Take the test online:
The HeartAware test is a free online screening available to anyone but especially recommended for men over 40 and women over 50. It takes about seven minutes. Those who test at higher risk of heart disease can receive a free screening from the University of Miami. You can take the test at www.umiamihospital.com.
Everyone seems to know someone who appeared healthy and then suffered a sudden fatal heart attack. The death of celebrities such as NBC news commentator Tim Russert at 58 and TV product pitchman Billie Mays at 50 has brought new attention to the issue of sudden cardiac death.
It's an issue we're likely to hear about more as more Baby Boomers reach the vulnerable age for heart problems, 40 for men and 50 for women.
Dr. William W. O'Neill is executive dean for clinical affairs, professor of medicine and chief medical officer of the University of Miami Health System. He is a leader in interventional cardiology and in research into the diagnosis and treatment of obstructed heart arteries.
He also has a personal interest in heart disease. His father had a heart attack at 47, and his mother suffered from heart problems. When he and his three brothers underwent CT screening, three of them were fine but his youngest brother needed heart surgery, even though he had suffered no symptoms.
We asked O'Neill about sudden cardiac death. His answers have been edited for space.
Q: Everybody seems to know someone who appeared healthy and one day dropped dead of a heart attack. How common is that?
A: It's not surprising that everybody knows somebody because in the United States about 300,000 people a year drop over dead with sudden cardiac death.
Q: What causes sudden cardiac death?
A: The overwhelming culprit, in 90 percent of cases, is blockages of coronary arteries and a plaque rupture. The sudden rupture of a plaque in a blood vessel causes blood flow to lessen acutely in one of the arteries and leads to a severe irregularity of the heartbeat called ventricular fibrillation. The plaque ruptures, a severe arrhythmia occurs, and the people drop over dead. In about 10 percent of cases, there are other abnormalities, such as congenital problems or myocarditis, an intense inflammation of the heart muscle.
Q: Are there any symptoms?
A: About a third of the time, people have described symptoms that they ignored: pressure in the chest or discomfort while exercising. Unfortunately, more than half the time the first manifestation of the problem is sudden death.
Q: Are some people more at risk than others?
A: This is an illness of middle-aged people. In men it starts around age 40 and in women it starts around age 50. The risk factors for sudden death are the same as the risk factors for coronary artery disease: diabetes, high blood pressure, family history of heart disease, smoking, high cholesterol.
Q: What causes some people with those risk factors to suffer sudden cardiac death while others live a long life?
A: In people who drop over dead, blockages occur at very specific locations in the arteries that supply blood to the heart, the left main coronary artery and the anterior descending artery. We don't know why some people with coronary disease develop these plaques in these specific locations and other people in less dangerous locations. We think there may be some genes that predispose people to develop blockages in particular areas.
Q: What should people do if they fall into the high-risk group?
A: The best thing you can do is try to control risk factors. If you're got high blood pressure, be on medication. If your cholesterol is high, get it down with pills. If you're smoking, stop. If you're not exercising, try to do moderate regular exercise. It's not sexy. But those are the things you can do to dramatically lessen your risk. If you really have a concern, I'm a very strong advocate of CT angiography, a noninvasive procedure that puts dye in the veins to look specifically at the coronary arteries to see if there is plaque in dangerous locations.
Q: For which patients do you recommend CT angiography?
A: People who have three or more risk factors for heart disease.
Q: What is the HeartAware program?
A: There are a lot of people who don't even know they have risk factors for heart disease. We offer this online test and we offer a free screening where a nurse will actually check a blood pressure and do some other very simple things to let people know whether they have a risk for heart disease. If they're at medium or high risk for heart disease, then more screening can be performed.
Q: Beyond research into a genetic link, what other research is under way?
A: The holy grail that cardiology is facing now is to try to predict why a plaque would rupture. There are lots of plaques in the blood supply. Inexplicably, some of these plaques break open. If they break open in a dangerous location, people drop over dead. There is a lot of interest in trying to identify people with these vulnerable plaques.
Q: What's the most important thing for people to know?
A: Get to know your risk factors and modify them. There are a lot of risk factors that can be very easily modified while we're waiting for the major answer and the magic cure for sudden cardiac death.
Health Q&A runs every other week.
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