Facing Up to Her Risk of Disease

Last Christmas Eve, Yvette Donnelly of Thousand Oaks came down with what she assumed were symptoms of the flu--aching jaw, pain in the arms, the typical discomfort. She took some pain reliever, crawled under the covers and attempted to sleep it off.

Two days later, Donnelly experienced chest pain. Not long afterward, she was taken to the hospital, where doctors told her she might have had a heart attack, though electrocardiogram (EKG) and treadmill tests were inconclusive.

It has been eight months, and the 43-year-old Donnelly is standing outside the Ventura Heart Institute office at Los Robles Regional Medical Center, waiting, with eight others, for Dr. Irving Loh to begin the lecture phase of the heart risk assessment program.

The possible heart attack isn’t the only reason Donnelly’s physician suggested that she seek an evaluation. Her family’s cardiovascular history is also of grave concern.

“My mom had a triple bypass when she was 47 and a stroke when she was 54. She died of heart failure at 58,” Donnelly says. “My dad had open heart surgery twice in his early 60s, and he died in December at 74.” Donnelly also had four uncles on her mother’s side who died just before or at the age of 50--two from strokes, one from a brain aneurysm and one from longtime heart problems.

Donnelly has extreme cholesterol problems, which started at the age of 21. Just one month before her assessment, her cholesterol count was 348, 148 points higher than what is considered a maximum healthy level. Today, judging from blood she had given recently, it stands at about 271. To complicate things, her good cholesterol (HDL, or high-density lipoprotein) is far too low relative to her bad cholesterol (LDL, or low-density lipoprotein).

Excess LDL can lead to cholesterol deposits on artery walls that can eventually clog. The HDL carries the cholesterol away from the arteries and toward the liver, where it is eliminated.

So there is little doubt that Donnelly is a good candidate for early heart disease. In addition to her cholesterol problems and family history, Donnelly has a pack-a-day smoking habit, is slightly overweight and is under considerable stress due to personal problems.

Nonetheless, no one has ever analyzed Donnelly’s risk of cardiovascular disease. The only treadmill test she has taken was immediately following her illness in December.

And no one has described to her in detail the workings of the cardiovascular system. When she was younger, she avoided doctors. “When you’re that young, you don’t care. You think you’re indestructible.”

Now, she says, she knows better.

Immediately following the group lecture, where Donnelly and the others hear Loh lecture about cardiac disease and the factors that contribute to it, Donnelly takes the treadmill test.

Based on her age, sex and other factors, it is determined that she will stay on the treadmill for a maximum of eight minutes, with the option to stop at any time.

She is anxious before the test. “I came in with my husband once for his stress test,” she says. “And when he left, his face was as white as a sheet of paper.”

After 7 minutes, 35 seconds on the treadmill, she has had enough. Loh finds the test results helpful in diagnosing Donnelly’s condition. They show characteristics of significant coronary artery disease.

Those results, along with the results of the blood test, the family history, cholesterol levels, weight, continued jaw discomfort and a number of other risk factors, are fed into a computer to calculate Donnelly’s chance of having a heart attack within eight years.

As with all of his patients, Loh meets with Donnelly to discuss the results. She is told the odds of her having a heart attack within the next eight years are 2 1/2 times greater than those of the average woman her age.

He gives her two options. She can treat the condition with medication or undergo a coronary angiogram in which X-ray dye is injected into the blood vessel that supplies the heart and coronary arteries, showing the degree and location of any obstruction. Donnelly opts for the angiogram.

The test is administered five days after the screening. It shows that one of Donnelly’s arteries is totally blocked and the other two are 60% blocked. It is decided, however, that she will forgo open heart surgery for the time being.

“That’s a lot of coronary disease for someone her age. We’ll probably repeat the angiogram in one or two years,” says Loh. “Meanwhile, we’ll be very aggressive in regard to controlling her cholesterol and her blood pressure, her diet and increasing exercise.”

Donnelly also agrees to be a part of two research projects at the medical center. One concerns the development of a preparation to treat angina, a chest pain that results from a shortage of blood making its way to the heart. The other project treats people with high cholesterol and abnormally low HDL.

Loh says he expects this approach to slow the progression of the blockage of Donnelly’s arteries.

“Part of me wants to go ahead and do what has to be done,” Donnelly says, in reference to any surgical procedures. “Another part of me wants to prolong this as long as I can. But I don’t want it to get any worse.”