A man in his seventies walks into your office for a physical exam. He is overweight, has elevated cholesterol despite taking cholesterol-lowering medication, and recently had a CT scan of his heart that revealed calcium deposition in his coronary arteries.
Do you really need a medical degree to know that he has some degree of heart disease? We don’t think so.
As physicians, we believe that debates about whether President Trump does or does not have heart disease have tragically overshadowed a critical opportunity for the media to improve awareness about heart health in the United States — and to improve the health of Americans.
Heart disease and stroke kill 800,000 Americans each year. President Obama’s smoking habit focused attention on the harms of cigarette smoking and probably helped some smokers quit. Trump’s abdominal obesity, high cholesterol and presence of coronary calcium could similarly increase public attention on risk factors for heart disease, the importance of healthy lifestyle choices for prevention, and the benefits of the most effective — but underused — medical treatment we have for cardiovascular disease-statins.
Unfortunately, the politics surrounding his health and the ensuing abandonment of common sense in an effort to either protect or punish the President are costing us a national opportunity — and, potentially, lives.
Trump underwent a coronary calcium test, which uses a CT scan to determine how much calcium is deposited in the coronary arteries. While the details of the coronary calcium score calculation are complicated, the information a patient should walk away with is simple: A score of zero is best, and suggests no presence of coronary plaque, while higher scores indicate the presence of more coronary calcium (a useful surrogate of plaque or arthrosclerosis), and more coronary calcium means a higher risk of heart attack and/or death.
The President’s coronary calcium score this year was 133, up from 34 in 2009. His score is about average for a man of his age (71 years old). To put this in context, President George W. Bush had a score of 24 while he was in office, and Obama had a score of 0, largely because he is younger.
So, does the President have heart disease? It depends on whether you see disease as something that suddenly happens when you reach a magic number, or whether you see it as an organic process. Medically, a patient is not considered to have heart disease unless plaque blocks at least 50% to 70% of a coronary artery, the arteries that supply the heart muscle
So, when White House physician Dr. Ronny Jackson said, “no, he does not have heart disease,” he was technically correct, because we have no evidence showing that President Trump meets this criteria for “obstructive” coronary buildup. However, the President’s coronary artery calcium score indicates that he does indeed have coronary plaque, so Dr. Sanjay Gupta, CNN’s chief medical correspondent, was also correct when he said the president does have heart disease, since coronary atherosclerosis is disease of the heart’s coronary arteries, even if it does not meet the “magic number” threshold we use to make a formal diagnosis.
Our opinion, based on reviewing the objective data that has been made public, is that Trump likely has subclinical heart disease. Because the data are compelling, we believe most physicians would concur with this conclusion. We also believe that the President is not unique in this respect because many men his age have subclinical heart disease, including other world leaders of similar age.
The United States should be congratulated for being open enough to provide detailed health information about our leaders to citizens.
As individuals, we cherish the right of every person to make health decisions that best fit their preferences, but as physicians, we can’t help but want our patients to avoid cigarettes, eat a healthy diet, exercise regularly, and maintain a healthy weight. Living long enough and well enough to enjoy your loved ones, spend time with your children, and play with your grandchildren are not partisan issues. The media’s responsibility in the face of Trump’s physical should be to help as many people as possible achieve this goal — not encourage partisan bickering about test results.
Ladapo, M.D., Ph.D., is associate professor of medicine at David Geffen School of Medicine at UCLA and a health policy researcher. Berger, M.D., M.S., is associate professor of medicine and surgery with appointments in cardiology, hematology and vascular surgery, and director of cardiovascular thrombosis at New York University School of Medicine. The views expressed are those of the authors and not necessarily those of UCLA or NYU School of Medicine.
