Young at Heart Event
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Prevention magazine published a great article recently outlining the steps you can take to help prevent future heart attacks and strokes. According to Dr. Arthur Agatston, the advanced imaging and blood tests available today can catch cardiovascular disease 20 to 30 years before it gets severe enough to cause a heart attack or stroke.
If you are at risk, these tests will help your doctor prescribe the right combination of diet, exercise and medication to reverse your heart disease. Each of Prevention magazine’s seven life-saving tests is explained in detail in the article below. The 7 recommended heart tests for cutting-edge prevention are:
1) Cardiac Calcium Scoring
2) Carotid Intimal Medial Thickness Test
3) High-Sensitivity C-Reactive Protein Test
4) Advanced Lipid Profile and Lipoprotein(a) Test
5) A1C Blood Glucose Test
6) Genetic Tests
7) Stress Echocardiography
Heart Attacks: 7 Heart Tests That Can Save Your Life
An article from Prevention Magazine
Think a stress test and a simple blood workup are all you need to assess your heart attack risk? Wrong.
Your physician has you come in to his office and run on a treadmill while you’re hooked up to an EKG. For the next 8 to 12 minutes, he’ll evaluate your heart rate, breathing, and blood pressure as the intensity of the workout increases. When the stress test is over, he’ll tell you whether you have coronary artery disease.
Here’s news that might make your heart skip a beat: For women, there’s a 35% chance the test results will be wrong. Most often, the test reveals false positives, meaning healthy women are told they have heart disease. Less frequently but obviously far more dangerous is when the test fails to detect clogged arteries that could, in fact, cause a heart attack. Fewer men are misdiagnosed. Possible reason for the gender gap: Phases of the menstrual cycle and birth control pills have been shown to throw off results, indicating that estrogen’s effects on heart cells might be a factor.
For decades, doctors had nothing more sophisticated than a stress test to offer. Not anymore. Cardiologists now use advanced imaging and blood tests that give a much more accurate assessment of heart attack risk. “These tests are the best ways to tell who is in danger, because they can catch cardiovascular disease 20 to 30 years before it gets severe enough to cause a heart attack or stroke,” says Arthur Agatston, MD, an early champion of many of them.
Better detection is urgently needed: More than 1 million Americans have heart attacks every year, and almost half die. Men have more than women do, but the gap is closing. From 1988 to 2004, attacks among women ages 35 to 54 spiked 42%. These tests are available at most major medical centers and hospitals. If your doctor doesn’t request them for you, demand the ones that are recommended for women in your age group and risk category.
Cardiac Calcium Scoring
How It Works: A CT scanner checks for atherosclerotic plaque (made up of calcium, cholesterol, and scar tissue) in your heart’s arteries. After electrodes are attached to your chest and to an EKG machine that monitors your heartbeat, you lie on an exam table that slides into a short, doughnut-shaped tunnel and hold your breath for 10 to 20 seconds.
Cost: $99 to $399
Duration: 10 minutes
Why It’s Heart Smart: “Calcium scoring is the number one best predictor of a future heart attack,” Dr. Agatston says. Calcified plaque– a major warning sign of coronary artery disease, the leading cause of heart attacks–shows up at least 10 years before a heart attack or stroke hits. By catching the problem early, you can treat it before the buildup narrows arteries so severely that it triggers a heart attack.
Get It If: You’re 50 or older with risk factors– or you’re younger with a family history and several risk factors. Since the test involves x-rays, women shouldn’t have it if there’s any chance they might be pregnant.
What the Results Mean: You’ll get an Agatston Score (developed by Dr. Agatston), which indicates the total amount of hard and soft plaque in your heart’s arteries. A score of zero means you have no calcium deposits and a low risk of heart attack in the next 5 years. A score of 400 or more puts you at high risk of a heart attack within 10 years; a score of 1,000+ means you have up to a 25% chance of having a heart attack within a year without medical treatment.
Next Steps: If your score is 200 or higher, your doctor may advise lifestyle changes, a statin to lower cholesterol, or a diabetes drug to lower blood sugar–all of which will also reduce plaque.Carotid Intimal Medial Thickness Test
How It Works: This “ultrasound of the neck” takes a picture of the left and right carotid arteries, which supply blood to your head and brain. After putting a gel on your neck, a technician glides an ultrasound transducer over your carotids to measure the thickness of the arteries’ lining.
