Don't Drop Dead! How to Know Your Heart Risk

Heart disease can strike unexpectedly at any moment causing illness or death. There's nothing pretty about lying in a cardiac care unit bed on a ventilator after a major heart attack, so here's straight talk about a plan to know you are young inside and out and NOT DROPPING DEAD. 

Dr. Joel Kahn: "Measure heart age with precision."

► Step 1: Get a coronary artery calcium CT scan (CACS) after 40

At age 50, a health care provider says, “we need to schedule your colonoscopy and a mammogram (if female)”. Why did your health care provider not also say to you that “we need to schedule a CACS so we know if your heart is aging”?

A CACS is a CT scan of the heart that takes only a few seconds, is painless, uses no dye or needles, has a very low radiation exposure (like a mammogram), and costs about $75-$100 at Detroit-area hospitals. The ideal result in about 50% of those tested is a CACS score of zero.  Anything higher raises the risk for heart attack and proves aging of the heart and entire body. 

Recently the American Heart Association and other organizations have included the option of getting a CACS for most people before starting prescription cholesterol medications.  Ask your health care provider for a CACS prescripotion if you have no known heart disease and are over 40. If you have had a heart attack, stent or bypass surgery, you do not need this screening.

 Step 2: Find a carotid intimal-medial thickness (CIMT) scan

A CACS identifies calcification of arteries, something called hard plaque. There is also a pathology called soft plaque that may threaten health. A CIMT is a 20-minute ultrasound of the neck that uses advanced software measurements to examine carotid arteries for both soft and hard plaque. The CIMT also measures the thickness of arteries, another sign of aging.

The biggest drawback is finding a quality center that offers it. Most of my patients have had both of these exams and they know with precision their true “arterial age” and work hard at a lifestyle program to stay “young at heart.”

► Step 3: Arrange advanced labs like a Lipoprotein(a) blood level

It is unacceptable to have the same lab studies you had for the last 30 years, as there have been major advances in laboratory testing. I suggest asking your health care provider for a few advanced blood tests or arrange your own testing online.

► Step 4: Calculate your Astro-CHARM Heart Risk Score

A major advance in 2018 was the publication of the “Astro-CHARM score” as an online risk calculator. It permits entering your CACS and hs-CRP along with more traditional measures (age, smoking status, total cholesterol, HDL-cholesterol, and blood pressure) to predict the 10-year risk of heart attack and stroke.

CONCLUSION:The current focus on learning CPR or having defibrillators in gym classes misses the mark. Heart disease is measurable, preventable, and reversible long before tragedy strikes.

Take the steps to guarantee that you are young on the inside.


As I say: test, not guess.

Dr. Joel Kahn

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