Sudden Death in Coronary Artery Disease

The American Heart Association says that more than 50% of men who die of coronary heart disease (CAD have had little or no previous symptoms). Tim Russert’s sudden death last week at 58 from a heart attack was another statistic in that he was being treated for CAD and his doctors “did not realize how severe the disease was because he did not have chest pain or other telltale symptoms that would have justified the kind of invasive tests needed to make a definitive diagnosis." In that sense, his case was sadly typical… Had the tests been done and the true extent of blockages revealed, Dr. Newman said, Mr. Russert would probably have been advised to have bypass surgery. Dr. Bren differed, saying it was not clear that there was enough disease to prompt a recommendation for surgery.

Could Mr. Russert’s death have been prevented through more medication and better lifestyle management? He had, after all, significant blockages in several coronary arteries including a branch of the left anterior descending coronary artery. Was he doing all he could to lower his risk? Even though he was feeling fine, “He took blood pressure pills and a statin drug to control his cholesterol, he worked out every day on an exercise bike, and he was trying to lose weight.” Dr. Michael A. Newman, Mr. Russert’s internist, however, offered: “If there’s one number that’s a predictor of mortality, it’s waist circumference”--over 40 inches in men and 35 inches in women. He added, “Most people would rather focus on their LDL cholesterol, instead of taking measures to reduce their waist size.”

- Grady D. “

.” NY Times. Published: June 17, 2008

A Search for Answers in Russert’s Death

A reader's response, below:

From: Harvey Frey Fredrick H (MD, PhD, JD)

Sent: Jun 17, 2008 1:28 AM

Here's a successful example of the HMO industry's push for "minimal" screening and testing. They saved perhaps 25 years of diagnostic and treatment expenses, since the man died at 58 instead of 83. And they avoided the dread "aggressive" treatment that prolongs life and costs money. The CEO of his insurance company will probably get enough extra bonus this year, out of the savings, to be able to put a hot tub in his LearJet.

The article says that he didn't have the chest pain needed to "justify" invasive testing, but also that more than 50% of men who die of coronary disease don't have chest pain before. So WHO made the rule that chest pain is needed to "justify" tests in otherwise high risk patients?

And this exemplifies the point that Dr. Phillips often makes. Russert could certainly afford the tests, and surely had the best insurance available. But, in this HMO age, EVERYBODY is treated like a malingering pauper by the managed-care-minded insurers and doctors.

And, if they won't or can't get their weight down, c'est la mort!