PICTURE THIS

In these United States, healthcare is expensive. We spend more on medical care than other industrialized countries at $3 trillion annually. This accounts for nearly twenty percent of the gross domestic product yet we are sicker and more likely to die of preventable conditions than those in other wealthy countries. What we do get for our money is some of the most advanced specialty medical services in the world with cardiac care, no exception. Many advanced interventions such as: coronary bypass operations, coronary stents, TAVR (transcatheter aortic valve replacement) and procedures such as left ventricular assist devices (LVAD) save lives for those with advanced cardiovascular diseases. Hospital systems readily advertise the “superiority” of their cardiac programs and insurance readily provides economic incentives that encourage such services. “Health care” on the other hand, doesn’t sell as well as “sick care.” Despite excellence in treating chronic disease, when it comes to prevention, we are not doing as well as we can. Our expensive healthcare system is premised on productivity and disease management, yet often fails to prioritize the fundamental importance of nutrition as the key driver of poor health in America. Medical students are not taught high-quality nutrition education, despite the centrality of nutrition to a healthy lifestyle, and the glaring fact that poor diet causes nearly half of all deaths due to cardiovascular disease and diabetes. The American College of Cardiology and the American Heart Association in 2019 identified the need to assess atherosclerotic cardiovascular disease (ASCVD) risk as a foundation of primary prevention. The process typically begins with “risk factors” and the standard lipid panel. This is a good start, but unfortunately, for many average individuals the standard risk factor check-up and lipid panel are just not enough. Our traditional risk calculators are a start but we misclassify more than half of average risk individuals. About half are actually at lower risk. And while some are correctly classified, a significant proportion of “average” individuals remain “hidden” and at high risk with traditional “risk-factor” based tools. Just consider for thirty to fifty percent of individuals the first manifestation of ASCVD is a heart attack or sudden death. The largest portion of the total burden of sudden cardiac death emerges, not from those “at high risk” by traditional risk analysis, but from the general population, those who are “average.” We can choose to do better and we need to do better. When it comes to providing the best risk assessment for “average” individuals, recent scientific and technological advances offer improvements to the status quo. Advanced lipid testing and the coronary artery calcium scan and/or vascular ultrasound studies can non-invasively and safely predict cardiovascular risk better than traditional approaches. This helps to determine the best care for the correct individual and represents a significant advance in preventive care. The choice is yours.