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Tim Russert's Death: Questions, Answers

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

How would someone find out that they have that? continued...

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.

Russert did well on a stress test in late April. What does a stress test tell you, and if you do well on one, does that mean you're in the clear?

Patterson: The critical question is what does it not tell you. Stress tests don't tell you about the presence of vulnerable plaque. Plaque doesn't have to obstruct blood flow to be vulnerable. The only thing that a stress test will tell you is if you have enough plaque to obstruct blood flow.

The fact he had a normal stress test is good prognostically; it put him in a lower-risk bundle. But it doesn't take his risk down to zero and it does nothing to identify whether he had plaques that were vulnerable and at risk for rupture.

Ostfeld: Every test is different and needs to be interpreted differently. But if someone has an excellent stress test, that would predict a very low risk of a short-term event and is largely reassuring. However that does not obviate the need, of course, to continue to have a healthy lifestyle and to be sure problems are well controlled.

If someone already has atherosclerosis, is the goal to prevent it from worsening or is the goal to undo it?

Ostfeld: The goal is to make the person as healthy as possible and to improve the health of the blood vessels as much as possible. We've learned that many of our therapies, although they may not change the absolute amount of atherosclerosis in a blood vessel, they improve the health of that blood vessel very much. So it may be that the health of the blood vessel itself is the key aspect. We know that a healthy lifestyle and appropriate medical therapy can improve the health of the blood vessels, so those things are obviously very important.

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