DOCTOR'S VIEW ARCHIVE
Medical Author: Daniel Lee Kulick M.D.
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
The sudden death of baseball pitcher Darrel Kile at age 31 has prompted numerous questions about how such an event might be prevented. While Mr. Kile's full medical history is not publicly available, it is known that his family history was remarkable for the presence of coronary artery disease (CAD) at an early age; his father passed away due to a heart attack in his early 40's.
The presence of a family history of CAD before the age of 50 is a particularly ominous "red flag," that should be taken very seriously. Even in the absence of other known "risk factors" for CAD (cigarette smoking, low HDL and/or a high LDL cholesterol, hypertension or diabetes), the presence of such a family history should alert one to the need for optimal lifestyle choices and the need for early screening for the presence of underlying CAD which has not yet resulted in symptoms. For example, in the setting of a genetic predisposition to the early development of CAD, a "normal" cholesterol profile might be made even more favorable by dietary changes or medication.
Numerous screening tests are available for the detection of CAD in young people with a family history of heart disease. Conventional exercise stress tests, even without adjunctive nuclear imaging, are designed to identify blockages of 50% or greater in the coronary arteries. Newer "calcium scans" of the heart may detect even earlier blockages, alerting one to the early presence of CAD, before a cardiac event like myocardial infarction (heart attack) or sudden death occurs. If the disease is detected early, lifestyle modification with diet, exercise, smoking cessation, and possibly drug therapy may forestall the development of more severe disease. The early detection of severe coronary artery blockages, before cardiac events occur, may result in potentially life-saving revascularization procedures, such as coronary artery stenting or angioplasty, or coronary artery bypass surgery.
All people with a family history of CAD at an early age should ask their doctors about which screening test is most appropriate for them. Early detection of CAD may allow the prevention of heart attacks and sudden death, enabling tragedies like that of Darrel Kile to be a much more infrequent occurrence.
For additional information, please visit the Heart Attack Prevention Center.