More on Tim Russert

The following article just came through and since we’ve posted on this previously, I wanted to continue the thread regarding Tim Russert.
Note the comment about CRP measurement for silent inflammation. It's especially critical to understand and be tested for levels of silent inflammation. We've posted on this often so you can do a search here and find more.

Also important information in this link on silent inflammation by Craig Weatherby of Vital Choice. Be sure to read.
[newsletter.vitalchoice.com]

Media mulls Russert's death as cardiologists weigh in

JUNE 18, 2008 | Shelley Wood
New York, NY - Media reports in the wake of Tim Russert's sudden cardiac death last week at age 58 have moved on from lamenting the passing of a respected political journalist to questioning whether his death was preventable.

According to information his doctors have provided to the media in statements and in interviews, Russert was known to have asymptomatic coronary artery disease, and he was being treated for hypertension, high LDL and triglycerides, and low HDL. Most recently, Russert's LDL was 68 and his HDL had been raised from in the 20s to 37: an "acceptable lipid profile," according to his doctors. Russert had minimally elevated blood glucose but did not have diabetes; a stress test in late April was normal. Media reports, including a New York Times story on Tuesday [1], note that Russert had even had a calcium scan in 1998, which yielded a calcium score of 210, signaling intermediate risk. A subsequent autopsy has confirmed that Russert had left ventricular enlargement and died of ventricular fibrillation following plaque rupture in his left anterior descending artery.
Journalists reporting on Russert's death are turning to the cardiology community to make sense of it. Most experts are emphasizing that Russert's case, while high profile, is not that unusual.

"More than 300 000 people die each year in the US from out-of-hospital sudden cardiac death, and Russert had the classic symptoms," Dr Prediman K Shah (Cedars-Sinai Medical Center, Los Angeles, CA) told heartwire. "This is a very common scenario that plays out 90 times per day, every single day of the year."

Could Russert's death have been prevented?
Stories like the one in the Times and the Wall Street Journal [2] the same day point to Russert's risk factors and his attempts to manage them. While his weight had crept upward during the US primary season, he seemed to have his cholesterol and blood pressure under control and was exercising regularly. The logical question being asked by reporters of cardiologists is: could Russert's death have been prevented?

Dr Douglas P Zipes (Indiana University Medical School, Indianapolis) agrees that much of the media coverage has tilted toward the possibility that Russert's death was inevitable. "That's been a real aspect of the media coverage," he acknowledged to heartwire. "But when I've been presented with that point of view from the media, my questions have been: what heart rate did he achieve in his stress test? Was it an adequate stress test? Was radionuclide or echo imaging done, which increases the sensitivity of the test? What medications was he taking, what were the doses, and did he take them on a regular basis? What was his cholesterol despite apparently taking a statin? What exercise program did he really participate in? I have no answer to any of those questions." Shah agreed, pointing out that many of the specifics about Russert's management are "still sketchy."

"So whether this was preventable or inevitable is difficult to say," Shah observed. "We can't be critical of his doctors since we don't really know the full extent of the medical background. Maybe he was doing everything that it was humanly possible to do and still died, which is not impossible. We still lose people in spite of the best available treatment."

Shah believes if anything good could come out of Russert's untimely death, it is the reminder to the public, to physicians, and to policy-makers that "the battle has not been won."

"We obviously need, in addition to screening, widespread attention to cardiac health through lifestyle modification and probably much earlier detection of the disease at a stage where you can actually arrest its progress," Shah said. "If you detect disease in a 58-year-old, it's a different ballgame than if you detect it in the 30s or 40s. The later you detect it, the less effect therapy will have in halting the progression."

Uncontrolled factors and unknown risk
Dr Eric Topol (Scripps Translational Science Institute, La Jolla, CA) pointed out to heartwire that Russert's weight was a major uncontrolled risk factor; he was also under considerable stress and acknowledged being sleep-deprived. These are "major factors," Topol suggests, but they don't explain everything. He believes a CRP test and newer genetic tests would have gone a long way toward to illuminating just how high Russert's MI risk indeed was. It is not clear whether Russert had had his CRP measured on a regular basis.

