OVERTREATING HEART DISEASE
Once you are labeled as a person with heart disease you need medical treatment for life.
The heart beats 100,000 times a day, pumping 6 quarts of blood around the body three times a minute. There is a delicate balance mechanically, electrically and chemically. This blood passes over 60,000 miles of blood vessels and capillaries. Over 65% of Americans have some cardiovascular disease. Fifty percent of men over 40 have some heart disease. Yet over one million people in the US die each year of heart disease.
Heart disease accounts for over 40% of annual deaths. Heart disease is a natural inevitable deterioration of blood vessels. Now it is called a preventable disease if treated and conceivably can be cured with treatment..
Today 2600 die daily and one American every two minutes dies of heart disease. It accounts for more than the next 5 leading causes of deathare cancer ½ million, with the other four about 65 thousand for each, that is accidents, lung disease, diabetes, and pneumonia.
What goes wrong? There is a build up of fatty plaques that block arteries, not enough blood get to the lungs and body, and extra irregular heart beats lead to strokes and cardiac deaths.
More people with heart disease are surviving yet it still is the leading cause of death. It kills fewer people but proportionately kills them later in life. It typically is not a 50 year old man that suddenly falls dead but a 70 year-old man that survives. We now get another 20 or 25 years to live thanks to stents, angioplasty, medication, and the new rotobladder that clears blockages of vessels..
This is a great triumph of medicine in the last 50 years. Over 54% of heart disease patients have coronary disease, another 18% have strokes and only 5% have congestive failure.
Yet this 70 year old man lives with severe heart disease. He is not cured but maintained alive with numerous surgeries. One million bypass surgeries occur annually and require a great amount of medication. It has become a chronic disease, not an acute disease.
The survivors of heart disease get congestive heart failure.The damaged heart struggles to pump blood. Its efficiency fails. Fluid builds up in the lungs resulting in shortness of breath. Our survivor can't walk across a room. Strokes also occur resulting in dementia, nursing home admission and disability.
When we stop our survivor from dying, is it a good thing? Is extending life always terrific? Is it worth it to live to be 85 after suffering a heart attack and now suffer dementia and frailty? Everything is not fine despite low death rates. The reason for these low rates is the new drugs, surgical treatments, and changes in behavior.
Today high blood pressure and cholesterol are controlled. Thirty years age only 16% were controlled of high blood pressure and now 65% are controlled. Most of this 65% have blood pressures of 140/90. Our definition of hypertension now includes a large number of borderline people.
High cholesterol is controlled today with statins. These are fairly safe and effective. Side effects include fatigue, stomach troubles and cramps. Over 116 million prescriptions were filled in Sept of 2002 and are rising. Lowering cholesterol does not mean no heart attack will occur. Monitoring everyone is expensive.
Doctors today give dissolving blood clot medications and operate to open these closed blood vessels with stents, angioplasty, and implantable defibrillators. Studies recently shows that the vast amount of heart attacks do not originate with blockages that have narrowed arteries. New evidence shows heart attacks occur when an area of plaque bursts, a clot forms over the area, and blood flow is abruptly blocked.
In 80% of cases, the plaque that broke lose did not come from an obstructed artery and in surgery, is not stented or bypassed. The dangerous plaque is soft and fragile, produced no symptoms and would not be seen as an obstruction of blood flow. That is why so many heart attacks are unexpected. A person can be out jogging, feeling fine, and is struck with a heart attack the very next moment. If a narrowed artery were the cause, exercise would have caused severe pain.
Hundreds of vulnerable plaques are present in heart patients. Preventing heart attacks means going after all their arteries not one narrowed section. One must attack the disease itself.
More people with no symptoms are now getting stents because of tests showing an obstructive vessel on testing. One million stents will be placed this year, doubling the rate from 1999. A patient goes to a cardiologist with vague symptoms and gets put into the cardiac lab for angiograms.
Since most middle aged people and older have arteriosclerosis the tests will show a narrowing and the patient will inevitably get a stent. Once you get on the cardiac lab train you can't get off. Its pretty likely you will get something done. Most are convinced they are a walking time bomb and this procedure will save their lives.
Only 20% of people with heart disease quit smoking, watch their diets or lose weight. They think their doctor will take care of everything. Obesity is also a concern today among young people and we worry that they will get diabetes or heart disease. Smoking rates did not affect heart disease because most of the smokers die of lung cancer and lung disease. Early detection is today's motto to pick up imminent strokes and heart attacks.
Let us consider the risk factors for heart disease.
Over 40 million people take medication for high cholesterol, high blood pressure and weight loss. There are new definitions of these diseases. Since high cholesterol is now defined as over 200mg/cc, over 2/3 of people need monitoring and 1/3 need statins. Since obesity is defined as over 20% over the ideal weight, 35 million people need to be on a weight reduction diet. Losing weight will add months not years to your life. You must be willing to exercise, count calories and must become dedicated.
HIGH BLOOD PRESSURE
High blood pressure is a moderate risk to your health. Sever elevation puts life in peril. We have a health problem and a solution. The importance of blood pressure is sold to the public and is the leading reason to see your doctor.
The benefits of preventing strokes and heart attacks in sever high blood pressure is undisputable. Yet the public is told that everyone with a mild rise in blood pressure requires treatment.
Standards for high blood pressure have been lowered in the US which results in a two time increase that in Australia and five times that in England. Large clinical trials showed less than expected benefits and the side effects were widespread. Drug companies put TV ads showing you may die if you don't keep taking their drugs. Risks were exaggerated and benefits were overstated.
In the past, mild rise in readings were written off as part of aging and decreased kidney filtration. Insurance companies detailed what was normal 110/80. Mild hypertension was defined as the diastolic over 90, and high blood pressure as the diastolic over 110.
In 1000 men 3.7 die with normal blood pressures and 5.5 with mild high blood pressure. The risk cuts your life by 2 years with mild hypertension, and 3 years by severe obesity. Woman's risk is 50% less.
How much of this risk can be reduced by medication? High blood pressure treatment has little effect in preventing coronary heart disease. Eight out of ten people with high blood pressure will have heart attacks despite treatment.
The treatment in some cases can cause heart attacks.
Some medications raise cholesterol, while others cause heart irregularities. High blood pressure does lower the stroke possibility by 35% but has no effect on lowering heart attacks. Ninety percent of the risks of high blood pressure remain despite treatment.
One-third of patients need to be withdrawn from treatment because of severe side effects. Diuretics block the retention of salt but can cause gout and mild diabetes. Ace inhibitors neutralize hormones that cause blood vessels to shrink. Everyone develops depression.
COMMENTS
We have transferred the power of living from the patient to the medical system. In the past you the patient decided when he was sick enough to see a doctor. The patient never expected or asked for a cure.
Now millions of healthy people are screened and told they have a disease requiring a medical treatment. The doctor has the power to tell who is sick and who is healthy.
This is a medical overkill. Decision makers have immense poser over our lives. Medicine is ruled by consensus and governed by guidelines. The average physician is not allowed to debate, and no voting is allowed.
If we exaggerate the risks, we can justify mass medical treatment. Millions of people get no benefit and many are harmed with unnecessary treatments. One person benefits and 38 others get severe side effects.
The premise is that we are healthy and might live forever unless treated for some disease. Once you are labeled as a person with a disease and need medical treatment for life, you have lost your freedom independence, and self reliance. This can affect you income, promotions, and life insurance premiums. You now require expert evaluation and management for life and are pressured into high level testing, treatments and develop new priorities.
So folks, it all boils down to the basics. Avoid fats, lose weight, exercise, avoid stress, and quit smoking. Acupuncture can help in many of these problems.
