What heart patients can learn from cancer patients

by Carolyn Thomas    @HeartSisters

Cardiologist Dr. Richard Fogoros has issued this blunt warning to those at risk for developing heart disease:

“You need to change your life. If you don’t, you will suffer the consequences  – possibly decades earlier than is necessary.”

In his Heart Health Center column, he observed that most high-risk people end up making only half-hearted efforts to modify their heart attack riskAnd he blamed doctors for enabling this lack of personal accountability. 

”  This may be related to the failure of primary care docs and cardiologists to stress to the patient the utter life-and-death importance of changing lifestyles.”

Instead, he says doctors say things like ‘You really should…” – when what they really ought to be clearly warning high risk patients is:

“You MUST – or your children will be orphans!”


He then asked this question to his readers:

”  Is there any group of doctors who have succeeded in getting their patients to stop whatever they’re doing, and to suddenly focus every ounce of energy on regaining their health?”

Yes, he answers: it’s the oncologists.

Patients who are told they have cancer, he explains, often put everything in life on hold and steel themselves to do whatever is necessary (whether surgery, radiation, or chemotherapy, often painful, and often lasting for months or years) to attempt a cure.

This is the same attitude that people must adopt when told they are at high risk for cardiovascular disease, he warns:

”  After all, being told you are at high risk for a cardiac event is not all that much different than being told you have cancer. Heart disease is no less fatal, and the outcome no less dependent on your attitude and your active participation in doing what’s necessary.

“If anything, you have a much better chance of favourably altering the ultimate outcome than the average patient with cancer.”

Dr. Fogoros believes that the high-risk patients who are most successful are the ones who adopt a “change it all now” attitude – the ones who accept that a complete change in lifestyle is needed. They’ll stop smoking, adopt an exercise program, and change their diet all at once. And they do it by making risk factor modification the central organizing theme of their lives.

  “One day they’re a high-risk-lifestyle kind of person, and the next day they’re not. They take on all the modifiable risk factors at once – it becomes the chief focus of their lives until the new lifestyle is an ingrained habit (and they are a different person). It sounds tough, and it is. But it’s a matter of life and death — and it can be done. I have seen seen several of these patients achieve remarkable success.”

I too have seen them. Yet alas I’ve seen far more who seem to utterly lack that “change it all now” attitude.

These are the heart patients who don’t exercise as instructed, or don’t change the way they eat, or stop taking their medications, or don’t show up at their cardiac rehabilitation programs even when they are referred, or keep smoking – and may start smoking again after being terrified into quitting by their initial cardiac event.

But I’m guessing that, unlike the tough talk of Dr. Fogoros, Dr. Victor Montori and his Mayo Clinic-based team understand these patients more than most physicians do. Their work on Minimally Disruptive Medicine helps to explain the “burden of treatment” that so often overwhelms those living with a chronic and progressive illness, and specifically how so many people somehow lose the capacity to cope under such relentless burden.

To help understand this puzzling behaviour, read To Just Be a Person, and Not a Patient Anymore”.

A few years ago, I wrote about Dr. Rainer Hambrecht of Bremen, Germany and his groundbreaking study suggesting that nearly 90% of heart patients who rode bikes regularly were free of heart problems one year after they started their exercise regimen.

The astonishing thing about his research (published in the journal Circulation) was that among study patients who had coronary angioplasty performed instead of participating in ongoing regular physical exercise like cycling, fewer than 70% were problem-free after that year.

Think about this. What Dr. Hambrecht is suggesting, and what a five-year follow-up of his study subsequently confirmed, is that physical exercise is better than angioplasty for patients with stable coronary artery disease.  In fact, he made this sweeping claim to other cardiologists at last year’s European Society of Cardiology Congress in Stockholm:

“Only exercise improves arterial function and slows the progression of heart disease.”

Dr. Hambrecht has gone so far as to describe standard heart treatments as just “palliative therapy”, while physical exercise actually has an impact on the underlying disease, adding:

   “I would be happy if I could convince everybody with coronary artery disease to participate in a moderate exercise program!”

And in 2009, Dr. Hambrecht presented new findings from a follow-up study 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.”

