All over the news in May were headlines declaring, “Bypass surgery is better than angioplasty.” A new study, published in the journal Circulation, followed 6,033 heart patients for five years after their procedures and found that the risk of death was a little lower in those who had bypass surgery compared to those who underwent angioplasty.(1)

What few journalists noted, however, is that a lot of people from both procedures still died – 931 deaths in total – 14% of the bypass patients and 16% of the angioplasty patients. The #1 cause of death was heart attacks.

Why? Bypass surgery and angioplasty, which often involves placing a wire-mesh stent in the coronary artery, are effective at reducing symptoms like angina (or chest) pain, “but neither does anything to remedy the underlying disease of atherosclerosis, or coronary artery disease,” states Dr. Jay Kenney, Nutrition Research Specialist at the Pritikin Longevity Center®.

New research on how heart attacks occur is proving that the longstanding “cure” (surgery that opens up one or two blockages) does not fit the new definition of the disease (a hundred or more small but dangerous plaques riddled throughout the coronary arteries).

Treating Symptoms Rather Than Disease

“ So you put a stent in that coronary artery, but unless you treat this as a systemic disease, unless you change the metabolic milieu that caused this disease to develop, you will not change the outcome,” states Steven E. Nissen, M.D., FACC, vice-chairman of cardiology at the Cleveland Clinic Foundation, a leading academic medical center, in his continuing education courses to physicians.

“Every single study I am aware of involving stenting, angioplasty, or any intervention does not change the prognosis. The risk of death from a myocardial infarction [heart attack] is exactly the same after the intervention as it was before the intervention.”

What does reduce heart attack risk, and substantially so, a recent in-depth article in The New York Times pointed out, are strategies like diet, exercise, and drugs that can aggressively lower key risk factors like LDL cholesterol, and, in doing so, improve the overall health, the “metabolic milieu,” of the inner walls of all the coronary arteries.

“A More Powerful Way”

In her article entitled “New Studies Question Value of Opening Arteries,” published March 21, 2004, New York Times health writer Gina Kolata states that increasingly popular treatments like bypass surgery and angioplasty may be “doing little or nothing” to prevent heart attacks. “A more powerful way to prevent heart attacks is to adhere rigorously to what can seem like boring old advice” – giving up smoking, for example, and adopting dietary plans and drug regimens that “get blood pressure under control, drive cholesterol levels down, and prevent blood clotting.”

Just one of these strategies, lowering LDL cholesterol to what federal guidelines suggest (below 100 mg/dL), can reduce the risk of heart attack by a third.

Fewer Deaths

Death rates would no doubt plummet, too. Years ago, another fiveyear study of heart patients was conducted by scientists at UCLA. All 64 patients had been scheduled for bypass surgery but opted to change their lifestyles and follow the eating and exercise guidelines of the Pritikin Program instead. Five years later, 80% still had not required bypass surgery.(2) What’s more, only two had died of heart attacks – a mere 3% of the patients involved – far less than the 14% and 16% death rates of the bypass and angioplasty patients in the new Circulation study.

So why are bypass and angioplasty so popular? It’s a complicated issue. To begin with, they’re profit-makers; they help keep many hospitals in the black. In the U.S. alone, more than a million angioplasties (at $25,000+ each) and about 300,000 coronary bypasses (at $45,000+ each) are performed each year.

“Fix My Arteries”

Secondly, as many doctors point out, patients demand them. “People have this notion that surgery is going to ‘fix’ their arteries,” says Dr. Robert Bauer, Medical Director at the Pritikin Longevity Center®. “Well, unfortunately, it doesn’t. The disease is still there, and growing.”

Old Theory

There’s another more fundamental reason for the continuing use of bypass surgeries and angioplasties. Deeply ingrained among many doctors is the old belief, taught for decades in medical schools, that diseased arteries are like clogged kitchen pipes. One or two blockages, or plaques, are mucking up the flow. If you remove the plaque by bypassing it or inserting a stent that presses the plaque against the artery wall, you’re home free. The obstruction that narrowed the pipeline is cleaned out. Blood flow resumes. Problem seemingly solved.

An overwhelming body of research, however, has now proven that these big, artery-narrowing plaques do not cause most heart attacks. Rather, 70% of heart attacks are triggered by much smaller plaques, often too small to be stented or bypassed. Most don’t even show up on an angiogram.

Small, Volatile Plaques

These smaller plaques, numbering one hundred or more in people with coronary artery disease, are dangerous not because they themselves obstruct blood flow but because they’re prone to rupture. Like boils, they’re soft and fragile, full of cholesterol-rich “pus.” If they become inflamed, they can burst and spew their contents out into the blood stream, triggering a chemical reaction that often culminates with a large blood clot, which can choke off blood flow to part of the heart muscle. The older, bigger plaques, by contrast, have tougher, thicker surfaces – and are far less likely to rupture.

