Guest post: Heart hoax

I received this intriguing guest post submission and unlike a lot of the unsolicited stuff that comes my way this one struck a chord. I’ve heard some interventionists make some of the same points in unguarded moments and I definitely appreciate the radiation warnings.

One caveat: While the “progress road,” consisting of healthy eating and exercise habits is definitely a great idea, people have a tough time making the changes and sustaining them. In defense of the interventionists, at least they can be sure that their interventions actually occur!

The Great American Heart Hoax: Economic and Political Implications
By Michael Ozner, M.D.,
Author of The Great American Heart Hoax: Lifesaving Advice Your Doctor Should Tell You About Heart Disease Prevention (But Probably Never Will)

Cardiovascular care in America is spiraling out of control.  We are now spending more than one hundred billion dollars a year for treatment and management of cardiovascular catastrophes (heart attack, stroke and diseases of the vascular system).

In The Great American Heart Hoax I have outlined the problems of cardiovascular care in America that is draining our healthcare dollars and contributing to our financial collapse.  In addition, I point out key areas of wasteful spending on expensive and risky diagnostic studies and procedures that are of no benefit to the millions of Americans who fall prey to the cardiovascular intervention industry.

Examples of inappropriate cardiovascular care are summarized below:

1. Coronary angioplasty and stent insertion:  While coronary angioplasty (the opening up of a blocked artery with a catheter device) and stent placement can be indicated and potentially lifesaving in acute coronary syndromes such as heart attacks, utilizing this technology in stable patients who have coronary blockages is inappropriate and has never been shown to reduce the risk of future heart attack or prolong life as compared to more conservative therapy (lifestyle changes and medications as indicated).  Indeed balloon angioplasty and stent placement can often lead to an increase in cardiovascular morbidity and mortality compared to an intensive prevention approach.  Despite this fact the cardiovascular intervention industry continues like a freight-train out of control.  This year over one million stents will be inserted in patients across America and many of these procedures are clearly not indicated.

2. Heart bypass surgery (also called coronary artery bypass graft surgery): like catheter-based intervention, heart bypass surgery is clearly indicated in select unstable patients, however bypass surgery is over-utilized in the majority of  patients with obstructive coronary artery disease.  Major clinical trials have failed to show a benefit in clinical outcome in the vast majority of stable patients treated with bypass surgery.

3. CT-Scans:  While CT scans are often necessary in unstable patients in the emergency room as a diagnostic modality, the proliferation of this technology to screen Americans for coronary artery disease is inappropriate and leads to a depletion of our valuable health care dollars.    There is no evidence that subjecting yourself to a CT scan will lower your risk of having a heart attack or prolong your life.  Most disturbing is the fact that these procedures subject unsuspecting men and women to excessive radiation exposure which stays with them for a lifetime and increases their risk of cancer.  At the end of the day ask yourself the following question: do I need to pay a large sum of money and be bombarded with a significant dose of radiation just to be told to do what I should be doing anyway?   Follow a healthy-lifestyle with optimal nutrition, regular exercise, stress management and smoking cessation.

4. Avoid stress-nuclear studies:  As with CT scans, stress nuclear studies are expensive and lead to significant amounts of radiation exposure via intravenous radioisotopes.  These tests should be avoided in the stable population.  If a stress test is recommended with imaging why not choose a stress-echo study which is less expensive than a stress-nuclear study and utilizes harmless sound waves to provide similar information?

5. Cardiac catheterization:  Another expensive diagnostic tool that carries risk.  This risk is justified in unstable patients however this procedure should not be performed indiscriminately on stable individuals.

The Solution

There is a better road we can walk down that will provide us with a lifetime of heart health.   This road is called progress road and it costs a fraction of the journey down the dead-end road, with excessive interventions and diagnostic studies that don’t improve clinical outcome.  Progress road is truly the biggest bang for the buck!

Progress road utilizes prevention rather than intervention to keep us healthy and lowers our health care costs that cripple the financial health of America thereby impeding our ability to compete in a global economy.

It consists of:

1. A heart-healthy Mediterranean-style diet

2. Regular exercise:  30 minutes of walking should be considered a daily routine.

3. Stress management:  Simple techniques such as yoga, breathing exercise or relaxation response training can serve to lower our blood pressure and pulse and protect us from vascular insults such as heart attacks and strokes.

4. Control cholesterol:  Following a Mediterranean-style diet will significantly lower cholesterol levels in the majority of Americans.  Judicious use of medications such as generic statins could also be utilized if required.

5. Blood pressure control:  Blood pressure can be managed with lifestyle changes (Mediterranean diet, exercise, smoking cessation and stress management).  Blood pressure medication should be used in select patients if lifestyle changes do not achieve goal.

6. Avoid metabolic syndrome and diabetes:  again diet and exercise are key to prevent or reverse these conditions.

7. Achieve ideal body weight

8. Lower inflammation and oxidative stress: a Mediterranean diet, regular exercise, weight control, avoiding pollution and pesticides, good oral hygiene (daily flossing) all serve to lower inflammation and free radical induced oxidative stress that leads to cardiovascular disease.

9. Have a routine physical exam with comprehensive blood work: an ongoing relationship with your personal treating physician to discuss prevention strategies is key. Get the proper screening blood studies to uncover hidden risk of cardiovascular disease.

