MD, MS, FACC
307 E 63rd Street
New York, NY 10065
Cardiovascular diseases, namely heart attack and stroke, remain the greatest killers of men and women worldwide. Heart attack and stroke are NOT syndromes that suddenly arise “overnight”, and cardiovascular disease does not start at the point in time when these events actually occur, or even when initial symptoms develop. Fifty percent of heart attacks in the US occur in people with traditionally defined “normal” cholesterol- people who would therefore likely fall through the cracks and not have further cardiovascular testing. Furthermore, 50% of men and 64% of women are asymptomatic when they have their first heart attack. Unfortunately, in 30%-40% of patients who have a heart attack, the first symptom is sudden death.
Currently, most approaches to detecting and treating this disease rely on a REACTIVE rather than a PROACTIVE approach, waiting for symptoms to occur, at which time treatment may be too late, and is certainly much more difficult and invasive. Furthermore, many of the testing modalities used by conventional cardiologists are based on outdated disease paradigms. It is now established that cardiovascular abnormalities resulting in, and pre-dating morbid events are detectable in the arteries before the development of symptomatic disease.
Advances in noninvasive techniques for studying the blood vessels now provide the opportunity to use actual detection of the earliest stages of disease rather than risk factors (e.g.-hypertension, cholesterol level, diabetes, tobacco use, family history) as the tool for clinical decision making. It is known that the over reliance upon existing and traditionally used population-based cardiovascular disease risk scores often results in significant misclassification of patients determined to be at intermediate to high risk, and may miss people that are thought to be at low risk (roughly 50% of heart attacks occur in patients with previously “normal” cholesterol levels). The problem with the message to prevent and treat risk factors is that it may be good public health policy but does not translate into a useful strategy for individual patient care. This is because risk factors are not the actual disease, and over reliance on them results in what amounts to a crude and imprecise approach to decision making. Yet the cardiology and primary care community continue to over-utilize these scoring systems in deciding which patients require additional testing and treatment, and have been slow to adopt diagnostic strategies akin to what has resulted in success in cancer prevention: namely, early recognition and aggressive intervention.
Dr. Marcus founded Preventive Cardiology of New York (PCNY) in 2015 to provide patients with the most state-of-the art, least invasive, earliest possible look into their cardiovascular future. The practice is leading a paradigm change in cardiovascular care, and is unlike other practices in the geographic area. We can often identify cardiovascular risk and disease 10-20 years before conventional cardiologists due to our highly advanced tests, many of which are only available at PCNY. Dr. Marcus spends hours with each patient, personalizing their care and making sure they are thoroughly educated about cardiovascular disease and their risk. His bedside manner has been touted by his patients and colleagues as one of his greatest strengths.
TESTING AT PCNY:
In addition to a thorough history and physical examination, patients undergo comprehensive, extensively clinically validated testing, which is not done elsewhere, some of which are listed below:
EBT Calcium Scoring and Body Scanning:
Electron Beam Tomography (EBT) allows us to detect those with coronary artery disease at its earliest stages, with a sensitivity of 99%, utilizing one-tenth the radiation dose of a traditional CT scan. An EBT study takes only minutes to perform, with literally no special preparation involved, and the results are available while you wait. The scan generates a “calcium score” that correlates extremely highly with the presence or absence of coronary artery disease, and, very importantly, with one’s risk of having a heart attack over a specified interval of time. EBT is an essential cornerstone of my initial cardiovascular workup, allowing me to take a proactive approach to the identification and treatment of my patients with possible coronary artery disease. Additionally, the scanner is capable of obtaining images of the lungs and vital organs to identify the presence of masses and cysts at their earliest stages, as well as calculating bone density in the most accurate fashion, and calculating visceral (bad) fat content- again - all at the lowest radiation exposure available between Boston and Baltimore.
CS-100 ECG Study:
The CS-100 ECG test is available exclusively at PCNY. It gathers electrical information about your heart from the same 12 electrode leads as a standard electrocardiogram. However, the data are analyzed by the CS-100 dedicated computer algorithm via a completely different mathematical analysis, allowing us to derive much more information than that of a traditional ECG.
It is known that about 60%-70% of heart attacks occur at the site of blockages of only 50% of the diameter of the coronary artery, yet conventional imaging stress tests such as a nuclear stress tests or stress echocardiography detect blockages in the range of approximately 70% or greater. This test enables the physician to detect coronary artery blockages of 40% or greater, with upwards of 90% sensitivity when compared to an invasive coronary angiogram, enabling us to get a far more complete and earlier look into your cardiovascular health.
ADVANCED BLOOD VESSEL HEALTH ANALYSIS: (The following two tests are rarely encountered during cardiovascular examinations, screening or otherwise).
