Reviewed on 22nd Nov 2024

Read this book now

This book is fantastic. Take the time to read it. I was lucky enough to be recommended to see Dr Bishop and have a heart checkup. It was the best thing to do for my health.

Reviewed on 22nd Nov 2024

Calcium scores and what to do with a high value

[I am not medical doctor. I have no medical training. However, I have 7 cardiac stents so my interest in Coronary Heart Disease is not purely academic.]

Once upon a time there was homocysteine, a sulfur-based amino acid. According to WebMD, "You get it mostly from eating meat. High levels of it are linked to early development of heart disease." The question, then, was to determine whether homosysteine was a like a car's accelerator or its speedometer, that is, was lowering homocysteine like taking one's foot of the brake, or was it like trying to stop a car by grabbing onto the speedometer? Again, from WebMD, "Research has shown, however, that getting your homocysteine levels down with vitamins doesn’t reduce your chance of having heart disease." Oh, well,...

Then, there was C-reactive protein, a measure of inflammation. It was thought to be a mediator of Coronary Heart Disease and the next big thing in assessing cardiac risk. And then...nothing. It felt like CRP went from being assessed on almost everyone thought to be at risk to almost no one. Maybe it's because so many things other than heart disease can lead to high levels.

Now, we have calcium score. The higher the calcium score, the greater the risk of a serious coronary event. But what is one to make of a high calcium score? I know someone with a score of 300 who was told not to do any exercise until he was given a stress test, which he passed. (And, yes, there are may tales of those who have suffered serious events after having passed a recent stress test.) Is a calcium score a real advance or is it merely the latest in a string of false leads?

The calcium score itself is not controversial. The question is what to do with it other than a stress test or a statin if the score is high. And might it turn out to be another homosysteine or CRP?

The value of Dr, Bishop's book is its suggestion of a next step after a high calcium score--a scan with contrast to determine the location of the deposits are that are behind the high score. He provides evidence to support his recommendation. I found it compelling enough to start a conversation with my cardiologist if I had a high score, myself. (This is not an option for anyone with stents because the stents would interfere with the scans.)

Those concerned with their risk of having a coronary event, perhaps due to family history, should read this book to prepare for an intelligent conversation with their own cardiologists.

Other comments:

Others have commented on the book's use of mmol/l instead of the mg/dl used in the US. It can be confusing. However,

(Bishop) mmol/l *38.7 = mg/dl (US)

Ratios are unaffected by the choice of units.

Try to avoid the audio version alone. I like audio books, but the information and message do not lend themselves well to an audiobook.

[Disclaimer: I was given a copy of the book in exchange for my honest review. Review copies of books are permitted by Amazon. I have no problem with my review. However, I've spent too much time agonizing over how many stars to award.

5 stars: I have seen first person someone with a high calcium score who was not offered the followup suggested by Dr. Bishop. The book is well worth the price if it prevents or postpones a serious coronary event, especially if it's yours. The information is presented in a way that anyone reading the book could have an intelligent conversation with his/her cardiologist about calcium scores and what should be done with them.

4 stars: A bit pricey, although much less expensive than having an MI. The choice of mm/l with no instructions for conversion to mg/dl was a huge distraction. A fear that I might be influenced to go higher (5 instead of 4) for having received a free copy. Note: fear of unconscious bias applies to the number of stars, not to the review itself.

When I started writing this disclaimer, I knew I'd award 4 stars because "If you have to think about it..." However, after reading what I've written about my quandry...]

Reviewed on 22nd Nov 2024

Despite known risk factors or lack of known risk factors....

I think this book is good for anyone with a question about whether they have a true risk of heart attack or to understand the functionality of the heart and arteries. However, to be clear, it doesn't actually teach you what your real risk is. It tells you how you can find out your real risk. It explains what the heart does, explains that risk factors such as cholesterol, blood pressure, weight/BMI, etc are not always indicative of the real risk, etc. It's a good book to learn about the true risk, and how each person is an individual. According to the book, the only way to know the true risk is to have the CT scan to evaluate the arteries. That's how you know your real risk. It makes sense.

Most doctors base risk on family history, lifestyles, and "numbers" (such as blood pressure, cholesterol, weight/BMI, etc). I have a strong family history. I have good "numbers" and a good lifestyle...so according to the doctors, I'm okay. My risk should be low. But, to assess my true risk, according to this book, I would have a CT scan to evaluate what's really going on in my arteries. I believe that would be a true indicator and could give me reassurance, or it could cause me to take steps to prevent the heart attack. Unfortunately, that CT is not covered and it's expensive here in the US---and you need a doctor who will agree to order the test and then you need to be able to pay out of pocket for it.

Overall, good information, and this could potentially have the ability to save someone from a heart attack.
Unfortunately, it's not a viable option for everyone to have that test to know their true risk.

Reviewed on 22nd Nov 2024

Thorough Information But More Terms and Medical Jargon than I Expected

I respect the author's extensive research and expertise about the heart. The book was packed with information--but I couldn't embrace it. I was looking forward to receiving info that spoke to me as a layman. From the title alone, I expected more clear and, dare I say, more entertaining guidance and advice. I'm not a medical expert so when the text jumped right into the bulk medical jargon--, it just simply wasn't what I expected. After some personal research, I will tackle it again.
Full Disclosure: The author provided me with an advance copy in exchange for an honest review.