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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
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