The blood pressure at the heart is different than the blood pressure measured at the arm, and can often predict who will go on to develop true hypertension years before this entity becomes clinically evident. People with normal blood pressure in the arm can have high central blood pressure that could go undetected on a traditional evaluation, often due to stiffening (hardening) of the arteries. Therefore, one can be treated less invasively years before hypertension would actually become detected by traditional means, allowing for less invasive, less toxic treatments. This test can assess your true “vascular age”. Higher central blood pressure means a higher risk of heart attack, stroke and kidney disease. The SphygmoCor system determines your central blood pressure and the health of your larger arteries, and provides a wide range of valuable information about one’s cardiovascular health and risk.
The EndoPAT system non-invasively evaluates the health of the endothelium- the lining of the blood vessels present throughout the body. The health of the endothelium is a vital indicator of overall cholesterol plaque burden, artery function, and cardiovascular risk. This study is extremely clinically well-validated and a valuable portion of the PCNY comprehensive cardiovascular evaluation.
Carotid and Vertebral Duplex Ultrasound:
This test evaluates the overall structure and health of the carotid and vertebral arteries (the arteries that carry blood to the brain) by looking for the presence or absence of plaque or arteriosclerosis, which in addition to providing immediate information on the status of these critical vessels, can also serve as a proxy representing general bodily blood vessel health and plaque build-up.
This commonly used test is a comprehensive evaluation of heart structure, including muscle structure and function (your “ejection fraction”), valve structure and function, evaluation for fluid around the lining of the heart, and evaluation of the part of the aorta that initially leaves the heart to supply blood to the entire body, among other structures.
Abdominal Aortic Ultrasound:
The abdominal aortic ultrasound study screens for the presence of aneurysms, or abnormal enlargement of the abdominal aorta, the largest blood vessel in the body, measured at three different sampling points, which may necessitate close follow-up in the future if abnormal.
COMPREHENSIVE BLOOD ANALYSIS:
50% of patients who have a heart attack have a normal “bad” cholesterol on traditional screening blood testing. Our blood testing goes far beyond simple determination of “good” and “bad” cholesterol, which can miss many patients at risk for a cardiovascular event and lead to inappropriate therapy or lack thereof.
PCNY’s more advanced analysis translates current cutting edge clinical concepts into applied practice and focuses on testing that will lead to actionable treatment steps:
The list below is by no means exhaustive and is continuously being re-evaluated and expanded.
-Includes multiple lipid measurements that much more accurately and incrementally evaluate your risk for a heart attack or stroke, and most importantly, are modifiable, potentially allowing you to steer clear of adverse events.
-Includes select genetic and parmacogenomic testing for deeper risk evaluation and assessment of appropriateness and safety of medications, as well as future risk depending upon specific circumstances.
-Evaluates multiple markers of inflammation, a central and often overlooked factor in the progression of heart disease and a potent stimulus for adverse events.
-Thoroughly evaluates for the presence, and risk of developing diabetes and metabolic syndrome, a main contributor to cardiovascular morbidity and mortality that can potentially be significantly modified by diet and lifestyle changes.
- Partners closely with centers of Clinical Excellence such as Mayo Labs
Not all patients will undergo the same lab testing. Lab testing is personalized to an individual patient’s clinical situation.
About Dr. Lee S. Marcus, MD, MS, FACC:
Dr. Marcus received his M.D. from New York Medical College in 1990 and subsequently completed postdoctoral fellowships at Columbia University, College of Physicians and Surgeons in the fields of Circulatory Physiology, Heart Failure, and Cardiac Transplantation, as well as at Yale University School of Medicine in Clinical Cardiology and Nuclear Cardiology. During his early clinical practice in Poughkeepsie, NY he was the founder and director of the Heart Failure Unit and program at Vassar Brothers Medical Center. Dr Marcus was listed in the prestigious Castle Connolly America’s Top Doctors directory from 2006-2009. Outside of his Clinical Practice, Dr. Marcus served a term as Board President of the Dutchess-Ulster County Chapter of the American Heart Association, and is currently the Medical Director of the NFL Alumni Association Wellness Challenge. He is the Chief Medical Officer and Chairman of the Medical Advisory Board of Arterial Health, Inc. He also sits on the Scientific Advisory Boards of Cognate Nutritionals, and Xablecath, Inc. Dr. Marcus is Board Certified in Cardiovascular Disease and Nuclear Cardiology, and is a Fellow of the American College of Cardiology, in addition to being an active member of the American Society of Preventive Cardiology, the Heart Failure Society of America, the American Medical Association, the National Lipid Association, and a Trustee of CEO Trust. He is the President of Preventive Cardiology of New York, which he founded in 2015.