Racism and Discrimination in Health Care The highly influential New England Journal of Medicine published a series of perspectives on racial bias in health care. Dr. Mary Bassett, New York City's health commissioner, suggested that the medical community should not only do more to improve …Read more. When Is an Older Driver a Danger on the Road? Telling an older person he should no longer drive is difficult. This can be a devastating blow to the patient, who may resist the suggestion vigorously. No longer being able to drive takes away one's independence and increases isolation, depression, …Read more. Priorities in Lowering the Risk of Heart Disease Heart disease is the leading cause of death in the developed world. Although occurring at a later age, heart disease is just as common in women as in men. Despite this fact, fewer than 1 in 5 women believe that heart disease is a significant health …Read more. Being Your Parent's Parent Is Difficult But Potentially Rewarding I truly miss my mother, who died 18 months ago, at age 90. She was the quintessential Jewish mother and an expert at guilt. When I phoned her in South Africa, I didn't just say hello; I also said I'm sorry. I had almost always done something wrong. …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.