What about executive physical examinations?

are they effective?

Popular with corporate executives, "Executive Physical" programs can give a false sense of security. Performing screening health physicals has no effect on overall mortality or on cardiovascular mortality (1). Stress tests, often employed to assess cardiovascular risk, are woefully inadequate (2,3,4). Although easy to use, risk calculators can also give a false sense of security, as they miss too many people who have high risk (5). 

Ask about their track record

Ask your executive physical program to provide their CV event statistics. How many of their executives have had events? How many have survived 5 years after a heart attack? Compare their statistics to our track record. We have a 100% survival rate after the heart attack. We are aware of no executive physical program that has published their MI statistics.

Heart attacks are the most common killer in the U.S.

Strokes are the biggest cause of disability

Heart attacks and strokes kill one of three Americans. Executive physicals and stress tests do not reduce the risk of heart attacks and strokes (1-4). Our prevention program has been proven to reduce the risk for events and to reverse artery disease. (6)

To determine your risk, we measure your artery disease. Then we identify what’s causing it, and help you reverse it. We can do blood tests anywhere in the U.S. Some of our most important tests can be done by a fingerstick specimen you obtain at home. Then you simply put the card pack in the mail. We get those test results without ever needing to draw your blood.

See your arteries getting better.

Live without fear.

If your risk is high, and if heart attacks and strokes can be prevented, what are you willing to do to change your story?

I passed my stress test

Does passing a stress test mean that your risk for a heart attack is low? Click on this button to find out.

do you have artery disease?  look at the arteries

Some people don’t believe artery disease is reversible. Click on this button to see the proof: artery disease reversed.

What other tests can be used to find artery disease before the event?

A heart calcium scan, with the proper equipment and technique, is much more sensitive than risk calculators (7) and stress tests.

There are two good non-invasive ways to assess how much plaque is in the arteries: CT calcium scores and ultrasound. The problem with CT scans is that they are currently being done by many hospitals with older sub-standard equipment. When the CT detection ring moves around the patient's chest too slowly, because the coronary arteries are in motion with every heart beat, pictures of the arteries can be blurred by "motion artifact." So these slower CT heart scans are not as sensitive in detecting calcium as the Electron Beam CT (EBCT) with no moving parts, which captures images at the speed of light. These old out-dated CT machines are (like stress tests and executive physicals) often giving high-risk patients a false sense of security by the telling them their arteries are OK, when their actual calcium scores are much higher.

After screening mammograms locate calcified lesions in the breast, ultrasound technology is employed to get a better picture of the actual breast tissue. In the same way, we use ultrasound technology to get a close-up picture of plaque in the peripheral arteries after calcium has been identified by screening CT heart scans. Combining the CT information from the heart arteries with the ultrasound data from peripheral arteries provides the most thorough and comprehensive non-invasive trending technology available today.

The most important question a doctor can ask is whether plaque is getting worse with therapy, or getting better. When we follow the effects of lifestyle and bio-marker changes on the actual plaque itself, our therapeutic decision-making process has the traction that can only come from the linking together of cause-effect relationships. This is the power of personalized medicine.

REferences

1. This meta-analysis of 14 randomized trials involving 183,000 adults who had screening health physicals showed no effect on overall mortality, cardiovascular-related mortality, or cancer-related mortality. Several trials showed that screening physicals did result in more diagnoses and in better self-reported health. General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ. 2012;345;e7191

2. Over 80% of people who have heart attacks would pass their stress test the day before the heart attack. So a stress test can never predict heart attacks. Stress tests are designed to determine whether someone's symptoms are caused by obstructive plaque which would require a surgical procedure or stent. A recent task force paper reviewed the evidence for screening by using EKGs, nuclear stress tests and stress echocardiograms to find coronary disease in low-risk patients with no symptoms. They found no evidence supporting the use of these methods. They failed to address the well-documented evidence for screening by using CT heart calcium scans, but they did recommend using risk calculators. Chou, Cardiac screening with electrocardiography, stress echocardiography or myocardial perfusion imaging: Advice for high-value care from the American College of Physicians. Ann Intern Med. 2015;162:438-447

3. E. Falk, PK Shah, V Fuster, Coronary Plaque Disruption. Circulation 1995;92:657

4. Little WC, Constantinescu M, Applegate RJ, Kutcher MA, Burrows MT, Kahl FR, Santamore WP. Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease? Circulation. 1988;78:1157-1166

5. Framingham-based risk calculators tend to miss too many high-risk people. A medical way of saying this is that risk calculators are specific for CV disease but are not very sensitive. Doneen AL, Bale BF, ISA June 15, 2009

6. In addition to the methods Dr. Hight used in the heart attack survival study above, he also uses the Bale-Doneen Method developed by Drs. Brad Bale and Amy Doneen, which has proven to have a positive effect on atherosclerotic disease: Feng, D., Esperat, M.C., Doneen, A.L., Bale, B., Song, H., Green A.E. (2015). Eight-year outcomes of a program for early prevention of cardiovascular events: a growth-curve analysis. J Cardiovasc Nurs, 30(4), 281-291

7. This excellent prospective study of 44,000 patients with no symptoms and no history of coronary disease compares the relative predictive value of risk factors versus heart calcium scores. "Our study findings support a paradigm shift in CVD risk assessment from RF-based (risk factor) approach to detection of sub-clinical atherosclerosis burden as evident by the fact that a significant proportion of those with no RF (risk factors) have a severe amount of coronary atherosclerosis and have a high risk for all-cause mortality. The higher precision of CAC (coronary artery calcium) relative to RFs (risk factors) for identifying at-risk individuals may be because of the fact that CAC is a measure of actual disease that occurs further down the causal pathway than the presence of RFs that are mere surrogates for this process." (parentheses and italics added) Nasir, et al. Interplay of coronary artery calcification and traditional risk factors for the prediction of all-cause mortality in asymptomatic individuals. Circ Cardiovasc Imaging. 2012;5:467-473