Tim Russert's heart scan score 210. . .in 1998

Despite the media blathering over how Mr. Russert's tragic death from heart attack could not have been predicted, it turns out that he had undergone a heart scan several years ago.

A New York Times article, A Search for Answers in Russert’s Death, reported:

Given the great strides that have been made in preventing and treating heart disease, what explains Tim Russert’s sudden death last week at 58 from a heart attack?

The answer, at least in part, is that although doctors knew that Mr. Russert, the longtime moderator of “Meet the Press” on NBC, had coronary artery disease and were treating him for it, they 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: more than 50 percent of all men who die of coronary heart disease have no previous symptoms, the American Heart Association says.

It is not clear whether Mr. Russert’s death could have been prevented. He was doing nearly all he could to lower his risk. 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, his doctors said on Monday. And still it was not enough.

“What is surprising,” Dr. Newman said, “is that the severity of the anatomical findings would not be predicted from his clinical situation, the absence of symptoms and his performing at a very high level of exercise.”


Buried deeper in this article, the fact that Mr. Russert had a heart scan score of 210 in 1998 is revealed.

That bit of information is damning. Readers of The Heart Scan Blog know that heart scan scores are expected to grow at a rate of 30% per year. This would put Mr. Russert's heart scan score at 2895 in 2008. But the two doctors providing care for Mr. Russert were advising the conventional treatments: prescribing cholesterol drugs, blood pressure medication, managing blood sugar, and doing periodic stress tests.

Conventional efforts usually slow the progression of heart scan scores to 14-24% per year. Let's assume the rate of increase was only 14% per year. That would put Mr. Russert's 2008 score at 779.

A simple calculation from known information in 1998 clearly, obviously, and inarguably predicted his death. Recall that heart scan scores of 1000 or greater are associated with annual--ANNUAL--risk for heart attack and death of 20-25% if no preventive action is taken. The meager prevention efforts taken by Mr. Russert's doctors did indeed reduce risk modestly, but it did not eliminate risk.

We know that growing plaque is active plaque. Active plaque means rupture-prone plaque. Rupture prone plaque means continuing risk for heart attack and death. Heart attack and death means the approach used in Mr. Russert was a miserable failure.

While the press blathers on about how heart disease is a tragedy, as Mr. Russert's doctors squirm under the fear of criticism, the answers have been right here all alone. It sometimes takes a reminder like Mr. Russert's tragic passing to remind us that tracking plaque is a enormously useful, potentially lifesaving approach to coronary heart disease.

Who needs to go next? Matt Lauer, Oprah, Jay Leno, some other media personality? Someone close to you? Can this all happen right beneath the nose of your doctor, even your cardiologist?

I don't need to remind readers of The Heart Scan Blog that heart disease is 1) measurable, 2) trackable, 3) predictable. Mr. Russert's future was clear as long ago as 1998. Every year that passed, his future became clearer and clearer, yet his doctors fumbled miserably.



Copyright 2008 William Davis, MD

Comments (10) -

  • Richard A.

    6/18/2008 4:51:00 AM |

    "He also had a dangerous combination of other risk factors: high triglycerides, a type of fat in the blood, and a low level of HDL, the “good cholesterol” that can help the body get rid of the bad cholesterol that can damage arteries."

    I wonder if he was taking fish oil supplements to try to drive down his triglycerides and niacin to prop up his HDL?

  • Anonymous

    6/18/2008 5:36:00 AM |

    I had a 234 score in 2005 and a 419 score in 2007 - if it wasn't for resources like TYP - I wouldn't have pushed my Dr with questions about Vit D and CQ 10 and Fish Oil...  sit waiting for the next scan to see if things are under control (now - small LDL-P 123 nmol/L).

    Just think if Tim R had the time to do a bit of research himself and found TYP - but that is what your physicans should be doing for you.... growing... learning... but as an engineer, I know the spectrum of people calling themselves engineers is a large spectrum... so it is with MDs.

    Thanks for what you do Dr D.

    Dave

  • Dr. William Davis

    6/18/2008 11:53:00 AM |

    Yes. Fish oil alone could have cut his risk of sudden cardiac death by 45%. It would have cost him all of $3 per month.

  • Anonymous

    6/18/2008 3:09:00 PM |

    I have been wondering if the trans-Atlantic flight several days before his death could have had something to do with it...

  • Anonymous

    6/18/2008 5:08:00 PM |

    Dr Davis I just wonder what you think of this Dr. Mehmet(?) Oz who keeps popoing up on television and writing books talking about the same old stuff, low fat, high carbs blah blah blah . . . I think since Mr. Russerts death I've seen him on tv 3 times and NOT ONCE has he mentioned calcium scoring, vitamin D, fish oil . . .

