All positive suggestions and solutions, well and good and encouraging.
Let's speak hypothetically, just for fun.
Suppose a female marathoner and triathlete has a complete physical workup, prior to signing up for what she knows would be her last Ironman. Expensive to sign up, no refunds after three months. She has not been able to run more than 90 seconds...this is a marathoner, keep in mind....lately. Weight good, blood pressure you should be so lucky to have, stellar blood work.
Doctors perform a treadmill running test, stopping too soon; at her age, they are happy the woman didn't come in on a walker, I suppose.
Everything hunky-dory: three weeks later the woman has a heart attack. Workups reveal an ascending thoracic aneurism and a dicky aortic valve, as well as scarring from previous "incidents". But you know females, they have "anxiety attacks".
When asked by the cardiac surgeon if she has considered surgery, she politely refrains from saying whatta nuts? Would I trust doctors who missed all the signs, to open me up like a chicken breast? Instead she considers the statistics, and knows she is better off avoiding the horrendous expense and doubtful outcome, of surgical intervention. She well knows that her importance is not as important as that of a male.
Speaking hypothetically, of course.
6
To me, "very fit" does not mean having good numbers (cholesterol and bp) that are controlled by medication. Very fit means having good numbers without medication.
If you need medication to control your blood pressure and cholesterol levels, then there is likely some underlying pathology.
10
Jane
Touching reading about your brother. As a cardiac surg Physician Assistant for more than 30 years, still tell CABG patients that they don't "graduate" being discharged from the hospital after surgery.
Graduating an Out Patient Cardiac Rehabilitation program, starting a few months after surgery is the gateway back to preoperation work and athletic activities, like tennis.
Exercise, diet and stress counseling are key components that keep people from redeveloping coronary disease. All part of any cardiac rehab program
2
In 1987, my 42 year old husband finished a marathon, had a normal cholesterol, did not drink, nor smoke and was underweight, "fit and trim". We had 3 small children. I am a critical care nurse and one morning he complained of a funny feeling in his chest. By the "look on his face". I knew something was very wrong. Once in the ER, and hooked up, he was having a major Heart attack. In the Cath lab he had a large lesion on the left anterior descending artery "the widow maker" . We were all in shock. He is now 72, has had 4 stents and most recently Bypass surgery. He stopped running, but counts steps, watches his weight, still trim and keeps his cholesterol very low. So while there's no guarantee, being in shape has only serve to strengthen his heart muscle. ( And of course, marrying me!)
12
I'm glad your brother is OK now, but this article might also be about people deluding themselves that they're healthy and "fit" when they're far from it. You make him sound like a person most unlikely to have a heart problem, and yet he's on blood pressure and cholesterol meds. Why? The doctor buys the "very fit" line, but the patient suffered from shortness of breath from minor exertion and ignored it. So I guess whatever he was doing for exercise wasn't so serious that not being able to perform wasn't much of a problem. I know the type, my father a "lean and fit (or so he imagined)" and had the same experience as your brother at an earlier age.
1
While there is a lot of information in Ms. Brody’s article, many important facts are lacking. If anyone receives a recommendation for any form of invasive cardiac procedures, they should do their research carefully. At a minimum, they should read Dr. Caldwell Esselstyn’s PREVENT AND REVERSE HEART DISEASE, Dean Ornish’s REVERSING HEART DISEASE, and Dr. Michael Greger’s HOW NOT TO DIE. They should obtain additional diagnostic opinions of their cardiac condition from cardiologists specializing in non-invasive cardiac care. When anyone receives the diagnosis of coronary artery disease it is often followed by recommendations for stents and often, coronary bypass surgery. When this occurs, the average person is terrified and overwhelmed. They need to step back and research their situation remembering that medicine is a business. Normally the cardiac care unit in a hospital is its greatest source of revenue. A recently diagnosed cardiac patient needs to be skeptical of any warnings of dire consequences if decisions are not made immediately. Get second, third and fourth opinions from cardiologists who treat heart disease with medication, diet, exercise and behavior modification first before they recommend consulting a cardiac surgeon. Moving slowly and deliberately is a wise alternative to forced urgency and rash decisions.
8
There are other risk factors, too.
Jane Brody's failure to mention her brother's rcomplete risk profile yet blame "numbers" is medically misleading and unhelpful to the public.
She should be more thorough and careful!
3
After a mild heart attack that lead to two stents, I too was fortunate to have found Dr. Esselstyn’s book. Wish I’d found it before the event. I thought I had been living a heart-healthy lifestyle, including lots of veggies and high-nutrient juices, but learned from the book what a real heart-healthy diet is. Although I follow it only 95% of the time (salmon once a week and a little dark chocolate), my annual doctor visits are proof it is the way to go. It’s only been 3 years since the attack, so time will tell, but the diet has given me hope that I won’t have another heart attack or need surgery again. I am surprised that few of the comments here mention the importance of diet. Perhaps more attention to diet in the first place could have eliminated the need for some to have had such a severe surgical procedure.
6
My story precisely parallels that of Ms Brodie’s brother, except that it happened 25 years ago when I was 52. I was fit, ran, played tennis, had normal cholesterol, but started feeling exhausted. A bypass was recommended for the same reason. I am now 79 and still playing tennis. What a gift that operation was.
4
For many of us this story is not a surprise. I was active until I was diagnosed with heart disease at age 49 after becoming exhausted just by some stairs. A drug-inducing stent was implanted in my almost-blocked main heart artery and I felt like a million bucks for seven days, when it became 100% blocked and I had my own widow-maker event. The doctors later claimed I must have been "drug resistant". My heart was scarred badly, and doctors recommended a pacemaker and a drug cocktail for life. After feeling sorry for myself for a few months, I stumbled on Dr. Caldwell Esselstyn's teachings regarding diet and heart disease. He gave me hope. Fast-forward six years to the present: I now have a plant-based diet, no prescription drugs, and I exercise daily. Tomorrow is my 8th marathon (and I have also done several 50k ultras). My heart is still damaged, but I am not suffering and actually living well. It is hard not to preach about this: western medicine refuses to truly address the problem of western diets and lifestyles. Actually that should be the next big NYTimes expose story.
11
It’s worth reading Caldwell Esselstyn’s research and what remedies he prescribes to his patients. Hint: no surgery involved.
9
There are several medically inaccurate statements in this article. It sounds as though he had an exercise echocardiogram and not an "echo EKG." patients can have an exercise echo and still be hooked up to EKG leads which it sounds like is what you are describing. Also, arteries are essentially always the preferred method of bypass during that type of surgery and the left internal mammary artery is used first; vein grafts are used only for the remaining blockages which still need to be bypassed. This article makes it sound like his Dr. was doing something novel by using an artery for the bypass, which is not the case.
4
Did anyone, Physician or Nutritionist mention a change in diet to a Whole Food Plant Based one.? It's time for people to take control of their health and not rely on medications and surgery. Watch Forks over Knives and then decide. Its a life changer.
7
@Cindy Nope, a plant-based diet is not the answer, especially not the kind that the misled documentary you mentioned espouses. Almost as bad and misinformed as “What The Health.”
8
Being a lawyer is a stressful occupation. Being a trial attorney compounds that stress. Stress can take a toll on the body and heart independent of healthy heart markers.
5
Thanks for the reminder. Your brother outlived parents who died of heart disease, Always a good goal. Doing what we need to do this side of a cardiac event whether lifestyle or medical intervention also a good goal. The brother who lived. My brother did not probably fearing the worse, didn't act. Thanks again for writing and reminding us why we do these things.
3
This was a happy result for Ms. Brody's brother who could certainly have died of sudden cardiac death. I'm struck by the snarky tone of so many respondents. Many object to her descriptions of the doctors as " top notch '. I've lived in N Y City. Everyone there is anxious to let you know they they have access to nothing but the best. After awhile it is hilarious. Sort of like Garrison Keeler's description of all of the Lake Woebegone children being brilliant. But think about it: These professionals indeed did save her brother's life. One is very grateful and impressed. So she praises them by name. Again it is very New York and perfectly natural. And heart surgery takes a team. There were some unsung professionals on that team too. Let's hear it for the techs, radiologists, nurses, anesthesiologists. And are we all now jealous of people with good insurance? We should instead want others-all of us-to have good insurance. Instead some of the commenters are being pretty hateful. And the superior remarks along the lines of -" He ate ice cream and store bought cakes ! He got what he deserved !" And : " I've eaten nothing but leaves for 77 years and run marathons." Well, good for you but I wonder how much fun you are ? New Yorkers are a contentious bunch.
Ms. Brody does not pretend to be an M.D, R.N. or Phd. nutritionist. She just tries year to year to sort out some of these matters for regular people. I think it is wonderful that brotherly sisterly love is on display here.
21
i love Dr. Sperling's comment that the bypass surgery "should be a life-long fix". wish i knew what that phrase would be termed in rhetoric, such as irony, simile, etc.
1
@edward murphy What a great medical phrase: "life-long fix". I too wonder what rhetorical or literary term could apply. The phrase is also unique in that there is no antonym.
@edward murphy yes, that phrase is misleading as I know of many bypass patients with subsequent clogged arteries and blockage.
Five minutes of my life I won’t get back. I thought this article might contain information useful to me. Instead it was a self-absorbed story about her brother and family. Please provide accurate titles to articles in the future but in any event, I shan’t click on this author again.
7
This is not reporting. It is advertising. Nothing that the primary doctor, the Cardiologist, or the Cardiothoracic surgeon did was in any way special or unusual. This is how healthcare is supposed to work. I hope the author's brother at least had his copay waived by the doctors for the amount of times she mentioned their names in this article.
The author is incorrect in stating that the the Left Main is the "Widowmaker." It is the LAD (Left Anetrior Descending) Artery that is colloqially referred to as the "widwomaker." However, disease in the Left Main coronary artery can certainly kill you.
Using thoracic arteries for bypass in a patient such as this is standard of care. I have no doubt the author's brother received excellent care. In our healthcare system this is the only type of care that should be expected. But this type of thing is done routinely across our country every day.
