The myth of the heart disease cure

10 Apr

by Carolyn Thomas  @HeartSisters

So a bunch of us, all heart disease survivors, were enjoying breakfast together one morning in Rochester, Minnesota. One of the women at our table looked up from her coffee and announced that, yes, even though she had survived a heart attack and subsequent open heart surgery, she didn’t really have heart disease anymore “you know, like the rest of you do.”

I looked at her and replied, in my most charitable tone:

“Honey, nobody gets invited to attend the WomenHeart Science & Leadership Symposium for Women With Heart Disease here at Mayo Clinic unless they actually have, you know, heart disease.” 

Her attitude of denial, I was to learn later, is not uncommon.

I’ve observed over and over since that breakfast conversation in 2008 that many women who have heart disease often believe that once they’re successfully treated, their heart disease is “cured” and gone forever.

I compare that attitude to how I felt after I’d spent a month in hospital around my 16th birthday following a ruptured appendix and a nasty case of peritonitis.  From the moment I was finally discharged from hospital (abdominal drainage tube still nicely attached), I can honestly say that I never again gave my appendix a moment’s thought. I never needed to.  Ever. My appendicitis and its associated deadly complications were cured.

That’s acute medicine for you.

But heart disease is not an acute illness. Welcome to the wonderful world of chronic and progressive disease . . .

Cardiologist Dr. Stephanie Moore of the Heart Failure and Cardiac Transplant Program at the Massachusetts General Hospital Heart Center has also observed this reaction:

“One reason some women aren’t too concerned about heart disease is they think it can be cured with surgery or an angioplasty procedure and they won’t have to worry about it again.

This is a myth! Heart disease is a lifelong condition and once you get it, you will always have it.”

I agree with Dr. M.  And whether you have been diagnosed with coronary artery disease, a cardiac arrhythmia, spontaneous coronary artery dissection, a heart valve problem, a viral condition, heart failure, or are living with a congenital heart defect, this applies to you.

Here’s part of a conversation on Twitter I had with cardiologist Dr. John Erwin, governor of the Texas chapter of the American College of Cardiology. We were pondering why it’s far harder to convince heart patients to make healthy lifestyle improvements post-diagnosis compared to cancer patients:

Screen Shot 2015-02-08 at 8.23.14 AM

I recall a woman in one of my heart health presentation audiences telling me after the talk that she felt “so much better now” about heart disease:

“I used to be afraid of getting heart disease. But now that I see you here today – a heart attack survivor, walking, talking, looking perfectly fine!  – I’m no longer worried anymore!”

Whoah!  Remind me to go easy on the mascara and blush next time I speak.  See also: “You Look Great!” And Other Things You Should Never Say to Heart Patients

As the eminently quotable Kentucky cardiologist Dr. John Mandrola once wrote on one of my favourite heart blogs:

“We urge patients to eat less, exercise more, and not to smoke.

“But when they don’t do these things, we still squish their blockages, burn their rogue electrical circuits, and implant lifesaving devices in their hearts.”

This is why our doctors are so keen on us making sweeping wholesale improvements to our lifestyle choices to lower our risks of developing heart disease – and even more so if we’ve been already been diagnosed.

That’s because one of the biggest risk factors for having a heart attack is having already had one.

In a perfect world, doctors tend to like the concept of “curing” disease. Even in the face of serious and incurable diagnoses, the subtle dream of a magical cure can live on. 

For example, consider Ellen Diamond and her recent essay published in Pulse: Voices From The Heart of Medicine

Ellen tells the story of a day 14 years ago when she heard a doctor making a promise to an audience of patients just like her.  Everybody in that audience was living with chronic lymphocytic leukemia (CLL). The doctor stood up and promised:

“Give me five years, and I’ll give you a cure!”

As desperately as she wanted to believe that promise, she recalls that she felt reluctant to pin her hopes on it. And 14 years later, she remains skeptical.  Ellen explained that although she’s heard many CLL experts make similar predictions, no one with CLL has ever been cured despite great advances in research and treatment.

