Tim Russert’s death was yet another reminder that life can be snatched away from us at any time — and in a hurry.

Mr. Russert’s physician revealed he had asymptomatic coronary artery disease, asymptomatic at least until the time of his death.  Within a large artery supplying his heart was a very small cholesterol-containing plaque.  This gave him no trouble whatsoever until a blood clot formed on top of it, blocking all blood flow to a large portion of his heart, disrupting its electrical system and ultimately causing it to stop beating.

Ironically, these small lesions can be more dangerous than large ones.  A 20% lesion sits there without any warning signs, while a 90% lesion alerts you with some chest pain or shortness of breath.  A 20% lesion won’t show up on a screening exam like an exercise stress test while a 90% lesion will be detected.  If a cardiologist finds a 20% lesion on cardiac catheterization it’s left alone, while a 90% lesion will be treated with a stent. 

The questions we ask and tests we run really focus on the size of the plaque.  What we need to know, though, is how likely a plaque is to rupture and form an obstructing blood clot on top.  This is what kills people.  Too bad we don’t have any reliable way to tell.

In the meantime do your part by eating right and exercising — and hope today isn’t the day your time is up.