Comments on: My take: Tim Russert http://www.kevinmd.com/blog/2008/06/my-take-tim-russert.html Tue, 14 Feb 2012 11:46:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2008/06/my-take-tim-russert.html#comment-86382 Anonymous Thu, 19 Jun 2008 15:08:00 +0000 http://clients.emmense.com/kevinmd/2008/06/my-take-tim-russert.html#comment-86382 More than enough epidemiological studies have demonstrated a direct, unequivocal relationship between cholesterol levels and incidence of MI. 50 years worth of studies, including some long before statins were developed. This is no longer disputed.<br/><br/>Second, a person can have totally normal cardiac tests, no vessel occlusion, and STILL be at risk for sudden cardiac death. How? Some plaques do not encroach into the lumen of the vessel and thus are not visible unless intravascular ultrasound (IVUS) or other techniques are used. However, these plaques may be extremely vulnerable to rupture. It's the worst case scenario in a way: no symptoms to warn of a problem, no narrowing of the lumen, no obstruction, and yet, tremendous risk for sudden death. <br/><br/>Stop badmouthing Steve Nissen; he's the one who pioneered IVUS and championed its use because he recognized that conventional imaging was missing a lot of the problem. <br/><br/>Last, previous posters are right: we can be on all the medication in the world, have expert care, and tragedy can still strike. Prevention measures on the part of the patient are a big area for improvement if we want to make a real difference. More than enough epidemiological studies have demonstrated a direct, unequivocal relationship between cholesterol levels and incidence of MI. 50 years worth of studies, including some long before statins were developed. This is no longer disputed.

Second, a person can have totally normal cardiac tests, no vessel occlusion, and STILL be at risk for sudden cardiac death. How? Some plaques do not encroach into the lumen of the vessel and thus are not visible unless intravascular ultrasound (IVUS) or other techniques are used. However, these plaques may be extremely vulnerable to rupture. It’s the worst case scenario in a way: no symptoms to warn of a problem, no narrowing of the lumen, no obstruction, and yet, tremendous risk for sudden death.

Stop badmouthing Steve Nissen; he’s the one who pioneered IVUS and championed its use because he recognized that conventional imaging was missing a lot of the problem.

Last, previous posters are right: we can be on all the medication in the world, have expert care, and tragedy can still strike. Prevention measures on the part of the patient are a big area for improvement if we want to make a real difference.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/06/my-take-tim-russert.html#comment-86349 Anonymous Wed, 18 Jun 2008 08:06:00 +0000 http://clients.emmense.com/kevinmd/2008/06/my-take-tim-russert.html#comment-86349 <i>Do statins work because they reduce LDL or because they reduce inflammation?</i><br/><br/>Bingo. THE question. Do statins work because they reduce LDL or because they reduce inflammation?

Bingo. THE question.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/06/my-take-tim-russert.html#comment-86335 Anonymous Tue, 17 Jun 2008 20:05:00 +0000 http://clients.emmense.com/kevinmd/2008/06/my-take-tim-russert.html#comment-86335 <i>How many studies showing high LDL and increasing heart disease does someone need to see. Of course it's not the only risk factor. Of course everyone knows the "butter paradox"in the French. But those treated with statins DO have less MI/death. <br/></i><br/>How many studies of LDL effect on heart attack risk came from studies done on statins and how many from other sources? How many of these other studies show causation? Do statins work because they reduce LDL or because they reduce inflammation? How come in recently published statin+Zetia vs statin trial higher reduction in LDL didn't translate into additional benefits? I think not that long ago, kevin, dinasaur, and other MD bloggers were questioning LDL effect on heart desease? Are they also anti-science? Why didn't you argue with them the same way you do with someone who may be a layperson.<br/><br/>Don't know anything about mike donovan, but it seems like a double standard to me. Also, mike was simply commenting on someone's interview discounting the effect of stress yet AHA seems to think that stress may be a risk factor - http://www.americanheart.org/presenter.jhtml?identifier=4750 How many studies showing high LDL and increasing heart disease does someone need to see. Of course it’s not the only risk factor. Of course everyone knows the “butter paradox”in the French. But those treated with statins DO have less MI/death.