“I’ve never doubted the doctors’ sincerity and good intent, but at times I’ve felt quite angry at their willingness to raise their audiences’ hopes in this way.

“Given the facts, how can they make these pronouncements?”

Part of the reason, she believes, is that when doctors and patients use the word “cure,” they mean very different things.

As a patient, Ellen defines “cure” as the moment when she’ll be told that her CLL has been destroyed, never to return. But in reality, she adds, the best treatment outcome is simply a kind of détente.

As a heart attack survivor, one of the Big Lessons for me has been that although my doctors, as Dr. Mandrola likes to say, can “squish, burn and implant” all they like, their heroic efforts do not address what originally caused this damage to my coronary arteries in the first place. 

And we now know that most heart disease is 20-30 years in the making.

Most of you coronary artery disease patients may believe that the life-saving cardiac intervention that you had was, well, life-saving.  In most cases, however, evidence suggests that the best your procedure could likely do was to relieve your cardiac symptoms – not the root problem that originally caused those symptoms, and not your risk of heart attack.

In coronary artery disease, the care model is arguably built entirely around opening blockages in patients with late-stage disease, which may relieve symptoms but does not prevent future heart attack.

The landmark research of Germany’s Dr. Rainer Hambrecht in Germany found that patients with significant coronary artery blockages actually do better in longterm follow-up studies when they participate in regular exercise programs compared to those having invasive cardiac procedures done to help revascularize those blocked arteries.(1)

What about those celebrity doctors – notably Dr. Dean Ornish – who believe that a highly restrictive, extreme-low-fat diet regime can prevent or even reverse heart disease?

But many other docs, including Dr. Timothy Harlan at Tulane University School of Medicine, remind us that what we eat is just one of several important risk factors in developing heart disease.  And he disagrees with these extreme diets:

“Is this healthier than the widely recommended heart-healthy Mediterranean diet? Probably not. The research is clear that extremely low fat diets do not prevent heart disease. In fact, due to the extreme nature of the regime, this diet may actually be harmful.”

The key point here is that, no matter what miracle “cure” you hear or read about (including the beaut last week about how a tablespoon of lemon juice every night will “prevent heart attack”), it is ultimately up to you to do all that you possibly can to minimize your own health risks.

No pill, no diet, no supplements, no health guru, no Dr. Oz show will do this for you.

Remember that group of heart patients having breakfast with me at Mayo Clinic back in 2008? In our training group of 45 women, some were vegans. Some were triathletes. Most had survived more than one cardiac event. One was a physician herself. The youngest woman attending was just 31 years old.

While existing cardiac treatments certainly cannot promise to “cure” heart disease, there is some encouraging news here: heart disease can be largely prevented in the first place if you’ve never had it:

  • Eat a heart-smart diet.
  • Exercise, exercise, exercise!
  • Learn how to improve how you react to stress.
  • Do more of what you love doing, and far less of what you don’t.
  • Develop healthy sleep habits.
  • If you have diabetes, you need to manage it well.
  • Absolutely no smoking.
  • Know/keep your blood pressure/cholesterol numbers under control.
  • Pregnancy complications are strongly linked with future heart disease – monitor your cardiac health indicators throughout.
  • If you have a family history of heart disease (mother or sister younger than age 65 at the time of their cardiac event, father or brother younger than 55), it’s especially important for you to manage all of these risk factors.

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(1) Hambrecht R, Walther C, Möbius-Winkler S, et al. “Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial” – Circulation 2004; 109:1371-1378

NOTE FROM CAROLYN:  A version of this post was originally published here on Heart Sisters in July of 2013.  Because I’ve started writing a new book for Johns Hopkins University Press (“A Woman’s Guide to Living With Heart Disease” – due out in November 2017!) I find myself temporarily with fewer hours in the day when I’m able to write new blog articles here.  I’m hoping that running some updated favourites from the archives of over 630 Heart Sisters posts will keep you informed, entertained and involved each week for a while.  And although I’m not able to write as many brand new blog posts for the time being, I do love reading your comments – so please feel free to leave a response here.   Meanwhile, thank you so much for your amazing support!