7
I was sorry to hear what Ms. Brody's brother went through, but he had "top-notch" and "superb" doctors. Of course he did. And BTW it was really nice to read an article by Ms. Brody where for once we were not subjected to a litany of all her daily, healthful activities.
1
Thank you so much for this article. My 73 year old dad was having exercise induced chest pain and read this and decided to go to the hospital on Tuesday to get checked out. Yesterday he had quintuple bypass surgery. He was headed to a stroke or heart attack and I believe that seeing himself reflected here and following up on it bought him more time.
12
Age, sex and family history impart much more cardiovascular risk than the so-called modifiable risk factors.
Little confused here, Jane. You describe your brother as a middle aged man with good health habits...but then finish up talking abut how he has to forgo full fat ice cream, pies and cakes...etc. etc. I know...and practice...moderation, but if you have a serious family history, should he be 'forgoing' store bought pies and cakes?
4
@Roscoe
73 is not middle aged!
3
Dear Ms. Brody,
News flash! Everyone WILL die one day.
And almost no one will know the death is coming...until it has come and gone.
2
Lipids and blood pressure are only half the picture. Insulin resistance is more involved in the development of atherosclerosis than once thought. The TG/HDL ratio is indicative of insulin resistance and a ratio over 3 should be evaluated with a 2 hour glucose tolerance test with an insulin response.. it has nothing to do with sugar but how the body is able to utilize sugar. All patients with atherosclerosis, even with a normal Hgb A1c, should be tested as studies have shown up to 2/3 of the “non diabetic” cardiac patient have abnormalities. LDL & HDL are not cholesterol but cholesterol carriers. A higher insulin resistance is associated with a “packed “ carrier that leads to more atherosclerosis..Normal numbers may under estimate a lipids atherogenicity. Insulin resistance which is associated with what I call BADGE is frequently the culprit after accounting for LDL. (B-belly fat A-age D-diet G-genetics E-exercise or lack of it). Prediabetes or borderline elevated sugars only refers to eye disease risk, not cardiac risk ( the use of HgbA1c for diabetes is based on incidence of diabetic retinopathy). With the fattening of America we need to be more vigilant about these risks and NOT be so surprised when heart disease occurs. Unfortunately physicians are most negligent as identification and prevention beats stenting and bypass any day.
14
Strongly recommend CT Scan for Calcium in arteries and heart vessels for everyone men and women at 45 years.
8
@MBS Yes! I had a CT Scan one year ago on the recommendation of a friend with heart disease. I was 62, fit, no family history of coronary troubles and no symptoms. My CT scan, however, revealed dangerous amounts of plaque in two arteries and a subsequent nuclear stress test revealed blockages I had no idea were there. I've kept myself out of trouble and out of surgery with plant-based eating and upping the exercise routines. Get a CT Scan. They're easy, affordable, and may save your life.
1
@Tom B--CT scans are NOT affordable. Not only that, they expose you to extra dangerous radiation which no one needs.
@MBS There is some controversy about Coronary Artery Calcium CT scans. Steven Nissen, MD, chief of cardiology at the Cleveland Clinic, claims they have no actionable benefit. Other cardiologists disagree
I had a CT CAC scan done on the eve of my 70th birthday. It was not expensive ($98 without insurance coverage) It showed a stratospherically high score of 1,600. I have no history of heart disease, no symptoms and excellent blood test risk numbers.
I had a follow-up stress exercise test with echocardiogram, the results of which were perfectly normal. My PCP started me on a statin, which may be a good idea. Was getting a CT Scan useful? I'm not sure, but thinking about the initial results nearly gave me a heart attack !
1
If this is the take home message, then let's all just enjoy ourselves and forget the nutrition advice du jour.
4
"What will be the healthy diet?" is the eternal question and depends on each individual. In my case, I have been paying attention to the longevity researches and Alzheimer's researches. The longevity researches advise us to control animal protein intake in the middle-age but to increase in the older age. For most people, it is too late for them to prevent various age-related degenerative diseases including heart attack, stroke, cancer etc. due to high intake of animal protein during the middle age. https://www.elsevier.com/connect/controlling-protein-intake-may-be-key-t...
Alzheimer's research by Dr. Dale Bredesen of UCLA recommends us over 45-years old to take "cognoscopy test" in order to find medical issues and to change lifestyle including diet and supplements, exercise, sleep management etc. https://www.drbredesen.com/participants
I learned this in older age, but I am still trying hard to change my destiny.
1
Jeffrey Brody's cardiac history is almost a mirror image of what I went through 14 years ago except I was only 39 years old and I got three stents that got blocked within 6 months.
This article can save lives, especially for folks with a family history of CAD.
3
Thank you for a great write up ... This is almost identical to what happen me.
i was active and ran NYC marathon for eight time last November. Never in my 66 years had I any heart issues or even a hint of that. In May however I found myself with short of breath, thought it was the normal allergy issue.... But it did not stop so in middle of July I went to the doctor and after a EKG and a angiogram ... and within a week I had a tripple bypass surgery.... Now recovering from surgery and what happened.
4
So there is no way to really know how much an artery is blocked without an angiogram or heart attack. It seems a fit person can have 80% to 90% blockage and be asymptomatic. Suppose I have heart disease, 90% blockage and no symptoms. I don't think there is insurance in the world that would pay for an angiogram as part of an elderly physical. And the risks of an angiogram are there as well.
5
@Jim I see a cardiologist due to a family history of heart disease. He does routine blood tests, EKG's, echocardiograms and periodic stress tests. I am also on a blood pressure medication. A stress test can reveal a lot and it is non invasive. There is also a nuclear stress test where you don't walk on a treadmill. I haven't had that one because I can walk on a treadmill.
1
@Sam C. Thanks for the reply. I have had all those tests including a PET scan AND the nuclear stress test where I practically jogged on an inclined treadmill. Yes, a stress test can reveal a lot, but also can reveal nothing. A fit person with significant arterial blockage can remain asymptomatic through ALL those tests which I think was the point of Jane Brody's article.
You can have a nuclear stress test with an exercise lr non-exercise stress test. These test can determine whether you may have a blockage greater than 70%.
1
"Normal" blood pressure and lipid panel are not actually that helpful. The science on what constitutes a healthy blood pressure and lipid range is rapidly evolving, and the role of statins in preventing heart disease is controversial, to say the least.
I'm sorry, but drug-controlled cholesterol and blood pressure levels are not normal by any stretch of the imagination. These are warning signs. Someone needing drugs to control the signs is not a healthy person. For a sick person to get a heart attack is, sadly, not news.
I'm glad your brother is getting better.
14
@NewAlgier
I completely agree with you. Jane’s brother is now doing what most of us are routinely advised to do: controlling our numbers by following a healthy diet low in sodium, sugar, dairy products, saturated fats, and rich in vegetables, rather than taking meds. Besides, foregoing processed foods may bring added benefits, such as a drastic reduction in asthma and (believe it or not) even seasonal allergies, as is the case for my husband. Let’s all start cooking from scratch!
6
Just a quick follow-up to my previous comment. I began self-injecting Praluent (Alirocumab) 8 months ago. My total cholesterol is 83 mg/dL. HDL is 54 mg/dL and LDL is 12 mg/dL!
@Edward Triglyceride? I target TG/HDL ratio (lower is better).
Too low. Extreme. I won’t go on and on. Not physiologically sound,
6
Triglycerides were 104. TG/HDL Ratio 1.9
I am 66 years old. I have seven cardiac stents, five in my left anterior descending (LAD) artery and two in my right coronary (RCA). In 1995 I was working in Saudi Arabia when I felt an unusual, painless"squeeze" after having climbed the stairs.
Cardiac enzymes tests were negative, indicating that there was no evidence of a heart attack. My physician (who reported to me) suggested I undergo an exercise stress test.
As I was working in a remote Saudi Arabian frontier town, I declined and instead flew back to Duke Medical Cardiac Center in Durham, North Carolina. My instincts proved valuable. My left anterior descending (commonly referred to as the "widowmaker") was 90% blocked by plaque, with a "probable" 10% blood clot. I was a walking, kmpending fatal heart attack.
Since 1995 I have received six more stents. In each instance I avoided a serious heart attack by "listening" to my body's symptoms.
Unrelenting heartburn after taking antacids and breathlessness after minornexertion were the obvious symptoms. However, recognising very subtle symptoms is how I have survived since 1995.
Very slight dizziness was one sign. Diffused odd fuzzy feelings encompassing my chest was another. Breaking out in a cold sweat without exertion was a third. Most importantly.... a very subtle and vaugue feeling that something is not right.
My message to everyone, you don't get many second chances with heart disease. Listen CAREFULLY to what your body is telling you. Trust your instincts.
30
This article essentially mirrors my brother's recent experience. He is fit, has good cholesterol and blood pressure numbers but had pain after an exercise workout that eventually went away. Only advanced testing (CT angiogram, catheter exploration) indicated problems that led to multiple bypass surgery which certainly saved his life.
As I am his identical twin, I am going to get a very rigorous check up ASAP!
9
12 weeks ago I had quintuple bypass surgery. I was active, briskly walking 4 to 6 miles per day. On alternate days I would bike 20 to 30 miles. I tried to watched what I ate, although not a stickler, and tried to maintain a reasonable weight. I take statins, a baby aspirin daily and, because I’m diabetic, metformin. But genetics betrayed me. My maternal grandparents, my mother and my younger sister all suffered from diabetes and heart disease. My primary care physician was astounded that two weeks after my normal physical I had a mild heart attack and wound up in surgery. I am lucky. Be vigilant and advocate for yourself. If something doesn’t feel right seek medical assistance immediately. Men especially are too inclined to brush off symptoms that may indicate a major issue. Luck may not always be with you.
11
Family history as her family. Very big indicator.
2
@BG I recommend getting tested for Lp(a). It tends to be the underlying cause of heart disease in people who are otherwise fit but have a family history of cardiovascular disease. It's the strongest genetic risk factor for CVD. The New York Times wrote an article about it earlier this year:
https://www.nytimes.com/2018/01/09/well/heart-risk-doctors-lipoprotein.html
Bypass surgery is NOT open heart surgery, open chest yes. They surgery does not actually go inside the heart but works on the arteries on the outside of it that supply the heart. Brody should know this distinction. Open heart is far more hazardous and difficult.
