on these findings.
Q: What does HeartCare do that is different from what most cardiologists do?
A: We specialize in treating the one-third (some say as much as one-half) of the population that suffers from heart disease arising from nontraditional factors.* We specialize in assessing the genetic metabolic disorders found in the blood that result in build up of arterial plaque. This condition, known as atherosclerosis, can ultimately produce heart attack, stroke, and poor circulation. Once diagnosed, risk for future events can be assessed and treated.
Specific diagnosis of a particular disorder is key, and since 1997 we have pioneered the use of advanced blood testing to provide that information. We also interpret findings from the heart scans that can show calcified plaque in the arteries. Depending upon the calcium score, the probability of risk for future coronary events can be assigned and behaviors modified.
*Traditional risk factors are cigarette smoking, high blood pressure, high LDL cholesterol, low HDL cholesterol, diabetes, and family history of premature coronary disease in first-degree relatives (parents, siblings, children).
Q: What the difference between advanced lipid testing and the usual blood tests?
A: Beyond the level of cholesterol and triglycerides routinely provided in blood tests, advanced testing provides more refined measures of other substances in the blood that paint a unique profile of a patient's risk.
Q: What are the non-traditional risk factors responsible for plaque formation?
A: The American Heart Association (AHA) and the American College of Cardiology (ACC) jointly released a statement in 1999 about considering nontraditional risk factors in assessing heart disease. These include small LDL cholesterol, lipoprotein (a), and homocysteine. Advanced lab testing allows measuring the size of the LDL cholesterol particles; this is significant because small particles will have the ability to penetrate the arterial wall to form plaque.
In May 2001, the following were added as equivalent risks for heart disease: symptomatic carotid artery disease, peripheral vascular disease (poor circulation in the legs), abdominal aortic aneurysm, and diabetes.
We also focus on identifying and treating Metabolic Syndrome that consists of a pattern (abdominal obesity or large waist size, triglycerides over 150, low HDL, fasting blood sugar greater than 100) that increases the risk of atherosclerosis and hypertension. The Metabolic Syndrome is also associated with small LDL cholesterol. We measure all of these factors and calculate a patient's risk accordingly.
Q: What about the statin drugs that are prescribed for many people with high cholesterol? Aren't they sufficient for most people to prevent heart attacks?
A: Statins are good at lowering LDL cholesterol generally, but if plaque formation is caused by other disorders, statins will not affect the problem. Two out of three patients with heart disease do not benefit from statins.
Q: What do you recommend in the way of diet, exercise, and lifestyle changes that are different from what most doctors advise?
A: Our recommendations are tailored to each individual based on the abnormalities uncovered by sophisticated laboratory tests. For example, some people can eat sweets and drink alcohol with relative impunity, while for others these behaviors exacerbate the problem. Surprisingly for some, a very low fat diet may worsen metabolic problems and result in higher risk.
Q: I don't eat a lot of cholesterol; why is mine still high?
A: There are two ways of creating high cholesterol levels: (1) eating cholesterol as well as eating a lot of saturated fat, or (2) producing it because of abnormal liver metabolism. Even if you don't ingest cholesterol and saturated fat in your food, you may lack LDL receptors in your liver, which will result in a high cholesterol level. This latter condition can be treated.
Q: If I have had a heart attack, why is this kind of treatment necessary? Why can't I just have a stent or bypass like I did before, if and when I need one?
A: Medical procedures like stents and bypass operations only resolve the immediate problem - they do not address the source of the problem that created the condition. If the condition is not addressed, the problem is likely to recur. The idea of preventive treatment such as the kind provided by HeartCare is to establish a plan to avoid a heart attack. Half of heart attacks result in sudden death.
Q: Do I have to have the advanced blood work and an electron-beam CT scan before I can see Dr. Wong?
A: No. We see many patients who have had neither, or only one. Both the laboratory and the CT centers refer to us because of our long history in this area, but we often see patients who have not had both studies done. We may refer you to one or the other, but they are not a condition of being seen in our practice.
Q: Even if I don't have any family history of heart disease, can I still see Dr. Wong?
A: Yes. There are patients who do not have a known family history of cardiovascular disease, but may have significant metabolic abnormalities predisposing them to disease, or who already have atherosclerotic disease. We do not do primary care, but we have practiced cardiology for over 30 years and have treated every kind of cardiac-related problem.
Q: If I am happy with my current primary-care doctor and/or cardiologist, can I see Dr. Wong?
A: Yes, we often provide second opinions, and are happy to work with other doctors. We routinely provide reports back to the referring doctors, and are open to consulting with them about mutual patients.
Q: What hospital privileges does Dr. Wong have, and where does he admit patients?
A: Dr. Wong has staff privileges at St. Vincent Medical Center, Good Samaritan Hospital and California Hospital Medical Center, where he was Chair of Medicine, all in downtown Los Angeles.
Q: What limitations do you have on insurance?
A: We accept most private insurance plans and Medicare. We do not accept HMO patients unless they have an authorization for a specialist in cardiology. Insofar as POS plan coverage, it is the patient's responsibility to obtain authorization from their primary care provider for each visit or procedure.
We have just accepted our first cash patient for an email consultation, and this form of visit (as well as a telephone consultation) is not recognized by insurance. Although this is not a favored means of communication (in fact we actively discourage it), we have agreed to this because we do have an increasing number of patients in foreign countries who are not able to see us regularly. An office visit is preferred, so that we can be sure our explanations are communicated, and we can observe and examine patients and chart progress first-hand. However, the times seem to require flexibility on this, so we are experimenting with it, and we have a cash fee schedule for those limited circumstances where we would consider it appropriate.
Q: What else is needed if I decide to see you for an initial consultation?
A: We ask for a release to obtain your cardiac-related studies and laboratory work from the recent past. Many insurance companies, including Medicare, refuse to cover more than one procedure per year, and if we must repeat these studies, the patient is liable. Often an older test can help provide a baseline as well, so we can measure progress. With a signed release, we can usually obtain records within a day or two.
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