Cardiologist, author, and heart health expert Dr. Sarah Samaan offers advice on how to live a heart smart life.See all posts »
What Does Prevention Really Mean?
A charming gentleman in his 70’s recently visited my office for the first time, encouraged by my reputation as a cardiologist with a focus on prevention. Joe (not his real name) had undergone quadruple bypass surgery several years prior, at which time his surgeon also replaced a leaky heart valve. His heart was functioning at about one quarter of its normal capacity; he had an irregular rhythm, hypertension, and severely elevated cholesterol. Adding to Joe’s woes, he was diabetic and had marginal kidney function. After poring through about 100 pages of Joe’s medical records and talking with him about his symptoms and overall condition, I advised a regimen of medical therapy tailored to his specific problems, in addition to diet and exercise, while taking into account his physical limitations.
Although he was onboard with my suggestions for improving his diet and lifestyle, Joe was dismayed by my recommendation for conventional medical therapy. “Doc,” he said reproachfully, “I thought you were ‘preventive’.” As I explained to Joe, “prevention” means different things under different circumstances. In his case, the horse was already out of the barn. He had advanced cardiovascular disease, and there was no amount of healthy living, vitamins, or supplements that could adequately treat his condition. As many as one in four patients with Joe’s condition do not survive beyond one year. On the other hand, optimal medical care had the potential to improve his likelihood of surviving the next five years by 30 percent or more.
Joe’s polar opposite is Joanne (not her real name), a 45 year old woman with a family history of heart disease. When I first saw her, Joanne’s LDL cholesterol was 140, which was far from optimal. We checked other blood tests and ran a coronary calcium score to see if she had already developed the early stages of heart disease. When that round of testing came back normal, I counseled Joanne to make some important changes to her lifestyle and daily routines. She lost 30 pounds, began exercising regularly, and worked hard to improve her diet. She also began managing her stress and made her sleep time a priority. Since she didn’t like to eat fish, I recommended a fish oil capsule, but no additional supplements. Three months late, Joanne’s LDL had dropped to 80, and she was feeling great. In Joanne’s case, there was no need for medical therapy. The simple changes she created made all the difference. Joanne is a perfect example of what we call “primary prevention,” or prevention of a disease process before it has had a chance to get started.
In the middle are people with early stages of heart disease, people who have suffered a heart attack and recovered completely, and people who are at high risk, such as diabetics. In those people, “secondary prevention” with both medical therapy and lifestyle will often prevent the disease from progressing. My patient Joe required secondary prevention of the highest degree.
The most important thing I want all of my patients and readers to know is that it is never too late to start working on your heart health. Not all medications will agree with everyone, but we are fortunate to have a range of drugs that save lives, prevent disability, and improve quality of life in very important and measurable ways. If you have questions or concerns about medications, it’s important to speak up and get answers. Your doctor should be your advocate and your partner in health, but ultimately the responsibility for your well-being belongs to you.
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