Coronary Artery Disease

On the X-ray image they printed out for me, trouble is a pink triangular speck, labeled LAD. The pink spot represents a calcium buildup - hardened plaque. And the LAD tag means the plaque lies in my "left anterior descending" coronary artery - the one cardiologists call "the widow maker." A blockage in the LAD tends to kill you. No one has said definitively that's what killed NBC newsman Tim Russert last week at the age of 58. But it wouldn't be a bad bet. Russert died after a heart attack in his Washington office.

On the X-ray image they printed out for me, trouble is a pink triangular speck, labeled LAD. The pink spot represents a calcium buildup - hardened plaque. And the LAD tag means the plaque lies in my "left anterior descending" coronary artery - the one cardiologists call "the widow maker." A blockage in the LAD tends to kill you. No one has said definitively that's what killed NBC newsman Tim Russert last week at the age of 58. But it wouldn't be a bad bet. Russert died after a heart attack in his Washington office.

For the first time in this country, an approved injectable drug will be used as an alternative to the stress test to evaluate the effects of suspected coronary artery disease.The drug will make it possible for a "tremendous number of people," who cannot tolerate exercise up to peak levels, to be diagnosed for this disease, researchers said yesterday.I.V. Persantine is a new intravenous form of oral Persantine, which has been used in this country for chest pain since the 1960s. The drug, also known as dipyridamole, will be available next month.

Too quick to discard accepted treatments In their column "Medical uncertainty" (Opinion Commentary, Feb. 18), Erik Rifkin and Edward J. Bouwer seek to emphasize the "uncertainties" that persist in modern medicine. In doing so, they challenge some pieces of conventional medical wisdom, including those on the detrimental effects of chronically elevated blood cholesterol and blood glucose. As support for their argument, the authors cite two recent studies - one in which the cholesterol-lowering drug Zetia did not significantly affect plaque build-up in the carotid arteries and a second in which very aggressive blood sugar control was associated with increased mortality rates.

In a reminder that heart disease starts developing years before symptoms show, Johns Hopkins researchers have uncovered a connection between apparently healthy people who are stressed and early signs of trouble in their hearts.The finding, published today in the journal Circulation, focused on adults with siblings who suffered from heart disease before age 60. But experts say its relevance is much broader, for it helps explain the role of stress in the development of coronary artery disease.

Drug-coated stents, the coil-like metal devices that prop open blocked arteries, appear to be superior to older bare-metal stents for treating heart attacks, according to a new study. The finding is the first randomized trial showing a clear benefit with drug-coated stents in an emergency setting, although some doctors already have been using the revolutionary devices to treat heart attacks. "Our study extends previous knowledge showing that ... drug-eluting stents are more effective and probably are as safe as bare-metal stents," said lead author Marco Valgimigli, chairman of cardiology at the University of Ferrara, Cardiovascular Institute in Ferrara, Italy.

Q: I am 72 years old and have been treated with a medication to lower my cholesterol for the past five years. My wife is concerned because she saw a recent newspaper article stating that a high cholesterol level does not increase the risk of having a heart attack in people over the age of 70. Would you advise that I stop taking my medication?A: Your specific question can not be answered without more information, such as the level of your cholesterol, the effectiveness of the medication in lowering your cholesterol, whether you had a previous heart attack or other evidence of coronary artery disease (CAD)

Q: Can a teen have an elevated cholesterol level?A: Although most discussions about cholesterol and itrelationship to coronary artery disease imply that this is a matter of concern to adults only, we know that the beginnings of this form of heart disease may be traced to childhood.Whether a cholesterol level is elevated is determined by measuring the cholesterol levels of large numbers of people of varying ages. A range of normal values is then developed, and people whose cholesterol levels exceed the 75th percentile for a given age and sex are said to have an elevated blood cholesterol.

Q: After having a heart attack five months ago, I stopped smoking and started on a diet and exercise program to lose weight and control my cholesterol level. My doctor seems satisfied with my cholesterol of 220, but I wonder if it should be lower.A: A cholesterol of 220 mg/dl is too high for anyone who has had a heart attack or any other evidence of coronary artery disease, such as angina or a history of bypass surgery or angioplasty to open a blocked coronary artery. This opinion is based on several types of information.

Q: I have always had a great fear of heart disease because my father died of a heart attack in his early 50s. In the year before his death he often complained of anginal chest pain. Although I am only 39, in recent weeks I have noted occasional episodes of chest pain and worry that they may be angina. How can I tell if my chest pain is due to heart disease?A: Coronary artery disease is the cause of angina pectoris -- a discomfort, usually in the chest, that is most often precipitated by physical activity and promptly relieved by rest.

