22 April 2015
Cardiologist Michel Accad advocates early testing for detection of heart disease.
“We do have very robust technology, non-invasive technology that is simple to use and reliable and that has been established for a long time, to try to detect heart disease before it actually causes any problems. Most of the time when heart disease becomes manifest with symptoms or sudden cardiac arrest or a heart attack, it has been present for many many years before that time. So there is an opportunity to make a diagnosis that is very specific.” Dr. Michel Accad, Athletic Heart of San Francisco.
Demography is one of the recurrent themes at populyst. In America Heading towards Zero Population Growth, I wrote that the population of the United States is growing at a slowing rate and that, except for immigration, it will not grow at all in the 2030s and 2040s. This prediction may however come into question if US life expectancy increases significantly in the next 20 years.
For this and other reasons, it is useful to periodically examine the progress being made in health and medical practice.
Heart disease remains the number one killer in the United States, accounting for 611,000 of the 2.6 million deaths in 2013. Strokes were responsible for an additional 129,000 fatalities, which means that cardio-vascular ailments led to 29% of all US deaths. By way of comparison, cancer in its various forms accounted for 23% of US deaths.
Death by heart attack is largely an older person phenomenon. According to the Center for Disease Control (CDC), as many as 40% of fatal heart attacks strike people aged over 85 and only 8% strike people aged under 55. This means that a hypothetical increase in US life expectancy, which currently stands at 79 years of age, must probably be accompanied by a measurable reduction in heart disease.
The table, compiled from CDC data, shows the percentage of heart disease and cancer fatalities per age group.
Detection and prevention are seen as essential ways to fight back against cancer. It has become widely accepted that after a certain age, people should undergo routine testing for detection of some cancers even if they appear on the surface to be completely asymptomatic. Some such tests are mammograms and colonoscopies. It is important to note that these tests are most often covered by insurance, a factor which certainly raised their adoption among patients and their doctors.
By contrast, historically, the approach to detection of heart disease has relied primarily on a nebulous review of the usual risk factors, mainly diabetes, blood pressure, cholesterol, smoking, and their frequently attendant obesity. More recently however, a growing number of cardiologists have started advocating proactive testing via CT Scans (aka CAT Scans) of all people over 45 or 50.
One of the most vocal among this group is San Francisco-based Dr. Michel Accad, a practicing cardiologist who is also the founder and medical director of Athletic Heart of San Francisco.
In addition to early detection of coronary heart disease and other heart ailments, Dr. Accad also champions a more proactive approach to early detection of any risk of sudden cardiac arrest. Although relatively rare compared to coronary heart disease, sudden cardiac arrest can strike any person of any age during strenuous physical activity.
Dr. Accad’s years of experience coincided with rapid advances in technology and the two have converged today into the following messages:
1- It is a good idea for any person over the age of 45 to get a CT Scan. Because the first manifestation of heart disease can be catastrophic (one third of all heart attacks are fatal), it makes sense to try to detect the presence of any plaque in the arteries.
2- It is a good idea for any person of any age who is active in high-intensity physical activity to undergo tests designed to detect early any risk of sudden cardiac arrest.
As noted above, insurance typically covers cancer tests such as mammograms and colonoscopies. But CT scans designed to detect plaque in the arteries are not generally covered. Perhaps this is due to the fact that treatment of cancer can be far more expensive than treatment of heart disease, at least in its milder form. Dr. Accad notes nonetheless that the cost of CT scans is not prohibitive for a vast majority of patients.
I discussed all of these issues and questions of life expectancy with Dr. Accad in a podcast which you can hear through this link or by clicking the timeline below.
TO HEAR THE PODCAST, CLICK HERE OR ON THE TIMELINE BELOW:
Disclosure: Sami Karam and populyst have no business dealings with, and receive no compensation from, Dr. Michel Accad, Athletic Heart of San Francisco or any other parties named in the podcast.