10. Avoid unnecessary procedures that increase the cost of medical care and do not lead to improved clinical outcomes.

At this critical juncture, we have to decide what is best for the health and wealth of the citizens of this country.  Will it be business as usual with indiscriminate utilization of diagnostic and interventional procedures that cost billions and don’t improve the overall health of Americans or do we want a health care system that is affordable and delivers preventive care that gives us the biggest bang for our buck?  I think the answer is clear.  The Great American Heart Hoax chronicles all that is wrong with our current health care system for cardiovascular treatment and it also delivers a concise, practical and clinically proven 10- step approach that can lead us to the promise land of affordable health care, fewer heart attacks and strokes and freedom from a misguided cardiovascular intervention industry that is sabotaging our financial and medical well-being.

Copyright  © 2009 Michael Ozner, M.D., author of The Great American Heart Hoax: Lifesaving Advice Your Doctor Should Tell You About Heart Disease Prevention (But Probably Never Will)

Author Bio
Michael Ozner, MD, FACC, FAHA,  author of The Great American Heart Hoax: Lifesaving Advice Your Doctor Should Tell You About Heart Disease Prevention (But Probably Never Will), is one of America’s leading advocates for heart disease prevention. Dr. Ozner is a board-certified cardiologist, a Fellow of the American College of Cardiology and of the American Heart Association, medical director of Wellness & Prevention at Baptist Health South Florida and a well-known regional and national speaker in the field of preventive cardiology. He is the medical director of the Cardiovascular Prevention Institute of South Florida and symposium director for “Cardiovascular Disease Prevention,” an annual international meeting highlighting advances in preventive cardiology. He was the recipient of the 2008 American Heart Association Humanitarian Award. Dr. Ozner is also the author of the BenBella Books title The Miami Mediterranean Diet.

January 26, 2009

7 thoughts on “Guest post: Heart hoax”

  1. @Dr. Ozner: So how do you keep the lights on and pay your staff if you don’t do EKGs at every visit and annual stress tests and echocardiograms on all your patients? Surely you realize that making a living on E/M payments alone will force you to spend no more than five minutes per patient, which, as you know, is hardly enough time for the kind of intensive education and counseling efforts necessary to counter the deeply ingrained American ideal of “more is better” and “better safe than sorry” to justify every possible test.

    I heartily agree with you, but hope your books do well. Yours is not a model for a successful practice in today’s procedurally oriented payment climate.

  2. A reduction in these invasive procedures would have the added benefit of saving lives that would be lost to Hospital Acquired Infection’s.
    But then money, the books, are why HAI’s are killing so many people.

  3. 1. Go one step better–reduce or eliminate all sources of omega-6 fats from your diet (see Paleo Diet, see Americans are so out of balance with too much omega-6 fats, which, from a biochemical standpoint will cause pro-inflammatory chemicals 2/3 of the time. we eat grain-fed beef, pork & chicken, farm-raised fish, and the dairy and eggs from those O-6 animals is also high in O-6. Go back to natural, grass-fed animals, wild-caught fish, wild-caught animals, free-range eggs/chickens (check out the documentary “King Corn” to see how we’re overfeeding ourselves and our cows with corn). Take an O-3 supplement
    2. Awesome–more exercise if you want to burn more calories
    4. If you take a statin, you must also take extra co-enzyme Q10; statins also block the endogenous production of the most important antioxidant that we produce ourselves: CoQ10! Take some extra even if you don’t take statins–100mg/day for average adults tends to be an adequate amount to recommend.

    Also, have there been any studies that show a protective effect of statin use for heart attacks? Don’t think so. WHY IS CHOLESTEROL SO HIGH IN THE FIRST PLACE??? Why aren’t we asking this question?

  4. One more thing: lots and lots of Vitamin D–see Cannell and Hollis study, articles by Dr. David Seaman (founder of
    *get some sun (sun-block free)
    Some cheap tests for Vit D:
    $30.00 Anyone can order a vitamin D test through this organization that includes the top vitamin D researchers in North America. The test is performed at home via simple finger prick blood draw.

    $39.00 Doctors can contact this organization, which is a buying co-op for laboratory tests through LabCorp.

    $65.00 Part of the proceeds of this test go back to the Vitamin D Council. Dr. John Cannell is the Excutive Director and author of many excellent papers on vitamin D.

  5. This is great food for thought, thanks for this posting. I have to tell you, though, from a medical consumer’s (or if you prefer, beneficiary’s) point of view, your “bang for your buck” argument is more than a bit scary. Though I want others to be healthy, more than anything I want to safeguard my own personal health, no matter the the cost or the degree to which it is invasive. And if I happen to be one of those for whom lifestyle changes does not work, I don’t want to be on the outside of that “bang.”

    David – I’m leery of clicking all of the links from those that have commented here (though my curiosity is piqued). It seems like these people are selling something. Can you vouch for their credibility?

  6. Thanks, MedHead. I often delete comments that are purely commercial, especially if they have nothing to do with the post. In this case I left comments #3 and #4 up, although they are mainly self-serving. I can’t vouch for their credibility but they don’t seem to be dangerous sites.

    I agree with your “bang for the buck” concern. However, there are plenty of cases where the patient isn’t missing out on anything by avoiding a costly intervention.

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