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*UPDATE* Russert's doctor points out that he did not have diabetes as reported by Newsweek, and that his LDL cholesterol was 68. It's recommended levels fall below 70.*
IMAGE SOURCE: Wikimedia Commons/ Tim Russert, New Hampshire debate, January, 2008/ author: Dan Pinnard
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The untimely death of Meet the Press moderator, Tim Russert last Friday, has raised the alarm bells for many men who might be facing the same risk factors for heart attack.
Russert suddenly collapsed while tracking a voice-over for his Sunday news show on NBC.
Russert, 58, had been diagnosed with coronary artery disease for which he had been prescribed medication and exercise. He also had diabetes, (See update*) often resulting from lifestyle when diagnosed at a later age. An autopsy on Friday revealed an enlarged heart.
In April, he performed well on a stress test, but USA Today is reporting that the routine stress test, which uses a combination of treadmill and electrocardiogram to force the heart to pump faster and to measure blood flow, discloses heart rhythm abnormalities during exercise, not an imminent heart attack.
There is very little one can do to predict sudden cardiac arrest which takes more than 310,000 Americans every year. That is more than breast cancer, lung cancer, stroke and AIDS.
Sudden cardiac arrest is still a mystery. Dr. Jeffrey Olgin, a cardiologist at the University of California, San Francisco tells Newsweek, “I can’t look at you and say you have a 10 percent chance of dying from this.”
Risk factors continue to be the best predictor of death from a heart attack. They include, heart disease, blood pressure, your cholesterol level, whether you smoke or not, have diabetes, are under stress, your abdominal fat, diet, and exercise.
Having a previous heart attack is perhaps the most important risk factor.
Those factors combined plugged into the Framingham Risk Score formula, remain the best predictor of a likelihood of having a heart attack.
Cam Patterson, chief of cardiology at the University of North Carolina-Chapel Hills tells USA Today, “You wouldn’t believe the calls we’ve been getting,” following Russert’s death.
He compares the death of Russert to the death of marathon runner Jim Fixx, 52, who died in 1984 after his daily run.
Neither man saw it coming though each had risk factors, which they were addressing.
In the case of Fixx, he had inherited multi-vessel coronary disease, which he addressed with diet and running. “He couldn’t do anything about it, no matter how many veggies he ate or miles he ran,” says Robert Califf, vice chancellor of clinical research at Duke University.
Fixx addressed his risks factor before there were cholesterol-lowering drugs.
Russert had been prescribed the drugs, which are credited with lowering death from heart disease, reportedly dropping by 50 percent from 1980 to 2000, according to the CDC.
Even with drugs and exercise, 20 percent of heart attacks occur in people who are without major risk factors. How does that happen?
The reason is plaque. Cholesterol accumulating on artery walls pushes them outward not into the artery where blood is flowing. The plaque can lie there indefinitely until it becomes inflamed and bursts. Debris is sent downstream and when the body tries to plug the hole it forms a blood clot that blocks an artery leading to the heart.
“This condition is known as a coronary thrombosis, and it is extremely dangerous. The heart muscle, now starved for oxygen-rich blood, falls out of rhythm; it quivers but doesn't pump. "In the final stage, the ventricle looks like a bag of worms. It's chaotically beating very fast and therefore is completely inefficient at pumping blood," Dr. Olgin tells Newsweek.
"Soon, there's no blood flow anywhere, including the brain, and people just suddenly collapse."
A shock from a defibrillator delivered within three minutes of a collapse may increase survival rate by as much as 50 percent, says Dr. Robert Myerburg of the University of Miami Miller School of Medicine.
There is no test for these inflamed cholesterol deposits. The best test so far comes out of Harvard, where a chemical sign of inflammation, C-reactive protein, or CRP, is being identified.
Russert was exercising and taking medication. He performed well on the stress test. For about one third of all with coronary disease, death is the first symptom.
Russert was an influential man. Judging from the accolades, Tim Russert had a profound impact on the way the public views journalists and journalism. His death appears to be generating a great deal of renewed interest in heart health. #