What is the average United States physician’s batting average for the prevention of heart attacks?

Many years ago president Eisenhower had progressive increasing cholesterol levels for which his physicians were powerless to control and he succumbed to heart disease. Physician’s batting average at that time was near 0.00. You probably disagree. However, let us continue.

For many years Framingham’s William Castelli has lectured that only 15% of the world’s population, probably a substantially less percentage in the United States, never suffer from cardiovascular disease or heart attacks. That is, with regard to this disease, these 10 to 15% are either genetically endowed or lucky in never experiencing the most common causes of a heart attack i.e. a significantly large ruptured or eroded atherosclerotic coronary artery plaque.

As a cardiologist, this is the most important fact I have acquired in my career. To me it means that if we can convert the other 85% into this group, heart attacks and the vast majority of cardiovascular disease could virtually disappear. But how? Sounds simple and yet is quite complex.

When we physicians take credit for these naturally endowed or lucky 10% to 15% we assume an unearned batting average of 100 to 150. Somehow, our physicians and society inappropriately arrogate these apparent successes into our win column and we attribute this success to a regimen of diet, weight control, exercise programs sponsored by the very profitable healthy lifestyle industry. Based on my cardiology experience. I do not accept these assertions as anywhere near the truth.

If a physician is astute enough to place a person on a statin whose destiny is to have a heart attack, three of four persons will still have a heart attack resulting in a batting average of 250 for the physician.

As a prime example of this failure is former president George W. Bush. Even though he was prescribed a Statin because of a converted CAC(coronary artery calcification) score from negative to positive, he continued on to a recent coronary stent placement, as has occurred throughout the years for many millions of persons including marathon runners and the unfortunate exercise physiologist author Jim Fixx. While in his second-year in office Mr. Bush despite an apparent very healthy lifestyle involving exercise and possibly healthy diet already had and was developing significant coronary artery disease. Although his CAC score was 4, considered trivial, there was much more (noncalcified plaque) present. His lipid panel was supposedly excellent even off the statin with LDL cholesterol of less than 100 mg. per deciliter. Mr. Bush had significant hidden risk not discernible by his physician from the standard lipid panel. It was already evident that Mr. Bush was part of the 85 to 90% who was destined sooner or later over a lifetime to suffer from cardiovascular disease,

Today in the vast majority of our population, we have the tools to diagnose and prevent atherosclerosis and Heart Attacks; Yet Mr. Bush with all his family wealth and connections was not placed on this course.

Another recent incident was the death of my fellow undergraduate alumnus James Gandolfini of Soprano fame, who despite his fame and fortune was much less fortunate. He perished at the age of 51 at a time that we had the diagnostic and therapeutic tools to prevent heart attacks in the vast majority of patients.

Many years ago there was an outrage about Tim Russert’s sudden cardiac death. Why did he have a sudden heart attack? Quite simply despite his physician being successful in obtaining the NCEP guidelines. . Mr. Russert had significant residual risk.

In between Tim Russert and the recent Bush, Gandolfini events, millions and I mean millions, have succumbed despite the presence of the tools for prevention of heart attacks and the vast majority of sudden cardiac deaths.

Looking at all the above discussed examples and statistics; it is my opinion despite would be protestations by many groups that the overall United States batting average for the prevention of heart attacks and cardiovascular disease is between 50. and 150 Yet there are some rare individuals physicians whose batting average approaches 1000. That is not a typographical error. There are! The secret is in appreciating William Castelli’s statement. Only those treated to attain the parameters of best 15% consistently for a prolonged period of time will enjoy this status.