"We are reasonably good at treating heart attacks when people get to the hospital, but they don't always get there, and we don't know how to predict plaque rupture," Topol said.

Topol believes genomic testing in the future, and even some of the tests available today, might have helped doctors get a better idea of the risks Russert was facing. "I wouldn't be at all surprised if Russert had 9p21 homozygote, and his son Luke should be tested," Topol said.
Much has been made of Russert's abdominal obesity as a risk factor, something Topol does not discount. But he points out: "There are a lot of people walking around with obesity, but only a fraction have plaque-rupture events that are fatal, so we need to pick out that tiny fraction who are at increased risk and we need better means to do that."

A stress test, Topol points out, is of no value for identifying arteries at risk of causing sudden cardiac death. "The cardiology community still doesn't get it, that stress testing isn't the way to pick up plaque ruptures. There's a classic study that shows that CRP is complementary, and obviously CRP is a very crude test, and we could do much better with genes and proteins, even with what we know today. But I think that the medical community's problem is thinking that stress testing is such a great thing and it simply isn't."

Russert's physicians clarify some points.
Several media outlets and bloggers also reported erroneously on Tuesday that NBC's studio did not have an automatic external defibrillator on site, something that one of Russert's physicians clarified on Larry King Live.
According to Dr Michael Newman, Russert's physician, Russert's resuscitation was initiated immediately at NBC and Russert was ultimately defibrillated three times before his arrival at Sibley Memorial Hospital. But how and to what extent resuscitation efforts were conducted appropriately before emergency personnel arrived is still unclear. USA Today has reported that emergency crews arrived at NBC to find someone trying to perform rescue breathing on Russert using a mask, but that this person was not doing chest compressions [3]. USA Today also reported that it was paramedics who, presumably using their own defibrillator, delivered the three shocks to Russert without success.

Sources
1. Grady D. A search for answers in Russert's death. New York Times,June 17, 2008. Available at: [www.nytimes.com].
2. Beck M. A visceral fear: Heart attacks that strike out of the blue. Wall Street Journal, June 17, 2008. Available at: [www.wsj.com].
3. Lawrence J. NBC's Tim Russert dead at 58. USA Today, June 13, 2008. Available at: [www.usatoday.com].

Additionally -

Cardiologist, Eric Topol’s remarks are worth viewing.
<[blogs.theheart.org]

Published online at:
[www.theheart.org]

Along these lines, I would like to add this article:

[discovermagazine.com]

Further down in the article it discusses the issue of people on medicines that are supposed to protect them dying.

Tish

Thanks Jackie. That's a good link on silent inflammation. Unfortunately that's the same article on Russert from 6/18 that was already posted. I wish something would change to say that there was some way this could have been predicted. Plaque rupture? I don't think there were great red flags.

I don't think that even with optimal intervention (AED that worked and immediate expert intervention) would have saved Russert. The plaque rupture completely blocked off his LAD which is the largest artery supplying the anterior left ventricle. I don't think any intervention could have saved him. He probably felt very little. Aside from his age........not a bad way to go.

This has to be brief. Afib as I'm typing. One Cardizem and my pillow for a while:~)

Hope you are all well.

Pam

I also would have like to have found something on George Carlin. All I can find is unrelated to his death. One article says that he had a long standing heart condition ~ 30 years ~ and went into the hospital with chest pain and was dead in 24 hours.

Also sad.

Seems like both Russert and Carlin believed in modern medicine...

William

Great article, Tish - I have John Abramson's book, "Overdosed America". It was a real "eye-opener".

Barb

Pam - I enjoyed George Carlin. Saw him in person years ago. Several articles indicated a connection between cannabis and his heart problem..and said he was a big fan of MJ. Don't know how true that is but there is support for the cardiomyopathy connection.

Jackie

George Carlin self-admitted having a problem or habit of red wine and cocaine at one time. His words. I'm sure Cannibus also

pam

Jackie et al

I'm confused. Wouldn't an angiogram have disclosed the plaque build up & narrowing of the LAD that ultimately led to his death from a plaque rupure & subsequent clot ? I know an angiogram isn't part of the protocol since he "passed" a stress test, but what about the newer CAT contrast imaging the CC & others use to detect stenosis of the PV after a PVI ? I had a angiogram 10 years ago that indicated "mild" buildup in the LAD. 5 years later my followup in Cleveland showed no PV stenosis, but noted the same narrowing in the LAD as the angiogram had indicated previously.

