The US President’s cardiovascular health

Whatever happened to privacy and doctor-patient confidentiality? Well, if you are the leader of a country like the US, the results of your physical check up is a matter of national importance because it would answer the question: Are physical fit enough to lead and occupy the highest office? Which is why the results of US President Barack Obama’s First Periodic Physical Exam are openly available to the public.

So let us take a look at the tests and results.

Cardiovascular Health

• Body mass index: 23.7
• Heart rate at rest: 56 bpm
• Blood pressure at rest: 105/62 mmHg
• ECG: normal
• Pulse-oximetry: 98%
• Total cholesterol: 209 mg/L
• Good cholesterol HDL: 62 mg/L
• Bad cholesterol LDL:138 mg/L
• Triglycerides: 46
• Homocysteine:11.6
• C-reactive protein (CRP): 0.015
• Fasting Blood Sugar (FBS): 87

Homocysteine is an indicator of coronary heart risk. CRP is a biomarker for inflammation. Total cholesterol level should ideally be below 200 mg/L. The value of 209 mg/L is “borderline” high. The optimal LDL value is less than 100 mg/dL. Desirable HDL value for men is around 60 mg/L. All values are within the normal range except total cholesterol and LDL cholesterol.

Cancer screening

• CT-colonography was performed to screen for colorectal cancer. Results: Normal. Follow up screening recommended in 5 years.
• No prostate nodularity or hypertrophy was observed. PSA was within the normal range (0.70).

Other relevant info

• Standard lab tests all normal
• Up-to-date immunizations, flu shots (seasonal and 2009 H1N1 flu), malaria prophylaxis
• Use of nicotine replacement therapy
• EENT: eyes, ears, nose, throat normal
• No other significant illnesses
• No past surgical history

Recommendations

• Continue smoking cessation efforts, a daily exercise program, healthy diet, moderation in alcohol intake, periodic dental care, and remain up-to-date with recommended immunizations.
• Continue modified exercise regimen, and lower extremity muscle strengthening program, for occasional left patella-femoral pain secondary to chronic tendonitis.
• Recommend dietary modification to reduce LDL cholesterol below 130.

Two clinically relevant findings are elevated cholesterol and chronic tendonitis nothing major to be concerned about. Thus, the doctor declared President Obama “fit for duty” and recommended another check up when the President turns 50

What do the health experts outside the White House have to say? Most agree that the President has very good risk factor profile. There is some discussion as to whether he should be prescribed statins or not. However, with his low CRP values, this might not be necessary for the moment.

Dr Howard S Weintraub of New York University School of Medicine tells heartwire:

“I disagree with the president’s physician who says don’t worry, come back in a year in a half. I would want his blood tests repeated in three to six months, and I’d also want to be sure that he is making greater efforts to stop smoking. Our absence of concerns could rapidly change. I don’t want to give him a year or more to bathe his coronaries in atherogenic goop.”

Dr Christopher Cannon of Brigham and Women’s Hospital, Boston, MA:

“His cholesterol is a bit high, but I calculated his Framingham risk score—it is 2%. He apparently had an EBCT, but the exact result has not yet been released. I would be very interested in his calcium score.  If it were 0, then I would likely recommend diet intervention and rechecking. But if his calcium score were elevated, that would suggest that the process of atherosclerosis had started, and a statin would be more reasonable.“