4
@Daniel Dole
Sorry but you are incorrect. Open heart surgery is a non-specific term used in the medical field to describe any surgery on the heart when the chest is opened. It is not limited to only cardiac procedures that involve opening the cardiac chambers such as cardiac wall aneurysm excision and open valve repair.
Yes this usage is imprecise but that’s the way it is.
6
The array of false paths you need to navigate these days when diagnosed with an issue is overwhelming. Ideally you would need phalanx of trusted doctors and lawyers in the family to make an informed decision. Most people don't have this luxury.
9
This article shows how outdated information can kill you! If you have a family history of heart disease, you MUST insist on have genetic testing to determine if your problem is due to easily treatable PCSK9 or other genetic syndromes. No amount of skinless chicken or exercise will prevent heart disease in people with this inherited condition. Statins do not adequately control this, but there is a new class of medicines which do. These new medications are proven to lessen the risk of heart attacks and strokes. See a lipid specialist if you have a family history like this!
A blood test is all that is required.
HeFH is an inherited condition, which means it is caused by an abnormal gene that can be passed down from one or both parents. This can lead to premature cardiovascular disease, as well as other complications caused by high LDL.
14
I think an important message here is that one sign of a heart problem can simply be a feeling of heartburn (interesting name). I had this immediate feeling one night and had to ask myself if I ever really get heartburn, or was there any particular reason why I might have it right then, to which the answer was no. So when I broke into a cold sweat, I knew something was definitely going on, and headed to the hospital. I had a 99% blockage in the same artery as this article. There was never any great pain, and I had and have a very healthy lifestyle and diet with normal blood tests and no medications. There’s no real answer, other than stress or mild family history.
13
I has balloon angioplasty 23 years ago with three stents placed in the blocked coronary. I was working again within one week. Sports activity in two weeks.
Until late March of this year I have been cardiac symptom free. for over 23 years. During that time I was followed by a cardiologist in my North Eastern city and then in a city of the gulf coast of Florida in retirement. As part of my follow up I have had a stress thallium stress test every other year since the angioplasty. All these test came back negative. Nothing to worry about. In addition, with the use of statins and blood pressure meds all my numbers looked great for cholesterol and blood pressure.
So when in late February I started having a reexperiencing of the angina symptoms in the early morning that alerted me to seek treatment all those years ago. Due to these symptoms I had a Pet Scan, being told it was state of the art. Again there was only small evidence of a very partial blockage.
I was scheduled for a catheter and possible angioplasty and stent. However as the cardiologist told me on the operating table once inside with the wire I had five 70% plus blocked arteries.
Three days later I had quintuple CABG. I'm telling you all this because to my great shock you cannot depend on the numbers or tests to assess your risk. Only the wire of catheter is truly definitive. My confidence in cardiac diagnostic technology is now zero. The wire in the only way to know for sure.
15
I was 36 when I suffered a heart attack 12 years ago due to a clot traveling to a 70% blockage in the LAD. I had felt discomfort throughout the previous 2 whole days. I had been eating healthfully and lived an active lifestyle with a normal BMI. But I didn’t develop the skills to cope with stress. I survived (stent) and has since made changes to my lifestyle to manage stress better. Do not neglect stress if you have a family history of heart disease.
9
@Wesley Ni
Have you been tested for Lp(a)? It's the strongest genetic risk factor for heart disease. And tends to be the cause of it in people who are otherwise fit, healthy or young. The NYT wrote about it earlier this year:
https://www.nytimes.com/2018/01/09/well/heart-risk-doctors-lipoprotein.html
No mention of his LDL levels to assess his coronary heart disease risk level.
Was his LDL < 60? If not, he was not adequately protected against CVD.
Without proper data, articles like this confuse the subjetc.
3
@R. R.
HDL, triglycerides, blood pressure, blood sugar, increasing waistline are all more significant and predictive of future risk than LDL.
But hey, LDL sure is profitable to medicate!
2
@The Pooch You are correct.
And there are other risk factors, too.
Jane Brody's failure to mention her brother's rcomplete risk profile yet blame "numbers" is medically misleading and unhelpful to the public.
She should be more thorough and careful!
There are no gaurantees in life no matter how you do the dance. Our human willingness/unwillingness to accept that reality is at play. If an individual thinks of him/herself as healthy- whether they are or not- affects interpretation of symptoms. Denial - it is more than a river in africa
2
Jane make sure your brother checks his lipoprotein a level. Inherited and can't pick up on basic lipid panel.
6
Good outcome for a NY area trial attorney who undoubtedly has top notch, gold standard medical insurance and care.
For everyone else in America who is not in his position you have my thoughts and prayers.
15
I’m waiting for the day when medical advice can be individually tailored to each person’s unique genetic makeup. For example, studies show that certain ethnic populations (such as South Asians) are at higher risk for heart disease, even when controlling for lifestyle factors. So much so that now some health organizations recommend screening South Asians for type 2 diabetes, high blood pressure and heart disease at lower BMI cutoffs than Caucasian populations, because they already display symptoms of obesity related diseases at what’s considered normal BMI levels.
All the comments espousing which diet to follow also seem misguided to me. I’ve read conflicting information on how efficiently different people’s bodies are able to convert plant-based sources of omega fatty acids, such as ALA into the DHA we’d get from fish. (Some studies show DHA levels have a protective effect on heart health.) Genetics may play a role there too in the optimal diet for each person.
Unfortunately, while most medical research is carried out on men, it’s also carried out on white Caucasian men from the WEIRD countries. There’s not enough research on how diseases affect women and other ethnic groups.
5
My doc suggested a $300 CT scan of my heart. Any thoughts? No insurance pays for it.
1
Is it cardiac calcium scoring? I have been treated for high blood pressure for years, diet better than thAn this man, take some meds for another chronic condition that my primary doc say can raise cholesterol a bit. But had low LDL The primary was not concerned.I am slim, active but not a super exerciser, have hobbies, volunteer and work full time at age 67.
I had some vague heaviness in my chest in two days from days with. 100 temps, blew off to heat. I did notice tiredness on walking to lunch but nit what I thought shortness of breath was I ended up in the hospital transported by 911 with a hypertensive crisis. BP went down, discharged with an appointment in two weeks with cardio telling me I had better LDL numbers than he. Next day back at another hospital with same symptoms. Different outpatient cardiologist ordered the scoring.
Score of 00-100 low likelihood of “hard cardiac event, 100-300 moderate, over 300 high, 1000 or over potentionally severe CHD. My score: over 1500! So now I am on the diagnostic treadmill and super aggressive blood pressure treatment, aspirin, statin, even lower salt diet than I was already following- had never added salt to my cooking, Brown-bagged lunch, did not eat much processed food, no red meat, never smoked, do not drink at all.
Who knew? Pay attention to subtle changes in your body and consider that test.
1
It seems we’re the only ones here concerned with cost. My insurance also pays for very little despite high premiums and the fact that although I’m in my 60’s I have no major health problems. I always wonder where these people are getting their insurance or the money to pay for all this.
1
@human being
Have you been checked for Lp(a)?
https://www.nytimes.com/2018/01/09/well/heart-risk-doctors-lipoprotein.html
"Top notch surgeon" nothing but the best for us NYT readers.
5
Go vegan, stay active and limit your alcohol. People will think you are much younger than you really are.
8
@ClydeMallory
Absolutely. After I got a stent in the widow maker 19 years ago for a 95 percent blockage, I found that any statin or other medication gave me severe insomnia. I was already a lacto-vegetarian, so what to do? Five years ago I went extreme vegan - no oils (no olive oil, e.g.), no nuts, no avocados, and with greens all day with beans, tofu, and other vegetables. Kinda boring but it lowered my total cholesterol from 240 to 130, LDL from 130 to 74, levels that one heart book says makes it almost impossible to have further artery damage. All grandparents both sides and parents died from heart attacks and strokes. No negative symptoms for years. Medications: only a low-dose blood pressure pill daily. I regularly do planks, push ups and other exercise at age 76. Walk 2-3 miles several times a week.
6
seems to me that part of the point in the article and many of the comments is that you can do all of the things you say you're doing, certainly including a vegan lifestyle and exercise, and still end up with blockages and cvd.
1
Or in the very least, plant based.
1
The next to last paragraph implies her brother was a human garbage disposal. Given his family history of heart disease, It's not surprising that he followed the same path.
So many athletic people tell me they exercise, therefore they can eat junk and get away with it. Some can, but many cannot.
3
Newsflash: fish and skinless poultry are meat.
14
Please present more statistics and less anecdata! It's not at all clear what the prevalence of cases like his is, because there is so little actual data in this article.
4
It's like a gossipy phone call from your aunt. All personal story, no reporting. How is this a health news column?
4
So it adds a year or two to your life, good part of it will be in the hospital, seeing your Dr. weekly. Clearly, this is Mother Nature's way of telling you, times up. There are things worst than death, laying in your hospital bed wondering how your going to pay your "top notch surgeon" might be one.
5
My friend, it's added 23 years to my life so far. Insurance aside, I have survived by reading, educating myself, listening to symptoms and being proactive. That may change tomorrow, but on four occasions I listened to my body, visited my cardiologist and pre-empted several heart attacks. Good luck
... we all need it :)
3
I was a 44 year old vegetarian with no family history of heart disease and excellent cholesterol and blood pressure numbers.
I ran 5 miles after work every day.
I had a triple coronary bypass that year.
I read this article and clearly get the point.
If you have symptoms, even minor ones, investigate, despite your overall health or stellar heart-related numbers.
If I didn’t go to the doctor (and was fortunate enough to have terrific medical professionals at every step of my treatment), I would likely be dead right now, a mere year later.
Argue economics, hereditary, and diet. Fine.
But if you start showing symptoms, even ones you can write off as runner’s indigestion, go to the doctor.
It is far better to be healthy and wrong than to be dead.