I'm sure my experience as a "plus 60" is similar to others: I can think of a dozen or so friends I ve lost due to sudden cardiac death. Many appeared to be the picture of health. A friend from high school had just completed a week at the Mayo Clinic for a complete workup. Passed with flying colors. Avid runner & in great shape. Dropped dead jogging 10 days later. IF he would have had an angiogram he probably would still be alive. My question: Why isn't the new CAT imaging being used as a screen ? It is my understanding, although the angiogram is still the "gold standard", this is a very accurate test.

Am I missing something ?

Thor:

Missing in our yearly check-up is the ferritin and transferrin saturation percentage. If your ferritin is above 50 and your TS% is above 45% you are beginning to store iron, increasing your risk for the major diseases.

If these values are elevated the cure is simple give blood and lower them to acceptable levels.

Check out www.irondisordersinstitute.org for more explicit information.

Raw oysters and walking barefoot on the beach may be fatal for people with iron overload due to vibrio in the oysters and in the sand.

1 in 7 persons has one gene and 1 in 200 has two genes for Hemochromatosis in the US. In Ireland the ratio is twice that of the US.

I treated myself based solely on my blood tests and did not find out until 4 years into treatment that I had one gene for HH... the penetrance of my gene is high and that is why I go for periodic blood letting.

Isabelle

The cure for high iron might be even simpler - there is a wormy critter that can live in our gut, named hookworm. It eats iron and a little protein, and will take the iron out of us.
All that's required is to stand barefoot in a place where wild animals have shat. Apparently they all have the symbiote.
If bats have it, I should be OK since it's unavoidable around my house, and I'm barefoot all summer.

Of course, we must also stop killing our gut critters.

William

Thor, I recently had a Coronary CTA as a follow-up for my PVAI ablation 6 months ago. I freaked when I saw the results that indicated mild plaque in the LAD artery since I had read that was the area that Tim Russert had his problems. I've also heard the LAD referred to as the "Widow Maker" because it is involved in many sudden cardiac death cases. Adding to my concern was that all my recent blood tests have shown low HDL and an unfavorable HDL/LDL ratio. I rushed off to my cardiologist to discuss.

My cardiologist basically said that the plaque was no surprise and that everyone has some amount of plaque by the age of 40 (I'm 44). It is not plaque by itself that causes SCD, but a plaque rupture. He said at this point there is not a way to predict when and where a rupture will occur. He is suggesting a statin drug to help my HDL and a stress test down the road. He felt a stress test was the only way to determine if the current plaque burden is enough to cause any problems. In the meantime I'll keep taking my fish oil to also help my HDL and perhaps protect me from plaque rupture.

He also referred to a recent article in the NY Times regarding the CT scans. It was an interesting viewpoint.

Best wishes,

Dave M.

Dave and Thor - see the post I offered today to Dean on Silent Strokes... it really comes down to - testing for markers of silent inflammation and the other risk factor's we've frequently mentioned here and addressed again in that post.

Of course, a thalium stress test would show blockages in coronary arteries and is less invasive than angiogram. The spiral CT scan shows calcifications and there is a specific survey just for coronary calcifications.

A friend of mine and his brother flew to Chicago and hand one of the first offered back in the 90's. They've been around for a long time. Expensive and may not be regarded by physicians as 'necessary'...but truly in any individual who has some obvious risk factors, it would seem smart to me to rule out any potentials.

I think this serves as a reminder for us all to be aware and knowledgeable about potential health risks and pursue the appropriate diagnostics even if the doctor doesn't think they are necessary.

So much goes into this whole picture... diet, essential electrolytes, stress factors, appropriate testing for risk markers not typically addressed by conventional medicine.... we all need to assess where we are on this checklist of prevention.

Jackie

oops...sorry... I meant to type less invasive than catherization - which was so prevalent there for a while to determine blockage.

Jackie, do you know if a thallium stress test is the same as a nuclear stress test?

Jean

Jean - yes.

See [www.texasheartinstitute.org]