Yesterday, President Donald Trump's presidential physical examination results were announced by Dr. Jackson, his physician. He declared President Trump to be in "excellent health". However, as a leading preventive cardiologist, it is my opinion that President Trump has mild heart disease. Even though his overall health is average, his overall risk for a cardiac event (heart attack) within the next 3-5 years is relatively high.
It is concerning that Dr. Jackson did not initially disclose the findings of the elevated calcium score on his cardiac CT test and only announced it after a reporter specifically asked if that test was done. He disclosed that President Trump's calcium score (measure of plaque build up in the arteries that supply blood to the heart) was 133. This score puts him at intermediate to high risk for a heart attack in the next few years, especially if he also has an elevated hs-CRP (High-Sensitivity C-Reactive Protein test will identify inflammation in the coronary arteries). A calcium score greater then 100 increases the risk of heart disease signifigantly.
The combination of significant plaque build up in the arteries of the heart and high inflammation is what causes "ruptured plaque". The ruptured plaque can cause a heart attack. The fact that Dr. Jackson did not mention hs-CRP test result either means this test was not done, or conveniently not mentioned in order to play down the risk. Note that obesity (especially abdominal obesity) is a major cause of elevated CRP. Given Mr. Trump's obesity (esp abdominal obesity) it is highly likely that he also has at least a modestly elevated CRP level which coupled with the plagues in this coronary arteries puts him at an elevated risk for a heart attack.
I have a hard time calling a borderline obese man with significant plaque build up in the heart arteries with high cholesterol and possible inflammation someone in "excellent shape". Two other important thoughts:
- The cardiovascular testing done on Mr. Trump was very simplistic and basic. Many other risk factors for future heart attack and heart disease were not tested (i.e, Lp(a). We now have the technology to assess one's risk of a heart attack a lot more accurately than what was done for our president.
- His treatment plan is not complete. He needs to be on a more comprehensive treatment plan than simply taking a statin (cholestrol medication) and an Aspirin."