Drug-coated stents, the coil-like metal devices that prop open blocked arteries, appear to be superior to older bare-metal stents for treating heart attacks, according to a new study. The finding is the first randomized trial showing a clear benefit with drug-coated stents in an emergency setting, although some doctors already have been using the revolutionary devices to treat heart attacks. "Our study extends previous knowledge showing that ... drug-eluting stents are more effective and probably are as safe as bare-metal stents," said lead author Marco Valgimigli, chairman of cardiology at the University of Ferrara, Cardiovascular Institute in Ferrara, Italy.

ORLANDO, Fla. - Intensive treatment with a cholesterol-lowering drug over 18 months halted coronary artery disease, according to provocative research presented yesterday. So-called statin drugs are known to significantly lower heart attacks and deaths, but this study, which compared two of those drugs, used a new type of ultrasound imagery to look into coronary arteries and showed the disease could be stopped in its tracks. The results suggest that a more aggressive approach to lowering LDL cholesterol (the bad kind)

Keeping physically fit significantly protects women against heart disease, which kills 255,000 women each year, according to a landmark study being released today. Chicago researchers who tracked more than 5,700 women for eight years discovered that the least fit were three times as likely to die of coronary artery disease during that period as women at peak physical capacity. "You can be completely healthy, have no cardiac risk factors, but if you're not able to achieve a good exercise capacity or physical fitness ... you're at high risk of dying," said Dr. Martha Gulati, lead author of the study and a cardiologist at Rush University Medical Center.

WASHINGTON - Vice President Dick Cheney, who suffered a mild heart attack in November and has a long history of coronary problems, said yesterday that his doctors have detected irregular beats in his heart and that he expects to have a pacemaker-like device implanted as soon as today. Cheney, 60, described the implantation as "an insurance policy" guarding against potentially dangerous acceleration in the heart's rhythm and said there's no reason why he can't continue as vice president.

COLUMBIA, S.C. - African-American women have higher levels of an obscure cholesterol molecule that worsens the risk of coronary artery disease, the nation's leading killer, a new study shows. Concentrations of the lipoprotein(a) molecule are significantly elevated in African-American women compared with American Indian and Caucasian women, the five-year University of South Carolina study found. Scientists blame genetics. Making bad news worse, exercise does not noticeably reverse these levels, unlike with other "bad" cholesterol, according to the study, which appears in the current issue of the journal Vascular Medicine.

Heart disease is the No. 1 killer in the United States. Even if a woman is diagnosed with breast cancer, she still is more likely to die of heart disease.More than one million people have heart attacks each year, and about one-third of them die. The American diet doesn't do the old ticker any favors, nor do long days spent in front of the computer instead of tilling the fields. And smoking -- forget about it.But could there be another causal factor in heart disease, something more insidious?

Q: A close friend of mine who seemed perfectly healthy just had a positive exercise stress test. That makes me wonder if I should have one, too. When is it a good idea to have an exercise stress test?A: During an exercise stress test you have a continuous electrocardiogram (EKG) done while walking on a treadmill. The exercise is made progressively more strenuous by gradually increasing the speed and incline of the treadmill. An abnormality in the stress EKG can detect a significant narrowing in your coronary arteries that might not be evident on an EKG taken while at rest.

Carroll County General Hospital will display information about its cardiac rehabilitation program at Cranberry Mall on Route 140 from 9 a.m. to 5 p.m. Thursday, Feb. 14 in recognition of Cardiac Rehabilitation Week, Feb. 11-15.The CCGH cardiac rehabilitation program is regular, supervised and individually prescribed physical activity for those with coronary artery disease. Those who have participated in the program have discovered the health benefits of an exercise and education program specially formulated for each individual.

Think about this the next time someone in a white coat instructs you to "open wide." Your mouth is a window to your health.Diagnosis through the mouth goes way beyond scanning for redness or white patches on the tonsils -- the telltale traces of strep throat.An oral exam can reveal many more signposts to illness:* A dentist peering at tooth enamel can see evidence of bulimia, the eating and vomiting disorder that exposes teeth to erosive stomach acids.* A periodontist probing inflamed gums thinks about eradicating bone-gobbling plaque bacteria that are suspected contributors to heart attacks, stroke and possibly arthritis.

In a reminder that heart disease starts developing years before symptoms show, Johns Hopkins researchers have uncovered a connection between apparently healthy people who are stressed and early signs of trouble in their hearts.The finding, published today in the journal Circulation, focused on adults with siblings who suffered from heart disease before age 60. But experts say its relevance is much broader, for it helps explain the role of stress in the development of coronary artery disease.