Donald Trump Has Moderate Coronary Plaque: This Is Normal For His Age And We Already Knew It

In October, 2016 the skeptical cardiologist predicted that Donald Trump’s coronary calcium score, if remeasured, would be >100 .  At that time I pointed out that this score is consistent with moderate coronary plaque build up and implies a moderate risk of heart attack and stroke.

Trumps’ score gave him a seven-fold increase risk of a cardiovascular event in comparison to Hilary Clinton (who had a zero coronary calcium score) .

Yesterday it was revealed by the White House doctor , Ronny Jackson, that Trump’s repeat score  was 133.

I was able to predict this score because we knew that Trump’s coronary calcium was 98 in 2013 and that on average calcium scores increase by about 10% per year.

I pointed out that his previous  score was average for white men his age and his repeat score is also similar to the average white male of 71 years.

Entering Trump’s numbers into the MESA coronary calculator shows us he is at the 46th percentile, meaning that 46% of white men his age have less calcium.We can also calculate Trump’s 10 year risk of heart attack and stroke using the app from the ACC (the ASCVD calculator) and entering in the following information obtained from the White House press briefing:

Total Cholesterol          223

LDL Cholesterol            143

HDL Cholesterol              67

Systolic Blood Pressure 122

Never Smoked Cigarettes

Taking aspirin 81 mg and rosuvastatin (Crestor) 10 mg.

His 10 year risk of heart attack or stroke is 16.7%.

Given that his calcium score is average it doesn’t change his predicted risk and the conclusion is that his risk is identical to the average 71 year old white man-moderate.

We also know that Trump had an exercise stress echocardiogram which was totally normal and therefore can be reasonably certain that the moderate plaque build up in his arteries is not restricting the blood flow to his heart.

Here is what Dr. Jackson said about the stress echo:

He had an exercise stress echocardiogram done, which demonstrated above-average exercise capacity based on age and sex, and a normal heart rate, blood pressure, and cardiac output response to exercise.  He had no evidence of ischemia, and his wall motion was normal in all images. the stress echo:

The New York Times article on this issue, entitled “Trump’s Physical Revealed Serious Heart Concerns, Outside Experts Say”  however, presents a dramatically worrisome and misleading narrative.

It quotes several cardiologists who were very concerned about Trump’s high LDL level, weight and diet.

It’s interesting that some of the experts quoted in the NY Times piece feel that Trump’s Crestor dose should be increased in light of the recent NY  Times piece questioning whether the elderly should take statins at all.

If we have serious concerns about Trump’s heart then we should have the same concerns about every 71 year old white man because he is totally average with regard to cardiac risk. In addition he is on a statin and on aspirin, the appropriate drugs to reduce risk.

In contrast to the average 71 year old male he has had a battery of cardiac tests which show exactly where he stands cardiac wise.

Most of these cardiac tests we would not recommend to an asymptomatic individual of any age. Jackson revealed that Trump had an EKG and an echocardiogram.

His ECG, or commonly EKG, was normal sinus rhythm with a rate of 71, had a normal axis, and no other significant findings.

He had a transthoracic echocardiogram done, which demonstrated normal left ventricular systolic function, an ejected fraction of 60 to 65 percent, normal left ventricular chamber size and wall thickness, no wall motion abnormalities, his right ventricle was normal, his atria were grossly normal, and all valves were normal.

So our President has a normal heart for a 71 year old white male. This automatically puts him at moderate risk for heart attack and stroke over the next 10 years but he is being closely monitored and appropriately treated and should do well.

Nonalarmingly Yours,

-ACP

N.B. I see that Trump’s LDL was reported previously as 93. The current LDL of 143 suggests to me that he has not been taking his Crestor.

N.B. Below is an excerpt from my prior post which explains coronary calcium

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.

4 thoughts on “Donald Trump Has Moderate Coronary Plaque: This Is Normal For His Age And We Already Knew It”

  1. How should one’s calcium level be customarily measured and how often
    ? Do you advocate the use of a CAC scan as part of one’s medical care beyond a certain age, regardless of one’s being asymptomatic or not? Thanks.

    1. I’ll pass on the first question. Calcium levels in my medical center are usually seen as part of a set of blood chemistries called the complete metabolic panel. Endocrinologists dealing with parathyroid patients and such may have more sophisticated measures that I am unaware of.
      I don’t view the CAC as mandatory based on age. I look at the overall picture of a patient or individual and try to ask “will this change our management or outcome in any way”?

  2. Very interesting post. When I was 54 (I’m now 58), after an abnormal ECG, I had a CT angiogram done (at my insistence due to family history of cardiac issues) despite a lifetime of vigorous exercise, no smoking, very good to excellent historic cholesterol numbers etc, my calcium score was a horrific 314. I had shortly before this test been put on 10mg. Lipitor due to my family history, and subsequently put on lisinopril to optimize my blood pressure. Fast forward to October 2016, and I admitted myself to the ER with chest pain. I was 99% sure my chest pain was an esophageal spasm, as I had had this pain infrequently over many years. After initial examination, and an ECG, the ER doc assured me I was having a heart attack. Many scans and 3 separate checks later of troponin (sp) levels showed I WAS NOT having a heart attack. Later that day, after discussion with the cardiologist at the hospital, I underwent an angiogram which showed only mild plaque. Should my plaque burden have been greater given my 314 calcium score? By his early 50’s my Dad had already had an angioplasty (he is now 85).
    I have continued to exercise, improve my diet (nuts! among other things) and follow the Skeptical Cardiologist religiously. My most recent lipid panel (9/17) showed total cholesterol 148, triglycerides 48, HDL 83, LDL 55. I am worried, however, that no matter what I do I may be fighting a battle I cannot win given my calcium score. Thanks for all your great information.
    P.S. it was through your blog that I learned about Dr. John Mandrol. I got his book—(The Haywire Heart), and ended up having him check me over last year.

    1. Rick,
      First off, congratulations on being so proactive with your cardiac health!
      I would say based on your current numbers, your lifestyle and with the statin and aspirin therapy your outcome and prognosis should be excellent.
      A couple of observations
      1. You had a CT angiogram in 2016 which allows assessment of the plaque more clearly than CAC. The CT angiogram actually is our most accurate way of assessing early plaque.
      2. The cath view of the vessels is crude and many angiograms that are reported out as normal actually have diffuse and extensive soft plaque.

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