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Take a Health Cue from Letterman?

I'm 47 and recently had a nuclear stress test because of a family history of heart attacks. The results were negative, no blockages. I also have slightly elevated cholesterol which is under control with diet and Lipitor. In light of David Letterman's recent ordeal, do you think I need an angiogram? My doctor hasn't recommended one. I'm just worried.

David Letterman's recent by-pass surgery generated a lot of questions, such as yours, about tests to diagnose coronary artery disease. Letterman's father died in his fifties of heart disease. When an angiogram revealed that Dave's coronary arteries were occluded (blocked with deposits containing cholesterol) his doctors recommended surgery.

The test you had, a nuclear stress test, is also known as a thallium stress test because a small amount of thallium, a radioactive substance, is injected into the blood stream. It gives doctors a picture of how well blood flows to the heart muscle during the "stress" of exercise on a treadmill or bicycle. Normal results, such as yours, show that blood is flowing adequately through your coronary arteries.

However, a plain stress test, one without thallium, is usually the first step in evaluating a person who isn't experiencing symptoms of heart disease but has a strong family history of the disease. If the person has some symptoms, such as mild shortness of breath with exertion, or atypical chest pain, a physician might repeat the stress test with thallium. If the symptoms are more worrisome, like chest pain with shortness of breath, nausea, vomiting, sweating, or radiation of pain, or if the person has had an acute heart attack, then an urgent angiogram is usually warranted.

While an angiogram (or angiography) is one of the most accurate ways to determine whether heart disease is present, the test is invasive. An angiogram involves threading a long, thin tube (a catheter) into an artery in the groin or forearm and moving it through the arterial system until it reaches one of the two main coronary arteries. Doctors then inject a dye into the bloodstream to highlight the arteries on an X ray, which shows whether any of the coronary arteries are narrowed and, if so, how much. Angiograms are relatively safe, but as with all surgical procedures, infections and other complications can arise. Also, a very small group of people -- particularly patients who are prone to allergy or asthma -- can have allergic reactions to the dye.

In view of your stress test results, I don't think you need to press for an angiogram. Instead, continue to control your cholesterol, stick to a low-fat diet, reduce stress, and get plenty of regular exercise. As a preventive measure, you may want to take a baby aspirin, or half an adult aspirin, daily. You should also take a B-100, B-complex vitamin, or at least eat lots of foods which are high in B vitamins, such as fortified cereals and juices, beans, and leafy greens. B vitamins help your body break down homocysteine, an amino acid by-product from protein metabolism. High blood levels of homocysteine have been associated with an increased risk of cardiovascular disease. You could also ask your doctor if a test for homocysteine levels is warranted, but taking B vitamins is inexpensive and has other health benefits as well.


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