Much of What we Believe About Obesity May Be Incorrect In the New England Journal of Medicine, scientists from nutritional centers in the United States and abroad have published a paper titled "Myths, Presumptions, and Facts about Obesity." They suggest that many of the beliefs regarding obesity are not …Read more. Smoking Reduces a Woman's Life Expectancy by 10 Years As a general rule when it comes to health, women are far better off than men. Prior to menopause, their risk of heart disease and stroke is substantially less than men, and the numbers of cancers occurring in both sexes is significantly lower. But …Read more. There Is a Strong Link Between Faith and Health For the past 50 years, significant research has focused on the strong link between faith and health. Studies have shown that those who believe in a higher power and that "God is on their side" tend to be healthier, have a lower risk of disease and …Read more. Seasonal Affective Disorder -- a Common Cause of Depression It is deep into November, the days are cooler and shorter, and Thanksgiving and Christmas are upon us. For many of us, this time of year is filled with special occasions, each one celebrating friends, family and community. But with these holidays …Read more.more articles
Heartsaver CT Scan More Often a Heartbreaker
Once again, new information about CT scans of the heart muddies the waters on the procedure, its effectiveness and its role in detecting heart disease. An article just published in the New England Journal of Medicine demonstrated that measuring the amount of calcium in coronary arteries using a heart CT scan is a sensitive predictor of heart attacks in men and women of all ethnic groups (blacks, Hispanics, Asians and whites), irrespective of age.
The authors suggest that this simple noninvasive approach will make the diagnosis of coronary artery disease quicker and more accurate. Adding the CT scan to other risk factors of coronary artery disease — such as high blood pressure, elevated cholesterol, being a male, having a strong family history of heart disease and cigarette smoking — increased the chance of accurately identifying heart disease from 79 percent to 83 percent.
On the surface, the heart CT scan seems like a simple, easy and effective way to identify coronary artery disease. However, there are serious concerns. In an editorial in the same journal, Dr. W.S. Weintraub questions whether the test adds any benefit to other screening tests, suggesting it is not cost-effective, and the amount of irradiation is so excessive that it could increase the risk of cancer.
While there is little debate that a CT scan can provide an incredibly detailed picture of the heart, the greatest concern is what is done when a problem is identified. Today, hospitals across the nation are offering a "Heartsaver CT scan" to screen for coronary artery disease for as little as $100. The result is thousands of asymptomatic adults flocking to hospitals to take advantage of this amazingly cheap "preventive" treatment.
Those with high calcium scores are referred to a cardiologist and, despite not having any symptoms, are tested further by stress tests and angiograms. Narrowed arteries are often opened by angioplasty and placing of a stent. On occasion, the patient is referred for coronary bypass grafting surgery (CABG).
While many patients and physicians swear that this is "lifesaving" therapy, there is little evidence that this approach is of value.
CABG does prolong life in select patients with isolated blockage of the left main coronary artery, in diabetics, and in those with severe damage to the heart muscle that significantly impairs its ability to pump blood out of the heart. But in asymptomatic individuals with significant narrowing of multiple coronary arteries, the evidence of benefit is marginal, particularly if the patient is committed to a heart-healthy lifestyle.
Sadly, I know of many asymptomatic patients over the age of 70 who, lured by the promise of a Heartsaver CT, were diagnosed with a high calcium score and received invasive, aggressive therapy. I will never forget the patient who, at age 78, had a Heartsaver CT. She had a high calcium score and was referred to a cardiologist, who told her she needed immediate surgery. She had major complications and spent the last three years of her life in a nursing home. Prior to her surgery she was healthy, happy and independent.
The heart CT scan is best used for patients experiencing shortness of breath or chest pain. In this circumstance, it can help determine the cause of the symptoms. But for the healthy, and particularly for those over age 70, the heart CT should be used sparingly, if at all. Everyone from middle age and beyond should consider himself at high risk of heart disease.
As such, we should all live a heart-healthy lifestyle — eat a healthy diet, exercise, take an aspirin a day, stop smoking, and treat elevated blood pressure and cholesterol. The greatest role of the heart CT scan is to help patients understand their risk of heart attack. For healthy, asymptomatic middle-aged adults, these scans ultimately confirm what we already should know — it simply does not make sense.
Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.
COPYRIGHT 2008 CREATORS SYNDICATE INC.