So why are heart patients not jumping on our bikes en masse and cycling off to healthier futures? The stats are truly discouraging, such as:

  • Up to 80% of heart attack survivors return to previous unhealthy lifestyle patterns, according to Dr. Diana Hughes of Long Island.
  • Half of all heart attack survivors who are smokers are being discharged from hospital still hooked, even though researchers show consistently that this decision to keep smoking doubles the chances of suffering a repeat heart attack.  

The Minneapolis Heart Institute reported last year that even among patients with known coronary artery disease – 100% of whom should be taking daily aspirin to lower risk of future cardiac events – “only 70% of patients were actually doing so”.

And the harshly shocking reality is that encouraging exercising is financially less appealing for hospitals than doing expensive cardiac interventions, as Dr. Hambrecht observed:

“That was my feeling, that hospitals were reluctant to participate in this study because they derive revenue from doing invasive cardiac procedures.”

This post was also picked up by  KevinMD.com

NOTE FROM CAROLYN:  I wrote more on adapting to life after a cardiac diagnosis in my book, A Woman’s Guide to Living with Heart Disease”. You can ask for it at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 30% off the list price).

See also:

Six Ways NOT to Motivate Patients to Change

Were You “Born to Walk”?

Heart Disease is a Sitting Disease

We Know We Should Do ____, But Instead We Do ____X

What Prevents Heart Disease “Better Than Any Drug?”

Why are Heart Patients Who Smoke Leaving Hospital Still Smoking?

Heart Disease: How to Improve Your Odds

Pregnancy Complications Strongly Linked to Heart Disease

Is Your Doctor Telling You to “Meditate, Eat Veggies, Walk, Quit Smoking?” If Not, Why Not?

Do You Know What Causes Heart Disease?

Your Daily Planner for Heart Health

Are You the Quarterback of your Own Heart Health Team?

Here’s Your Basic Heart-Smart Grocery Shopping List

Women’s Heart Disease and Chronic Stress

12 thoughts on “What heart patients can learn from cancer patients

  1. This is an outstanding article!

    I have not only shared it with my own cardiologist, doctor and staff but with my family, friends, neighbors and anybody who will take the time to read it (male or female).

    Perfectly healthy my whole life, all my “numbers” were excellent and the only thing I took every day was a multi-vitamin w/iron and low dose aspirin (just because my Oma always told me too!)

    While my cardiomyopathy EF25% and left bundle branch block is caused from unknown origin because I have always been doing the right thing i.e. exercise, healthy weight, nutrition, etc, it was shocking to become so ill at 46 years old. Before I got completely so sick and was too stubborn to go to the doctors until I was literally dying that day, had thought I was hitting the “middle age crisis thing” and not exercising enough, etc.

    I can’t stress enough to be your own advocate. Don’t stop looking for healthcare professionals that “get it” until you find one. Very few but they are there!!! And find a family member and/or friend to speak bluntly for you when you might be too sick to watch out for yourself while hospitalized or during office visits.


    1. Very sound advice, Mary: “Be your own advocate!” Your own story as such a young woman with serious heart disease is compelling – please take care.


  2. Pingback: Judith Westerfield
  3. This was a wonderful and timely post. I am one of those people who half-heartedly and periodically change my lifestyle only to go back to not exercising and eating junk.

    I’ve had the same experience with my doctors – including my electrophysiologist – either not even mentioning lifestyle change or the response to MY inquiry – “Yes, that’s a good idea.” end of discussion.

    Why the idea of cancer is more frightening and therefore motivating is a puzzle to me. Perhaps because our heart “belongs” in our body and cancer is looked at as a foreign invader that needs to be expelled?


    1. Interesting premise, Judith. I’ve heard many heart patients say that they felt like their heart had “betrayed them” or “let them down”, a personalized resentment of sorts, the ultimate life-altering disappointment in one’s body’s failure to do what it’s always done.

      Do cancer patients by comparison just want to “get it out”, this foreign invader, so will do what it takes to do so?


      1. Cancer patients I’ve worked with who have led healthy lifestyles prior usually blame some known or unknown genetics – Those who have not led a healthy lifestyle can often come up with a very stressful time in their life as the precursor and can blame a philandering husband, a job, etc. I can’t recall anyone thinking their BODY has betrayed them.