Scientists call a plaque that has burst or ruptured the single most common lethal event of the industrialized world.

80% Reduction in Heart Attack Risk

The good news: With a healthy lifestyle and, if needed, cholesterollowering and blood pressure-lowering medications, you can stabilize these volatile plaques and improve the entire health of the inner walls of your coronary arteries, so much so that “you could very well reduce your risk of a heart attack by 80 to 90%,” asserts Dr. Kenney.

Regular exercise and a diet like the Pritikin Eating Plan, very low in saturated fats, trans fatty acids, and cholesterol, and very high in fruits, whole grains, and vegetables, can dramatically lower the amount of cholesterol entering plaque, aid weight loss, reduce insulin levels, control blood pressure, reduce inflammatory markers like C-reactive protein, and
bring down blood sugar levels – all good things for your arteries.

Attacking the Disease

With these nonsurgical interventions, in effect, you’ve done what bypass and angioplasty cannot do. You’ve attacked the disease – and the conditions that cause heart attacks. You’ve transformed the “metabolic milieu” of your arteries into a calm, stable environment. In 1999, University of California at San Francisco researchers assigned heart patients to either angioplasty or intensive LDL cholesterol-lowering medications. Within one year, the patients who received the aggressive LDL-lowering treatment had about 40% fewer heart attacks and hospitalizations for cardiac-related events than the patients in the angioplasty group.(3)

In another recently published study, a five-year follow-up of 409 heart patients, scientists found that aggressively controlling cardiovascular disease risk factors with diet and medications shrunk atherosclerotic plaques, and very few of the patients required surgery or suffered heart attacks. Among those who followed the very low-fat, near-vegetarian diet and took meds to keep their cholesterol and other risk factors under maximal control, only 3% died. In the other groups, by contrast, 13 to 15% died.(4)

Avoiding Complications of Surgery

By focusing on diet, exercise, and, when needed, medications, you also avoid the all-too-common complications of surgery. That’s no small benefit. “In almost half of all patients, bypass surgery is associated with a significant loss of mental function – and it appears to be permanent,” says Dr. Kenney. And stenting can actually cause minor heart attacks in about 4% of patients, notes Dr. Eric Topol, cardiologist and researcher at Cleveland Clinic Foundation.

Quick Stabilization of Plaque

Researchers are also finding another major benefit of nonsurgical strategies like diet, drugs, and exercise. They can stabilize plaque and dramatically reduce heart attack risk very quickly, within about 90 days. “Very rapidly, intense cholesterol-lowering strategies can transform unstable, cracking plaques into much more stable plaques,” asserts Stephen Inkeles, M.D., Pritikin Scientific Advisory Board.

And the more intense your efforts to reduce risk factors like cholesterol, the better your chances of avoiding a heart attack altogether. Half-way measures are only half-way successful. In 1998, another five-year study found that heart patients who had made moderate lifestyle changes (a 30% fat-fromcalories
diet) were more than twice as likely to have suffered a heart attack, undergone bypass surgery or angioplasty, and entered a hospital for heart-related problems than heart patients who had followed a Pritikinstyle diet (10 to 15% fat from calories).(5)

What’s more, lead investigator Dean Ornish, M.D., and colleagues at the University of California at San Francisco discovered, most of the patients on the Pritikin-style plan showed improvement, including overall widening, of coronary arteries. The arteries of the patients on the 30% fat diet, on the other hand, had worsened.

“It’s time,” concludes Dr. Kenney, “that the American people – and their doctors and insurance companies – recognize that bypass surgeries and angioplasties do not usually save lives, and that the right lifestyle interventions do. The most effective – and least costly – answer to our heart disease epidemic is regular physical activity and a diet that is very low in cholesterol, saturated fats, and trans fatty acids, very high in whole, fiberrich foods like fruits, vegetables, whole grains, and beans, and also includes moderate servings of omega 3-rich foods like seafood.”

Harvard Heart Letter

Anthony L. Komaroff, editor-in chief of the Harvard Health Letter, concurs. “You may be tired of hearing us say this,” he wrote in the March 2004 issue of the Harvard University newsletter, but “to reduce your risk of atherosclerosis and the diseases that it causes, eat a healthy diet (high in fiber, fruit, and vegetables and low in saturated fat) and exercise regularly. That combination produces immense benefits – more than any single medicine yet discovered and with more evidence behind it than any alternative.”

(1) - Circulation, 2004; 109: 2290.
(2) - Journal of Cardiac Rehabilitation, 1983; 3: 183.
(3) - New England Journal of Medicine, 1999; 341: 70
(4) - Journal of American College of Cardiology, 2003; 41: 263
(5) - JAMA, 1998; 280:2001.