Commentary from Thomas Dayspring MD, FACP, FNLA regarding the angioplasty and stent of President George W. Bush
George W. Bush underwent stent placement because during a routine physical a stress test (which is rarely indicated in an asymptomatic person) revealed an abnormality that led to a CT-angiogram test (which is rarely indicated in an asymptomatic person) that led to a coronary angiogram test (which is rarely indicated in an asymptomatic person) that as usual led to a stent (which is rarely indicated in an asymptomatic person). Why was an angiogram done on an asymptomatic person? Did the test show early marked ST depression that suggested a main stem lesion? There is a bit of a history here – all public knowledge. During his second year in office during a yearly physical at Bethesda his physician did a routine coronary calcium level which was 4 (trivial). Even though his LDL-C was fine (~100 mg/dL superb by 2001 standards) they started him on a statin and as one would suspect, a low fat diet. It is well known what a super exercise routine Mr. Bush pursues (then and now): secret service men cannot keep up with him on jogs or bike rides. Now we find out that he suddenly needed a stent. Well do not clogged pipes; I mean arteries – need plumbers to fix them? And is it not dietary fat and cholesterol that clogs the arteries? For more opinions on the inappropriateness of the workup please see http://www.theheart.org/article/1567069.do
Earlier in the year I posted a commentary on LecturePad.org regarding “Clogged Arteries.” (click here to review) That posting was provoked by a perspective authored by Michael Rothberg of the Cleveland Clinic which was published in Circulation Cardiovascular Quality Outcomes. (Circ Cardiovasc Qual Outcomes. 2013;6:129-132) entitled Coronary Artery Disease as Clogged Pipes A Misconceptual Model. It is a brilliant piece and needs to be read by all providers including Mr. Bush’s physicians. Here are some of the many highlights verbatim from that perspective ....