How many studies of LDL effect on heart attack risk came from studies done on statins and how many from other sources? How many of these other studies show causation? Do statins work because they reduce LDL or because they reduce inflammation? How come in recently published statin+Zetia vs statin trial higher reduction in LDL didn’t translate into additional benefits? I think not that long ago, kevin, dinasaur, and other MD bloggers were questioning LDL effect on heart desease? Are they also anti-science? Why didn’t you argue with them the same way you do with someone who may be a layperson.

Don’t know anything about mike donovan, but it seems like a double standard to me. Also, mike was simply commenting on someone’s interview discounting the effect of stress yet AHA seems to think that stress may be a risk factor – http://www.americanheart.org/presenter.jhtml?identifier=4750

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/06/my-take-tim-russert.html#comment-86331 Anonymous Tue, 17 Jun 2008 18:30:00 +0000 http://clients.emmense.com/kevinmd/2008/06/my-take-tim-russert.html#comment-86331 None of us have all the facts, meaning all kinds of possibilities exist: maybe Tim was urged to have an angiogram and declined it. Maybe he did have a nuclear scan that was normal. Maybe his internist made a mistake. We should all be careful to keep our eyes on the ball and never forget we are taking care of people, not categories of risk, and act accordingly. None of us have all the facts, meaning all kinds of possibilities exist: maybe Tim was urged to have an angiogram and declined it. Maybe he did have a nuclear scan that was normal. Maybe his internist made a mistake. We should all be careful to keep our eyes on the ball and never forget we are taking care of people, not categories of risk, and act accordingly.

]]> By: Alisonhttp://www.kevinmd.com/blog/2008/06/my-take-tim-russert.html#comment-86321 Alison Tue, 17 Jun 2008 13:15:00 +0000 http://clients.emmense.com/kevinmd/2008/06/my-take-tim-russert.html#comment-86321 I don't understand why Tim Russert did not have a angiogram. I recently had one and it showed 100% occult in the same artery "widow maker" One stent and I am back to normal. His doctors should be sued!!! The doctors generally don't take their patients seriously!! Our lives are in their hands when we go to them for help. They need to take responsibility for their mistakes! I don’t understand why Tim Russert did not have a angiogram. I recently had one and it showed 100% occult in the same artery “widow maker” One stent and I am back to normal. His doctors should be sued!!! The doctors generally don’t take their patients seriously!! Our lives are in their hands when we go to them for help. They need to take responsibility for their mistakes!

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/06/my-take-tim-russert.html#comment-86316 Anonymous Tue, 17 Jun 2008 03:38:00 +0000 http://clients.emmense.com/kevinmd/2008/06/my-take-tim-russert.html#comment-86316 One thing a great number of people don't realize is the inadequate care and cardiac prevention many people are getting at the hands of their internists. Some do a great job but many don't. Many are doing and reading cardiac tests in their offices when this is best left to a cardiologist. What does it do, it provides poor quality testing to make money for the person who really isn't adequately trained to do the right test or to interpret it. These plain stress tests are just money makers for these internists. The majority of people should have a nuclear or echo test with the stress test and they should have it under the supervision of a reputable cardiologist. I went to a cardiologist once who couldn't repeat my test because my internist had just done one, which was probably substandard. I paid out of pocket for a repeat test with my cardiologist and it was amazing how much more information was gathered. I suspect Tim's relationship was too tight with his internist and he would have been better off in the hands of a cardiologist. Since there appears to be none involved you've got to think his internist didn't refer him or if he did he took over the care. Such a shame... One thing a great number of people don’t realize is the inadequate care and cardiac prevention many people are getting at the hands of their internists. Some do a great job but many don’t. Many are doing and reading cardiac tests in their offices when this is best left to a cardiologist. What does it do, it provides poor quality testing to make money for the person who really isn’t adequately trained to do the right test or to interpret it. These plain stress tests are just money makers for these internists. The majority of people should have a nuclear or echo test with the stress test and they should have it under the supervision of a reputable cardiologist. I went to a cardiologist once who couldn’t repeat my test because my internist had just done one, which was probably substandard. I paid out of pocket for a repeat test with my cardiologist and it was amazing how much more information was gathered. I suspect Tim’s relationship was too tight with his internist and he would have been better off in the hands of a cardiologist. Since there appears to be none involved you’ve got to think his internist didn’t refer him or if he did he took over the care. Such a shame…

