In response to my post about Bernie Sanders’s heart condition, a reader who is a professor of medicine at a major academic medical center, emailed me the following:
I am a cardiologist.
I think Senator Sanders’ risk of mortality is underappreciated because the importance of his heart attack is underappreciated. In a man of this age with a heart attack, good evidence suggests he has a median survival of 5 years. Here is the data, and the figure of it.
It would be reasonable to argue that care is better now than it was in 2005. That is true. However, the patients in this study were doing all the things that are currently recommended in the 2014 AHA/ACC guidelines for care after a heart attack. The patients in the registry well treated: 80 percent on statins, 94 percent on aspirin, 70 percent on ACE/ARBs, 70 percent on clopidogrel. Thus, these outcomes are salient to outcomes now. In my opinion, this just does not bode well.
As a cardiologist, to make a better assessment, I would like to know the following:
- Which vessel was blocked and required the stenting?
- Did he have ST segment elevations or depressions on his ECG?
- How many vessels have significant blockage (>50%)
- Is his heart pumping function normal or reduced?
- Does he have diabetes?
- How is his kidney function?
- Does he have other vascular disease (stroke, known carotid artery stenosis, peripheral artery disease) as well?
- What medications is he on now?
- Are his blood pressure and cholesterol controlled?
With that information, we can provide more insight.
