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Trump’s exam shows serious heart concerns, doctors outside the White House say

Dr. Ronny Jackson, a Navy rear admiral and current White House physician, conducted the president’s physical.
Dr. Ronny Jackson, a Navy rear admiral and current White House physician, conducted the president’s physical. (Tom Brenner/new York Times)

WASHINGTON — Cardiologists not associated with the White House said Wednesday that President Trump’s physical exam revealed serious heart concerns, including very high levels of so-called bad cholesterol, which raises the risk he could suffer a heart attack while in office.

Dr. Ronny L. Jackson, a rear admiral and the White House physician, said Tuesday in his report on the president’s medical condition that Trump was in “excellent” cardiac health, despite having an LDL cholesterol level of 143, well above the desired level of 100 or less.

Dr. Eric Topol, a cardiologist at the Scripps Research Institute, disputed that rosy assessment. On Wednesday, he said the most alarming fact is that the president’s LDL levels remain above 140 even though he is taking 10 milligrams of Crestor, a powerful drug that is used to lower cholesterol levels to well below 100.

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“That’s a really high LDL,” Topol said, echoing the concerns of other heart experts who reviewed Jackson’s report. “We’re talking about a 70-plus-year-old man who is obese and doesn’t exercise. Just looking at the lab value, you would raise a big red flag.” He added: “I would never use the word excellent health. How you could take these indices and say excellent health? That is completely contradicted.”

On Tuesday, Jackson said he would be prescribing a higher dose of Crestor, the brand name for rosuvastatin, to help lower the LDL levels. He said he is pressing Trump — who at 6-foot-3 and 239 pounds is just below the official label of obese — to eat better and abandon his largely sedentary life for one that includes exercise.

But on the positive side, Jackson said Trump has no history of smoking or drinking and does not have diabetes. An exercise stress test using a treadmill showed “above average” capacity for his age. An ultrasound of the heart was normal, he said.

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“His cardiac health is excellent,” Jackson said. “He doesn’t smoke, he doesn’t have diabetes — a lot of the traditional risk factors he doesn’t have. And so I think those things, in combination with the excellent cardiac results that we got from the exercise stress test, I think, are very reassuring.”

Asked if Trump has heart disease, Jackson said he did not. “Technically, he has nonclinical coronary atherosclerosis,” Jackson told reporters.

Outside doctors who have not examined Trump questioned that conclusion, saying the combination of weight and cardiac test results raised more concerns than Jackson’s comments would reflect.

Dr. Sanjay Gupta, chief medical correspondent for CNN, repeatedly expressed concern on Wednesday about test results that showed Trump’s coronary calcium score had increased to 133, from 34 in 2009. On CNN, Gupta showed a chart suggesting levels above 100 indicate someone with heart disease.

That helped spark a flurry of activity on Twitter, where people debated whether the president officially had heart disease, based on the lab results released by Jackson and his comments to reporters.

Topol disagreed with Gupta about the calcium test, which measures the amount of plaque containing calcium in a person’s blood. Higher numbers indicate the development of coronary artery disease, which could lead to dangerous blockages in the heart.

But Topol said he would not be concerned unless a patient of Trump’s age had calcium levels of 700 or more.

“That tells you there’s some calcium,” he said. “It doesn’t tell you whether that’s inside or outside the arteries. That doesn’t tell me the risk.”

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Several cardiologists said the president’s weight and diet are serious problems that likely contribute to his high LDL level and increase his risk for heart problems. Topol dismissed as irrelevant the debate about whether Trump technically meets the definition of obese.

“Here the issue is, does he have abdominal obesity?” Topol said. “I don’t care what his height is. All you have to do is look at his abdomen. Abdominal obesity, that’s the machinery for inflammation for the heart.”

Sarah Huckabee Sanders, White House press secretary, stood by Jackson’s assessment, noting on Wednesday that he has been a White House physician 12 years, treating George W. Bush and Barack Obama in addition to Trump.

“He is the only doctor that has weighed in on this matter that has actually examined the president,” Sanders said. She called Jackson “the only credible source when it comes to diagnosing any health concerns. We support what he said yesterday 100 percent — that he is in excellent health.”

David Axelrod, one of Obama’s top advisers, said on Twitter Tuesday: “I knew Dr. Ronny Jackson in the White House. In my experience, he was very good guy and straight shooter.”