]]> By: Frank Drackmanhttp://www.kevinmd.com/blog/2008/06/my-take-tim-russert.html#comment-86278 Frank Drackman Mon, 16 Jun 2008 10:56:00 +0000 http://clients.emmense.com/kevinmd/2008/06/my-take-tim-russert.html#comment-86278 Where was Hilary Clinton Friday afternoon? Funny how Russert drops dead the week after Clinton suspends her campaign. People have a strange habit of getting dead around her. If shes VP she's in the Oval Office within 6 months guaranteed. Where was Hilary Clinton Friday afternoon? Funny how Russert drops dead the week after Clinton suspends her campaign. People have a strange habit of getting dead around her. If shes VP she’s in the Oval Office within 6 months guaranteed.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/06/my-take-tim-russert.html#comment-86275 Anonymous Mon, 16 Jun 2008 04:27:00 +0000 http://clients.emmense.com/kevinmd/2008/06/my-take-tim-russert.html#comment-86275 Reitired Hospital CEO,<br/><br/>4 nuc's and 4 caths?? I hope you are paying those out of your own pocket and not soaking the taxpayer (medicare) or spreading to other policyholders that happen to be healthy Reitired Hospital CEO,

4 nuc’s and 4 caths?? I hope you are paying those out of your own pocket and not soaking the taxpayer (medicare) or spreading to other policyholders that happen to be healthy

]]> By: Retired Hospital CEOhttp://www.kevinmd.com/blog/2008/06/my-take-tim-russert.html#comment-86274 Retired Hospital CEO Mon, 16 Jun 2008 01:09:00 +0000 http://clients.emmense.com/kevinmd/2008/06/my-take-tim-russert.html#comment-86274 On four occasions I have had negative stress nuclear tests however on the basis of other signs and symptons my cardiologist has sent my for a cardiac cath. Three of the four caths have revealed an 80 - 90% blockage in a different artery requiring angioplasty. I am fortunate to have a great cardiologist <br/>who takes the time to understand my subtle changes in addition to the test results and uses his gut instincts and knowledge of me to complement the science. I hope that Tim had been followed closely by a competent cardiologist in addition to his internist. On four occasions I have had negative stress nuclear tests however on the basis of other signs and symptons my cardiologist has sent my for a cardiac cath. Three of the four caths have revealed an 80 – 90% blockage in a different artery requiring angioplasty. I am fortunate to have a great cardiologist
who takes the time to understand my subtle changes in addition to the test results and uses his gut instincts and knowledge of me to complement the science. I hope that Tim had been followed closely by a competent cardiologist in addition to his internist.

]]> By: shadowfaxhttp://www.kevinmd.com/blog/2008/06/my-take-tim-russert.html#comment-86271 shadowfax Sun, 15 Jun 2008 18:07:00 +0000 http://clients.emmense.com/kevinmd/2008/06/my-take-tim-russert.html#comment-86271 The confounding factor is that I read (I forget where) that he had a ruptured plaque. Small atherosclerotic plaques, which are non-obstructive, can exist in the setting of a negative nuc stress. When an acute thrombus forms on the plaque (i.e. "ruptured plaque") then you get occlusion and ischemia.<br/><br/>This is why a lot of cardiologists are doing in-vessel ultrasound these days, to detect the non-occlusive disease, and this is also why I'll still admit someone with chest pain even if they have had a recent negative nuc stress. The confounding factor is that I read (I forget where) that he had a ruptured plaque. Small atherosclerotic plaques, which are non-obstructive, can exist in the setting of a negative nuc stress. When an acute thrombus forms on the plaque (i.e. “ruptured plaque”) then you get occlusion and ischemia.

This is why a lot of cardiologists are doing in-vessel ultrasound these days, to detect the non-occlusive disease, and this is also why I’ll still admit someone with chest pain even if they have had a recent negative nuc stress.

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