Posted by - J. Rand Baggesen, M.D.

Last Thursday, July 26, Skip Prosser, the head coach for Wake Forest’s basketball program, died suddenly from an apparent heart attack. At 56 years old, Mr. Prosser leaves his wife and two sons too early, and it is inappropriate to comment how this loss has affected them.

It is with the greatest sympathy and respect for Mr. Prosser and his family that this column considers how an apparently healthy 56-year-old male could suffer an untimely death with the level of medical technology available today. Hopefully it is possible that the shock and sadness of this situation can become a catalyst for others to contemplate how they might avoid such tragedy in their own lives.

In earlier columns, I have tried to highlight medical technology that is available today which has the promise to identify the causes of Mr. Prosser’s early and untimely death before such a catastrophe could occur. There are of course no guarantees in life, but utilizing these high-tech approaches early might allow interventions which have the potential to prevent early mortality.

Our current medical system is one of the best in the world at treating problems. Unfortunately, we are-ranked 37th out of 191 countries when it comes to preventative care. Our system will spend almost limitless resources to fix what are often, preventable problems once they are critical. When it comes to prevention however, tests that can identify the earliest signs of vascular disease are not currently covered by insurance.

It is important to remember that in the unfortunate deaths of nearly half-million Americans a year from heart attacks, many patients, including perhaps Mr. Prosser, have only a 30-50% blockage of an artery. That small blockage can become inflamed and an acute clot/clog can form and prevent blood flow downstream resulting in tragedy.

Consider this, vascular disease in its many forms; heart attack, stroke, peripheral vascular disease, blindness, kidney failure, etc., is the cause of death for nearly 50% of Americans, including Mr. Prosser. We do not normally test for the presence of vascular disease in our American preventative care system. Cancer on the other hand is something that we routinely look for with preventative medicine. Women undergo Pap smears, mammography and regular physical examinations trying to find the earliest signs of any problems. Men undergo prostate exams and PSA testing. Colonoscopy is recommended for anyone over the age of 50.

Today there exist multiple noninvasive tests that can answer whether or not an individual has the early signs of vascular disease. In general, these tests are not covered by normal insurance benefits and are not part of the routine delivery of medical care. It is only until the patient complains of symptoms that a simple stress test is covered by insurance. Like many of the tests listed above for cancer detection, our new high-tech diagnostic capabilities can identify vascular disease at a stage when lifestyle modification, medical therapy and other techniques can make all the difference in the world.

Carotid ultrasound and the measurement of the arterial wall thickness can identify early deposits of cholesterol years before a stroke or heart attack could happen. This is the only American Heart Association approved method for the early diagnosis of vascular disease. Coronary calcium scanning can also show deposits of calcium in the arteries that supply your heart with blood. The latest high-tech CAT scan machines can actually look inside your coronary arteries and see any early sign of blockage. These techniques are not usually covered by insurance. In a society where a $100-150 cell phone bill is not uncommon, is it not reasonable to direct some of our own personal resources toward tests that might save our lives?

Being able to show a patient hard evidence of the existence of early stage disease can be a powerful motivator for a lifestyle change. Both diet and exercise are essential for the proper management of vascular disease.

The management of cholesterol in today’s high-tech world gives doctors the ability to stop the progression of disease. Based on the Asteroid Trial released in April of 2006, we can actually see a reduction in cholesterol plaque burden using today’s medicines. New blood tests that can identify the types of protein particles that carried cholesterol and your blood can have a major impact on how your cholesterol is managed. Understanding these protein particles, cellular receptors, genetic influences and your personal dietary habits are all necessary to maximize today’s medical therapy.

My heart goes out to the Prosser family. I hope this topic helps the memory of a great coach live on and that he is able to teach us all one more lesson. If his unfortunate passing has reached one person’s consciousness regarding what preventative medicine can actually accomplish in 2007, maybe another family could avoid this sadness.

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