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The Great American Heart Hoax

May 2009

By Michael Ozner, MD

The Great American Heart Hoax
Dr. Michael Ozner: The World's Leading Preventive Cardiologist.

America spends at least $60 billion a year on invasive cardiovascular care. Even in these days of escalating national debt and unbalanced budgets, that’s a staggering amount of money. And shockingly, evidence suggests that much of it is being squandered on high-risk, expensive procedures that have not been proven to either save lives or prevent heart attacks. Studies show that these now-common cardiac procedures—including coronary artery angioplasties, stent placements, and coronary bypass surgeries—are of dubious value, adding little in terms of long-term health outcomes, and sometimes even making things worse than if they hadn’t been performed at all. America has 5 percent of the world’s population, yet we perform half of the world’s bypass surgeries and stent placements. And countries that spend a fraction of what we do on heart surgery have fewer per capita heart attacks and fewer heart-related deaths! Cardiovascular care is an almost obscenely lucrative industry in America, and evidence abounds that financial concerns may be distracting hospitals and physicians from focusing on what should be their primary concern: what’s truly best for the patient.

The American Heart Association reports that 80 million men and women suffered from cardiovascular disease in 2005. Many of those unfortunate individuals experienced severely reduced quality of life, enduring symptoms that include intermittent to constant chest pain, to the inability to walk, breathlessness, and countless drug side effects, among other troubling symptoms. As heart disease worsens, doctors are often forced to prescribe an increasing number of drugs to alleviate escalating symptoms—medications that present the risk of dangerous drug interactions. And despite the billions spent on cardiovascular medicine annually, nearly a million men and women in America over the age of eighteen die each year of heart disease.

Clearly, we have a problem. But it doesn’t have to be this way. We don’t have to resign ourselves to lives of increasingly clogged arteries and ever-mounting risk of heart attack or stroke. Nor must we resign ourselves to dependence on expensive medications, or submit to surgeries that don’t work. There is an alternative to invasive procedures, costly surgery, and an ever-declining quality of life.

In my work as an experienced, well-trained, board-certified cardiologist and a Fellow of both the American Heart Association and the American College of Cardiology, I’ve seen countless numbers of patients not only avoid worsening heart disease, but actually improve their health and quality of life.

The Numbers Tell the Story

More than 1.5 million angioplasties and coronary bypass surgeries are done annually in the US, which makes heart surgery among the most commonly performed surgical procedures for both men and women. Although heart surgery can be lifesaving, the truth is that surgery benefits only a small fraction of the millions of patients who undergo these operations. For the majority—an estimated 70 to 90 percent—these procedures are at best unnecessary. In fact, except for a minority of patients, bypass surgery and angioplasty have never been shown to prolong life or prevent heart attacks. And while American patients are seven times more likely to undergo coronary angioplasty and bypass surgery than patients in Canada and Sweden, the number of Canadians and Swedes who die from cardiovascular disease is nearly identical (per capita) to the number of people who die from heart disease in this country.

The Numbers Tell the Story

We’re spending billions of dollars every year on risky procedures that have never been shown to benefit the majority of patients, or make a significant difference in the overall mortality rate.

In fact, the mortality rate for bypass surgery ranges from 3 to 5 percent. This may sound insignificant initially, but when you consider that half a million people undergo these procedures every year, 3 to 5 percent quickly adds up: to 15,000 to 25,000 lives lost a year. Additionally, an estimated 25 to 30 percent of angioplasties fail, requiring patients to repeat the procedure. And eventually many of these angioplasty patients will also require bypass surgery.

The mortality rate isn’t the only worrying statistic associated with bypass surgery. Up to 80 percent of patients may experience cognitive difficulties after surgery, something that can be especially devastating to elderly patients, who may already be experiencing problems with memory and other early signs of cognitive decline. People who undergo bypass surgery are nearly four times more likely to suffer a subsequent stroke at the time of surgery than if they had elected not to go under the knife. They are also vulnerable to post-surgical infections. Nor are coronary angioplasty and stent placement risk-free; complications include heart attack, stroke, aneurysm at the puncture site, infection, and the need for emergency bypass surgery. Contrast this with the cost of following a heart-healthy lifestyle: none!

An Important Disclaimer

I’m not saying that all heart surgery is a hoax. Far from it! Over the past thirty years, tremendous strides have been made in the surgical treatment of many once-fatal heart problems. Indeed, heart surgery is a life-saver for many, many patients.

Atherosclerosis-related conditions that do warrant surgical intervention include disabling chest pain, despite maximal medical therapy and lifestyle changes; severe blockage of the left main coronary artery; critical blockages of all the major coronary arteries in patients with a weak heart muscle; and unstable coronary syndromes, such as an evolving heart attack.

Don’t mistake my intent: my concern isn’t with cardiac intervention that’s appropriate. My concern’s with the sheer number of inappropriate and unnecessary procedures that are performed—procedures that subject stable patients with coronary artery disease to needless risk when they would be far better served in other ways.

Heart Disease—It’s Not Worth Dying For

Heart Disease—It’s Not Worth Dying For

What we call cardiovascular disease encompasses a wide range of conditions that affect the heart and vascular system, from high blood pressure (hyper-tension), to coronary artery disease, to heart failure, heart attack (myocardial infarction), peripheral arterial disease, aneurysm, and stroke, among others. All are manifestations of disease within the heart or within the literally thousands of miles of blood vessels in our bodies.

The majority of heart disease is related to something called atherosclerosis, the “hardening” of the arteries through chronic inflammation due to fatty deposits in the artery wall. Healthy arteries are tough while still remaining flexible and elastic. Atherosclerosis gradually destroys this crucial elasticity. When arteries harden, they can block the flow of vital oxygen and nutrient-rich blood to the heart, brain, and other organs. Unfortunately, for a majority of men and about half of all women with atherosclerosis, the first indication that they have this condition is heart attack or sudden cardiac death. Atherosclerosis may take decades to develop, and its progression is stealthy.

Metabolic, Not Surgical

Neither plaque formation nor plaque rupture is simple or straightforward. They both occur because of complex interactions between cholesterol, free radicals, and inflammatory cells. All of these are controlled, either directly or indirectly, by our metabolic processes, which makes heart disease a metabolic disorder—a disorder caused by abnormal chemical reactions in the body that disrupt the normal process of metabolism (how we create energy from the food we eat). And metabolic disorders require metabolic solutions—not surgical ones.

But surgery, in any circumstance, is like putting on a band-aid: it doesn’t fix the problem; it just covers it up for a while.

If we want to stop heart disease, we have to address the underlying causes: cholesterol levels, free radical production, inflammation. The good news is that, because heart disease is a metabolic disorder, all of these things are, to a certain degree, within our control. No one has to die prematurely from heart disease.

Preventing heart disease is in large part a matter of simply encouraging a healthy metabolism: eating the right foods, getting plenty of exercise, and avoiding chronic stress. And you can reverse heart disease the same way. Studies have shown this again and again, including one study published by Harvard-based researchers in the New England Journal of Medicine that concluded that lifestyle changes (diet, exercise, etc.) are capable of reducing cardiovascular disease risk by more than 80 percent—a figure which trumps even statin drugs, known to reduce the relative risk of cardiovascular disease risk by 30 to 35 percent.

But if all this is the case—and I can tell you from experience that it is—why aren’t your doctors telling you this? Why does the treatment of heart disease still rely so thoroughly on surgery, which often doesn’t work?