  • Anonymous

    6/19/2008 3:45:00 AM |

    What a tragedy.  All week long I have been asking myself how such a smart man could be so uninformed about his own health?

    With all the resources at Mr. Russert's disposal, I would think he could have easily learned more about his condition, and the measures he might have taken to save himself.  [Then too, he might have also come across the Track Your Plaque website... or the book.]  Instead, he was apparently greatly trusting of his internist and cardiologist, and perhaps thought he was receiving optimal medical management... and nothing more could be done?

    Beyond that, I wonder about his Vitamin D status, and whether he was dehydrated from the long flight back from Europe?  I also wonder if the emotional stresses (good and bad) of a quick trip to Europe, his son's graduation from college, and having recently placed his beloved father into a care home, on top of what could only be termed a stressful and grueling work life (no matter how much he may have loved it) might have lead his body to the tipping point on that day.   I suppose we are unlikely to have these answers under the circumstances.

    R.I.P. Mr. Russert, but shame, shame, shame on your physicians, IMO they really let you down.

    Thanks for this truthful blog, an antidote to all the media nonsense and C.Y.A. I have seen in the past few days.

    Terri
    madcook

  • sschein

    6/23/2008 5:36:00 PM |

    My wife has been to Dr. Michael Newman the internist for Tim Russert.  I don't think she is going back.  I had Angioplasty about 10 years ago with stents put in my right and left artery.  Since then I have the thallium stress test every year, take 1500 mg's of niaspan a day, Lipitor, a blood pressure lowering drug, and aspirin.  Both my cardiologist, and my internist state that a heart scan would not do me any good, and my cardiologist stated that the heart scan would simply confuse the issues.  Are they right? Would the heart scan harm me?  If so, how?

  • Anonymous

    6/25/2008 5:18:00 PM |

    In response to the comment by sschein, I'm not sure it's such a great idea to have a thallium stress test every year.  You should probably investigate the possibility of a CT-angiogram.  

    I am not a doctor so I don't want you to think I'm defending them, but there's only so much that a doctor can do in the office visit environment.  It's really up to the patient to do the research and decide on what he believes is the best course of treatment for him or herself and then try to bring the doctor around to his point.  In my own case I refuse to have a thallium stress test and have finally decided to have a 320 slice CT-angiogram when I go to Boston next month.  My cardiologist may not agree that it's the choice he'd choose, but he's going along with it.  Quite simply they don't have the time to convince the patient one way or the other.  We really don't know all the details about Tim Russert's care.  If he had his own private physician who tended only to him or who was consulted extensively I'd probably expect better.  As just one patient (admittedly a famous one) I'm not sure how much you can expect from a doctor.  If he suggests a stress test or an angiogram and you think better of the idea, it's up to the patient to chart his own course.

    Andy (the164club) TYP member

  • Jeffrey Dach MD

    7/1/2008 11:38:00 AM |

    Tim Russert and George Carlin

    Two beloved American celebrities have succumbed to heart disease before their time.  The national response has been disappointment in a medical system that could allow this to happen.  What could have been done differently to save the lives of both Tim and George, to avoid this fatal outcome?

    To read more...Saving Tim Russert and George Carlin by Jeffrey Dach MD


    Jeffrey Dach MD
    4700 Sheridan Suite T
    Hollywood FL 33021
    my web site

  • buy jeans

    11/3/2010 6:54:38 PM |

    A simple calculation from known information in 1998 clearly, obviously, and inarguably predicted his death. Recall that heart scan scores of 1000 or greater are associated with annual--ANNUAL--risk for heart attack and death of 20-25% if no preventive action is taken. The meager prevention efforts taken by Mr. Russert's doctors did indeed reduce risk modestly, but it did not eliminate risk.

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Track Your Plaque makes Consumer Reports!

Track Your Plaque makes Consumer Reports!

. . . but not in a good way.

The September, 2011 issue of Consumer Reports showcases their Protect Your Heart discussion. Third paragraph: "The website Track Your Plaque warns, 'The old tests for heart disease were wrong--dead wrong.' It says heart scans are 'the most important health test you can get.'"

They go on to expose the overuse of heart procedures like angioplasty and stent implantation and offer their advice on how to manage heart disease risk: lower BP, reduce LDL cholesterol, lose weight, stop smoking, take aspirin. They quote Dr. Paul Ridker who declares heart scans are not useful because the "deposits cardiologists worry about are the less stable plaques that CT scans routinely miss."