Cost: $150 to $500
Duration: 15 minutes
Why It’s Heart Smart: Studies show a link between abnormal thickness of the carotid lining and coronary artery disease. “This test can detect even the earliest stages, before blood flow is blocked,” says Dr. Agatston. Because it’s not an x-ray, it’s also helpful for women who are or may be pregnant.
Get It If: You’re 40 or older–or you’re under 40 and a close relative (parents or siblings) had a heart attack or stroke before age 55.
What the Results Mean: You’ll get two numbers: the thickness of your carotid lining (normal is less than 1.06 mm) and your “arterial age,” an estimate of how that thickness compares to that of healthy women your age. If your arteries are more than 8 years “older” than you are, your doctor can tailor treatment to reduce your risk.
Next Steps: A diet and exercise plan, stress reduction, and, if necessary, drugs to lower your cholesterol, blood pressure, and blood sugar and reduce your intimal medial thickness.High-Sensitivity C-Reactive Protein Test
How It Works: A blood test measures CRP, a protein in your blood that’s a strong indicator of inflammation throughout your body.
Cost: $8
Duration: 5 minutes
Why It’s Heart Smart: Cholesterol plaque injures blood vessels, triggering inflammation and raising CRP levels in your blood. That’s dangerous because women with high levels of CRP may be up to 4 times more likely to suffer a heart attack or stroke. A high CRP is most dangerous if you also have another risk factor: a waist circumference of more than 35 inches, indicating the presence of belly fat.
Get It If: You’re 40 or older.
What the Results Mean: If your score is under 1.0 mg per liter, your risk of developing heart disease is low. A score between 1.0 and 3.0 mg/l equals average risk. Above 3.0 mg/l, you’re at high risk. It’s possible to have high CRP without heart disease, though, because infections and injuries can also trigger a spike in levels.
“We don’t consider high CRP to be a warning sign unless we’ve done the test on three separate occasions with the same results and there’s no other reason for the inflammation,” says Dr. Agatston. If you get three high scores, you need cardiac calcium scoring and the CIMT test to check your blood vessels.
Next Steps: A statin, along with weight loss and exercise, can cut risk of heart problems in women with high CRP.Advanced Lipid Profile and Lipoprotein(a) Test
How They Work: Unlike the traditional cholesterol blood test, which measures total cholesterol, HDL, LDL, and triglycerides, the advanced test also looks at particle size. This is important because some particles are big and fluffy, so they tend to bounce off artery walls as they travel through the body. Others are small and dense, meaning they can penetrate the artery lining and form clumps of plaque. (Think beach balls versus bullets.) The Lp(a) blood test analyzes a specific type of cholesterol that can triple heart risk.
Cost: $19 each
Duration: 5 minutes
Why They’re Heart Smart: Sizing up your particles gives a clearer picture of heart risk than the conventional test: Having a lot of large particles cuts risk, while small ones raise it. The more Lp(a) you have, the worse it is too–it makes LDL particles extra sticky, so they cling to the lining of blood vessels, causing plaque and clots.
Get Them If: You have a family history of heart disease.
What the Results Mean: “You do not want more than 15% of your particles to be the small, dense type,” says Dr. Agatston. For Lp(a), levels above 30 mg/dl put you at increased risk.
Next Steps: If you have small particles, your doctor may prescribe a drug to increase their size, most likely a fenofibrate (such as TriCor or Trilipix) or niacin (vitamin B3), along with a healthy diet and exercise. Niacin is also the best treatment for high Lp(a).A1C Blood Glucose Test
How It Works: A blood test indicates your average level of blood sugar over the prior 3 months. Unlike other glucose tests that require fasting or drinking a sugary beverage, this test requires neither.
Cost: $50
Duration: 5 minutes
Why It’s Heart Smart: “This is the simplest way to detect your future risk of diabetes,” Dr. Agatston says. This disease puts you at 5 times higher risk of developing heart disease–yet 5.7 million Americans have undiagnosed diabetes (on top of the 17.9 million who are diagnosed) because they haven’t had their blood sugar checked.
