More Treatment Isn't Better

Jane Brody writes on health topics for The New York Times, and last month she wrote two articles on treatments for coronary artery blockages that are worth summarizing here.

The first article began with a story about a man with no heart symptoms, apparently in perfect health, who took an exercise stress test as part of an application for insurance. An abnormality in the EKG led to an angiogram, which eventually led, still without any symptoms, to an angioplasty with a stent.

Citing an interview with cardiologist and author Dr. Michael Ozner, the article goes on to tell what’s wrong with this picture. Angioplasty and stents can be lifesaving during a heart attack or when exertion causes chest pain. Absent those conditions, these procedures don’t reduce the risk of future heart attack or sudden cardiac death. In some cases, they can make matters worse. Medication, exercise and diet are at least as effective.

Doctors who tell apparently healthy patients that they need to have their arteries opened do so without any basis in fact. Their belief is apparently based on an old mistaken theory of how heart attacks occur - that arteries gradually narrow until they close completely. Opening partly closed arteries would prevent future problems if that were true. But newer studies show that heart attacks occur when plaque in an artery ruptures and forms a clot, and there is no way of knowing where plaque is likely to rupture.

Most interventional cardiology, Dr. Ozner says, is cosmetic: it makes the artery look nicer, but it doesn’t help.

The second article tells what should be done. The old advice about smoking, cholesterol, blood pressure, exercise and healthy weight is still good. But low fat has fallen off the list.

The Seven Countries Study, published in 1970, found that heart disease was rare in Mediterranean and Asian countries where diet centered on fish and vegetables, but common in northern areas where meat and cheese were consumed. The result was a recommendation for a low fat diet. But we now know that the Mediterranean diet is not low in fat, it’s just low in saturated fat.

Eat oily fish, cook with vegetable oil, eat nuts. Other advice: thirty minutes of exercise a day can just as well be three minutes at a time; see your dentist to avoid gum disease; reduce chronic stress with relaxation techniques like yoga. And don’t bother your arteries unless they bother you.