The world was shocked this week by the news of the death of comedian Garry Shandling in LA at the age of 66. I was one of his many fans back in the early days of HBO. His recent video with Jerry Seinfeld mentions his own death but apparently no one saw it coming so soon. His death of an apparent heart attack is certainly sad and maybe even sadder by the news that he may have seen his physician the day before his death but did not make it to an emergency room for treatment. Whether it is a comedian, the world renowned figure skater Toller Cranston, or your neighbor, fatal heart attacks often strike with no warning or with symptoms mistaken for the flu or stomach upset. I send my condolences to the Shandling family and the world is a sadder place without his humor to buoy us.
I have no knowledge of Mr. Shandling's medical history, but I have cared for tens of thousands of patients in the office, hospital and catheterization laboratory diagnosing and treating coronary heart disease (CHD) for over 30 years. My focus now is entirely on the early detection of CHD, searching for root causes with advanced testing, and working to reverse the disease aggressively at any stage. There are lessons to learn from his tragic death. Would there have been a delay in his presentation to an emergency room if he knew the answers to the following questions I urge you to know as well.
1) Coronary artery calcium score (CACS)? A CACS is a one-minute CT scan of the heart arteries performed without injecting dye and without exercise. It is done in most major hospitals and is available for $75 in my area. It is the most accurate way to detect silent CHD even at the earliest stages. It is certain Mr. Shandling's CACS would not have been zero if he had one a week or a year before his death and may have alerted all involved to put impending heart attack at the top of the list of diagnoses.
2) Advanced cholesterol panels? It is simply no longer adequate to know just your total, HDL and LDL cholesterol numbers. Studies comparing advanced cholesterol results like the LDL cholesterol particle number to the standard panels show a superiority in diagnosing and predicting heart events.
3) Inflammatory markers? Over a hundred years ago the concept that CHD was an inflammatory process was introduced by Rudolf Virchow and an increasing number of lab tests are available to assess this. In my clinic half a dozen inflammatory vascular markers are routinely assessed. At a minimum, knowing your hs-CRP and PLAC results give insight into your burden of inflammation and risk of imminent stroke or heart attack.
4) Genetics? We are on the verge of translating the success of the Human Genome Project in 2003 to daily use in the clinic. In my practice patients know their apo E genotype, MTHFR genotype and increasingly the "heart attack" gene SNP 9p21. Also, it is important to know your lipoprotein a level, an inherited cholesterol particle that is strongly related to CHD.
While no one can help Mr. Shandling, we can use his unfortunate death at a young age to quote boxer Roberto Duran "no mas, no mas." In an age of driverless cars it is time we work for the goal of heart attack free lives, a dream whose time is here right now.