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 risk. And 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 2004 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
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