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
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