Donald Trump Has Moderate Plaque Buildup In His Coronary Arteries and his Risk For A Cardiac Event Is Seven Times Hilary Clinton’s Risk

Donald Trump recently appeared on the Dr. Oz show and handed a letter to the celebrity medical charlatan and TV host, Mehmet Oz.

The letter was written by his personal physician , Dr. Harold Bornstein,  screen-shot-2016-10-04-at-3-21-11-pm
and summarized various  laboratory and test  results which led Bornstein to conclude  that Mr. Trump is in excellent health (Bornstein did not repeat his earlier, bizarre statement that “If elected, Mr. Trump, I can state unequivocally, will be the healthiest individual ever elected to the presidency.”)

From a cardiovascular standpoint the following sentence stood out:

“His calcium score in 2013 was 98.”

Regular readers of the skeptical cardiologist should be familiar with the coronary calcium scan or score (CAC) by now.  I’ve written about it a lot (here, here, and here) and use it frequently in my patients, advocating its use to help better assess certain  patient’s risk of sudden death and heart attacks.

coronary calcium
Image from a patient with a large amount of calcium in the widowmaker or LAD coronary artery (LAD CA).

The CAC scan utilizes computed tomography (CT)  X-rays, without the need for intravenous contrast, to generate a three-dimensional picture of the heart. Because calcium is very apparent on CT scans, and because we can visualize the arteries on the surface of the heart that supply blood to the heart (the coronary arteries), the CAC scan can detect and quantify calcium in the coronary arteries with great accuracy and reproducibility.

Calcium only develops in the coronary arteries when there is atherosclerotic plaque. The more plaque in the arteries, the more calcium. Thus, the more calcium, the more plaque and the greater the risk of heart attack and death from heart attack.

What Does Donald’s Trump’s Calcium Score Tell Us About His Risk Of A Major Cardiac Event?

We know that, on average, even if you take a statin drug (Trump is taking rosuvastatin or Crestor), the calcium score goes up at least 10% per year which means that 3 years after that 98 score we would predict Trump’s calcium score to be around 120.

Based on large, observational studies of asymptomatic patients, Calcium scores of 101 to 400 put a patient in the moderately high risk category for cardiovascular events.

When I read a calcium score of 101-400, I make the following statements (based on the most widely utilized reference from Rumberger

This patient has:

-Definite, at least moderate atherosclerotic plaque burden

-Non-obstructive CAD (coronary artery disease) highly likely, although obstructive disease possible

-Implications for cardiovascular risk: Moderately High

Patients in this category have a 7-fold risk of major  cardiac events (heart attack or death from coronary heart disease) compared to an individual with a zero calcium scorescreen-shot-2016-10-04-at-3-16-25-pm

 

 

Clinton versus Trump: Zero is Better

Since we know that Hillary Clinton recently had a calcium scan with a score of zero, we can estimate that Trump’s risk of having a heart attack or dying from a cardiac event is markedly  higher than Clinton’s.

Clinton, born October 26, 1947 is 68 years old and we can enter her calcium score into the MESA calcium calculator to see how she compares to other women her age. A  coronary calcium score of 6 is at the 50th percentile for this group.

Interestingly, Trump’s score of 98 at age 67 years was exactly at the 50th percentile. In other words half of all white men age 67 years are below 98 and half are above 98, creeping into the moderately high risk  category.

(This should not be surprising, I touched on the high estimated cardiovascular risk of all aging men in my post entitled “Should all men over age sixty take a statin drug?”)

So, based on his coronary calcium score from 2013, Donald Trump has a  moderate build up of atherosclerotic plaque in his coronary arteries and is at a seven-fold higher risk of a cardiac event compared to Hilary Clinton.

Let the law suits and tweets begin!

Electorally Yours,

-ACP

 

 

 

 

10 thoughts on “Donald Trump Has Moderate Plaque Buildup In His Coronary Arteries and his Risk For A Cardiac Event Is Seven Times Hilary Clinton’s Risk”

  1. It would of use to know how much Crestor Mr. Trump is taking. LDL-C of 94 on a statin with his CAC score is not good.

  2. Do you factor ASCVD risk scores into your determination of whether a patient should be on a statin, or do you tend to utilize coronary calcium scores & other factors more? Can you also speak on the relative value & advantages/disadvantages of each of these scoring mechanisms?

    1. Yes, I use the ACC 10 year ASCVD risk calculator as a starting point in a discussion with the patient. I tell them this is your risk and what the standard guidelines would recommend based on that…. but the CAC in addition usually puts them into below, at or above that standard risk and we add in that additional information to make a decision. The 10 year risk calculator also helps serve as a determinant of who gets the CAC.
      Which scoring mechanisms are we talking about here?

      1. I think you answered my question in such a way that it ultimately made my final question null & void. You stated you used both. I was more under the impression that some doctors use ASCVD & others prefer to use CAC over it rather than using both to further stratify patients into risk categories.

        Thank you for your time in answering my questions.

      2. Since the ASCVD risk calculator is free and without risk it is a good starting point. Really low risk people with no family history don’t need more information and really high risk people <65 probably don't. The calculation allows me to share what the standard guidelines would recommend as a point of reference.

      3. It is also interesting that Donald Trump got one. It seems that doctors like to “go the extra mile” for their VIPS. Sometimes this leads to overtesting and all the bad things that can happen when inappropriate tests are done.
        In this respect it is interesting to note that all the astronauts get a coronary calcium. It probably makes sense in people performing really high risk occupations or occupations that if they drop dead multiple other people are at risk (truck drivers, airplane pilots, etc.() irrespective of their risk profile.

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