Heart Disease: Widening Our Lens to Fight a Deadly Killer
Dr. Nancy A. Palermo, Thrive Personalized Healthcare and Wellness
“There is no such thing as a sudden heart attack. It requires years of preparation.” Unknown
February was Heart Health month. We all donned red and vowed to fight the number one killer of Americans. However, when you look at the statistics it seems one month is not enough to alter the magnitude of this disease. The numbers are dismal. In 2018 over 800,000 Americans died of heart disease or its related co-morbidities. That accounts for one in three of all deaths. Despite spending over 300 billion dollars to “fight and treat “the disease we have made no progress and it appears the numbers have only increased. In 2015, only 3 years, prior there were little over 600,000 deaths accounting for 1 in 4 deaths.
We clearly are doing something wrong. Spending more is not feasible. The increased expenditures have made no difference in the death rates from this killer. In fact, the numbers show the dollars have only focused on prolonging the lives of those living with the disease, not preventing or reversing it. Of course, this has proved beneficial to the corporations profiting most from the expenditures. Pharmaceutical sales of Lipitor, the number one statin in the US are over $130 billion since its introduction in the 1990s and over $2 billion in 2018 alone. Hospitals and cardiologists are more than happy to encourage imaging and procedures at $70,000 to $200,000 a pop instead of considering preventative approaches since these therapies are what insurance companies are willing to reimburse.
The motivation for change is the fact that 80% of these cardiometabolic diseases are preventable through diet and lifestyle. In fact, clinical research has provided evidence that such lifestyle interventions have also been successful in reversing disease. In addition, widening the lens on risk factors interventions can help to personalize the preventative approaches and optimize outcomes.
Current conventional screening modalities are incomplete in identifying those individuals at risk for developing heart disease. We all have been told that the risk factors for heart disease include elevated cholesterol levels, smoking, diabetes, lack of exercise and hypertension. If we simply focus on these large categories, we are missing a chance to intervene effectively. In fact, 50% of patients who have a heart attack or stroke had normal lipid levels – the conventional cardiac risk screening tool. Updated research has suggested there are possibly over 300 risk factors that should be addressed. Even addressing the top twenty risk factors could significantly affect outcomes. These risk factors include looking at fasting sugar, insulin and leptin resistance, genetic factors like APOE, MTHFR and Lp(a) and measurements of inflammation and oxidative stress (an imbalance of dangerous free radicals known to damage cells and DNA), now believed to be significant drivers of heart and vascular issues. Once identified these risk factors can be used to personalize preventative and treatment protocols and aid patients in implementing tools into their own life. Lab companies like Boston Heart Diagnostics are transforming the approach to heart disease by providing clinicians with these specific diagnostic tools to personalize treatment protocols. This is the first step toward changing outcomes.
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Lifestyle intervention is also powerful, yet little is done to stress this in the care of heart disease. Addressing diet and nutrition should be first and foremost but the training and investment in such interventions is scarce. Most physicians never received formal training in nutrition and even when nutrition and lifestyle intervention is recommended insurance companies do not feel the need to reimburse these services. There is little motivation to include them in treatment protocols. Patients are left to “figure it out” on their own using data that can be conflicting and confusing.
There is some hope. More and more scientific evidence is suggesting diet and lifestyle have an impact on the prevention and even reversal of many chronic diseases, including heart disease. The research and outcomes are helping to drive change. In 2010, Medicare began offering reimbursement for the first Lifestyle Medicine program introduced by Dr. Dean Ornish. His program which focuses on a whole food, plant-based diet, low in saturated fats and refined carbohydrates, teamed with an exercise prescription and stress management, produces outcomes that easily rival the top-selling heart pharmaceuticals. Even better the side effects are much more tolerable. They include weight loss, increased energy, reduction of medication doses, improved libido and reduction in cancer risks. Studies after the 12-week program also showed an increase in the length of the telomeres of participants. These are the ends of our chromosomes that determine cell life and thus longevity. The reported “side effects” of the lifestyle program seem more tolerable than the ones advertised for pharmaceutical drugs during the nightly news.
Many forward-thinking health centers are taking the results to heart. For example, top medical centers like The Cleveland Clinic and Geisinger Health System in Pennsylvania are opening Food Farmacies, where patients can purchase healthy foods and learn how to cook them through integrated cooking classes. Early results from these introductions have been promising. While insurance companies and most health centers appear to be more talk than action when it comes to prevention, patients can now purchase books from many of the top lifestyle physicians, like Dr. Ornish, providing a foundation for an approach to introduce changes into their lives. This is not only educational, but it is also empowering and transformational. It seems the only successful change can come from the bottom up from thoughtful clinicians offering patients the tools to take their health into their own hands. In the words of Margaret Meade, “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever has. “