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Tim Russert's Death: Questions, Answers

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

A lot of people may still have the idea of plaque being something that clogs the arteries like hair in a drain. Can you explain to them how they should picture it inside the walls and how a blockage and rupture happens?

Patterson: Plaque can be the kind of buildup you're talking about -- that's where the water doesn't flow through the drains right. But that's not really what a vulnerable plaque is. If you want to think about what a vulnerable plaque is, it's like having a pimple in the side of a blood vessel wall, a pimple that's prone to open up and rupture. It's when that rupture occurs that the blood will clot and the heart attack will happen. So it's really a very different process, fundamentally, than the obstruction of the flow of blood.

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