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See also:

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Q:  Have you been shocked to realize that you actually do have a chronic disease that isn’t “fixed”?

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18 Responses to “The myth of the heart disease cure”

  1. Chris Weigand May 8, 2017 at 7:37 am #

    It’s especially hard to recover from a near fatal heart attack when your husband has his own heart issues and is not well. Add to this that he is very dependent on you to voice his health complaints every day… I look for chances to be alone and you helped me understand why without feeling guilty…thanks!!!

    Liked by 1 person

    • Carolyn Thomas May 8, 2017 at 8:07 pm #

      Hello Chris – you may be interested in the excellent book by Dr. Wayne Sotile called “Heart Illness and Intimacy: How Caring Relationships Aid Recovery”. He talks about the “family scramble” that can happen when somebody in that family is diagnosed with heart disease, particularly if there’s already a heart patient in the family. I’ve written about Dr. Sotile’s work here and here, FYI. Meanwhile, see if you can track down a copy of this book. I hope it will help you make some sense out of what’s been happening. Best of luck to you…

      Like

  2. Doctor Sahaab blog August 18, 2016 at 7:33 am #

    Nice share.

    Like

  3. Chris April 26, 2016 at 10:17 am #

    I think of it as CONTROLLED, not CURED. A few months ago I ended up with heart failure and afib (seemed to be the result of an extreme allergic reaction to an antibiotic, but no one is sure). After learning about Dr. Esselstyn’s work in How to Prevent and Reverse Heart Disease (similar to Ornish) and The China Study, I changed to nonfat vegan/plant-based diet and have had fantastic results (lost A LOT of weight with little effort, heart getting stronger, able to exercise again). My cardiologists are supportive (whew!) and thrilled with my results so far. But even with my success, I’ve never thought “okay, that’s fine, now I can be a slug and eat junk.” It’s an ongoing battle, one I thought I would *hate* (really? fat-free vegan? R U kidding me?) but I ended up loving living this way (much to my surprise). Also, I have noticed (and others have as well) that my weight loss has been centered around belly fat mostly. That had not happened before when I tried Weight Watchers, Atkins, South Beach and many other plans. So, yes, there is no cure, but controlling the disease is possible for many people. I do recommend reading one or both of those books to get the big picture. It helped me a lot.

    Like

  4. Karen April 10, 2016 at 2:10 pm #

    Today’s the one year anniversary of my near fatal heart attack, so it’s timely but sobering to be reminded that I have a chronic disease. I benefit greatly from the weekly blog posts and share them.

    Liked by 1 person

    • Carolyn Thomas April 10, 2016 at 4:00 pm #

      Happy Heart-iversary, Karen. The one-year milestone is a significant one in the life of a heart attack survivor. Hope you celebrate many many more of these…

      Like

  5. Sheila April 10, 2016 at 1:03 pm #

    Thank you Carolyn for this excellent blog. I am a new follower so am enjoying your previous articles. I forward your blog to my sister in South Africa who is unable to register to receive it directly. My sister in turn forwards it to her friends. You are providing a wonderful service for women in many parts of the globe. Thank you

    Liked by 1 person

    • Carolyn Thomas April 10, 2016 at 3:59 pm #

      Thanks so much Sheila. I wonder why your sister in South Africa isn’t able to subscribe via my email link? Thanks for continuing to forward links to her and to others!

      Like

  6. Quitting the Sitting April 10, 2016 at 12:02 pm #

    I think it’s terribly hard to face the reality of living with a life-threatening chronic illness. We want to believe that modern medicine can cure anything and restore us to full health. It’s terrifying to get a diagnosis that forces us to come to grips with our own mortality. It’s not surprising that many people live in denial and just want the whole thing to be over with. If only wishing made it so.