11
@Grey Cavitt
Get checked for Lp(a). It might be the underlying cause of your heart disease, at least according to the Times:
https://www.nytimes.com/2018/01/09/well/heart-risk-doctors-lipoprotein.html
"Beating heart by-pass" or "off pump bypass". Find someone who does that, if at all possible. Google it.
Usually, you have some time (at least a day or two) to set up the by-pass surgery, use those word to find a surgeon. When you contact a surgeon ask how many procedures they have done. These are two things that can markedly improve outcome and post-surgery quality of life.
2
@JMB
And go to a hospital that does lots of procedures and try to get their outcome data.
2
"be sure to pick a top-notch surgeon who uses the most effective, up-to-date techniques and operates at a hospital with an excellent coronary care unit."
Wow, and it's just that easy. Thanks for sharing your wisdom.
32
What about the differing heart attack symptoms in women? I was recently trying to update my knowledge (drinking and smoking aunt had a heart attack at 73, badly overweight brother at about the same age). I am amazed at how hard it is to find out the most recent medical opinions on women's health. This includes the lack of medical trial information on statins (8,000 men in initial trial I believe). Most people do not start in a cardiologists office when in heart attack avoidance mode.
15
@poslug
Look at nih.gov, Mayo, even Webmd. They do differ and seem to potentially more subtle.
1
How many people have access to the "top-notch surgeon who uses the most effective, up-to-date techniques and operates at a hospital with an excellent coronary care unit." And even if they know that they should be seeing such providers, how many will find them accepting new patients? And how many people have access to "top-notch" primary care physicians who will make such recommendations and have the time to assist in helping the patient find them? Only those with enough resources to afford the "boutique" practices?
38
Excellent article with information for everyone.
However, significantly important message from this article is that EVERYONE NEEDS COMPREHENSIVE HEALTH INSURANCE WITHOUT EXCLUSIONS FOR PRE-EXISTING CONDITIONS AND WITHOUT CEILING ON COVERAGE.
I am not trying to inject politics into this discussion - but logical, good common sense. Only way to protect and expand insurance coverage for ALL will be political.
We need major changes in Congress to move towards Universal Health Coverage. Keep this in mind as you register to vote and VOTE Nov. 6th.
We need a BLUE TSUNAMI.
77
@joyce
I am sending this second comment because I did not show reason why I wrote my first comment.
Note that Mr. Brody is 73 years old -- Very Important Fact.
He would likely be covered by Medicare insurance and may also have a comprehensive supplement. It is possible that his medical care was completely, or almost completely covered by his insurance plans.
Insurance coverage - be it comprehensive, some coverage, or none - will have different levels of coverage.
The junk insurance policies being promoted by trump and republicans is not comprehensive, may exclude pre-existing conditions, may have low ceiling and other mechanisms to limit what insurance company will cover and pay for.
What if patient was 53 years- Mr. X- without insurance but had the same family history and health profile as Mr. Brody?
Would he have continued to hesitate to go to the doctor or ER because he didn't have insurance or money?
Even Mr. Brody, with excellent insurance, hesitated to acknowledge his symptoms for 6 month -could have died during these six month.
Would Mr. X have received the same speed of transfers and acess to specialists and even the same advice?
The article tells us a stent was considered. Certainly a less invasive procedure and less expensive and would be protective -but would that be the best procedure for Mr. X. Or would it be advised because it is a good procedure but less costly?
UNIVERSAL HEALTH COVERAGE FOR ALL !
read pnhp.com-Physicians for National Health Program
38
@joyce
Amen and good Medicare supps or insurance carried over into retirement are expensive! There are many people without Medicar supp. Many people live on SSalone. Many providers do not take Medicare assignment. Observation status is covered under Medicare part B so subject to high copays outpatient care can have high copays. Mr. Brody is very lucky in many ways, health and resource wise. Even older adults with Medicare may not have sufficient coverage. Our health care system is criminal with tragic outcomes. Health care is a human right.
I suspect that as we age into our seventies and eighties we become more complacent and not so focused on our daily health habits - and that's when those "forbidden" cakes, pies, steaks, salts, alcohol and sugars become more attractive and catch up with us
6
Interesting article. I'm an 81 year old very active male - tennis 3T/wk golf 2X/wk, walking 18, Gym 2T/wk, good weight, eat a very heart healthy diet, never smoked, annual physicals with no indication of heart disease. One day feeling unusually uncomfortable with no particular pain checked into the ER which resulted in two catheterizations and two stents over two months. I then got a second opinion at the Cleveland Clinic and discovered I had an extremely high reading of (Lipoprotein a) an inherited trait not treatable that is a precursors for arterial disease not normally tested for in a routine blood tests. Also got the sense I might have been treated differently had I gone to CC i.e. Bypass. Highly recommend cardiac rehab and now back to normal activities with heart meds. Life is still good and I'm much more informed concerning coronary artery disease.
14
@Robert Buys Well said. I have been recommending to other people on this thread that they get checked for Lp(a) as well. It's very common but often overlooked:
https://www.nytimes.com/2018/01/09/well/heart-risk-doctors-lipoprotein.html
Diet and exercise are important, but dealing with stress is just as important. I had a heart attack fixed by a stent. I changed my diet and continued to exercise, but take an anti-anxiety drug to deal with stress. And I am a nicer person now.
25
He did the right thing but he is the exception to the rule ie most people do not have this problem.
On the other end, if you don't have any immediate or chronic heart symptoms, don't go looking for them.
Don't take endless extensive tests/procedure searching for something that cost the American taxpayer trillions of dollars or the individual if they are not insured.
7
Yes. It surely would be cheaper if everyone would just avoid medical care and die before we spend any money on health care. After all it costs quadrillions of dollars.
9
@Sneeral-Thank you for your reply. The solution for the average American is to use common sense.
The person usually the man who never sees a doctor and then racks up a big medical bill since they never took care of themselves or the opposite the person, usually the woman who goes to the doctor every other week with any symptom taking frequent tests, procedures that cost, usually the taxpayer, a fortune.
Add our de facto criminal health care system where billionaire HMO/PHRAMA execs make money before the heath of the average citizen, add in outright crooks that scam medicare etc. and you have our system that costs trillions of dollar more than any peer country with up to 50 million Americans (pre ACA) that have no insurance.
as a cardiologist, I agree, but with 2 points to make:
first, good risk factor control does not always prevent heart disease, as Ms Brody points out. But what it almost always does is provide the patient with warning signs (months of chest pain), that get the patient to the doctor, with an opportunity to get fixed, rather than coming out of the blue with a heart attack in the middle of the night.
secondly , slightly misleading statement by Ms Brody - every surgeon everywhere will use the internal thoracic artery when available - which is about 99% of the time. no surgeon will use vein grafts when arterial grafting can be used. However, with multiple grafts, its usually a combination of arterial grafting to the most important vessels, veins to the less important. the arterial grafts usually take care of one or 2 blocked arteries.
24
This is a great story. I hope Many read it and learn from it, however it is missing one important element, cardiac rehabilitation. All patients who have had events or surgery should undergo cardiac rehab for a variety of reasons, including monitored exercise, risk factor management, peer support, etc. it’s somewhat a disservice to say that a patient can ha e CABG, recover and go back to the tennis court.
11
At the community garden I met many seniors that gave up their heart medicines and went vegan. They all enjoyed good health and lost weight, bags under eyes went away, more energy. I was amazed at the outcome.
15
@Therese Stellato Of course this is s biased sample. The folks who gave up their meds, changed their diet, and suffered from it are either too debilitated to garden or dead.
3
Awesome!
I am a cardio-vascular surgeon in active practice since 22 years . I can safely vouch for a good quality of life and longevity of bypass surgery (called CABG) as I now have a number of patients who are now over 20 years post surgery. They are generally very active and lead a good quality of life . I am not alone in this experience . A number of well conducted trials (the most comprehensive being the SYNTAX trial) have clearly documented the superior early and long term results of CABG over stenting in the vast majority of cases .
Additionally there are 2 major factors one of which (the 2nd one) was not stated in the article:
1. Most cases receive at least one of not more arterial grafts which have a clear superiority
2. Most cases are now done on a beating heart thus doing away with the drawbacks of the heart lung machine . CABG is no longer a 'heart stopping' experience - literally
16
It’s a shame more people like your brother don’t pay attention to the research results of doctors like Dr. Esselstyn who have shown that a Whole Foods plant based diet can avoid and even reverse disease like your brother’s without dangerous surgery. Another lesson of this research is that getting your numbers in line using drugs is not nearly as meaningful as doing it with diet. You have dismissed this research in some of your writings, which is sad because now you see first-hand the results of ignoring this option. There are many who have successfully reversed even worse disease than your brother’s just by adhering to a whole foods plant based diet. Even now, such a diet could help your brother increase his chances against reoccurrence. After all, the surgery can only fix a few spot points of trouble; this disease is throughout the system—which explains why stents and bypass have been shown to have no impact on longevity.
22
@ET
You're right about that diet. Google the doctor to get the links to his published astounding results at his website. Following the diet has plunged my total cholesterol more than 100 points and brightened my life as well as probably my future after a stent 18 years ago.
My situation was similar but my doctors were more proactive. My father had coronary disease and angina that started in his mid-fifties (although he was a smoker). I have always exercised regularly and have normal weight and blood pressure. When my cholesterol level rose when I was in my mid 40s, my doctor insisted I take a stress test before he would prescribe mevacor (there was no lipitor at the time), a statin. My ECG in that test went haywire after about 5 minutes of running altho I felt fine. A thallium stress imaging test showed good heart perfusion but the cardiologist said to go to the ER should I ever feel any chest pain while exercising.
11 years later while hiking I felt short of breath walking up steep hills, which never happened before. I could have ignored it since it was mild and went away if I took a standing break, but I did call my doctor and he sent me to the ER where an echo stress test showed a region of poor perfusion but no infarctions. Later an angiogram showed an LAD blockage. They put 2 stents in right there on the spot. In retrospect, I wish I had the bypass but as of today, 11 years later, I am doing fine. I take heart meds now as well.
