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By DEBRA MELANI



Published: Sat, February 8, 2003 @ 12:00 a.m.



By DEBRA MELANI

SCRIPPS HOWARD

eart disease has a grip on Roger Hesselltine's family, having killed his father at age 52 and threatening his brother's life just months ago. The nation's No. 1 killer has taken uncles and, indirectly, his mother, who died on an operating table as doctors worked to unclog her arteries.

Hesselltine wants to do everything he can to loosen the killer's grasp, and because of new technology, his options are growing.

Hesselltine joined thousands of Colorado residents who have headed to Colorado Heart and Body Imaging in Denver to have high-tech snapshots taken of their hearts. Many are prodded by fear.

After former Colorado Rockies pitcher Darryl Kile died unexpectedly last June of a heart attack at age 33, "We ... probably had a couple of hundred people aged 30 to 40 who have visited us," said Dr. James Ehrlich, the center's medical director.

Many of them were surprised to learn that they already had a serious buildup of plaque, or arteriosclerosis, which can lead to heart attacks, Dr. Ehrlich said.

Heart disease affects 7 million Americans and kills more than 500,000 a year, exceeding all cancer deaths combined.

Steps toward prevention

Although heart scans are gaining acceptance and headlines tout blood tests that might help doctors predict who carries potential time bombs in their chests, most people still hold their fate in their hands.

"The biggest bang for your buck would be to quit smoking," said Dr. Nelson Trujillo, a cardiologist with Boulder (Colo.) Community Hospital. Smoking boosts the chance of a heart attack as much as fourfold, a risk that drops to that of a nonsmoker's within a year of quitting.

The next-biggest bang would be to cut out fast food and pizza and to increase exercise, Dr. Trujillo said.

If everyone listened to Dr. Trujillo, his business would plunge. Yet there would still be people like Kile, Hesselltine and Dr. Trujillo himself -- people with strong family histories of the disease. For them, probably about 20 percent of heart patients, the new technology can be most useful, many doctors agree.

Hesselltine, 60, doesn't smoke. He leads a relatively quiet life in Gypsum, Colo., and exercises at least five times a week. He patrolled ski slopes for 25 years and did triathlons well into his 50s. He married an avid cyclist, who because of his heart and her racing schedule has always insisted on a balanced, low-fat diet. He monitored his cholesterol levels, and four years ago his doctor put him on drugs to lower the dangerous blood fats.

Hesselltine was doing everything right, yet his heart scan suggested he was doing everything wrong. An average score for a man between 60 and 70 is about 100. Hesselltine's score was more than 1,000.

"I'm not surprised, with all of my family history," Hesselltine said after learning the scan had indicated severe plaque buildup in his arteries.

His older brother, also a "health nut," had suffered a massive heart attack and underwent emergency bypass surgery just two weeks before Hesselltine's visit. "I feel it's good to know where you're at," he said.

Creating more tension?

Not everyone agrees. Some doctors argue that the only thing the test did for Hesselltine was to increase his anxiety -- not good for someone prone to heart attacks.

"The patient should be trying to avoid a heart attack anyway," said Dr. Scott Valent of Rocky Mountain Heart Associates, in Wheat Ridge, Colo. Dr. Valent said a heart scan is largely a psychological test -- and an expensive one.

Dr. Ehrlich urged Hesselltine not to worry. "We see scores like these every day," he said. Now Hesselltine and his doctor can treat the disease more aggressively, Dr. Ehrlich said.

The test takes only minutes. Patients are hooked to an electrocardiogram (EKG) machine and asked to hold their breath for a few seconds while the scans are taken. It generally costs at least $400 and frequently is not covered by insurance, although that's beginning to change.

Many patients think the test has saved their lives because either they or their doctors were not taking their risk seriously enough, Dr. Ehrlich said.

Preventive measures

Hesselltine said he has spent $400 on worse things and would urge his doctor to follow Dr. Ehrlich's advice and boost his cholesterol-lowering drug dosage.

Doing so could further stabilize his plaque, making it less brittle and unlikely to break. Breakage might lead to a clot, which could block the artery and deprive the heart of oxygen. Recent research indicates that heart attacks are more dependent on plaque's stabilization than on its amount.

"You may be as likely to have a heart attack if you have 90 percent blockage as you would with a 30 percent blockage of unstable plaque," Dr. Valent said.

The drugs that lower cholesterol levels stabilize the fatty buildup.

The heart scan, or electron beam tomography, measures calcium, a recognized marker of plaque. The American College of Cardiologists has not endorsed the scan, though it is performed at such prestigious medical facilities as the Mayo Clinic and Johns Hopkins University.

Some doctors argue against the scan, saying they can predict patients' risk of heart disease and treat them just as well with standard tests. Critics also contend that the new test is particularly bad for those with no apparent problems.

Nevertheless, Dr. Ehrlich said of heart scans, "The trend is more and more toward acceptance. We feel the heart scan is the most valuable component."




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