Why do some seemingly “healthy” patients die of heart attacks? The answer is simple. The methods used today by many physicians to determine who is “heart healthy” are not reliable predictors of a possible heart attack. While useful, the Framingham score, cholesterol screening, and even stress tests are not enough.  We must think about the early detection of heart disease in a new way. 

Although the Framingham Score, which is based on a population study, is valuable in identifying an individual patient’s risk, it is not enough. Many heart attacks occur in people with few or no conventional risk factors. 

Cardiac CT has shown that some patients with low total cholesterol, and even low LDL levels, may have significant burdens of plaque in their arteries. Thus, cholesterol screening alone is of limited value. In fact, it is frightening to note that more individuals have acute myocardial infarctions with total cholesterol levels less than 200 than those over 200! This occurs because each individual will have their own cholesterol threshold, the point at which cholesterol actually begins depositing in the vessel walls and forming plaque.        

Finally, stress tests are poor predictors of potential heart attacks because they seek to answer the wrong question. Meant to evaluate heart function, the stress test will not assess the wall of the coronary vessels, the origin of atherosclerotic disease. Fortunately there is an alternative, a painless examination that can accurately detect the presence of this potentially lethal coronary artery plaque – coronary CT angiography (CCTA).