5
Yes the facts are true. Sorry that’s the reality for your family. Yet it shouldn’t alarm purple unduly with a “you never know” sense of alarm. I’m sorry he has coronary disease. The biggest indicator for your family is the history, “We share a family history of midlife heart disease:”
Good he has good treatment however others doing the right things with a good internist and no family history of heart disease shouldn’t worry if they have good cholesterol numbers, and are fit and trim. It would be absurd without family history to obsess about being in danger triggered by this piece.
5
To me this is a story of the power of money and the fear of death. It is a hymn to being able to afford the best and wanting to live forever. If this level of care was available to everyone there would be no problem. But not everyone in any country can afford the best cardiac surgeons. But based on my brother’s experience we do a pretty good job of caring for your average person in Canada. This essay given that it is written in the US is sickening.
But as a Canadian why should I worry about the injustices in the US,particularly racial. The US is a very sick society and I worry that our own Trumpistas (Doug Ford) will take inspiration from this narcissistic sickness. And then there is the way the US working hard to destroy the planet. Maybe if we put the country in a dome and let it survive on its own eco-system we would soon be rid of the world’s greatest threat to peace and survival.
I’ve had it. Over sixty per cent of Americans voted directly for Trump or indirectly by not voting. As if Trump and Clinton offered no difference.
Everyday I feel as if I am watching Reservoir Dogs. I think the world really wish you would go away and wait for the rapture entirely on your own.
33
@Allan
This is an article dealing with heart health. It is not an article dealing with politics. It is not another opportunity for a Canadian to tell us how screwed up the USA is. And as far as “ruining the planet” goes look at your own homegrown greedheads. We don’t want your tar sand oil piped to the Salish Sea. It is an inevitable disaster waiting to happen. It’s also one of the least ecologically sound ways to get petroleum products. And please keep your rapacious mining companies at home. Their plans to start a copper mine in the pristine Methow Valley is one example of their disregard for the planet. Let those without sin.......Those in glass houses.......etc.
3
@Allan I get what you're saying but this rambling comment seems to have very little to do with the article save for your remarks about your brother and the inequity of the US healthcare system. I'm heartbroken over what's happening in the US myself but good grief, man, you may want to get that anger under control, it's not good for your heart.
4
Speaking as an American who detests Trump and voted for Clinton, I'd like to tell you to take your belligerent attitude and.... well, The Times wouldn't allow me to say what is in my mind.
5
Family history. Biggest factor when the rest was good. No one should draw a fear that they are in peril.
You could have led with “family history” followed by “slim and fit”.
3
Never ignore serious symptoms of anything. Shortness of breath, new onset of clumsiness or loss of balance, headaches that don’t go away. Pain anywhere that keeps you up at night. These are a few examples. Early diagnosis and treatment could be the difference between life and death.
5
She seems to be warning everyone but everyone doesn’t have the extensive family history as he did. His Dr might have used that as a basis or testing? Did he?
3
A few years ago there was also a new test that looked more deeply at blood factors. The science cams from questioning why people in good condition with no family history had heart attacks. “Large particles” were what a Dr friend said he used as an indicator to prescribe a statin to a person with otherwise good blood works. Insurance companies refused to cover it even though if they rejected paying there was no charge.
It isn’t used now I don’t think because they said they didn’t want to do the paperwork rejecting it.
1
Guys if you feel muscle soreness after a workout and chest muscle in particular and you’re in good health with no other factors that is olaiin muscle soreness - cause and effect- arm muscle too. Now everyone knows if you’re unduly short of breath or have big left arm pain or worse feel like someone’s sitting on your chest get to the ER.
The key thing here is the big family history of heart disease. Other people who are trim d fit d have very good to good cholesterol numbers and no history if heart disease
sad a good internist probably have no problem. Period. His Dr might have had tests of carotid artery, Abdominal aortic aneurysm (AAA or triple A) is a localized enlargement of the abdominal aorta) or other tests of the heart. Perhaps he did. If he had diabetes too it would have been worse.
1
Wow. I'm so happy your brother is okay. A great story. I'm happy for your family and we all appreciate you sharing this. It's wonderful that your brother's doctors listened to him and continued to investigate his systems.
However, I can't help but think of the documented disparities in healthcare in the US - how access & acknowledgement are so key to receiving top-notch care. And, so many communities don't have access and their docs don't listen to their patients.
My wish is that everyone has the opportunity to live long, wonderful lives. Quality care is key.
17
Yeah socialist medicine will fix everything. We can pay for poverty stricken people who have 4 or 5 kids and hate us but expect medical care
Then with their arteries clogged, heart disease from smoking and drugs and alcohol and diabetes, we will give the best in heart care to sustain their wrecked lives. God bless them.
8
Then they go on full disability, kids in social programs on their way to poor health with obesity leading to heart disease and diabetes which is totally related.
2
Good to see this report. The key here is that traditional testing falls far short of understanding what actually causes the risks for developing atherosclerosis. Sugar and carbs cause big insulin releases. Insulin is like shards of glass scarring the arteries. Cholesterol is the band-aid that patches the scars and we blame cholesterol! Cholesterol in it's neutral state is required by every cell of the body. Oxidized LDL cholesterol, ApoB and a heart scan calcium score are reasonable tests that will give people a better idea of what's going on inside. Remember the first symptom for most women is a fatal heart attack.
16
Yup, but his family history is a huge huge factor and having a good internist who might be getting other tests.
3
@Dr Alice Behr It is highly likely that this physician, I assume MD, knows well of what she writes.
"He is now devoted to a heart-healthy diet that includes 'no added salt', lots of vegetables, fish and 'skinless poultry but little or no meat and saturated fat'. Gone from his larder are 'butter', cheese, full-fat ice cream and store-bought pies and cakes."
I am stunned by the dietary advice from these cardiology doctors or perhaps from Jane to the poor brother of hers recovering from the heart surgery. However, American Heart Association continues to sanction the idea that women can add six teaspoons of sugar to their diets each day, while men can get away with nine! No wonder.
It is so unfortunate that we are all misinformed by the organization that has been misleading us so many times without taking consequences.
27
@Wind Surfer
The AHA makes no such recommendation in adding 6 or 9 teaspoons of sugar. This is what I call "fake news" or more likely made-up stuff on the internet. I am a survivor of 4 bypasses 2009 and consume very little sugar or salt.
7
@Mae T Bois
The American Heart Association (AHA) recommends limiting the amount of added sugars you consume to no more than half of your daily discretionary calories allowance. For most American women, that's no more than 100 calories per day, or about 6 teaspoons of sugar. For men, it's 150 calories per day, or about 9 teaspoons.
https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/a...
1
@Wind Surfer Sock it to them, good job.
My husband also had the 'widow maker', and went through a similar experience to Mr. Brody, except he only had one blockage. His surgeon also recommended the thoracic artery be used. Because his legs weren't impacted he was able to begin walking as part of his rehab almost right away.
He recently passed away - at age 90 - of cancer. He got almost 40 additional years from his by-pass. Pretty good return, in my opinion.
34
Past medical studies have echoed Jane Brody's message from her brother's silent progression of coronary artery disease in spite of "good numbers" on cholesterol medication. In 2017 Dr Matthew Budoff stated: “I want you to think that if someone is on a statin or not and they are progressing (meaning the calcium score is progressing), they are failing their current therapy.” In 2004, Dr Paolo Raggi published his study of 500 heart disease patients on cholesterol lowering drugs. Dr Raggi reported that in spite of "good numbers" (an LDL cholesterol of 118), 41 of the 500 suffered heart attacks over 6 years. All 41 had annual progression of coronary calcium score greater than 15 per cent, while those who remained heart attack free, annual progression was less than 15%. Dr Paolo Raggi's study represents a paradigm shift in the management of coronary artery disease. For more see:https://jeffreydachmd.com/2018/03/calcium-score-paradigm-shift-in-cardio...
jeffrey dach md
4
@Jeffrey Dach MD You might do well to heed what the good doctor wrote.
Kudos as we say in the Strava world. Athletes over 70 are a poorly researched group. We have to push for docs to take symptoms seriously. One test we all should get: a calcium score. The usual numbers-cholesterol, bp, etc.- can be outstanding and you can still develop arteriosclerosis.
6
@JEH what has not been explained above when "calcium scores" were noted, is that this is CT scan of heart, when calcification of the coronary arteries are assess for the degree of calcium in them The calcium is apparently the body's attempt to heal damage to the arteries.
Anyone correct me if I have misspoken.
1
Kudos to the team of doctors who have given Ms. Brody’s brother a new lease in life.
Unfortunately a large group of Americans cannot afford the insurance and out of pocket expenses that made his return to health possible.
Eat right, exercise, and make sure your affairs are in order.
20
@Ikebana62 The important question is what is "eat right?"
Ummm, did any editors check Ms. Brody’s claim of a 1-in-200 mortality rate for bypass surgery?
From PMID 17323602:
“Conclusion: Overall, the mortality rate of coronary artery surgery is low, at around 2%–3% (Keogh and Kinsman 2004), although this benefit is offset by a complication rate of 20%–30%. Furthermore, post-surgical neurocognitive impairment is of concern (Wolman et al 1999; Newman et al 2001)." [See also the whole book: David Jones, Broken Hearts: The Tangled History of Cardiac Care (2013) on the cognitive effects of being on a heart-lung machine.]
Also : “Thirty-day mortality [of] 2.44% in 2011–2012…while 1-year mortality [of] 6.25% in 2011–2012.” PMID 25849679.
Hardly 1-in-200, or 0.5%, Ms. Brody’s editors. (And really easy to check.)
2%-3% is FOUR to SIX TIMES Ms. Brody’s rate. And, of course, she conveniently fails to mention the 20%–30% complication rate.
The Cleveland Clinic considered its bypass surgery on my own father to be a success, despite it putting him him on permanent dialysis and ruining the remainder of the rest of his then-shortened life. Selecting surgery was a fatal mistake. (Not that elective stents would have provided any benefit. See PMID 26559572 and 24296791. As in all medicine, just follow the big money…)
20
@SRP I’m very sorry about your father and agree the risks of surgery are sometimes much greater than the patient (or doctor?) knows. (Sometimes a specialist surgeon probably doesn’t even learn of the health events that follow a surgery as they can be precipitated by the surgery but not related to what the surgery was targeting). Having said that I wonder if in this case the 1/200 number may be accurate - perhaps it’s compared to people who get a different treatment.