        I do think that cancer is thought about in our society as something EXTERNAL to our “being” – reflected in our language – as an alien invader looking to destroy, does not belong and is to be driven out at all costs.

        Parenthetically: (This is reflected also in our world. All cultures are threatened by “that which is foreign” whether it be religion, race, nationality, political beliefs etc etc. We try to destroy anything and everything which enters our territory that is not viewed as “Us” or is a perceived threat to our survival. The war on cancer is simply a microcosm reflective of that perception.)

        Our heart is internal to our “being”, Our heart IS us, no threat there. Nothing to declare war against.

        Causes of heart disease aren’t necessarily viewed as “living” in the same way as are cancer cells. So the need to “make war against, attack and destroy” is not part of the heart lexicon. Who wants to attack and destroy the very thing that keeps us alive.

        Well, that’s my 3 cents. Maybe 23 cents

        Liked by 1 person

        1. Thanks for this fascinating article and comments. It has inspired me to tell myself everyday that exercise is A MUST!
          Janet K Kurtz, a ‘heart sister’

          Liked by 1 person

          1. Thanks so much Janet! I really like the advice of cardiologist Dr. John Mandrola: “You only need to exercise on the days you plan to EAT!” 🙂


        2. I have metastatic breast cancer – I lived a healthy lifestyle before I was diagnosed with Stage II cancer and didn’t change much before being diagnosed with Stage IV. I didn’t have much to change.

          Cancer is a disease, just as heart disease is. I haven’t heard many cancer patients blame genetics (except, of course, the ones who are actually BRCA positive). I have, anguishingly, heard many of them blame lifestyle – being 10 pounds overweight, or drinking a glass of wine at night – when there is zero proof that any of these things causes breast cancer. I hate it when a cancer patient points to themselves, when in truth, it’s an ugly disease – some of our cells went awry and nobody in the medical profession knows why or even has a clue. For every study saying alcohol contributes, there is another that says it doesn’t.

          So, we do what we can – get on our exercise bikes, even when struggling through breath lost by chemo, give up the wine we love, all in the hopes THAT is the thing that will stop this train in its tormenting tracks. It’s true, cancer is an outsider attacking US, but we also know that they are OUR CELLS attacking us.

          The idea that the lifestyle some with heart disease are living isn’t something that can be stopped and reversed is hard to understand for me. My own brother-in-law lived before he died of his 3rd heart attack at 50, and he ate fast food daily, was morbidly obese, got zero exercise, and came from a heritage where the population tends to die of heart disease. He had three warning heart attacks, and still – let himself die. Never made a single change.

          There are cancer patients who refuse chemo, but usually because they believe in some alternative therapies. Few just – die. Like my brother in law did. I suppose for him, it was the power of the food he wanted balanced against what he must have felt was his own immortality that cost him his life. Very sad, nonetheless. The one thing we cancer patients know – stage I to the last stage – we are not mortal.

          Thanks for the interesting post, saw it on KevinMD. Good luck to all of you in your struggles.

          Liked by 1 person

      2. Wow – thank goodness for the internet, as I feel like my cardiologist has failed me, but my heart sisters have not!!

        My hospital release post-stent placement was only about how to care for my angioplasty wound site. Next to nothing about the need for healing my body or my mind.

        I absolutely feel like my heart betrayed me – your words were true therapy today, Carolyn! I have not made a big lifestyle change, and I do need to. I believe that if I did have a foreign invader – like cancer- I would have never come home and continued my old life, I would have fought hard to get rid of it. But because it’s my own body doing me wrong, I don’t feel like I have anything to fight.

        Thanks for the clarity on this, I feel like just knowing the way I’m looking at it is skewed will help me make a change.

        Liked by 1 person

        1. Thank you for your perspective on this (and also thanks to Judith and her first comment here for her wise ‘foreign invader’ cancer theory).

          I too felt that sense of ‘betrayal’, especially at the beginning, until a wonderful therapist/friend reminded me that my heart hadn’t betrayed me, it had actually SAVED me – and was strong enough to help me survive what many do not. Whenever I had chest pain (I had a lot post-op, which continues to this day), she instructed me to pat my little heart very gently and say: ‘Thank you for saving my life!” This gesture has meant a small but important shift for me. Good luck to you, Kaylen, and pls keep me posted on how those changes are coming along.


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