Healthier Hearts

UNM Doctors Urge CT Screening and Medication to Reverse Coronary Artery Disease

Heart disease kills more than 600,000 Americans each year, according to the Centers for Disease Control and Prevention, making it the nation's No. 1 killer.

University of New Mexico physicians David S. Schade and R. Philip Eaton think most of those deaths are preventable - and they're proposing a simple, inexpensive program they believe will make heart disease a thing of the past.

It's a two-step approach, based on the latest research, that starts with diagnosing heart disease before its symptoms ever appear.

In a recent commentary published in the American Journal of Medicine, the pair, along with UNM pediatrician S. Scott Obenshain, MD, and Albuquerque cardiologist Barry Ramo, MD, advise that most people should be screened for cardiovascular disease by age 50.

"A safe, inexpensive, non-invasive approach is now feasible with coronary artery calcium scanning," they write. It's essentially a CT scan to spot deposits of calcium that serve as markers for the artery-clogging cholesterol plaques that can trigger a heart attack, says Schade, chief of the Division of Endocrinology in UNM's Department of Internal Medicine.

"Anybody with a CAT scanner can do it," he says. The tests take just 10 minutes to complete and cost in the neighborhood of $150.

A score of zero on the test means practically no artery disease is present and the likelihood of a heart attack in the next five years is nil. But a higher score, Schade and Eaton say, should trigger a simple drug regimen to reduce levels of low-density lipoprotein - LDL - the so-called "bad" form of cholesterol that spurs the development of arterial plaques.

A daily 10 mg dose of rosuvastatin, a cholesterol-lowering drug, and a similar dose of ezetimibe, which also lowers LDL cholesterol, should help most patients get below a target LDL level of 50 mg/dl - the point at which the body actively clears plaques from the arteries, they say.

Schade and Eaton acknowledge that their LDL-lowering target is aggressive: most experts and organizations such as the American Heart Association suggest keeping LDL below 100 mg/dl - or 70 mg/dl for those at high risk for heart disease.

"The major difference in approach is we believe in treating disease, and the American Heart Association, with other organizations, believes in treating risk," Schade says. "At an LDL cholesterol of 70, only 60% of patients are reversing, but 40% are getting worse, so who wants a goal that gets worse with a disease that's the No. 1 killer?"

Eaton, an emeritus professor in the Department of Medicine who served as executive vice president for Health Sciences at UNM from 1998 to 2005, points out that for most people, heart disease is a silent killer: no symptoms are evident until a heart attack strikes.

"Asymptomatic doesn't mean you don't have disease," Eaton says. That's why coronary calcium scan results can provide peace of mind. "If your scan is zero, you don't have the disease," he says. An additional advantage is knowing that they have tested positive for arterial disease also motivates patients to comply more consistently with their treatment regimen, Eaton says.

CT scans briefly expose patients to X-rays, but Schade and Eaton say the dose is miniscule, equivalent to the amount of "background" radiation people get simply from living in a high-elevation location like Albuquerque for four months.

Nationwide, the American Heart Association estimates the direct and indirect costs of cardiovascular disease and stroke to be $350 billion, with one in two Americans experiencing some form of disease.

The pair are urging state lawmakers to require health insurers to cover the costs of the scans, because in the long run it will save money. New Mexicans - 40 percent of whom are covered by Medicaid - experience 16 heart attacks per day, each one averaging $94,000 in direct and indirect costs. That translates into a significant cost to taxpayers.

"You can see what that does to the state budget," Schade says. "They're paying a lot of money every day just to take care of these people."

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