June 25, 2002 -- The sudden death of St. Louis Cardinal's pitcher Darryl Kile underscores the need, some experts believe, for aggressive cardiac screening among patients who, like Kile, have a family history of premature heart disease.
But there is disagreement among experts on exactly which tests should be performed.
Kile was no stranger to heart trouble. His father died at age 44 from a heart attack. And a preliminary autopsy shows the younger Kile had undetected hardening of the arteries — and 85 to 90 percent blockage of two of three branches of his coronary artery, which most likely contributed to his death.
While it's not yet clear if Kile had intensive medical screening, one of the country's leading heart specialists believes his death may have been preventable had the right screening been undertaken.
"All patients who have a compelling history like Mr. Kile should have intensive screening and this should not have been missed," says Dr. Eric Topol, chief of cardiology at the Cleveland Clinic. Topol has spoken out before on the importance of agressive screening, for instance, calling for a much more agressive approach to tests for Vice President Dick Cheney, who now has a defibrillator implant.
Among Topol's recommendations for patients with such early history (i.e. death before age 45), include:
Special blood markers which may add even more to understanding of risk than cholesterol tests
Exercise stress testing
Agressive preventive care, "often with the use of statins," the name for the widely used class of cholesterol-lowering drugs.
Predicting Risk for Heart Disease
Kile leaves behind a wife and three young children, and one cardiologist says the children should be given cholesterol tests to see if they are at risk. Dr. Richard Smalling, director of cardiovascular medicine at the University of Texas Houston, says people with early family history need to be tested. "We now have very effective medicines with few side effects that can virtually stop this disease in its tracks. The time to act is literally yesterday."
It's not only new medicines but also new technology that many heart experts believe can detect coronary disease early. Dr. Robert Schwartz, medical director of the Minnesota Cardiovascular Research Institute in Minneapolis, says "We are developing technology that now allows us to predict who is at risk and who might be treated early to prevent such tragedies."
One test used by the institute, said Dr. Schwartz, is the CT scan for calcium in the arteries, which some studies suggest indicates blockages that could trigger heart attacks.
Kile's death appears to have already prompted some to take steps to find out if they have early coronary disease. The hospital in Minneapolis that Schwartz is associated with reported a large increase in calls from people seeking CT scans.
"One of our receptionists made 24 appointments in a half hour this morning. The phones were ringing off the hook," according to Jennifer Syltie Johnson of Abbott Northwestern Hospital.
Screening for All?
But will CT scans, exercise tests and sophisticated new blood markers detect so many cases of early coronary disease that they should be widely used on everyone with a family history of heart disease? Many experts do not believe they are ready for widespread screening of so many people.
"Routine stress testing is not an accurate screening method. Coronary calcium screening may have been more sensitive but its value in general populations has yet to be determined," says Dr. Douglas Weaver, head of cardiology at Henry Ford Hospital in Detroit.
Other heart experts say that if you start talking about screening everybody with a family history, the payoff may be very low. "One would need to do a huge number of stress tests in asymptomatic 33-year-old men to find the few abnormals," according to Dr. Stuart Seides, associate director of cardiology at the Washington Hospital Center. Seides says there would also be many people who tested positive, but who did not have coronary disease.
ABCNEWS Medical Editor Dr. Tim Johnson believes the take-home message here is: "You can't tell what is going on with your heart arteries by looking in the mirror. You may look perfectly fit and have dangerous disease in your arteries."
Johnson agrees that anyone with a family history of heart disease should "arrange to be screened for risk factors starting in their early 20s." And in light of the death of the six-foot-five-inch, star professional athlete, Johnson says: "You may look great on the outside and quite literally be dying on the inside."