Get It If: You’re 45 or older–or earlier if you’re overweight and have one or more diabetes risk factors, such as family history, high triglycerides, or low HDL.
What the Results Mean: An A1C level between 4.5 and 6% is normal, between 6 and 6.4 indicates prediabetes, and 6.5 or higher on two separate tests means you have diabetes.
Next Steps: The disease can often be reversed with weight loss, exercise, and dietary changes. If that’s not enough, you may need oral medication or insulin injections.Genetic Tests
How They Work: A blood sample is tested at a lab for mutations of the KIF6 and APOE genes.
Cost: $130 each
Duration: 5 minutes
Why They’re Heart Smart: A common variation in the KIF6 gene and two mutations in the APOE gene raise your heart disease risk. “You have no control over your genes,” says Dr. Agatston, “but these tests can help your doctor better tailor your treatment to head off a heart attack.”
Get Them If: You’re 40 or older.
What the Results Mean: “The KIF6 gene test predicts how effective statins are likely to be at heading off a future heart attack,” says Dr. Agatston. A recent study found that people with a certain variant of KIF6 had a better response to statin treatment, with a 41% drop in heart attack risk, while people without this mutation didn’t respond as well, with a 6% drop. “So we’ll use a different treatment in these cases,” he says– typically, a fenofibrate or niacin. As for the APOE gene, certain people with those variants have a much greater response to a low-saturated-fat diet. “So they may not need medication if they’re diligent about avoiding saturated fat,” Dr. Agatston says.
Next Steps: A drug to lower cholesterol, changes in diet, or both.Stress Echocardiography
How It Works: This test is an improvement over the standard stress test because it adds an ultrasound both before and after exercise to evaluate blood flow to your heart’s pumping chambers and check for blockages in the arteries that supply the heart.
Cost: $850 to $1,600
Duration: 45 minutes
Why It’s Heart Smart: Adding echocardiography to the standard stress test raises accuracy by as much as 85% for women. “It’s an excellent way to tell if your heart disease is severe enough that you could require treatments like a stent or a bypass,” he says.
Get It If: You have signs of heart disease, regardless of your age. “If you experience shortness of breath, chest pain, neck pain, or any other symptom, you need this test,” says Dr. Agatston.
What the Results Mean: If the test detects reduced blood flow, one or more of your coronary arteries may be blocked.
Next Steps: Your doctor may recommend a cardiac catheterization to check for blockages. If your vessels are clogged, they can be reopened with angioplasty, a stent, or bypass surgery.Will Your Insurance Pay?
Compared with the $760,000 it costs to treat a single heart attack patient, these tests are cheap–but some insurers won’t pay for them. “The system rewards doctors who do bypasses but doesn’t pay for prevention,” says Arthur Agatston, MD. Many companies are coming around: Most will pay for the stress EKG, blood glucose, and advanced cholesterol tests. Some will cover the gene tests and CIMT. Cardiac calcium scoring usually isn’t covered. Call your carrier beforehand to find out what it will pay for and what your co-payment will be.Prevention Pioneer: Arthur Agatston, MD
A preventive cardiologist and Prevention advisory board member, Dr. Agatston passionately believes that the right combination of diet, exercise, medication, and advanced tests can wipe out heart disease–and he’s proving it: Of the 2,500 patients he sees in his Miami clinic each year, only one or two have heart attacks. “One of the best-kept secrets in cardiology,” he says, “is that doctors using cutting-edge prevention have stopped seeing heart attacks in their patients.”It was Dr. Agatston and Warren Janowitz, MD, who developed the first CT scan heart screening–the cardiac calcium scoring test–in the 1980s. “At first, it was a constant battle to educate physicians that the standard of care needed to change,” Dr. Agatston says. But now, because of his work, patients everywhere can get this test. Not content to stop there, he continues to develop treatments to prevent heart attacks. “This disease,” he repeats emphatically, “does not need to exist.”
You can subscribe to Prevention Magazine at www.prevention.com
For more Prevention tips: Get a healthier heart in 28 days.
