HEALTH & FITNESS
profile
Thwarting Death
Beaumont researcher tracks
the dangers of uncontrolled
coronary plaque.
Berl Falbaum
Special to the Jewish News
D
r. James A. Goldstein, a quiet,
soft-spoken man, is on the
trail of a killer — indeed, a
serial killer.
Director of Cardiovascular Research
and Education at Beaumont Hospital
in Royal Oak, Goldstein believes he is
closing in. Just give him a little more
time and much-needed funds, and he is
confident he will be successful.
The "slow, lurking killer" he is after:
Unstable coronary plaque — usually
cholesterol-laden plaque that suddenly
ruptures and clots off the artery in the
heart, causing heart attacks and death.
The deaths are sudden, unexpected
and frequently involve people believed
to be healthy, like the late Tim Russert,
who hosted the nationally acclaimed
political talk show Meet The Press and,
at 58, suddenly died of a heart attack.
Russert died in June 2008 because,
according to his doctor, Michael
Newman, cholesterol plaque ruptured in
an artery causing coronary thrombosis.
What made Russert's death particularly
alarming and surprising, he had passed
a stress test only two months earlier.
Goldstein, a Franklin resident, is
determined to help prevent such trag-
edies— sudden, unexpected but poten-
tially preventable deaths — which, he
said, number about 300,000 annually in
the U.S. In addition, more than a million
people suffer heart attacks that, though
not immediately fatal, leave the heart
muscle severely damaged, often leading
to debilitating heart failure.
To make his point on the number
of deaths and loss of lives, he asks
somewhat incredulously: "Consider if
three jumbo jets filled with passengers
crashed daily for a year? That would
approximate 300,000 deaths. What
would the government do? It would shut
down the airline industry immediately."
Thus, he feels, the medical community
must meet this challenge of finding an
answer to this highly complex medical
dilemma.
Goldstein describes his three-fold
mission at Beaumont: To find the rea-
sons why plaque becomes unstable,
producing "calamitous events," to
24
December 31 • 2009
employ screening methods to identify
patients at risk, and then to develop
treatments that attack the plaques to
avoid the inevitable and usually tragic
fatal consequences.
"We have made tremendous progress
in patients suffering heart attacks, using
catheters and stents to open up blocked
arteries in a timely fashion, which saves
heart muscles and has transformed
the outcome of this No. 1 killer in the
Western world," said Goldstein.
"But despite the progress in under-
standing why arteries block up, we still
are struggling to fully understand this
disease," he said.
very important in the treatment of those
who complain of some kind of discom-
fort as well as those who appear to be
completely healthy.
Treatment Tools
What Future Holds
In Support
Goldstein, 59, said the reason he joined
the staff at Beaumont was the hospital
had a worldwide reputation as the "epi-
center" in research and science in this
field and "fortunately, we have been able
to move the ball forward."
He joined the Beaumont staff in 1994,
coming from Washington University in St.
Louis where he directed the congestive
heart failure-cardiac transplant program.
One of the goals is to increase the
number of tools available to detect
which plaques are threatening (vulner-
able plaques), characterize "their archi-
tecture and composition" and then treat
them effectively.
These tools include, he said, non-
invasive medical techniques such
as computed tomography (CT) that
produce extremely clear photos of
the heart, and in patients undergoing
catheterization, novel imaging catheters
employing ultrasound and infrared
spectroscopy that Goldstein and his
colleagues are helping develop.
The medical community now deals
effectively with patients who show the
commonly known symptoms of heart
disease, such as shortness of breath
and chest pains, he said.
"But even after initial successful
treatment, one out of five will later suf-
fer another heart attack and may die,"
he said. "Then there are those who are
beneath the radar, those who have had
no symptoms, but suffer a sudden heart
attack or suddenly die."
Goldstein believes that the answers
to the research he is conducting will be
How far are his research and the rest
of the medical community away from a
definitive answer?
Goldstein said, "We are connecting
the dots," first to validate the hypothesis
that cholesterol-laden plaques contrib-
ute to heart attacks and sudden death
and second to then treat such plaques
with pre-emptive placement of a stent
by cardiac catheterization.
"I can't say that we have proven this
approach will prevent heart attacks and
save lives at this point, but I believe it
to be true," he said. "As scientists, of
course, we need evidence collected
from high-quality, randomized prospec-
tive trials."
The answer to a "serious public health
problem" may be only "two, three years,"
away, he predicted. "I am very optimistic,
and it is exciting to think about diagnos-
ing cholesterol-laden plaques with non-
invasive procedures, then fixing them to
prevent catastrophes."
Sufficient evidence exists, he said,
that cholesterol-laden plaque is a pre-
cursor — but not the only one — of sud-
den deaths.
The next step is to validate this con-
cept through clinical studies and then
develop treatments that can include
stents or medical therapy, principally
drugs.
Goldstein foresees the day when
screening for cholesterol-laden plaque
becomes as routine as colonoscopies
and mammography.
Interestingly, the tests would be cru-
cial for patients before they reach senior
Goldstein's research is funded by sev-
eral sources, including the Beaumont
Foundation.
Walter Wolpin, chairman of the execu-
tive committee for the Campaign for
Beaumont Hospitals, said Goldstein's
work illustrates the commitment of
medical research and "its direct impact
on patient care."
"It is to our advantage to do whatever
we can to help underwrite his important
work," said Wolpin. "We and those we
love will, after all, will be the beneficia-
ries of his success.
"I believe that there is no better time
for donors to make their mark on the
future of medicine in our region through
their personal philanthropy. Our support
of critical research like Dr. Goldstein's will
ensure that our children and grandchil-
dren will have access to the same high-
quality health care that we have enjoyed."
Wolpin said the Foundation is indebt-
ed to Gwen and Evan Weiner, who
have been instrumental in supporting
Goldstein's research.
"We are delighted to have been able
to assist Dr. Goldstein in his pioneering
research on this extremely important
health issue," said the Weiners. "We look
forward to Dr. Goldstein's research corn-
ing to a successful conclusion, as it will
have a profound impact on the lives of
so many people." I 1
Dr. James Goldstein examines a scan of the heart.
citizen status because if they do not
show signs of blocked arteries by the
age of 55, it is unlikely they will develop
significant problems thereafter.
Berl Falbaum is a former political reporter
who is now an author and Farmington Hills
public relations executive. He also teaches
journalism at Wayne State University, Detroit.