The following guest post is reprinted with permission from Anthony Pearson, MD, a cardiologist who is the medical director of the Echocardiography Laboratory and Anticoagulation Clinic at St. Luke's Hospital in Chesterfield, Mo. Dr. Pearson writes The Skeptical Cardiologist blog, where this post originally appeared.
Donald Trump recently appeared on the Dr. Oz show and handed a letter to the celebrity medical charlatan and TV host, Mehmet Oz. The letter was written by his personal physician, Dr. Harold Bornstein, and summarized various laboratory and test results, which led Bornstein to conclude that Mr. Trump is in excellent health (Bornstein did not repeat his earlier, bizarre statement that "If elected, Mr. Trump, I can state unequivocally, will be the healthiest individual ever elected to the presidency.")
From a cardiovascular standpoint the following sentence stood out:
"His calcium score in 2013 was 98."
Regular readers of The Skeptical Cardiologist should be familiar with the coronary calcium (CAC) scan or score by now. I've written about it a lot (here, here, and here) and use it frequently in my patients, advocating its use to help better assess certain patient's risk of sudden death and heart attacks.
The CAC scan utilizes computed tomography (CT) X-rays, without the need for intravenous contrast, to generate a three-dimensional picture of the heart. Because calcium is very apparent on CT scans, and because we can visualize the arteries on the surface of the heart that supply blood to the heart (the coronary arteries), the CAC scan can detect and quantify calcium in the coronary arteries with great accuracy and reproducibility.
Calcium only develops in the coronary arteries when there is atherosclerotic plaque. The more plaque in the arteries, the more calcium. Thus, the more calcium, the more plaque and the greater the risk of heart attack and death from heart attack.
What Does Donald's Trump's Calcium Score Tell Us About His Risk Of A Major Cardiac Event?
We know that, on average, even if you take a statin drug (Trump is taking rosuvastatin, or Crestor), the calcium score goes up at least 10% per year which means that 3 years after that 98 score we would predict Trump's calcium score to be around 120.
Based on large, observational studies of asymptomatic patients, calcium scores of 101 to 400 put a patient in the moderately high-risk category for cardiovascular events.
When I read a calcium score of 101 to 400, I make the following statements (based on the most widely-utilized reference from Rumberger). This patient has:
- Definite, at least moderate atherosclerotic plaque burden
- Non-obstructive coronary artery disease highly likely, although obstructive disease possible
- Implications for cardiovascular risk: Moderately High
Patients in this category have a seven-fold risk of major cardiac events (heart attack or death from coronary heart disease) compared to an individual with a zero calcium score:
Clinton vs Trump: Zero Is Better
Since we know that Hillary Clinton recently had a calcium scan with a score of zero, we can estimate that Trump's risk of having a heart attack or dying from a cardiac event is markedly higher than Clinton's.
Clinton, born October 26, 1947, is 68 years old, and we can enter her calcium score into the MESA calcium calculator to see how she compares to other women her age. A coronary calcium score of 6 is at the 50th percentile for this group.
Interestingly, Trump's score of 98 at age 67 years was exactly at the 50th percentile. In other words, half of all white men age 67 years are below 98 and half are above 98, creeping into the moderately high-risk category.
(This should not be surprising, I touched on the high estimated cardiovascular risk of all aging men in my post entitled "Should all men over age 60 take a statin drug?")
So, based on his coronary calcium score from 2013, Donald Trump has a moderate buildup of atherosclerotic plaque in his coronary arteries and is at a seven-fold higher risk of a cardiac event compared to Hillary Clinton.
Let the law suits and tweets begin!
Electorally Yours,
-ACP