Each year in the US, there are several thousand unintentional deaths involving fatal overdoses from incorrect prescriptions. In the following article from The Membership Medicine Blog, the author suggests that doctors with heavy patient loads do not have enough time to focus on each individual patient, leading to the treatment of symptoms, not causes. The ability of membership medicine, also called concierge medicine, to solve these problems is explained in their article reprinted below:
Write It Right. Prescription Errors Lessen As Doctors “Normalize” Their Patient Load
July 27, 2010 by
Creator & of Author of The Membership Medicine BlogIn 2000, there were over 7,000 deaths annually in the United States from incorrect prescriptions, according to Carmen Catizone of the National Association of Boards of Pharmacy. Unintentional deaths involving prescription drugs increased 114 percent from 2001 to 2005, according to The Office of National Drug Control Policy.
Catizone told The Washington Post that as many as 5 percent of the 3 billion prescriptions filled each year are incorrect. In fact, prescription drugs cause most of the more than 26,000 fatal overdoses each year, says Leonard Paulozzi of the Centers for Disease Control and Prevention.
So, What or Who Is To Blame?
Both patients and physicians feed the evolving cycle. With less time to see every patient, doctors are stressed, burned out and don’t really have time to get to know their patient. Spending about 6 to 7 minutes per patient and handling patient loads of 3,000 or more patients per year, doctors are bound to treat more symptoms than causes and much more likely write you a prescription and move onto the next patient.
Patients however are more reliant on drugs than ever before. In fact, following the introduction of oxycodone into Toronto’s drug formulary in 2000, there has been a 500% increase in deaths due to these drugs because of our dependency on them. This according to a new study conducted by physicians at St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences (ICES) in Toronto.
What or Better Yet, “Who” Is The Solution?
Membership medicine or as it is also known concierge medicine physicians provide healthcare services in a more convenient, relaxed, accessible and cost effective delivery model. These physicians can be found across the country and charge patients a “membership” fee (thus term ‘membership medicine’) ranging anywhere from less than $25 per year to $136 per month.
Couple these costs with the understanding that over 80% of your healthcare needs can be met by your PCP or family physician…that results in huge savings to even your most cost-effective insurance product. And, if you need to visit the hospital or ER, there are catastrophic health insurance plans available at considerable savings.
According to a recent excerpt from Marcy Zwelling, MD in The Society of Innovative Medical Practice Design Newsletter, ‘the HSA offered by private insurers has proven that economics 101 works to decrease cost and offer appropriate care. And, over 30% of those purchasing HSA-associated catastrophic insurance had no insurance when they entered the marketplace. Those already owning insurance who convert to an HSA plan use the emergency rooms less and govern the quality of their care. Membership Medicine patients are very happy with the closer relationship they have developed with their doctor and continue to fund their HSA-privately owned account(s).’
In conclusion, if you choose to look into Membership Medicine, the physician you choose will generally include 24/7 access to their patients via the doctor’s personal cell phone (not a receptionist somewhere or answering machine). Also included by most membership medicine are same-day, no wait appointments, personal follow up by the doctor, house calls, visits while you are in the hospital and more.
As healthcare costs continue to rise, more employers and self-employed individuals are looking for affordable solutions to traditional, low-deductible health insurance plans. Signed into law in December of 2003, the Health Savings Account (HSA) was designed to give you tax advantages to offset your healthcare costs. HSAs, coupled with high-deductible health plans (HDHPs) have become increasingly popular with both employers and individuals as an alternative to a more traditional health care plan.
If you have an HSA, you can use distributions from your account to pay your healthcare costs with pre-tax dollars, so your money goes much further. Your account also earns tax-free interest. With an HSA you have more control over your healthcare decisions instead of having your options limited by the insurance companies. You can choose the doctors and treatments you prefer to use.
Many healthcare expenses can be reimbursed through your HSA. Some examples include: non-prescription medicines and name brand medications, durable medical equipment, dental and vision care and services provided by a concierge or personalized physician. *
Many people have discovered that an HSA is the perfect complement to concierge or personalized medical care services. Concierge physicians limit their practices to only a few hundred patients rather than several thousand as in traditional medical practices. This healthcare model facilitates easy access for the patient to be seen by a doctor who knows all about them and their medical history. And, while the retainer fee for a concierge physician is not likely to be a qualified reimbursable expense from an HSA, the medical services provided would be.
