PRITIKIN ePERSPECTIVE - 08/22/07 Issue 130

Angioplasty and Bypass Surgery: Our Only Options?

Will Noninvasive Solutions Like Diet and Exercise Work For You?

Got chest pain? Get an angioplasty. Got a lot of chest pain? Get coronary bypass surgery.

That’s what thousands of Americans have done over the past two decades after being told they have heart disease, the country’s number one killer. Bypass surgeries cost about $45,000 each; angioplasties, about $30,000 each. In the U.S. alone, the total cost for the diagnosis and treatment of heart disease with angioplasty and coronary bypass surgery now exceeds $100 billion annually.

But a growing body of research is now finding that angioplasty and bypass are not the only options for people diagnosed with diseased coronary arteries. In fact, for many people they’re probably not even the best option.

Explains Dr. James Kenney, Nutrition Research Specialist at the Pritikin Longevity Center®: While both angioplasty and bypass surgery appear to reduce angina (chest) pain, at least in the short term, “neither does anything to slow, stop, or reverse what causes most heart attacks and strokes – namely, the growth and eventual rupture of atherosclerotic plaques.”

Medications, lifestyle changes

New studies are proving the efficacy of other options, such as medications and lifestyle changes like a heart-healthy diet and exercise. They’re simple, they’re noninvasive, they’re far less costly, and some may even do what angioplasty and bypass have never been able to do – halt heart disease.

New studies

One large study, funded by the National Institutes of Health and recently published in the New England Journal of Medicine, followed for four years more than 2,000 patients who were treated 3 to 28 days after a heart attack.(1) Half of the patients received drugs alone, which included aspirin, beta blockers, and other medications. The other half had angioplasty in addition to drug treatment.

After four years, the trial found no benefit to having an angioplasty procedure. Angioplasty performed 3 to 28 days after a heart attack was no better than medications alone at reducing the risk of death, a second heart attack, or heart failure.

Another newly published study, a five-year randomized controlled trial, compared the impact of coronary bypass surgery, angioplasty, and medications alone on patients, average age 60, with stable heart disease. The trial found that death rates over the next five years were not significantly different among the three groups.(2)

So why are bypass surgery and angioplasty so popular? It’s a complicated answer. For starters, they’re profit makers. They help, for example, keep many hospitals in the black.

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

Old theory

There’s another more fundamental reason for the continuing popularity 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 big blockages, or plaques, are mucking up the flow.

You can free up blood flow, the old reasoning went, by bypassing the plaque or inserting a stent, as angioplasty does, that presses the plaque up against the artery wall.

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.

They’re small but deadly. They’re also numerous. People with coronary artery disease often have one hundred or more – and they’re all over the arterial system, not just in one spot.

Small, volatile plaque

These tiny plaques trigger heart attacks not because they themselves clog arteries but because they can rupture. Like boils, they’re soft and fragile, full of cholesterol-rich “pus.” When inflamed, they can burst and spew their contents out into the bloodstream, triggering a chemical reaction that often culminates with a large blood clot.

It’s the blood clot that chokes off blood flow to part of the heart muscle, causing a heart attack. The older, larger plaques, by contrast, have tougher, thicker surfaces and are far less likely to rupture.

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

Calming the fires

That’s the bad news. The good news is that a heart-healthy diet and regular exercise, and, if necessary, medications, can stabilize these volatile plaques and improve the entire health of the inner walls of the coronary arteries. With heart-healthy lifestyle changes, “you could very well reduce your risk of a heart attack by 80 to 90%,” states Dr. Kenney, who has been on the faculty at the Pritikin Longevity Center since 1985.

A heart-healthy lifestyle, in effect, can do what bypass and angioplasty cannot. It can attack the disease itself, quelling inflammation throughout the arteries and ameliorating factors, like high blood pressure and high cholesterol, that damage arteries.

Heart-healthy diet

According to new research presented at the American College of Cardiology annual meeting in New Orleans in March,(3) dietary changes alone were very successful in reducing heart attack risk and death.

Scientists randomly divided 101 people who had recently survived a heart attack into two different heart-healthy diet groups. Both groups received intensive dietary education – seven individual counseling sessions and at least six small group workshops led by registered dietitians over the course of two years.

Another 101 patients, also recent heart attack victims, were given usual care – one short visit from a dietitian on the benefits of a low-fat, fiber-rich diet before being discharged from the hospital.

Whole grains, fruits, vegetables

The first intensive education group (50 people) followed the American Heart Association Step II diet, which emphasized whole grains and fruits and vegetables with moderate lean animal protein.

The second group (51 people) was instructed in the Mediterranean-style diet, which also focused on whole grains, fruits, and vegetables but emphasized fish and other sources of omega-3 fatty acids in lieu of animal-based fat.

Both diets recommended limiting cholesterol consumption to less than 200mg a day and saturated fats to less than 7% of total calories.

