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"The Last Heart Attack" boosts expensive, high-tech medical care with doubtful benefits
Medpage Today
The following is a guest blog post by Marilyn Mann, a securities lawyer who became interested in medical research while researching treatment options for her teenage daughter, who has heterozygous familial hypercholesterolemia, a genetic disease that causes very high LDL-cholesterol.
By Marilyn Mann
“Oh no he didn’t.” That was my first reaction when, a few minutes into CNN’s one-hour special, “The Last Heart Attack,” Sanjay Gupta is shown being wheeled into a CT scanner to undergo a coronary artery calcium scan. I had read a story on the CNN website promoting calcium scans, so I was expecting a certain amount of boosterism for the high tech scans, but it hadn’t occurred to me that Gupta was going to make himself a guinea pig as part of a “mission to never have a heart attack.” Here are my thoughts:
1. The calcium scan exposed Gupta to significant radiation, increasing his risk of developing cancer.
2. A trim, healthy man in his early 40s, Gupta is almost certainly at low risk of a heart attack as estimated by his Framingham Risk Score (i.e., less than 10 percent risk of a heart attack in the next 10 years), and the leading cardiology societies do not recommend calcium scans in low-risk patients such as Gupta.
3. The use of high-tech tests such as calcium scans, and the carotid ultrasound and advanced lipid testing Dr. Gupta also undergoes on the program, is one of the primary reasons our health care expenditures are spiraling out of control.
4. Calcium scans, when they are positive for calcium in the coronary arteries, often lead to referrals for expensive and potentially risky additional tests.
6. Calcium scans and carotid ultrasounds have only been shown to provide a small amount of incremental risk prediction over screening using traditional risk factors such as age, gender, blood pressure and LDL and HDL cholesterol.
7. Even if a person is found to have atherosclerosis through a calcium scan or carotid ultrasound, the main recommendation would be for the person to start taking a statin or take a higher dose of a statin, if already on one. Statins do not make a person heart-attack-proof — they only lower risk 25 to 30 percent.
8. The fact that calcium scans are not a magic answer is, oddly enough, demonstrated on the program by the fact that both Bill Clinton and Tom Bare, a heart patient interviewed on the program, had calcium scans several years before their bypass surgeries.
