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Arthritis Diet and Exercises

How Not to Predict  a Heart Attack (Stress Test and Heart Attack Resurgence in the US)


But first, we’re going to go to a
different scene. This was about 10 years prior in Washington, D.C., April 29th 2008.
Some of you already know a little bit about this story. It was in the you know
as you can tell cherry blossom. It was beautiful weather in the 60s… half 50s…
60s. It was in the K Street district. You can see it’s kind of funny. It sits
in downtown in a cosmopolitan area. They could clearly afford to build buildings
higher than seven stories, but why do they not do that? There’s a law there that no building can
be higher than the US Capitol so that’s why it’s kept that way. What’s
it in? What human life form is in it? It’s infested with lobbyists so this is a big
obvious area where we’re joining in the in the office of a very, very good doctor.
He was doctor to the stars in D.C., doctor to the lobbyists in D.C. Because lobbyists
tend to have a lot of money. His name is Mike Newman. The patient was 58 years old…
excuse me 54 years… I need to get new glasses, I thought it’s 58, I’m gonna have
to look back here… 58 years old. Nonsmoker. A fairly unremarkable family history.
Weight waist was 40 inches. He liked his food. He had to eat out a lot as
part of his job. And he was a very social guy. He had high blood pressure. It was
controlled on an ACE inhibitor. We might talk later about ACE inhibitors and the
fact that the ACE was changed to an ARB and that actually might have had some
impact on what happened later but we might not… it depends on whether you have
interests. I’m on an ACE inhibitor, and this is the first day I’ve been able to
talk without coughing for about three weeks. But we’ll talk about that later
too. The CRP was unremarkable. It was actually remarkable. The fact that Dr.
Newman knew in 2008 to get a CRP. Very, very few docs knew that. The
cardiovascular risk event risk estimator… anybody know what that is?
Framingham. We’ll talk about Framingham. It’s not a measurement of plaque. It’s a
guess, and it’s a very bad guess. We’ll talk about why. Anyhow, he was
worried. He knew that he needed to… he kept saying, Doc, as soon as my job slows
down a little bit, I’m gonna start losing some weight. That was his mantra. He and
Newman had shared their multiple times publicly and so they said, okay, let’s do
a stress tests, we’ll see if you’re good. It
turned out normal, so he was relieved. He went back to his lifestyle that he came
from. And they changed the medicines from the an ACE to an ARB. Six
weeks later… oops… I gave away the story but many of you knew already. Six weeks
later, he’s in the bureau recording. Well, we’ll get to that in a
minute. Six weeks later, he’s at work. He collapses. CPR was done by co-workers. EMS
was called at 1:40; they arrived four minutes later so it wasn’t because there
was a slow EMS. They shocked him three times on the way into the hospital where
he was pronounced dead at Sibley Memorial. Autopsy showed plaque rupture
in the left anterior descending artery. And yes, that’s who it was. Tim Russert,
big Russ, 1950-2008. He was returning from a family vacation in Rome. His son had
graduated from some Ivy League school, Boston College, and has had a birthday. So
they were celebrating that. He was the host of Meet the Press and flew home to
tape some things. He was walking to the sound room to do
voice-overs. His last words were, “What’s happening?” You know, this was 2008. That
was the thing that he said. Instead of “Hello,” “What’s happening?” He said that to Candace Harrington, the editing supervisor.
He’d been hosting Meet the Press since 1991. His passion, research, and ability to
find clips of inconsistencies… you know, he made fools of people.
He did his research, and government officials made fools of themselves
because they were being inconsistent with what they did, what they said, or
what they did years before and they had to squirm in front of the the press and
the public. And people loved him for that. But all that was ended.
Plaque ruptured in his left anterior descending. Now, why did that happen? Well, the New York Times said, well,
doctors didn’t know that he had plaque. You know that’s one of the things we’re
gonna start talking about. How do you know you have plaque? It’s pretty
important to know, wouldn’t you think? I think for most of us in here, we
understand that. That’s a reason why a whole bunch is in here so we
could get that CIMT. Well, they did know… they were very clear he had a
positive calcium score ten years before, score of 210. Doctors Newman and Bren –
Newman was his internist, Bren was his cardiologist – they did say, look, the
autopsy showed a lot more plaque than we expected because he just had a negative
stress tests and given that he passed the negative stress test, we do know that
he didn’t have a 50% occlusion. But that was over ten years ago. So things are a
lot better now, right? Medicine has moved very quickly well. Actually, there have
been improvements in the heart attack rate. We’ll talk about that in just a minute.
These guys, the interventional cardiologists, love to give them a hard
time. As you know, they’ve actually done some stuff. There are very few groups of
medicine that have actually changed the American life expectancy they have by a
few months. The public health guys did by decades but the docs really can’t take
credit for that as the engineers anyway. And anyhow, is that your choice for how
you extend your life? It’s hard to… it’s hard to change your habits. But it’s a
lot worse going through that and we’ve got we’ve got some folks that could
share if that comes up later. So Wall Street
Journal. When did that come out? Does anybody know? Three months ago… four
months ago. This was very, very recent. Speaking of family and your loved ones, this is the family for… I believe his
name is Oscar. We’ll find it in just a few minutes. We’ll see a picture of him.
Heart Attack at 49 – America’s Biggest Killer is Making a Deadly Comeback.
We’ll look at the numbers. Yep, right there.
So yes, things were getting a lot better. We were… actually, you can see that if
you can. I’m going to just… this is a yellow line and that’s the cancer-death
rate. So we were about to take a heart attack off the number one spot for
killers until about ten years ago, about the time Tim Russert died. That curve
started going right back up. And it’s still number one. And again,
it’s happening younger. Well, we’ll talk about that. Oscar died at 49. It’s happening. This is
Steve Nissen. He’s a well-known CIMT researcher. It’s happening among younger
people, obese people. The obesity epidemic is a major part of that curve going
right back up. It’s also happening though among non-smokers and women. This is a
woman that had a breast cancer, woman that was struggling and had a heart attack. She’s
struggling with changing her health habits so she doesn’t have another one.
This is the CDC getting into detail on where that’s happening. It’s happening in
urban areas. It’s happening in small bedroom communities. Think
what you’ve done with this is amazing. I know there’s others out there that are
teaching and talking about heart attack and stroke prevention. But very few
people are really trying to get people in a room, consumers in a room, and do
it. So I want to commend you for that. It’s a great course. Thanks for allowing
me to be part of it and talk a little bit about how dentistry fits in. I really
appreciate it, and I really hope people would come and search this out and take
this course.