Six years after the study began, the researchers found that the two groups that received intensive education in heart-healthy diets were significantly more likely than people in the usual-care group to avoid deaths, heart attacks, unstable angina, and other cardiovascular-related events. (See graph.)

A total of eight events occurred in each of the dietary intervention groups, none of them deaths. In sharp contrast, 40 events occurred in the usual-care group, seven of which were deaths.

Dramatic reductions in deaths

Overall, the intensive education groups slashed the risk of all events, including total death rates, by nearly two-thirds compared to the usual-care group.

Outcomes According To Diet

By contrast, neither angioplasty procedures nor coronary bypass surgery “have been shown to reduce total death rates, and only bypass surgery has been shown to reduce the risk of dying from a heart attack in patients with advanced left main coronary artery disease,” notes Dr. Kenney.

Shrinking Plaque

Nonsurgical interventions like diet, exercise, and medication therapy have even been found to regress, or shrink plaque build-up.

In 1999, for example, Caldwell B. Esselstyn, Jr., M.D., at the Cleveland Clinic Foundation found that a diet rich in fruits, vegetables, whole grains, and beans, much like the Pritikin Eating Plan, and cholesterol-reducing medications reversed heart disease in 70% of patients over a 12-year period.
All patients who maintained the diet achieved the cholesterol goal of less than 150 and had no heart attacks or other heart-related problems during the 12 years. These data are particularly compelling considering that the same group had experienced more than 49 coronary events during the eight years before this study.(4)

Several other studies have demonstrated that plaques are stabilized and are less likely to rupture when heart patients adopt lifestyle-change programs – and plaque blockages are reversed. Wrote Dr. Esselstyn in Preventive Cardiology in 2001: “Compelling data from nutritional studies, population surveys, and interventional studies support the effectiveness of a plant-based diet and aggressive lipid [cholesterol]-lowering to arrest, prevent, and selectively reverse heart disease. In essence, this is an offensive strategy.”(5)

A heart-healthy lifestyle combined with medications “can achieve total disease arrest and selective regression even in advanced cases,” concluded Dr. Esselstyn.

Total Healing

What makes lifestyle change so successful is that it heals virtually every factor that breeds plaque build-up, not just a tiny section of one artery, as angioplasty and bypass do. The Pritikin Program of diet and example, for example, has been found to dramatically lower people’s cholesterol levels(6), aid weight loss(7), control blood pressure(8), reduce inflammatory markers like C-reactive protein(9), reverse the Metabolic Syndrome(10), and control type 2 diabetes(11) – all good things for our arteries.

And the benefits are felt quickly. Research has documented that nearly two-thirds of people who came to the Pritikin Longevity Center on drugs for angina pain left Pritikin within three weeks pain-free and drug-free.(12)

The benefits have proven lasting, too. A five-year follow-up of 64 men who came to Pritikin instead of undergoing bypass surgery found that 80% had done so well that they never needed the surgery.(13)

Children’s Hearts

Children benefit, too, and “never before was it so vital that we pay attention to our kids’ health. We don’t have a few overweight children with signs of heart disease and diabetes in America. We have a national health crisis,” points out Jeffrey Novick, MS, RD, Director of Nutrition at the Pritikin Longevity Center.

Alarmingly, nearly 70% of teens in the U.S. show the initial stages of fatty streaks, or early heart disease, in their arteries. New research on kids who have adopted the Pritikin Program demonstrates how quickly the disease can be controlled.(14) After just two weeks of eating heart-healthy food and exercising daily at the Pritikin Longevity Center, children ages 8 to 17:

• Lowered total cholesterol on average 23%.
• Decreased LDL bad cholesterol 25%.
• Shed 9 pounds.
• Lowered triglyceride fats 39%.
• Reduced key markers of inflammation, including C-reactive protein and oxidative stress, by 41% and 81%, respectively.
• Decreased total matrix metalloproteinase-9 (MMP-9), a marker of plaque destabilization, by 49%.
• Lowered myeloperoxidase (MPO), known to promote plaque instability and rupture, by 53%.
• Increased the body’s production of nitric oxide, a very beneficial chemical that expands blood vessels, increases blood flow, and squelches plaque growth and blood clotting.

Bottom Line

To address the cause of heart disease, and help eliminate it, our best option is not bypass surgery or angioplasty.

“To decrease atherosclerosis itself, the best thing you can do is adopt a heart-healthy diet and exercise program like that taught at the Pritikin Longevity Center,” recommends Dr. Kenney.

“In the short run,” he explains, “a heart-healthy lifestyle and, if needed, medications, can reduce inflammation and clotting, and stabilize plaques so they are much less likely to rupture. In the long run, they can gradually shrink the atherosclerotic plaques and improve blood flow to the heart, and dramatically reduce your risk of dying from cardiovascular diseases.”

Printer Friendly Version