I thought I'd been transported back to 1995. Not only is it clear that the Consumer Report writers never looked beyond the homepage of Track Your Plaque, but somehow saw our heart disease prevention and reversal program as promoting heart procedures. Incredible.

Of course, the Track Your Plaque program does the exact opposite: Advocates an approach that virtually eliminates the need for procedures and returns control over heart disease to the participant. That's a critical difference.

And, as I've had to remind my colleagues time and time again, what we are really after is an index of total coronary atherosclerotic plaque. Even in 2011, that index remains the simple coronary calcium score, a gauge of total plaque, not just of "hard," stable plaque. Perhaps in 10 years we will be using a better tool to gauge progression and regression of all the components of coronary atherosclerotic plaque, but today it remains the simple, accessible, mammogram-like coronary calcium score.

Consumer Reports does for the idea of heart disease prevention what food manufacturers do for health and weight loss: Echo conventional wisdom of the sort that generally makes us fatter, more diabetic, leads us to more heart procedures and needless deaths. I might use Consumer Reports to rate MP-3 devices or toasters, but I certainly would not rely on them for insightful health advice.

Comments (27) -

  • Carl

    8/8/2011 1:37:53 PM |

    Actually, I have been unhappy with the some of the consumer products they recommend. Their tests are not as objective as they seem to believe. For example, I bought an inferior, yet expensive, air cleaner which happened to win their blessings just because its lowest fan speed was higher than the lowest fan speed of the competition. Air cleaned to noise ratio would have been the better metric.

  • Frankie

    8/8/2011 2:04:15 PM |

    I am sorry this happened to you and your excellent program. I expected more from Consumer Reports.

  • Dee

    8/8/2011 2:59:16 PM |

    My Dr is worried about the amount of radiation that I would be gettin from a heart scan.  I am 72 and get mammo's every year.  Plus other mri's and x-rays.  He feels they would add up to to much radiation.

    Dee

  • Princess Dieter

    8/8/2011 3:16:46 PM |

    Thanks for the heads up. I bought this CR yesterday, and have been reading some parts of it (smart phones, heart issue).

    I never smoked. I was obese for decades, but am no longer as of Friday, hah! I can't take aspirin due to sensitivity (flares up my asthma). I got my blood pressure normal (off meds), and my sugar is great (finally), but my LDL is up. I gave up wheat/gluten and cut way down on starches, mostly gave up convenience/fast foods and eat fresher, better. HDL is very very good. Triglycerides great. But LDL went up. Lipoproteins are the fluffier kind. I'm a regular exerciser now.

    So, I'm doing a lot to improve things, but obviously, I have some to go. I 've never done this test you recommend, so that goes on the list to ask doc for. Whether she approves it or not, don't know, but it's on my list to request. I just had a bone mineral density (great) and some x-rays (suspected arthritis hip, sacrum/coccyx). So, I don't want to be exposed to more anytime soon....I do mammos every 2 years, not years, due to radiation concerns, but I do want to know what that coronary calcium score says for my heart.  I suppose I can consider it as my "non-mammo year" test. Thank you...

  • chuck

    8/8/2011 4:07:14 PM |

    based on this half assed research on the part on CR, can you trust their reports on simpler things such as toasters and TVs???

  • Gene K

    8/8/2011 5:33:19 PM |

    The next day I received this issue of CR, I sent them a comment saying that I found the way they mentioned trackyourplaque.com uninformed and out of context and an explanation why I thought so. Maybe my comment or somebody else's will appear in the next issue's Letters to the Editor section.

  • Gene K

    8/8/2011 5:40:39 PM |

    The kind of advice CR gives people on health made me discontinue my subscription to CR on Health. Either you read CR on Health, WebMD, etc. or you listen to Dr Davis, Dr Eades, Dr Kruse. Combining both kinds of sources makes no sense to me.

  • Dr. William Davis

    8/8/2011 5:57:40 PM |

    You need either to educate your doctor or get a new doctor.
    A standard CT heart scan yields the equivalent of 2 mammograms. He is confusing a heart scan to generate a coronary calcium score with a CT coronary angiogram, which can expose you to plenty more.
    Sorry, but your doctor is confused.

  • Dr. William Davis

    8/8/2011 10:06:09 PM |

    I'm wondering the same thing. I do believe that, with this analysis, they bit off more than they can chew.

  • Dr. William Davis

    8/8/2011 10:07:31 PM |

    Hi, Princess--
    I think that would be a very good compromise, especially in view of the fact that heart disease afflicts far more women than breast cancer.