@S to the B
The article is soundly based on medical evidence. The mortality in elective bypass surgery is indeed under 1 % . Additionally now we surgeons ( I am a CTV surgeon in practice since 22 years) perform bypass surgery on a beating heart and this does away the drawbacks of the heart lung machine. In fact bypass surgery is indeed no longer a 'heart stopping experience' - literally. Various well conducted multicentric trials have clearly shown the advantage of bypass surgery over stents in the vast majority of cases . The most important has been the SYNTAX trial .
" He’s lean, physically active and takes medication to help keep his blood pressure and cholesterol levels normal."
What medication was he taking?
6
I was 72 when I was stricken. It came as a bolt out of the blue. I had been working outdoors in the hot sun and had become dehydrated. After shifting a flagstone I noticed a sudden a weakness. I sat down then slowly walked into the house and told my wife I wasn't feeling well. I went upstairs, took a shower and took an aspirin. I was still feeling poorly when I lay down on the bed. I called 911. By then the pain in my chest had become very pronounced. I told the operator what was happening and she said an EMT crew was on its way and could I move downstairs. I did. The crew arrived within 8 minutes of my phone call. I was in agony. They gave me vaso-dialating nitro-glycerin tablets and strapped me in a gurney and off we went to the hospital. After an exam I was loaded on a helicopter and flown to a cardiac surgery center where I had double bypass surgery.
I had never had a problem with my heart. I had regular physicals including EKGs. I was on a statin to reduce cholesterol and the levels were within the good range. I was physically active. I was asymptomatic when the coronary blockage occurred. The surgeon told me that taking an aspirin had probably saved my life.
Now, four years later, I work out at our local gym. I'm doing yoga as well as resistance exercises with free weights. I see my cardiologist twice year. I have passed several dynamic stress tests. I urge everyone to have regular cardio exams. There are no promises once one has coronary artery disease. Enjoy life.
21
PART 1: As Mark Twain famously said, "It's not so much that people are stupid, as that they know so much that isn't true." Today's exemplar? Jane E. Brody, "healthcare reporter" for the NYT. Ms. Brody's supposedly "heart healthy" brother who was thin and physically active yet still had heart disease (i.e., clogged arteries). Hmm. What to think? How can this possibly be explained? Guess what? You don't get clogged arteries just out of the blue, they don't come from "bad luck," nor are they genetic/hereditary: You get clogged arteries (i.e., atherosclerosis) from a BAD DIET. It's the lousy food you eat. Ms. Brody and her brother do not share a family history of heart disease, they share a family history of poor diets (which lead inexorably to heart disease). Thus understood, the overwhelming preponderance of cases of atherosclerosis are self-inflicted, the results of lifestyle choices: Eating bad food. To dispel more delusion and misinformation unwittingly brought to us by Ms. Brody: If your so called "great numbers" can only be achieved through taking blood pressure medication and cholesterol lowering medication, you're not heart healthy, your already sick. People with good diets don't need constant, expensive medication to achieve good numbers, they have them naturally, sans medication. More bad news for Ms. Brody's brother: You cannot outrun a bad diet. Sorry. (See Jim Fixx.)
34
@Greg Gerner When I had coronary bypass surgery, my diagnosis was not that I had a lot of plaque on the walls of my arteries. I had followed a healthy diet for years. The attending physician explained that dehydration was probably the precipitating factor that caused something in an artery to break loose and travel until it reached a point where it could not pass. Then it began to block the artery that fed into two smaller coronary arteries. The surgeon who performed the double bypass on me explained that a heart attack can happen at any time to very healthy people. My health profile was exemplary. I took good care of myself. Dehydration and physical exertion under a hot summer sun - not poor diet - was probably responsible for precipitating the blockage. Enough said.
3
@Greg Gerner
Agreed that diet plays a role, although your comment assumes that we know exactly what is or isn't a healthful diet, for individuals or for populations.
I'd love to move past the "clogged arteries" thing, it's just a bad metaphor. Arteries are not simple pipes which become "clogged" by directly receiving chunks of [whatever].
1
Whole food, plant based, no oil !
3
I hope he realizes how fortunate he is that Jane Brody is his sister!
1
PART II: As for Ms. Brody's brother's purported great medical care, while the autologous transfer of a thoracic artery might buy him a little more time than stents, unless he changes his diet, that bypass too in time will clog up. (Alas, it turns out that thoracic arteries can't outrun a bad diet either.) Sorry, Jane. This will not end well for your brother. Please spare us your critically important messages; please give serious thought to getting out of the healthcare advice business. You're doing real damage here.
12
Is it just me or does anyone else notice that people in the last few months in their replies to Jane Brody’s articles have been very critical, sarcastic, angry and demeaning to her. What’s wrong with you? IMHO Jane Brody is a treasure and a terrific reporter. I look forward to reading her excellent articles every Tuesday. Keep up the great work Jane!
77
Yes! Can’t we leave comments that are not surly lectures?
25
@Cluny Brown...I agree one hundred per cent. Where is this nastiness from?!?
Dad had a heart attack at 71. He’s now stented. His dad had a coronary history too. What makes things challenging for diet is dad has Irritable Bowel Syndrome so he cannot simply eat all vegetarian or the result can be diarrhea.
5
Plant based whole food no oil will dramatically improve the IBS. Proven.
4
@Barbara I have IBS, and plant foods are NOT my friend. I have to be very, very careful of what I eat. Look up FODMAP diet to become more educated on this issue.
2
@Mina Check out Teicholz's book on eating much more fat meaning for saturated fatty acids and monosaturated fatty acids. Most avoid processed seed oils.
The Big Fat Surprise.
1
Your comments on exactly what doctors your brother saw and their qualifications are entirely inappropriate. How do you as a non-physician know how qualified they are? You might want to do an article on how patients might choose a "top-notch" doctor.
also your comments on fat and cv risk are not accurate as there is a growing controversy as reported in the NYT of the risk with carbohydrates but not fats for cv disease
17
This is all well and good for those with ample health insurance. The rest of us will just have to die an early death. Please support candidates who support universal health insurance for all Americans.
151
Nobody wants to hear it, but there is quite a bit to our health that is out of our own control. It might make you feel like you can achieve some kind of immortality and assuage your fear of death to believe otherwise, but the reality is that any one of us could experience a heart issue, regardless of lifestyle choices.
Moral judgement of people based on their level of "healthfulness" is wrongheaded and harmful. You can do all the right things, and still have a heart attack, become diabetic, get cancer, etc. In the end, we will all die, no matter how superior we feel our lifestyles are.
66
@rockstarkate Most all of what you have written is wrong, except we all are going to die.
Besides not or never smoking, avoiding drunkenness, buckling your seat belts, watching where you step, avoiding motorcycle riding, the single most important thing one can do is determine what is the most appropriate diet (which is controversial), and eat it seriously until whatever takes you out, i.e. kills you.
This article is so depressing.
After writing for the NY times about health for decades, Jane Brody still doesn't have a comprehensive understanding of heart disease.
Her 73 y/o brother, who was treated for hypertension and hyperlipidemia, and has a family history of heart disease develops heart disease. Is this surprising? What is the lifetime risk of developing heart disease in a man with these risk factors?
You say your brother is trim and fit, but it would be nice if you defined those terms. What's his BMI? What's his body fat percentage? What's his waist to hip ratio? Has he been tested for insulin resistance? Does he gain weight centrally?
In terms of his family history, has anyone measured his Lp(a). Has he had any measures of advanced lipid testing. Do you know his LDL particle number, size, and density? What is his triglycerides, HDL, or VLDL?
After reading the comment section, you can get depressed about diet advice. He should be a vegetarian. No! That's not good enough. VEGAN. No! LOW CARB. CARNIVORE. KETO!
There is no clear and cohesive understanding of mechanisms of heart disease in this article. The role of weight gain, insulin resistance, and its effect on lipids is completely ignored.
SAD!
19
Great article.
Whether or not being physically fit prevents any particular disease, being fit definitely lengthens your odds once you are sick. In this case the patient was able to withstand a demanding heart surgery at an advanced age with great results. The same is true for any other number of valuable treatments that can lead to recovery when the dice turn up snake eyes.
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@JRF
And it makes recovery - from heart surgery, or knee /hip replacements, or anything, much easier and usually more successful.
13
@JRF Thank you for your important post. I've been temporarily disabled and have taken care of family and friends after joint replacements and debilitating fractures and have learned that it's much easier to cope if you're light and fit enough to be able to shift your own weight. It can be the difference between being able to stay at home and needing professional care.
7
This article told me very very little! "Even if your numbers are good?" What does that mean? By chance, does it mean even if you have low LDL cholesterol?
4
@Steel Look up and read books by Nina Teicholz on dietary fats, and by Gary Taubes on being fat, and sugar (easily digestible carbohydrates.
1
@Jim N
Preacher, choir. Read 'em all! Thanks.
Good article. Someone at the New York Times should research and write about pulmonary embolism. A person with chest pain and shortness of breath could very well not have heart disease but have pulmonary embolism. The seriousness of a PE varies. 25% are lethal. There are no age restrictions for getting a PE. Causes of the clots can be surgery, birth control pills, Tamoxifen, Evista and other prescription drugs (especially those with estrogen or pseudo estrogen), injuries/bruising from falls or other accidents or genetic factors (which a PE patient should be tested for). I had a PE that was detected by a CT scan with contrast (ordered due to family history of CAD (I don't have CAD)). I had refused a stress test, because my brother went into cardiac arrest while on the treadmill taking a routine stress test. I was lucky that it was a single PE, did not need hospitalization and it dissolved within 6 months after taking anti-coagulent prescription daily. Many people have massive or multiple PEs and need to be hospitalized initially with heparin drip. I do not see anything about pulmonary embolism in the mainstream media. Please research and write about this. Lives could be saved through awareness. I searched "pulmonary embolism" on the Times website and what came up were obituaries. Yes, I knew that PEs kill, but I did not know that you could have it without knowing it and, with proper treatment, survive.
