A Look Back at Heart Disease… and a Look Forward at Your Heart
- Posted on: Tue, 01/20/2009 - 19:57
- By: execadmin
Heart Disease – Then, Now and in Your Future
by William M. Bethea, M.D., F.A.C.P.
I hope that you will allow me to reminisce a bit since today is my birthday, and I am about to begin my sixty-fourth year on earth; thirty-seven of which have been as a physician. During those years, I have witnessed changes in the treatment and prevention of heart disease that rival some of mankind’s most impressive advances. In fact, man’s first step on the moon, as impressive as it was, will probably have far less impact on your life than those advances in medicine that have made heart attacks much less common, and hopefully will have the same impact on strokes and senility as the effect of aggressive preventive medical care bears its fruit in the coming years.
When I had the privilege of joining the original five members of Consultants in Internal Medicine (CIM) in 1977, the world of heart disease was almost unrecognizable when compared to 2008. The importance of cholesterol levels was well known, but the blood levels that were considered “normal” were anything under 350 mg%! Today that cholesterol level would approach the threshold of a biochemical medical emergency! The idea of “good (HDL)” and “bad (LDL)” cholesterol had not yet surfaced, and treatment of high cholesterol levels was essentially confined to dietary changes. In our daily lives as physicians, heart attacks were a common occurrence as reflected by the fact that I once admitted five patients with that diagnosis on a single Christmas day! Among the six internists of CIM, we averaged approximately five patients in the Coronary Care Unit at all times as they recovered from their life threatening illnesses. There were no cardiac catheterizations for “acute intervention” in the form of stents or bypasses, and the heart attack was allowed to do its damage unchecked. Deaths before our eyes were not uncommon and chronic heart failure as a result of heart damage was even more common. The average hospital stay after a heart attack was two weeks, and the patients were not allowed out of bed for the first week! At discharge, the patients were sent home without any specific program for cholesterol control, and no medicines were even known then that offered any real hope of diminishing the incidence of the next heart attack.
Then the tide began to turn in favor of the responsible patient! Acceptable Cholesterol levels dropped dramatically to 300, then 250, and now have fallen all the way to 170 – less than half of what was considered normal just 30 years ago! In fact, current data suggests that you continue to accrue benefits from the lowering of your cholesterol levels all the way down to a total cholesterol level of 132 mg%! The discovery of HDL’s and LDL’s redirected our preventive efforts towards reducing LDL’s to less than 70 mg% in order to trigger what has become known as the “reversal phenomenon” – an actual reabsorption of previous cholesterol depositions on the walls of blood vessels! For the first time in medical history we had a tool to mimic the effects of the proverbial “Fountain of Youth”! The “magic bullet” that allowed us to shoot a hole in the deadly effects of heart attacks were the statin drugs, now primarily represented by Lipitor, Zocor and Crestor. Nothing in my medical career has had the impact of these drugs on the quality and duration of the lives of those that we have cared for for years. When the effects of aspirin therapy are added to aggressive cholesterol lowering, tobacco abstinence, maintenance of normal blood pressure, regular exercise and adherence to acceptable weight parameters, the incidence of heart disease drops more dramatically than we ever envisioned possible!
Almost twelve years ago, the doctors of the Executive Evaluation Center and what would become the Dedicated Care Center recognized the possibility that the aggressive reduction of risk factors might pay huge dividends for our patients in the form of a reduction in the incidence of occlusive vascular disease leading to heart attacks, strokes and senility. With that in mind, we began and have continued what is now recognized to be among the most aggressive protective programs in the country for our patients. We recognized the value of drastically lowering cholesterol levels and mitigating other recognized risk factors when insurance companies and many doctors were saying that it was “overkill”. But now the fruits of our patients’ labors are becoming obvious. The incidence of heart attacks in our patient population has fallen so dramatically that I have not seen a heart attack in my practice in over four years. The average number of patients that we have under our care each day in the Coronary Care Units has fallen to a dramatic number – essentially ZERO! The combination of aggressive cardiac screening in the Executive Evaluation Center utilizing stress echo cardiography in symptom-free patients in conjunction with very aggressive measures for the lowering of cholesterol and control of clotting parameters by a combination of daily aspirin and a statin has yielded dividends that have exceeded our most optimistic expectations.
And the changes continue to mount! The most recent data, now hitting your network news and daily papers, shows that those heart attack patients previously thought to have been at low risk for heart disease because of very low total and LDL (bad) cholesterol levels appear to benefit from statin (Lipitor, Zocor or Crestor) therapy to the same degree as those with known threatening cholesterol levels when a “new” test is used to identify those patients. In simpler terms, there are many patients who have normal cholesterol levels, but elevations of a particular protein called C-Reactive Protein (CRP) who can diminish their risks for life threatening heart disease by adding a statin drug to their program. In fact the incidence of heart attacks in those patients with elevated CRP’s appears to be reduced by 54%, stroke by 48% and bypass or angioplasty (stent) by 46%!
That “new” test for that threatening protein is CRP-HS, or C-Reactive Protein, High Sensitivity.
How new is it? Not very! In fact, we have included that very test in the EEC protocol for five years, and have used the results to reinforce the need for optimization of cardiac risk factors since its inclusion in our program.
So once again, the aggressively protective principles of our EEC/DCC practices in effect for years have become the medical “news” of the day. For those of you that have followed our recommendations for years, you can be assured that your risks of heart disease, stroke and senility have been significantly reduced. If you fall into that group of patients with normal cholesterol levels, but a high CRP level, we will be even more aggressive in suggesting the addition of a statin to your program. You can also be certain that we will continue to lead the way in the efforts to optimize your longevity and enjoyment of life to the maximum by reversing or mitigating every risk factor for life threatening disease that can be identified!
We would welcome further discussion of any questions that you may have on this very important topic.
Recommendations for avoidance of the consequences of occlusive vascular disease:
- Annual stress echocardiography (EEC)
- Aggressive control of Cholesterol levels (Total <170; LDL <70: HDL>40)
- Daily Aspirin therapy
- C-Reactive Protein blood study (EEC) with Statin therapy for elevated tests
- Maintenance of normal Blood Pressure with meds when indicated
- Total tobacco abstinence
- Maintenance of normal body weight
- Regular Exercise
- Consider office & home defibrillator