17 thoughts on “How Not to Predict a Heart Attack (Stress Test and Heart Attack Resurgence in the US)

  1. You noted that Tim Russert just returned home from a family vacation in Rome. By jet, no doubt, it is a long swim. I just found out about "bleed air," the way most passenger jets siphon off hot air from a jet's turbine to maintain temperature and air pressure in the jet’s passenger cabin. Pumped into the passenger cabin, this "bleed air" is usually contaminated with tricresyl phosphate [TCP – a weak organophosphate poison], a chemical component in jet turbine engine lubricants. TCP is a known neurotoxin, a cause of aerotoxic syndrome. It would be interesting to know if a “fume event” occurred in any of the jets Russert had traveled on in the weeks before his death, causing Russert to be exposed to more than the usual background level of TCP in the cabin air.

  2. His calcium score was 210 10 years prior. At an average rate of annual increase (without serious intervention) his score would have been 900 or more at the time of his death.

    If no stenosis >60%-70% a normal stress test provides no information.

  3. Also he would have been 48 y.o. at the time he got the calcium score of 210. That would have placed him over the 95th percentile for age and gender.

  4. Thank you dr Brewer for this awakening video.For me the takeaway is that, cimt is sometimes , as you said once,
    difficult to interpret but if done correctly by a talented expert, turns to be superior (detection of the vulnerable plaque ),
    cheaper and safer (the ct scan damages the DNA and speed up the aging process by 50 %).Perhaps, we shouldn't attach too much credit to our lipid markers , to the Framingham test ,
    to the stress test on a treadmill or
    even to the calcic score.On the
    opposite, let's first have a Cimt doppler echography
    to detect any vulnerable plaque
    and also use Holter device to
    measure out heart rate variability
    (the critical role of the vulnerable
    plaque shouldn't make us ignore
    the importance of the electricity
    of the heart ).

  5. Bbbbbbbbut as a nation we eat 40% less red meat, replaced butter & lard with seed oils, consume a diet based on heart healthy gains, stopped smoking and eat more than 5 servings of fruits & vegetables each day.

    How can things be worse after 50 years if the science was clear 50 years ago ?

    Cccccccould it be a false science like the one used by lab coats to defend smoking ?

  6. I wonder if the Great Recession had anything to do with heart attack deaths increasing. Rates started going back up in 2008.

  7. It is funny. When I suggest to some that they should eat real food and exercise even a little bit they balk.
    Then they have a heart attack and say they wish they had listened.
    Worse they may have a stroke and then they can't listen.
    I do hope you get through to people with the importance of exercise and real food preventing 90% of diseases and problem most people have.

  8. People imagine things will only happen to them when they are in there 60s 70s., which may have been true 40 years ago, before the obesity epidemic and the rise of 'fast foods'. I am curious though as to what causes the actual rupture of plaques, given that they are normally sealed under a calcified cap. Passing a stress test would indicate that there wasn't significant narrowing of arteries, no significant blood flow restriction, I imagine? Yet there was considerable plaque at autopsy. I am aware of alternative theories as to how heart attacks initiate. The build up plaque suggests also the capillary damage in the heart muscle as being the result of the same lifestyle. The solutions the same of course. I do have my doubts about the capillary theory though as you would be getting pains long before critical failure I imagine, in the manner of cramp due to slowing clearance of lactic acid from the heart muscle…so the theory goes.

  9. @Doctor Ford Brewer. So why do you think that heart attacks deaths are going up? Do you think it’s because of the increased obese or something else ?

  10. With the FRIEND registry, we now have good ranges for VO2Max for CPX tests. Perhaps reimbursement smiles on old stress tests, instead of the newer CPX tests. Know a rehab doctor that says anyone at any age with a VO2MAX below 32 has a weak cardio system and is more predictive than cholesterol and lipid tests for future heart disease. Like I say, if we spent as much time on physical activity per day as we do shoving food in our mouths, we'd all probably be pretty healthy.

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