In an era of transparency, presidential candidates recently revealed details of their medical records. Records released by Hillary Clinton indicate that she had a coronary artery calcium score of (CACS) of zero. Donald Trump released details of his medical examinations during the last few years. These were discussed by the candidate on the The Dr. Oz show, where Dr. Oz declared Trump "healthy enough" to serve as president. Trump's records revealed that his blood pressure was 116/70, his total cholesterol was 169, HDL cholesterol 63, LDL cholesterol 94, and that he had a CACS of 98 in 2013 (https://www.donaldjtrump.com/press-releases/donald-j.-trump-releases-medical-records). The records further revealed that he takes a low-dose daily aspirin and rosuvastatin, a cholesterol-lowering agent.
What do these CACS mean for politics and health? First, a CACS is derived from a rapid CT scan of the heart done without injecting any contrast agent and is widely available at most medium-to-larger hospitals (http://www.huffingtonpost.com/joel-kahn-md/a-plan-to-save-lives-in-h_b_6627450.html). The use of a CACS to risk stratify Clinton and Trump given in accord with American College of Cardiology/American Heart Association guidelines (http://www.ncbi.nlm.nih.gov/pubmed/?term=coronary+artery+calcium+score+american+college+of+cardiology). The superiority of CACS to calculations of risk scores along based only on clinical measures has been demonstrated (http://www.ncbi.nlm.nih.gov/pubmed/27599267).
The ideal score on a CACS is zero indicating the absence of detectable calcified atherosclerosis and providing an excellent prognosis (http://www.huffingtonpost.com/joel-kahn-md/do-you-know-your-heart-calcium-score-you-should_b_9287452.html). Bravo, Senator Clinton. What about Trump? There are several web-based resources to put into perspective Trump's results. The Multi-Ethnic Study of Atherosclerosis (MESA) has an online calculator to evaluated some aspects of the score. When Trump's data is entered (assuming he was 67 when he had the CT scan), his score would be in the 50th percentile, not "normal" but average (https://www.mesa-nhlbi.org/Calcium/input.aspx). Another resource from the same database permits a calculation of arterial age from the CACS. Using this site and the data for Trump, his arterial age in 2013 was 72 years old (https://www.mesa-nhlbi.org/Calcium/ArterialAge.aspx). Furthermore, the data indicate that his 10-year Framingham hard CHD risk (death, heart attack) was 10 percent in 2013. A more optimistic prediction for Trump comes from a more detailed online calculator from the MESA study, indicating he had a 6.6 percent 10-year risk of a CHD event in 2013 (https://www.mesa-nhlbi.org/MESACHDRisk/MesaRiskScore/RiskScore.aspx).
Does the CACS of 98 in Trump's heart arteries indicate that they are blocked up and narrowed? Fortunately for Trump, that is unlikely. The higher the CACS the higher the probability of actual narrowed heart arteries, and scores well above 98 provide a threshold at which actual stenosis is a clinical concern in asymptomatic patients (http://www.ncbi.nlm.nih.gov/pubmed/27461528). In a recent investigation about the relationship of the CACS and significant heart artery narrowing, a CACS of 1-100 identified such narrowing in 8 percent of subjects (http://www.ncbi.nlm.nih.gov/pubmed/27621776). However, it is likely that if Trump's CACS were to be repeated today it would be over 100. This is particularly true in light of data that being treated with a statin medication like he is on may increase the rate of rise over time of the CACS (http://www.ncbi.nlm.nih.gov/pubmed/16415377). Assuming his CACS is now 101-400, his risk of a significant heart narrowing becomes 13 percent and would actually be 28 percent for the combined end-point of significant narrowing and high-risk plaque (http://www.ncbi.nlm.nih.gov/pubmed/27621776).
What should Trump do? If he scheduled a visit to my clinic I would review his diet, exercise, sleep and stress programs. Increasing his intake of vegetables, fruits, legumes and whole grains while decreasing his intake of foods rich in added sugars and saturated fats (baked goods, sweetened beverages, cheese, processed and red meats, and processed packaged foods) would be of value in lowering his risk for heart events and diabetes mellitus while facilitating weight loss. An ethical imperative would be to review the scientific data with him indicating that low-fat plant based diets and lifestyle may improve and reverse atherosclerosis (http://www.ncbi.nlm.nih.gov/pubmed/20102949). Novel supplements like aged garlic have shown promise for reducing "vulnerable" plaque in heart arteries and are used in my clinic (http://www.ncbi.nlm.nih.gov/pubmed/26764322). Clinical studies indicate that high blood levels of vitamin K2 may halt arterial calcification and would be discussed with Trump (http://www.ncbi.nlm.nih.gov/pubmed/26985380). Finally, the recent announcement about plans for the second phase of the Trial to Assess Chelation Therapy or TACT2 are provocative in terms of the reversal of atherosclerosis (http://www.ncbi.nlm.nih.gov/pubmed/27199065). Data on unique supplements shown to lower the CACS would be presented as an option for Mr. Trump (http://www.ncbi.nlm.nih.gov/pubmed/15364120).
Overall, it is likely that both candidates Clinton and Trump would serve 1-2 terms without heart disease events and I agree with Dr. Oz that Trump is healthy enough to serve as president. Furthermore, the fact that both candidates have had a CACS examination is encouraging. This week I referred an asymptomatic man the same age as Mr. Trump for coronary bypass surgery based initially on a routine CACS that returned over 2,000. He subsequently failed a stress test and his coronary angiogram demonstrated 100 percent occluded right and 80 percent narrowed left main arteries, all without any angina symptoms. I know there are many more people like my patient that have no clue about the severity of their silent CHD. The CACS can be a life-saving tool in some and largely reassuring for our presidential candidates (www.widowmakerthemovie.com).