 One-third
of all deaths in Wisconsin each year are related to cardiovascular
disease, and a small, but growing number of physicians, are tackling
the problem.
These specialists are known as
lipidologists, as they focus on a person’s lipids, or fats in the
bloodstream.
"My job as a lipidologist is to
prevent you from having a heart attack or stroke," says Dr. Tara
Dall, whose clinic in Delafield was recognized in 2007 by the National
Lipid Association as the first fully certified lipid clinic in the
United States.
"We try to identify things that
put people at risk, and intervene in various ways. We can ultimately
trump genetics — that’s powerful stuff," says Dall.
Lipidologists see patients who are
referred from their primary physicians, who already have had a heart
attack or bypass surgery, or who have a family history of heart
disease.
"We also see people in their 40s,
50s or 60s who simply are worried about heart disease," says Dr.
Donald J. Meyer, a lipidologist and family physician who practices in
Cedarburg. "The risk becomes more real when their best friend has
had a heart attack."
Identifying those at risk goes beyond
the cholesterol and triglyceride screening that has been standard for
many years. Advanced lipid testing looks at LDL particles, not merely
the level of the LDL, or bad cholesterol in the blood. It costs about
$90 and usually is covered by insurance for testing up to six times a
year.
A second test is known as CIMT, a
specialized ultrasound that examines the thickness of cholesterol
deposits in blood vessels of the neck. Insurance usually does not
cover the $200 to $300 cost, Dall notes.
 The
prevailing thought process used to be heart attacks were caused by a
buildup of cholesterol plaque in the blood vessel walls —
atherosclerosis, or what is commonly called "hardening of the
arteries."
According to Meyer, though, the problem
comes when the plaque becomes unstable, breaks away and forms a clot.
When such a clot blocks blood flow to the heart’s main pumping
chamber, the resulting heart attack often is instantly fatal, as in
the case of news anchor Tim Russert.
"The treatment is to stabilize the
plaque so it has less chance of rupturing, and if possible, to regress
it," Meyer says.
Dall and Meyer point to obesity as a
major factor in unhealthy cholesterol levels. On a recent vacation at
Disney World, Dall says she became alarmed at the number of overweight
people she saw. "I was thinking, ‘I wish I could talk to them,’"
she adds.
Obesity is a major cause of Type 2
diabetes, which also is dangerous. Meyer says a diagnosis of metabolic
syndrome or pre-diabetes fails to convey the seriousness of a patient’s
condition.
"The reality of it is it’s like
calling a puppy something other than a dog. It’s still going to grow
up to be a dog," he explains.
Both local lipidologists are big
believers in lifestyle changes to improve one’s cholesterol.
"Even when we identify genetic
factors that contribute to weight, absolutely we advise exercise and
diet," says Dall. "It’s not about giving a pill to fix a
problem."
It’s not just the obese who can have
cholesterol problems. Among Dall’s patients are Waukesha’s Olympic
gymnastics medalists Paul and Morgan Hamm. Testing revealed that Paul
had an elevated lipoprotein particle level.
"It pointed out that no matter how
fit you are, you still can have risks," Dall notes.
According to the American Heart
Association, heart disease causes more deaths than all forms of cancer
combined — about 3,500 deaths a day nationwide. "It’s like
9/11 every day," notes Meyer.
Still, it was just four years ago that
the American Board of Clinical Lipidology began to certify doctors.
Dall and Meyer are among a handful of Wisconsin physicians who have
passed the organization’s certification exam. The National Lipid
Association, meanwhile, was formed only seven years ago.
Dall is hopeful that both the health
care system and individual patients will begin to take steps to
improve the outlook for cholesterol management.
"In a few years, we’ll be doing
this advanced testing routinely and identifying risks very early on. I
would hope we as a society would become more active," she says.
"The key is early detection and prevention. If we wait until
people have heart disease, we’re backpedaling."
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