The Widowmaker. The very sound of this deadly cardiac blockage (the first portion of the largest heart artery called the left anterior descending, or LAD) causes fear and often results in sudden closure, massive heart attacks, or sudden death.
Unfortunately, the Widowmaker is the most frequent location of narrowing in all of the heart arteries. It poses a risk, like a cobra waiting to strike, until it may be too late.
For example, when the Widowmaker closed off blood supply in late 2012 to the heart of Imre Molnar, provost of the College for Creative Studies in Detroit, during a bike ride, he died tragically at age 61. His sudden passing not only affected his beloved family, but for the school, it struggled for nearly a year to replace his position.
Was the physical exam you had at age 45, 50, or 60 reliable to avoid the bite of the Widowmaker? It sadly was not adequate for Molnar, nor is it adequate for many of the nearly 2,000 people each day who die of cardiovascular disease in the U.S.
The concept that heart attacks are preventable is not new. More than 60 years ago, a famous Harvard Medical School professor challenged the medical system, saying that “a heart attack after age 80 is an act of God, before age 80 a failure of medicine.” Dr. Paul Dudley White was caring for President Dwight D. Eisenhower after the president’s massive heart attack.
In reality, little has changed since White’s words. The routine executive evaluation, whether done locally or at the high-priced meccas in Cleveland and Rochester, do not afford the peace of mind many assume was measured. After practicing cardiology for more than 30 years and having spent countless nights in the “cath” lab opening Widowmaker arteries, a better plan is available.
Step 1: Get a coronary artery calcium scan (CACS)
A CACS is a CT scan of the heart that takes under one minute, uses no dye or needles, has a very low radiation exposure (equivalent to a mammogram), and costs between $75 and $125 at Detroit area hospitals. It is the only way to actually see heart arteries, including the Widowmaker, in a painless and simple manner. The ideal result identified in about 50 percent of those tested is a CACS score of zero. A zero indicates the absence of calcium in the Widowmaker area and is associated with a long-term freedom from worry about a future heart attack that reassures for 5-10 years. Even a slight elevation in the CACS raises the risk for a future heart attack. Without question, scores of Detroit-based executives who have suffered heart attacks of the Widowmaker, fatal or not, would have had ample time to be fully evaluated had they had a CACS within a few years of the tragic day. If you have had a stent, heart bypass surgery, or a known heart blockage or heart attack, generally the CACS is not necessary as the details of your heart disease are already known.
Step 2: Arrange for advanced labs.
In general, the same lab studies done during a physical exam in the 1980’s are ordered today. There have been major advances in laboratory testing. Here are some labs I request and analyze on patients as a routine to gauge their risk of the Widowmaker.
Advanced cholesterol panel: Rather than the “calculated” LDL cholesterol level found in routine panels that can be quite inaccurate in the presence of weight excess, elevated blood sugar or diabetes, and a sedentary lifestyle, all often found in executives, an advanced cholesterol panel measures the LDL particle number and size. These numbers have been shown to be more accurate in predicting future heart and stroke events. These tests are widely available (NMR lipid profile) and quite inexpensive.
Hs-CRP: The high sensitivity C-reactive protein is a blood test patented by Harvard Medical School to measure inflammation, or the “fire,” that results from an irritated immune system. The higher the Hs-CRP, the greater the risk of the Widowmaker and a future heart attack, stroke, and even other conditions such as cancer and dementia.
Lipoprotein (a): This is a genetic form of cholesterol that’s elevated in about 20 percent of the public. It’s rarely drawn even though hundreds of research studies indicate that if it’s high, the risk of heart attack and stroke skyrocket. It runs high in many families that have been decimated by heart disease.
Homocysteine: This amino acid is produced by a process called methylation. It can injure arteries when elevated. It may be due to a genetic defect in the MTHFR gene, which is easily measured. It can be treated with methylated B-complex vitamins.
apoE: This is a genetic marker related to cholesterol metabolism that is measured from a blood sample. A pattern called apo E 4/4, found in 5 percent of the public, greatly increases the risk of both the Widowmaker and future Alzheimer’s disease, permitting time to optimize lifestyle and overall health.
Step 3: Never leave an emergency room (ER) visit without a complete evaluation
If by some misfortune in you end up in an ER with chest discomfort, a black out spell, shortness of breath, or racing heart beats, take my advice: DON’T GO HOME without a thorough evaluation for the Widowmaker. Ask for “serial” cardiac enzymes that are repeated two or three times, every four to six hours, even if you might stay a few hours extra. Ask for repeat electrocardiograms (ECGs) to compare to the one that was done within the first few minutes of arrival. Finally, ask for a definitive test before discharge. Many ERs offer an even more advanced test than the CACS, called a coronary CT angiogram (CCTA). This is by far the most accurate way to be sure your arteries are clean and free of the risk of the Widowmaker before discharge.
Many decades have passed since Dr. Paul White announced that heart attacks are a failure of the medical system. The emphasis on learning CPR or placing defibrillators in gyms misses the main point for a successful and healthy career and life. There is simply no reason not to be tested for the presence of a silent Widowmaker artery in your heart and the factors that might have caused it. A responsible corporate business plan must ensure the health of its leadership.
