The Elimination of Heart Attack -- Is it Possible? (ARA) - Heart disease is the largest killer of Americans -- more people in the United States die from diseases of the heart and blood vessels than all other diseases combined. Despite the fact that our country has the best heart hospitals and the finest cardiovascular specialists in the world, the heart attack rate here is not substantially different than the heart attack rate in any other country. The most common culprit in this deadly scenario is atherosclerosis -- premature plaque build up, which clogs the coronary arteries that supply the heart muscle with vital oxygen and nutrients. Seventy percent of heart attacks take place in coronary blood vessels that are not severely blocked enough to require balloon, stent, or bypass. These small, unstable plaques that are barely visible at angiography are often the culprit lesions where heart attacks occur. For one-third of patients with atherosclerosis, death is their first symptom. Another third experience heart attack and almost half of those are dead in one month. We now have the tests and drugs to abolish coronary heart disease in the first quarter of the 21st century. Lifestyle intervention with exercise, nutrition, weight control, smoking elimination, and stress management would likely reduce by more than 50 percent the expression of premature cardiovascular disease through control of risks such as obesity, diabetes, hypertension, dyslipidemia, and the sedentary life. Fortunately, we are now living in an era blessed by the promulgation of incredible pharmacologic advances that allow us to actually ponder the extinction of atherosclerotic heart attack. Four drug classes now exist that if prescribed appropriately and aggressively could eliminate atherosclerosis. These four classes include: aspirin, statin, ACE and niacin. Here’s how they work: 1) Aspirin: The drug inhibits the platelets that form the clot that adheres to the unstable, fractured plaque, which could potentially block blood flow down the coronary artery and cause a heart attack. Research has consistently shown the benefits of aspirin therapy to generally reduce vascular events by about 20 percent for those suspected of having atherosclerosis (Physicians’ Health Study, 2003). 2) Statin: There are several of these plaque drugs on the market, which are often mistaken for cholesterol drugs. This distinction is important: 30 to 50 percent of patients with atherosclerotic plaque have relatively normal cholesterol levels. Studies have shown that even patients with normal cholesterol profiles have fewer cardiovascular events when taking a statin drug. 3) ACE Inhibitors: These medicines have traditionally been used to treat heart failure and high blood pressure. However, recent trials have shown them to be highly beneficial to those with coronary artery disease even if blood pressure is normal, reducing heart attack death by an additional 26 percent in the heart outcome prevention education. Therefore, the benefits of the ACE inhibitor seem to extend beyond the lowering of blood pressure. This should encourage us to clamor to receive such medication even if our blood pressure is normal. 4) Niacin: The vitamin niacin has long been known to benefit the heart. As early as 1975, the Coronary Drug Project showed that high doses of niacin contributed to a 27 percent reduction in coronary events when compared with placebo. For prevention to work, each person must take control of their health and proactively take steps towards a healthier heart. A good place to start is by becoming a more informed and educated healthcare consumer. I encourage people to get all the information they can, by talking to their doctor, researching on the Internet, and reading. Another avenue for education is healthcare seminars. Houston is going to be hosting Cardeo, a consumer education event, Feb. 12 to15, 2004. This Medical Conference & Consumer Expo will bring together an estimated 20,000 healthcare professionals, patients, insurers, vendors and the general public to discuss the complete eradication of heart disease, which is an extremely achievable goal. The event will move the community towards true prevention. In reality . . . the patient has to be the one to decide to take control and then the healthcare system will move in that direction. Courtesy of ARA Content EDITOR’S NOTE: Jeffery L. Boone, MD, MS, is a consultant in Preventive Cardiology, Stress Medicine and Hypertension Colorado Heart Imaging, Denver; assistant clinical professor of medicine, The University of Colorado College of Medicine, Denver; and chair of the Cardeo Consumer Expo and The Schull Institute Medical Conference.