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    Tim Russert's Death: Questions, Answers

    Get Answers to Questions About Tim Russert's Heart Attack -- And Your Own Risk

    Does having diabetes make it harder for people to be aware of heart attack symptoms?

    Ostfeld: Yes, that's quite possible. Sometimes people can have a "silent" heart attack where they actually had death to part of the heart muscle -- the heart attack -- but did not feel it, and that is reportedly more common in people with diabetes because they may have some nerve damage that may reduce their ability to feel that.

    His coronary artery disease was asymptomatic -- that's silent heart disease?

    Patterson: That's silent heart disease. It's important to remember that half of people who have heart attacks don't have symptoms before they have a heart attack.

    How would someone find out that they have that?

    Ostfeld: There are a handful of ways that we can predict future risk and/or specifically screen for atherosclerosis that may not be clinically apparent. Routine screenings are things like cholesterol and high blood pressure and diabetes -- things that, if elevated or present, may significantly increase your future risk of heart disease. Those should be part of routine evaluation.
    Other tests include a blood test looking for inflammation in the body; one blood test is a high-sensitivity CRP test. But it is not clear that checking this blood test will always modify how we treat the patient.

    There are more expensive tests that can be performed that look directly at blood vessels, looking specifically for atherosclerosis. Two such tests are a carotid ultrasound test that looks at the thickness of the blood vessel, something we call an IMT ... if it's thick, that suggests that there is atheorscloerosis present.

    Another imaging study is a heart CT can or heart CAT scan, which can look for calcium in the blood vessels and or look at the blood vessels themselves to see if signs of atherosclerosis are there.

    Zipes: Heart scans can be useful. In general, they're expensive and generally not paid for by insurance, but if someone can afford it, yes, that's a very reasonable thing to do.

    Osfteld: It's important to know that [some] CAT scans do have risk. The one that looks specifically at the blood vessels [sometimes called a "noninvasive coronary angiogram'] ... has more than trivial radiation and may increase cancer risk down the line. So these are not tests that I believe should be done on everyone. Others would argue otherwise, but I believe that should be individualized as well, and, I believe, done under the care of a physician.

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