  • Terrence

    8/8/2011 11:00:27 PM |

    I am not at all surprised that CR gave Dr Davis such an uniformed, silly "review/comment". I used to read them all the time. But they slowly (early 1990's on) became politically correct, and published more and more uninformed nonsense - not reviews, simply uninformed opinion pieces.

  • Gene K

    8/9/2011 2:52:44 AM |

    Dr Davis,

    I suggest that you comment on the CR article. They always publish these comments with disagreements. Go to http://custhelp.consumerreports.org/cgi-bin/consumerreports.cfg/php/enduser/ask.php, select Consumer Reports Magazine from their product list and choose Comment on a Report or Letter to the Editor. The more people will see it, the more people will visit your site.

  • Gene K

    8/9/2011 2:56:48 AM |

    I still trust their reports on physical goods, because they actually test them instead of just publishing an opinion. They have never lost a lawsuit filed by a manufacturer, according to what they say.

  • Ed Terry

    8/9/2011 2:01:01 PM |

    Most of the health and nutrition information provided by Consumer Reports parrots the information from the AHA and the ADA.  In other words, it's just plain wrong.

    I can sum it up best by relaying the conversation I had with my latest cardiologist (I fired my first one.)  When he saw that my calcium score had decreased since my initial scan, he was puzzled.  I then explained my diet, and all he could say was "That's not what we were taught in school."  My response was "I understand."

    Keep up the good work.

  • Might-o'chondri-AL

    8/9/2011 7:35:29 PM |

    Hi Renfrew,
    Was "SERVER" blocked responding in previous post, so trying here:
    It is not my place to make dietary suggestions on anyone's blog. The reason I just wrote out that specific data of a Japanese report was to indicate that individual fatty acids can have different affects. There is a link above  which goes to one Drs. discussion of Arachidonic Acid (AA) and how although  many think AA is only pro-inflammatory that AA also performs worthwhile functions. I find it interesting that although insulin increases the synthesis of AA from other n-6 polyunsaturated fatty acids the Japanese find AA itself does not worsen insulin resistance; but again tissue specifics are complex.


    Let's look at the vascular role of AA in tissue cell lipid membranes as it responds with cascades of both pro & aniti-inflammatory responses by  AA converting into prostaglandins . When AA from the lipid membrane  interacts with the notorious COX1 & COX2 cyclo-oxygenase enzymes found in blood vessels Prostanoid series 2 can form (prostanoids = both prostacyclin and prostaglandin molecules). Normally the 1/2 life of prostanoids is just a duration of minutes.  
    What is important to grasp is that when prostanoid 2 is at work in vascular tissue  it can  prolong any local inflammation reaction. AA (with COX catalysis)  generated pro-inflammatory prostanoid 2s are what  lets the circulating leucocytes (neutorophils) drifting across blood vessels previously irritated by cytokines  (ex: TNF alpha the tumor necrosis factor also now called cadexin). Prostaglandin 2 is part of the immune response loop and also has it's own receptor inside of the leukocyte itself; this becomes involved in signalling that makes a risk laden leukocyte physically reorganize it's own actin cyto-skeleton enough so that it (the leucocyte) can move across the endothelium layer of a vessel into the inside of a vascular tissue cell made permiable due to cytokine inflammation.

    The poly-unsaturated fatty acid EPA  generates it's own prostaglandin, the Prostaglandin  D3, which blocks  a lot of the relatively short lived risky Prostaglandin D2s. EPA in people is not always in high enough concentration to counteract the pro-inflammatory reaction, and in that case a person's AA level may be so high that it negates the helpful level of  prostaglandin D3 being put out (by EPA). The trick is to get high EPA levels which can  use the COX enzymatic pathway to make prostaglandin D3 and  allay prostaglandin 2 signal ; for if there is sparse prostaglandin 2 then it isn't binding to it's receptor inside a leukocyte , and  thus no leukocyte tarries long enough to be tethered by an adhesion molecule to the wall of that blood vessel. Without EPA supplementation blood levels of EPA average +/- 1 uM and with supplementation can average +/- 5 uM, while the levels of AA  needing off setting in terms of vascular risk will vary greatly depending on which substrate PUFA n-6 fats are ingested.

  • Sifter

    8/9/2011 11:01:28 PM |

    I have that copy of CR. My 93 year old mother is suffering from CHF, and its a terrible thing to see, oxygen, Oxyfast, Adavan (sp) Seems like some days are fairly well, than others are just frightful. I think CR has slipped quite a bit over the past decade. They generally take a mainstream approach, while pretending to find 'hidden truths' that mainstreamers won't disclose. Utter nonsense. Separately, I've found them to be rather biased towards any Toyota vs American made vehicles as well. I find this blog to be an excellent source of info and constructive applications to better heart health. Thank you.

