A billboard in cardiologist Dr. William Bestermann‘s hometown of Kingsport, Tennessee is sponsored by a local hospital there. It recently proclaimed:
“More procedures equal better outcomes in heart disease.”
So, he explains, the public in Kingsport likely understands coronary artery disease to be a progressive blockage, like hard crusty scale building up in a plumber’s pipe. And thus the more procedures, the more treatment, the more technology you can throw at coronary artery disease, the better. Dr. Bestermann adds:
“The current system of cardiac care works like this: even if a patient has a 60% blockage of a coronary artery, it does not interfere with blood flow. It does not cause chest pain or other cardiac symptoms. The patient is thought to be safe, and nothing much is done for or to the patient.
“But if the blockage is 70% or greater, it begins to interfere with blood flow. It may cause some pain or other symptoms. The patient is thought to be in danger, and this level of disease activates our entire health care system of treadmill stress tests, cardiac catheterizations, implanting stainless steel stents and doing open heart bypass graft surgery.
“A 100% blockage is a heart attack, but if we can catch the blockage before it becomes 100% and open it with a bypass or a stent, then we have saved the patient from having a heart attack.
“This is the way most patients and physicians currently understand the problem of coronary artery disease, and it is the way our current system operates.”
But Dr. Bestermann maintains that our current cardiac treatment does “too little, too late”. In cardiovascular disease, the care model is built entirely around opening blockages in patients with late disease, which can relieve symptoms, but does not prevent heart attack.
Dr. Bestermann explains how a heart attack or myocardial infarction happens in the first place:
“LDL (bad) cholesterol plaque builds up within the walls of the coronary arteries. They do not belong there, and the body attacks these plaques with white blood cells. The plaques become inflamed collections of LDL cholesterol. They function like little boils or abscesses filled with soft or ‘vulnerable’ plaque, and they can rupture.
“When the contents come in contact with the blood flowing inside the coronary artery, it causes the blood to coagulate or clot. This is why aspirin, an anti-coagulant, can help to prevent heart attack. It is why tissue plasmin activator, a clot buster, may help to stop a heart attack in progress by breaking up the clot and restoring blood flow to the artery.”
The fundamental, underlying event in heart attack, he says, is usually plaque rupture.
Responding to Dr. Bestermann’s theory, Connecticut pathologist and author Dr. Richard Reece adds:
“Myocardial infarctions stem from a metabolic problem, not a plumbing problem, and deaths from hypertension, diabetes, and dysplipidemias are almost always vascular in nature and due to a ruptured plaque.
“Our epidemic of vascular deaths are also cultural in nature. North Americans tend to think of the body as a machine. If the face drops, lift it. If the pipes plug, unclog them. If the joints creak, replace them.”
According to Dr. Bestermann, most cardiac experts now agree that preventing a heart attack requires identifying patients at high risk and then stabilizing plaque by aggressively treating blood pressure, high LDL cholesterol, triglycerides and glucose with diet, exercise and evidence-based medical treatments.
Dr. Rainer Hambrecht of Bremen, Germany is one of those agreeable experts. Dr. Hambrecht published a 2004 study in the journal Circulation suggesting that nearly 90% of heart patients who rode bikes regularly were free of heart problems one year after they started their exercise regimen. Among patients who had an angioplasty instead, only 70% were problem-free after a year. And five years later, Dr. Hambrecht presented new findings from his follow-up research to the 2009 European Congress of Cardiology meetings in Barcelona, confirming his earlier 2004 results that regular exercise training is superior to angioplasty at preventing subsequent cardiovascular events. He said:
“It’s difficult to convince people to exercise instead of having an angioplasty, but it works.”
An angioplasty “only opens up one vessel blockage,” adds cardiologist Dr. Christopher Cannon of Harvard University.
“Physical exercise does a lot more than fixing one little problem. Among other benefits, exercise lowers LDL (bad) cholesterol while raising HDL (good) cholesterol, helps the body process sugar better, improves the endothelial cells lining the blood vessels, and gets rid of waste material faster. Exercise also lowers blood pressure and prevents fatty plaque buildup in coronary arteries.”
Previous research has estimated one third of heart disease and stroke could be prevented if patients did two-and-a-half hours of brisk walking every week.
Read Dr. Bestermann’s essay, The New Science of Vascular Disease.
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