Premium healthcare is a smart decision. The average employer pays thousands of dollars a year in loss and productivity costs for each employee who becomes ill and doesn’t have timely access to care. If the employee has a HSA and a HDHP (high-deductible health plan) and is a member of a concierge practice, he can be seen and treated quickly, saving time and money for him and his employer. Having a medical home in a concierge practice also saves money by reducing emergency room visits, which are costly, impersonal and time-consuming.
You can learn more about the benefits of personalized medical services and joining a concierge practice at http://DestinationHealth.com/ or you can call us to arrange a no-cost consultation at (817) 310-6050.
Beyond the obvious healthcare benefits, there are solid financial advantages to setting up a Health Savings Account:
• You can claim a tax deduction for contributions.
• Your employer’s contributions may be excluded from your gross income.
• Contributions remain in your account over the years until you use them.
• Earnings and interest on the assets in your account are tax-free.
• Qualified medical expenses may be paid with tax-free distributions.
• If you change jobs or stop working, you keep your HSA.
If you’re interested in setting up a Health Savings Account to provide tax advantages to offset your healthcare costs, here are a few helpful details:
How do I set up an HSA? – A Health Savings Account (HSA) is a tax-exempt trust or custodial account you set up to pay or reimburse certain medical expenses you incur. It’s not necessary to get permission or authorization from the IRS to set up an HSA. But, you must use a qualified HSA trustee, like a bank, an insurance company, or anyone already approved by the IRS to be a trustee of individual retirement arrangements (IRAs).
Am I eligible? – You must be an eligible individual to qualify for a Health Savings Account. You may be eligible if you’re covered under a high-deductible health plan (HDHP), have no other health coverage (exceptions listed in IRS Pub. 502), are not enrolled in Medicare and you can not be claimed as a dependent on someone else’s return.
What’s an HDHP? – A High Deductible Health Plan (HDHP) has a higher yearly deductible than a typical health plan. There are minimum and maximum out-of-pocket limits set for HDHPs for 2010. They are:
• Individuals – Minimum of $1200 and maximum of $5950
• Families – Minimum of $2400 and maximum of $11,900
Your HDHP plan may also cover preventive care benefits at no deductible, or at a lower deductible.
How much can I contribute to my HSA each year? – The amount of your yearly contribution depends on several things. But as a general rule, for 2011 if you have individual HDHP coverage you can contribute up to $3050. HDHP families can contribute up to $6150. In 2010 and later years, you can contribute an additional $1000 If you are an eligible individual 55 or older. You have until April 15, 2011 to make your 2010 contribution.
When should I set up my HSA? – You must establish your HSA before you incur the unreimbursed medical expenses. You can’t pay/reimburse medical expenses you had before you set up your account. So, it’s important to go ahead and set up your HSA now. Don’t wait. You’ll still have until April 15th of the following year to fully fund it.
For example, in order to have funded an HSA for 2011, your HSA account must have been established prior to 12-01-11. But, you have until 04-15-12 to fully fund it.
How do I use my HSA to pay for or be reimbursed for medical expenses? – Most HSA accounts will issue a debit card, a checkbook, or both as a way of accessing funds. If you do not request distributions from your HSA each year, the balance in your account may be carried over to the next year.
Your financial advisor or health insurance broker can help you decide if an HSA is right for you.
*See IRS Publication 502 for a detailed list of eligible expenses. More information about HSA’s can be found in IRS Publication 969. Find IRS publications online at http://irs.gov/
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©2011 Dr. Robin Hall All rights reserved.
This publication is designed to provide accurate and authoritative information with regard to the subject matter covered. It is offered with the understanding that the author and the publisher are not engaged in rendering tax, legal, accounting or other professional advice. If professional assistance is required, the services of a competent professional should be sought. Dr. Robin Hall and her publisher, individually or corporately, do not accept any responsibility for any liabilities resulting from the actions of any parties involved.
