Stress Tests Fail to Determine Heart Attack Risk


By now you probably already know, but the much beloved host of NBC’s Meet the Press, Tim Russert, has died. He collapsed from a heart attack at the NBC News studio in Washington, D.C. on Friday. Nicole Weisensee Egan of People Magazine reports:
In a statement detailing autopsy results, Dr. Michael Newman said his famous patient had passed a stress test on April 29 and had even worked out on a treadmill the morning of his death.

"Russert, age 58, was known to have asymptomatic coronary artery disease (atherosclerosis), which resulted in hardening of his coronary arteries," Newman said. "The autopsy revealed an enlarged heart and significant atherosclerosis of the left anterior descending coronary artery with (a) fresh clot which caused a heart attack resulting in a fatal ventricular arrhythmia…"

…Dr. Cyril Wecht, a nationally renowned forensic pathologist, said Newman's description of why Russert died makes sense. "The left anterior descending artery is well known among pathologists as the widow-maker," he tells PEOPLE. "That tells you a lot, doesn't it? It's a classical situation that one encounters with great frequency in sudden unexpected death where you get a blood clot, or a thrombosis, or bleeding and if he had an enlarged heart, that adds to it."

Clots can be caused by any number of things, he said. "Sometimes it's associated with stress and exertion, physical and/or emotional," he said. "Was he flying a long time? Was he tired? People shoveling snow in the wintertime can get them. People working excessively hard. Or people under great physical and/or emotional stress and that can include flying."
He PASSED his stress test, how could that be? If he checked out okay, how could be dead a couple months later? Something doesn't seem right. I called Dr. Fuhrman and asked him about stress tests. Here’s what he had to say:
A stress test is not an accurate test for determining the risk of a heart attack. A stress test only identifies obstructions, it doesn't identify vulnerable plaque—the plaque that is likely to throw a clot. A stress test can only detect a blockage of more than 80% and the propensity of plaque to rupture has nothing to do with the amount of obstruction. You could have a completely normal stress test and then have a heart attack the next day.1 Juvenile plaque, which is thinly laid down, has a higher propensity to rupture then the old plaque that is more obstructive.


Cardiologists' attempt to intervene with cholesterol-lowering drugs hoping that cholesterol-lowering will reduce the thickness of the lipid pool within the plaque, but it only partially reduces risk. Over fifty percent of Americans still die of heart attacks and strokes. About 70 percent of the clots that cause death are formed in areas of the heart with non-obstructing lesions, not visible to cardiac testing and not treatable with stenting or bypass.

Stress tests are big money-makers for doctors. They identify those people with large blockages who qualify as candidates for costly angioplasty or bypass surgery. However, drugs and medical procedures reduce risk only slightly. There is a more effective option. People who normalize their weight, blood pressure and cholesterol through nutritional excellence and exercise don't have heart attacks.
Dr. Fuhrman makes it pretty clear. Protection against cardiovascular disease will not be found by a scalpel or in a bottle of pills. The best way to prevent heart disease is through aggressive dietary intervention; specifically a nutrient-dense vegetable-based diet. He explains:
A high nutrient, plant-based diet is more effective at lowering cholesterol than drugs, but also the weight loss, blood pressure lowering and reduction of oxidative stress from the high levels of micronutrients are all important factors in dramatically lowering one’s risk of heart disease.2 Their have been numerous medical studies to document that dietary intervention is more effective than drugs, and that heart disease is preventable and reversible.3,4 That’s why my patients with advanced heart disease get well and never have heart disease again.
Maybe if less focus is placed on pointless money-making procedures that only promote a false sense of security, millions of Americans, like Tim Russert, wouldn’t die needlessly each year.
1. http://www.medscape.com/viewarticle/553538

2. Jenkins DJ, Kendall CW, Popovich DG, et al. Effect of a very-high-fiber vegetable, fruit, and nut diet on serum lipids and colonic function. Metabolism 2001 Apr;50(4):494-503.

3. Hu FB. Plant-based foods and prevention of cardiovascular disease: an overview. Am J Clin Nutr 2003 Sep;78(3 Suppl):544S-551S.

4. Esselstyn CB. In cholesterol lowering, moderation kills. Cleve Clin J Med 2000 Aug;67(8):560-564. Esselstyn CB. Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology). Am J Cardiol 1999 Aug 1;84(3):339-341, A8.
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Comments (2) Read through and enter the discussion with the form at the end
LolaBloom - June 17, 2008 1:17 PM

Great article and great point at the end too. It has been disheartening and frustrating to say the least to watch how our medical industry works.

I think many people think of it (and trust in it) as a system that is meant to have and promote the knowledge to make people healthy. But what is clear is that it is an INDUSTRY that is focused on treating symptoms with medication or medical intervention. The focus isn't on prevention and that's scary.

I wish reading Dr Fuhrman's books and books like The China Study were required study for all medical school students and that the focus of those schools was nutrition first and foremost.

Anau Speizer - July 29, 2008 8:21 PM

Thanks for the insight on this info, I agree. But how can we attack obesity and diet for multicultural community when their perception on this issue is no a problem and also socio-economic is not helping. Any suggetion on this people's diet ( Pacific Islanders). How can we help?. I will appreciate your feedback.

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