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.