Twenty years after practicing traditional cardiology, in 2001, I started to find a way to incorporate aggressive heart attack prevention as part of a routine cardiology visit. By 2006, I became convinced that preventing heart attack is the future of cardiology as I witnessed a progressive incremental reductions in heart attacks in my own practice. I made enthusiastic presentations to several hospital administrators. The responses were the same: preventing heart attack is a good thing and that is in the future.... but prevention does not work for us... we need more heart attack and stroke patients,,, we have stroke center to support... The lesson I learned quickly - the healthcare system is hard if not impossible to change. It seemed hopeless to fight a goliath and I stopped fighting for change. After this pandemic, there may be a new opportunity to improve patient outcomes while reducing cost by preventing most heart attacks and strokes.
900,000 Americans have already died since the pandemic began, more than during the 1918 Spanish flu. It is a devastating calamity that we have not completely processed yet. While the acute phase of the pandemic appears to be coming to an end sometime this year, this pandemic will continue to impact our lives for years to come. As of February 2022, about one out of every 300 adult Americans who were alive before the pandemic are no longer here - killed by the COVID-19 virus.
There is another longstanding epidemic here is the US that we have been trying to fight for many decades. We have won many battles but continue to lose the war against heart attacks. Every year, about 620,000 Americans have their first heart attack. About 200,000 die without reaching the hospitals. They are largely preventable - an established medical truth that no one can dispute. So why have we not win the war. It's quite complicated.
Experts are forecasting an increase in heart attack after the pandemic ends. There are several reasons for this: patients are not having their usual follow-up visits, needed blood tests are not being done, medications are not being refilled, patients are not taking their medications regularly, diet is less healthy, lack of physical exercise and prolonged sustained mental and emotional stress from isolation and stress from work and family situations. And for the many millions who got infected and survived, there is also concern about an increase in heart attack risk.
The is a high concentration of virus in the heart in addition to the lungs where it caused severe endothelial dysfunction. The arteries are rich in ACE2 receptors - the binding site of the spike protein and portal of entry of the virus into the cells of the endothelium. Once infected, these cells are destroyed after making millions of copies of the COVID-19 virus. This destruction of the endothelial cells causes endothelial damage and severe endothelial dysfunction. This is the cause of elevated cardiac troponin enzyme - a marker of heart muscle damage, among those hospitalized. Endothelial dysfunction initiates, fosters and, without optimal medical therapy, accelerates atherosclerosis - the plaque build up in the coronary arteries.
All of these are reasons behind our Save Your Heart Campaign. I believe we should make every effort to save more lives whenever it is possible after losing so many in the last two years.
For now, we will start a virtual campaign and produce a series of short ten-minute videos that are educational and empowering while also fighting medical misinformation and medical disinformation in social media. You will then be able to take charge and be responsible for not becoming another victim of a heart attack or stroke. We are here to help but ultimately, it is up to you to become more engaged and ask questions when you see your primary care physician and cardiologist on your next visit.
The science-based approach that we developed and refined since 2001 can be described simply as "stop your heart attack before it happens". There are two steps to this approach: (1) determine if and how much calcified plaques are present in one's coronary arteries by coronary calcium scoring for eligible patients and (2) and if plaques are present, initiate a comprehensive medical therapy that induces plaque stabilization to prevent plaque rupture, that stops disease progression and even induces disease regression. This goal is achievable in most patients. We have proven that in our practice.
The stakeholders are you - the patients, the cardiovascular healthcare industry, the insurance companies including Medicare and the federal government. Are their interests aligned? (No, they are not.) And if not, how can we make all the parties align themselves to a common goal - eliminating premature heart attacks and strokes.
A Picture is Worth a Thousand Words. A Video even More.
I want to choose one picture that captures best what a heart attack is - this is the one because it clearly shows the three components needed to have a heart attack: (1) a plaque, (2) a tear in the surface of the plaque causing plaque rupture, and (3) a clot that stops the blood flowing to the heart muscle.
I am thankful for the people and their families featured in The Widowmaker documentary film who willingly shared their own stories to spare others from suffering the same fate.
Here is a short video excerpt (with permission from the producers of The Widowmaker):
Margaret, John and Melinda want to share their stories that others may be spared,
While coronary artery disease is silent for a long time, its presence can be easily and inexpensively (about $100) detected by coronary calcium scoring test years before your heart attack or sudden cardiac arrest. After its detection, an effective medical treatment can be prescribed by your primary care physician or your cardiologist to stop its progression and prevent a heart attack, and avoid the future need to have stents and heart bypass surgery. Also, the same treatment that prevents heart attack prevents stroke.
Coronary calcium scoring test was approved, endorsed and recommended by the American Heart Association and the American College of Cardiology over a decade ago but access to it has been blocked by lack of awareness by the general public and insurance denial. In Texas, all health insurance companies are mandated by the Texas Heart Attack Prevention Bill to pay for this test.
Our primary objective is to spread the correct information about coronary calcium scoring test and to stop denial of services by all insurance companies. Consider coronary calcium scoring test as "mammography" for the heart but unlike regular routine mammography, it is done only once or twice during a lifetime. The secondary objective is to provide reliable information on what to do next if your calcium score is zero, 100 or 1,000.
Please visit Save Your Heart Campaign website.
When a 40 or 50 year old patient comes in for heart attack prevention, the initial evaluation involves clinical cardiology expertise.
After or during the initial evaluation, preventive cardiology expertise determines how most accurately determine the risk for cardiovascular events within the next 5 to 10 years.
Advanced Lipid Clinic
Once the severity of risk is known, medical therapy is optimized to the level of risk. Advanced lipid therapy is the foundation of prevention in high risk patients.
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