    And it doesn’t take a catastrophic illness either. Lots of healthy folks have found many ways to reframe and ignore the mountain of research-based evidence that our diet, exercise, sitting, smoking, seat belt, sleeping, and stress habits are the biggest determinants of our health and well-being. “Not going to happen to me. My Aunt lived to be 96”. I’m at the age where most of the people I know have become quite proactive about retirement planning. Which is great, but without equal thought to lifestyle choices, statistically speaking their time might be better spent on estate planning.

    Our Health IS our Wealth. I intend to do everything I can to be an active, healthy, vibrant and happy nonagenarian!

    Liked by 1 person

    • Carolyn Thomas April 10, 2016 at 3:57 pm #

      Such good points, Denise. Here’s to being an active, healthy, vibrant and happy nonagenarian!

      Like

  7. Kim B April 10, 2016 at 9:34 am #

    This one’s a hard lesson to learn. Before surgery I told myself if I just got through it I’d be all better. Which I am, but not the way I thought. (I actually wrote a whole post about this realization:

    Great post though, as always.Good luck with your new project!

    Liked by 1 person

    • Carolyn Thomas April 10, 2016 at 11:18 am #

      Thank you Kim – I love your blog post! You write: “When you’re sick with a cold or the flu, you can’t wait till it’s over.” I happen to be sick in bed today with a brutal stomach bug (my daughter and grandbaby have been sick with it all week) and that’s exactly what I’m thinking as I plan the week ahead. When will this be “over” so I can resume normal life? Right now, I’m cancelling plans left and right and feeling very sorry for myself… 😉

      Liked by 1 person

      • Kim B April 20, 2016 at 12:16 pm #

        I’m glad you liked it. And I hope you’re feeling better by now! 🙂

        Liked by 1 person

        • Carolyn Thomas April 20, 2016 at 1:04 pm #

          By now, I’m feeling so much better, thanks. There’s nothing like being (acutely) ill to make you feel utterly grateful when you even start feeling not quick so sick!

          Liked by 1 person

  8. Sharon April 10, 2016 at 9:32 am #

    Thank you for reruns of older blogs. I just joined and am looking forward to reading them. I have PAD….peripheral artery disease and AFIB and I’m assuming my arteries aren’t that healthy. I was shocked I had PAD because I didn’t smoke, exercised and ate fairly well. Now, I can’t walk without pain and I’m having angioplasty or stents in a month. Do you think women with heart disease should have an ABI done to check their circulation in their legs?

    Like

    • Carolyn Thomas April 10, 2016 at 11:13 am #

      Hi Sharon – I was just wondering about this recently. PAD (peripheral artery disease) is atherosclerosis of the extremities – usually the legs – and it makes sense to have the simple non-invasive ABI blood pressure test (Ankle-Brachial Index). Good luck next month with your procedure.

      Like

  9. Mary Jo April 10, 2016 at 6:35 am #

    Thank you so much for this blog. I am a 49 year old female and have just been diagnosed with coronary artery Vasospasm, sometimes called Prinzmetal’s disease. I am an avid tennis player and work out on a rowing machine and with weights 2-3 times a week. I am a normal weight but my fat stores in my belly. The cath lab procedure showed 20% plaque build up in my arteries. I am taking a nitrate drug and Diltiazem for high blood pressure but I refuse to take the statin because I have heard and read terrible things about them. Do you think that is reasonable? I take krill oil and am adding red rice yeast to my diet.

    Thanks!

    Liked by 1 person

    • Carolyn Thomas April 10, 2016 at 6:59 am #

      Hello Mary Jo – I’m not a physician so can’t comment specifically on your unique case. Have a discussion with your physician about the pros and cons of your plan. FYI, I’ve written further about vasospam disorders here. Best of luck to you…

      Like

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