11
Describes my father who ended up with a quadruple bypass. Pick your physician well because they are not all equal!
4
I recently under went a quadruple bypass 30th Aug of this year, And I'm only 39 yrs old. I was a semi professional sportsman with a good diet for the majority of time and a high level of fitness,the prognosis was hereditary. The symptoms as described in the artical are the same as I suffered, but in the space of 5 months went from tightness in the chest, aches in the arm to not being able to walk 25 meters. I was lucky to have one of the top surgeons in the country to conduct my opp and he used all arterys as replacements, some from behind the chest and others from my forearm. I'm now four weeks post opp, out walking twice daily and apart from a few aches and pains feel a million times better. (Nothing been mentioned in the comments but my biggest struggle has been lung/diagphram capacity.) I have quit red meats,soda,processed foods,alcohol,chocolate, sweets etc. Drastic but with a 10 yr old son and 15 yr old daughter it's a no brainer,as I need to educate them if it is genetics on a healthier lifestyle.i will have a good look into the plant based diets from the links etc. As it is something that interested me before all of this. But most of all guys don't ignore what your body is telling you, even if it's the smallest things and odd pain here and there,as the night before my surgery the surgeon told me he couldnt believe i was sat there with him and hadn't had a catastrophic heart attack, that in his words I wouldn't of come back from.
20
you're so correct. Guys should not ignore what their bodies are telling them. Of course, for women, our doctors will ignore what WE're telling them.
@Jamie So, Jamie, how tall are you and how much did you weigh, if pounds if possible? Stone are not that accurate.
I always enjoy your columns and as someone with a family cardiac history, today was enlightening-right up until the last sentence. Burning wood for heat produces fine particulate pollution, which causes heart attacks and strokes. For example, see this BMJ editorial re its effects:
https://www.bmj.com/content/360/bmj.k167/rr-3
Please encourage your brother to switch to a cleaner form of heat for his sake and for his neighbors.
11
Full fat dairy is actually better for you, if you believe the NT Times.
Is Whole-Fat Dairy Good for the Heart? From the NY Times
Dietary guidelines suggest substituting fat-free or low-fat dairy for full-fat products, but a new study questions those recommendations.
By Nicholas Bakalar
Sept. 11, 2018 Published in the Science Times section 9/18/2018
8
Jane Brody byline + heart disease = same old tired outdated disproven "advice" to cut out all red meat, animal fat and salt. How about starting with not buying the packaged food in the first place?
17
Top notch! Superb credentials! Please, Jane Brody, do tell by what metrics you are judging your doctors? I consider myself to be fairly intelligent and somewhat savvy, but sorry, the true metrics of the competence of any doctor is in data they will never allow to be made public.
22
I am amazed there is still as much arguing about this as there is. There have only been two doctors to prove with published, peer reviewed science that heart disease can not only be stopped, but reversed. Both Drs. Ornish and Esselstyn used the same whole food plant based protocol to accomplish this.
Can any other dietary protocol claim this? If so, please let me know who else has published peer reviewed results that can reverse heart disease. If not, why isn't this our DEFAULT diet, considering heart disease is the #1 killer in America?
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Well, I think the trouble with Esselstyn's and Ornish's research is that their samples have been very small and also not randomly assigned. And because a vegan, very low fat diet is challenging for those of us accustomed to more conventional fare (I'm learning my way around one right now), it's difficult to recruit and assign subjects for repeat trials. Maybe, too, the $$ aren't there to support this kind of research? I don't know that; just a guess.
2
@Elizabeth If you are looking for a larger sample size, how does a prospective study that consists of 120,000 participants over a period of 40 years sound? The Adventist Health Studies (1 and 2) show that the group of participants who consumed animal products experienced 178% more incidents of fatal heart disease than those those who did not consume animal products. The study controlled for income level, education level, exercise levels, and other lifestyle factors since all participants were part of the same Seventh Day Adventist community.
@Andrew
Ornish and Esselstyn recommend a low fat, low protein, "all starch" vegan or near-vegan diet. If that sounds healthful, successful, or appetitzing to you, knock yourself out.
Neither one of them actually reversed heart disease. Their diet + exercise + smoking cessation + counseling improved some _indicators_ of heart disease risk, while the control group gets none of those things.
At age 54 (now 56) I had 5-way OHS. From 1989 to now, I've competed in over 100 endrurance events (mostly triathlons incl. 3 full Ironmans) with many podiums and wins. I was trim and still super fit. Now I use a ketosis diet. No dirty carbs and a high HEALTHY fat adapted diet. Before it was a low fat/high carb diet(bad choice)constantly inflamed arteries and body. Get your your lipid cell density measured. Mine were extremly (as they say) sticky. Also, my anatomical structure of the arteries supplying blood flow to the heart were very flawed. Not supple. Also, inflamed as many endurace athletes with intense training(many studies on this). High carb low fat diets garantee this inflamed overall condition. Now, I include healthy pasture raised (not housed) meats, and vegetables. No alcohol at all now, as maybe abnormal higher consumption of wine(dirty carb)might have been an issue. No grains whatsoever now, not even whole grains! Real butter and nuts. Still race a two or three times a year and cut my training time in half at a lower overall body weight(under 170lbs at 5'8"). Much lower because the carbs are lower(under 200 grams a day of the non-dirty ones). Now my my lipids are fluffy and non-sticky. Overall cholesterol is 30% lower without statins. Blood pressure is constantly 115 over 90. Conventional wisdom I threw out the window. Not saying I could of avoided the disease, but am pretty sure the old conventional ways had something to do with it.
12
How could he think that he was eating a healthful diet when it included butter, cheese, full fat milk, ice cream, red meat, cakes and pies? Reading labels should be standard practice for anyone trying to eat a protective diet.
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A friend just had cardiac bypass and developed pneumonia and infection. As the cause could not be determined, patient was left in induced coma rather than enabling system to operate full capacity. This entailed feeding tubes and oxygen. After two weeks, an infectious disease specialist is called in, and a week (or two?) layer, it is the feeding tube itself that is suspect. Patient now had repeated bouts of infection, and a month later, he is finally waking up. After two months in hospital, and entubated, he is weak, cannot talk, develops bedsores. Finally they are able to send him to intermediate care. However, they give him inappropriate diet there, and another emergency entails putting him back in the hospital. He is a diabetic, but why is that facility giving unhealthy food even for non-diabetic? The original bypass operation was middle of April, and this friend is released for home in mid-September.
9
Once again, I draw your attention to the research and publications of Caldwell Esselstyn Jr, MD, T. Colin Campbell, PhD., John McDougall, MD, and Dean Ornish MD. Conventional cardiology has been failing us for decades and your brother’s case is another unfortunate example. The fact that he developed hypertension alone was a warning sign that his heart was under stress. We have been fooled into thinking that rising blood pressure is a part of ‘normal aging’. This is not true - it is; however, a normal sign of worsening cardiovascular disease.
Ironically, the same people who call a whole-food, plant-based diet (without added oils) extreme, welcome open-heart surgery as a miracle. When will we ever accept the truth as we have with tobacco use? Remember how difficult is was even for physicians to finally jump on that wagon? This situation is no different, except that it affects the health of many, many more people.
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@Jennifer Jones, NP
T Colin Campbell, author of the China Study, should be immediately and summarily ignored.
The actual data is based on casein, but Campbell extends the findings to cover all animal proteins, a finding the data does not support.
Don't take my word for it. Do as I did and investigate yourself.
Specifically, pay attention to how the best studies are set up and evaluated, and compare that information to Campbell's study design and analysis.
You might start with Denise Minger and the Weston Price Foundation.
4
I am curious about all of this evidence people claim to have seen that avoiding oils and fats of any kind, even avocados, is some kind of Panacea. I suppose it's the same kind of evidence that says that practically everyone should be on statins over a certain age... I just don't know if I believe it. Eating a high-fat diet has saved my life. Maybe that's just me, but maybe that's part of the point. What works for one person clearly doesn't always work for another person. We need medical care that is more individualized and less determined by a chart in an insurance company office.
1
I realize that coronary CT angiography is an excellent technique to diagnose anomalous coronary arterial anatomy in adults. For detection of coronary artery disease, positive-predictive values are in the range of ~64 to 91%, and negative-predictive values approach 99%.
A limitation of the technique, however, is its lower specificity in heavily calcified vessels, which are more common in elderly patients (CT angiography also tends to overestimate the percentage of stenosis compared with intravascular ultrasound).
The ratio of coronary to aortic pressure measured at maximal flow, called the fractional flow reserve (FFR), represents the percentage of normal flow across the stenosis. Lesions with FFR values higher than 80% are considered nonischemic and do not require revascularization. Conversely, PCI may be justified for a lesion with an FFR lower than 80%.
After a PCI is undertaken, the lesion’s length, true diameter, eccentricity, and degree of calcium involvement can be determined by intravascular ultrasound catheter-based imaging, or with reflected light by optical coherence tomography to depict intravascular anatomy and to guide a subsequent PCI.
However, neither intravascular ultrasound nor optical coherence tomography can substitute for a functional determination of ischemia by FFR calculation.
1
My marathon running partner almost did a face plant. He had had pain for years, went to his doctor, and ran the top off of treadmill stress tests. He was told not to worry. When he could hardly walk he was finally given the correct tests. Bypass surgery was scheduled for the next day.
This was almost twenty years ago. The medical profession has gotten better at recognizing heart disease in the very fit, but it looks like they have a way to go.
I guess it’s still up to us gym nuts to push our doctors when we think something is wrong.
11
My "heart healthy" (vegetarian, low- to no-fat. salad loving) mother got Alzheimer's disease and heart disease and died of a heart attack. My carnivorous father who chowed down on salami and chose steak over broccoli every time was healthy as a horse. My friend's husband, a physician in his early 70s, is now in the throes of progressive dementia and heart disease after decades of a heavy fitness regime and that famous "heart healthy" diet.