  • PHK

    8/10/2011 1:28:09 AM |

    I subscribed Consumer Report's monthly health letter in late 90's.
    it was the same old stuff, not much different from what mainstream (TV/AHA/ADA).
    so i did not renew.
    regards,

  • Cardiac Test

    8/10/2011 9:28:10 AM |

    The best part about this program is that it ddvocates an approach that virtually eliminates the need for procedures and returns control over heart disease to the participant.

  • Dr. William Davis

    8/11/2011 12:25:49 AM |

    Wow, Ed. You manage to reverse an important marker of heart disease that most of my colleagues regard as impossible and all your doctor can say is "That's not what we were taught in school?" "Good riddens!" was the right response! You are better off without this sort of incredible ignorance and disinterest.

  • indium

    8/11/2011 5:44:51 AM |

    me too, what can  i do

  • Dee

    8/11/2011 3:11:50 PM |

    I looked up the 64 slice CT scan and indeed you are right.  My Doc is very open to suggestion and I'm sure he will go along with that.  He is a primary care Dr and would have to send me to a Cardio dr.
    Thanks for your reply.  Dee

  • Doug

    8/23/2011 2:59:41 AM |

    Dr. Davis,

    I used to work as a researcher for a consumer products company testing automatic dish washing machine detergents.  Consumer Reports once reported on one of my products in a comparison study with our major competitors.  I do not know how they achieved their results, but their results were virtually the opposite of the ones I got when I ran the very same tests every day.  

    In  our tests, our main product was so good, that we used it as the reference to a perfect 10 in our grading scale, yet to CR, we were mid range. The product ranked #1 by CR usually was graded a 6 in our tests,  but somehow it was ranked the best in their whacky experiment.

    Since that time, I have learned not to trust Consumer Reports' ratings.

  • Dr. William Davis

    8/23/2011 11:55:10 AM |

    Hi, Doug--
    That's priceless! Thanks for the insight.

  • Barkeater

    8/30/2011 1:35:06 PM |

    I am a long-time TYP member and have read the CR article.  I would stress these points:  

    (1)  As Dr. D says, the article takes a swipe at coronary artery calcium score CT scans if used as a tool for selling interventions that are not beneficial.  It is true that CAC  scans have been used like this, but absolutely false that TYP does this.  Most TYP members want nothing more than to avoid bypass, angioplasty and stents, recognizing (as did the CR article) that, except in acute circumstances, there is a better approach to managing heart disease and heart disease risk.

    (2)  The CR article confuses CT angiography and CT CAC scans.  In CT angiography, the patient has a dye injected, but not in CT CAC scans.  The dose of radiation from CT angiography is very high, vs. a very low dose from CT CAC scans.  Supposely, CT angiography identifies soft plaque as well as calcified plaque, but the information is not too useful to measure the effects of preventative steps on plaque.  The CAC scan gives a measurement of the calcified portion of plaque.  It is not a perfect measure of plaque, but it is very informative.  The TYP program looks in particular at the rate of progression of the calcified plaque (or, we hope, regression), so it shows whether preventative measures are working.  People with stable or regressing calcified plaque are very safe from heart attack.

    (3)  One of the conventional wisdom complaints about CT CAC testing is this:  If it were recommended for the population at large, it would not identify a lot of people at risk or change the recommendations as to what to do about the risk, as compared to existing tests and guidelines.  While this is highly debatable (I don't buy it), it is irrelevant to any motivated individual.   Whenever testing is dismissed by experts, you need to assess whether they are saying the test is useless to me as an individual or whether the test would not be helpful if given to the population at large.  The latter point is irrelevant to any person who wants to seize control of his or her health.  I grant that many people are passive about their health, and their doctors have very limited knowledge of how to reduce heart risk in any event.  If you are in control of your health, then CT scans can be massively informative (with little radiation exposure), and a program like TYP can save you from heart disease and invasive procedures.

  • Dr. William Davis

    8/30/2011 6:32:31 PM |

    Wow, Bark. Elegantly said!

    I find it odd that the conventional answer tries to pigeonhole a fairly detailed preventive approach like Track Your Plaque and compare it to, say, advertising for bypass surgery. Despite the years that have passed with people like you and me fighting this battle to get the real truth out, we still have incredibly silly comments like those in Consumer Reports.

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