I'm not suggesting that salami is health food and I know that anecdotal evidence is not science, although there's plenty of anecdotal and research evidence in this direction. What we know about nutrition has evolved in the last few decades. FAT IS NOT THE ENEMY. MEAT IS NOT THE ENEMY. There is nothing inherently dangerous about eating meat, but there is inherent danger in depriving the body and brain of fats. The types and quality of meat and fats do matter, however, and an omnivorous diet that includes fruits and vegetables gives us the best of all worlds.
What none of us needs is the processed grain-heavy, corn syrup-laden junk food that passes as nutrition in the SAD (Standard American Diet).
And let's not overlook the actual point of this article. Regardless of which diet or exercise program we have total faith in and follow like a religion, we have no guarantee that mortality isn't around the corner. Listen to your body, respect your symptoms and for goodness' sake, go to the doctor.
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@Round the Bend Processed meats kill off some of your intestinal microbes and are clearly bad for your heart, as studies have shown. The processing is done to preserve meats from spoiling. This doesn't do much good for those microbes you have been collecting that are good for your health.
1
Genes.
This an eye opener for me. Thanks Dr. Jane Brody for this article. Sorry to hear about your brother. Glad that he has recovered thanks to the timely medical procedure.
We get chest pain due to acidity also. That’s where the confusion lies. Anyway periodical health check up will help for sure.
While I've admired Jane Brody['s writing for years [I still use Good Food Book], this seems a bit alarmist to me. I agree that even seemingly minor issues like slight pain/discomfort, shortness of breath, etc. warrant a visit to a doctor and/or cardiologist as her brother did. Nevertheless, I can imagine hundreds of people who have been taking various medications to control blood pressue and cholesterol and have the "right numbers" and who also have had a stent implanted racing to a cardiologist demanding to know why by-pass surgery wasn't done.
4
I like Dr Colin T Campbell's view. "Heredity loads the gun but diet pulls the trigger". Yes my father ate meat ,dairy and oils and processed foods and had a Heart attack but it was because of Heredity .
11
Glad he's getting better!
4
A 73-year-old male whose male relatives all had early heart attacks and died from heart attacks ignored persistent chest pain for six months? Please tell me you're kidding.
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@Gary E. Right?!? Where was this guy's critical thinking skills? The article definitely needed to emphatically state that family history is a key factor in determining heart health! Too bad it failed to do that.
No mention of the effect of stress on heart health here. Along with the full-fat ice cream, he may want to ditch the trial attorney gig.
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The best preventive measure to achieve heart health and avoid heart disease is a 100% whole-food, plant-based (WFPB) diet. It will help you prevent or reverse every other chronic disease, including type 2 diabetes, high blood pressure, obesity and auto-immune disease. Visit forksoverknives.com; nutritionfacts.org; dresselstyn.com (click on "Successes" on the toolbar). Also see https://www.forksoverknives.com/category/success-stories/#gs.WNJA1iY
Forget about keto, Paleo, and the other diets based around heavy ingestion of animal foods. A healthy plant-based diet is the ONLY diet that has been shown to reverse heart disease:
http://dresselstyn.com/JFP_06307_Article1.pdf
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@DrVeggie
Also see Gary Taubes and Michael Eades, M.D. to truly and thoroughly evaluate carbs vs animal proteins in diets.
Pay attention to how hormones, such as insulin, behave in processing carbs vs proteins (and fats.)
It's not the calories.
5
The best preventive measure to achieve heart health and avoid heart disease is a 100% whole-food, plant-based (WFPB) diet. It will help you prevent or reverse every other chronic disease, including type 2 diabetes, high blood pressure, obesity and auto-immune disease. Visit forksoverknives.com; nutritionfacts.org; dresselstyn.com (click on "Successes" on the toolbar). Also see https://www.forksoverknives.com/category/success-stories/#gs.WNJA1iY
Forget about keto, Paleo and the other diets based around heavy ingestion of animal foods. A healthy plant-based diet is the ONLY diet that has been shown to reverse heart disease:
http://dresselstyn.com/JFP_06307_Article1.pdf
12
Dear Jane, I am so sorry to hear about your brother. I had a 99% blocked widow-maker artery at 39 and was very fit too. I started the Lipoprotein(a) foundation because 1 in 5 of us have inherited a fatty, sticky lipoprotein particle in our blood called Lipoprotein(a) [Lp(a)] that causes early build-up of plaque and an increased risk of blood clots and diet and exercise have little to no impact on it. You can find out more information at www.TESTLpa.org We need to spread the word that you can INHERIT clogged arteries and a simple blood test once in a person's life that costs as little as $39 can diagnose not only you, but your whole family, as being at increased risk for premature cardiovascular events or death due to high Lipoprotein(a) [Lp(a)]. #TESTLpa
You probably read Bob Harper's story in the New York Times Science section Tues, Jan 9th, 2018 - he had the same thing. Please watch your brother for PTSD and depression after his event and tell him that there is probably a genetic reason for his disease and to not feel guilt or shame or put-up with lifestyle shaming from anyone because you can be young, fit and have a heart attack!
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@Lipoprotein(a) Foundation,
A preliminary research presentation concluded that a defined plant based diet can significantly reduce Lp(a) and other atherogenic lipoproteins and particles. I haven’t seen the publication in a peer reviewed journal yet; the link provided is to the presentation.
https://www.researchgate.net/profile/Rami_Najjar2/publication/325825851_...
I’ve also read that moderate changes have moderate effects; that may explain why previous studies of diet did not see any reductions in Lp(a): advice to eat more veggies, or less meat, or less processed food may simply be insufficient to see significant benefits.
5
@Lipoprotein(a) Foundation
Flagging depression, or some version of PTSD, for a post bypass patient is important: it happens. It is not only a "psychological" reaction - the surgery is a massive assault on the body, even tho' it is life saving. who knows how it affects everything else. Excessive irritability and anger are one big sign -not just depressed affect.
2
@Dr. J
Any "plant-based" diet which claims to prevent or reverse any health condition always involves the removal of _sugar_, refined carbs, and other highly processed foods.
Yet somehow all the benefits are attributed to the veganism, while ignoring the sugary elephant in the room.
Best wishes for a speedy recovery for your brother. BTW, I definitely want a doctor who talks about how you should not "dillydally."
15
My experience was that a normal EKG had my internist sending me away... three times (friends seeing my distress made me persist). Finally he threw up his hands and said, “What do you want me to do? Send you to a cardiologist?!” Turned out I was in heart failure. Could have been sexism, could have been my age (47). Normal EKGs don’t prove much. I don’t know why they’re still in use.
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@Nancy
I've heard many stories such as this. I was having intense chest pain and after 5 minutes a male cardiologist diagnosed me with "anxiety." I sought a second opinion from a female cardiologist who asked pertinent questions and diagnosed me with coronary artery spasms. She prescribed medication and they are now under control.
I recommend a book that was just published "Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave women Dismissed, Misdiagnosed and Sick" by Maya Dusenbery. Eye opening!
8
Ms. Brody wrote: "He is now devoted to a heart-healthy diet that includes no added salt, lots of vegetables, fish and skinless poultry but little or no meat and saturated fat. Gone from his larder are butter, cheese, full-fat ice cream and store-bought pies and cakes." I thought he ate that way earlier? But I guess not.
He should go further, and ditch ALL animal products. e.g., chicken has been bred to have up to 50% of it's calories from fat -- even without the skin. All animal products contain saturated fats and cholesterol. And that's just for starters.
He should also be eating beans and whole grains, fruits, lots of greens, and some nuts and seeds, in addition to "lots of vegetables." And obviously, eat whole foods -- minimal to no processed foods.
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@Dr. J Agreed. Chicken without or without skin is NOT healthy, and it IS meat. I would add that he should spend the extra pennies to buy organic produce, grains, and beans.
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@Dr. J
I recommend some reading on how metabolic syndrome and insulin are affected by a high-carb, low-fat diet, versus a low-carb, high-fat, moderate (animal) protein diet.
The science is illuminating.
5
I think it is incorrect to refer to coronary artery bypass surgery as “open heart surgery“.
5
Not incorrect at all. What else are you thinking open heart surgery is?
4
My father had great numbers and was fit right until he died of a massive heart attack at 65 (in 1994). His BP and cholesterol numbers were good without medications. However, his mother died of heart disease in her late 50s.
It took years for my family to figure out why he died so early. He never had breathlessness. He did have left shoulder pain diagnosed as job related bursitis. He also had a history of severe gum disease in his 30s which we found could cause inflammation elsewhere in the body. Finally, he worked nights his whole career but slept in two shifts of 3and 4 hours so he would be up during the day.
Meanwhile, my mother had severe COPD from smoking. My brother and I never thought our father would go first.
10
I had a very similar experience in April 2017, thankful that my cardiologist did not allow me to ignore the symptoms that led me to have a quintuple bypass surgery at age 59. In my case also, no conventional risk factors before surgery and good physical condition... But, in retrospect, high lipoprotein-a [Lp(a)] levels were likely the flame that caused extensive atherosclerotic pathology in my coronaries. This is an inherited condition that affects 20% of the population - most of whom have no clue that it affects them. Lp(a) levels are not affected by statins, diet or exercise. Fortunately, there are now trials underway to evaluate the impact of a new class of drugs (antisense oligonucleotides) that may help to lower the risks associated with Lp(a). As two of my three kids also have this condition, this gives me hope - for all of us!
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@David (Van Wagoner) For much more information on Lp(a), please see: https://www.lipoproteinafoundation.org/.
1
For more information on Lp(a), there is a very good evidence-based website:
https://www.lipoproteinafoundation.org/
I’d my own vascular scare. I was active, a vegetarian but I didn’t watch my diet for fats and oils. I are butter and yogurt, cheese and veggie pizzas. I ended up with an occluded artery in my leg which causes pain when I walk. One vascular surgeon recommended a leg-bypass operation, another surgeon drugs and exercise. I’m trying the exercise remedy. It’s spooky to me maimed like this, not to be able to hike or run. I went on an Esselstyn-Ornish plant based diet, no meat or dairy, no fish and no fats or oils, not even olive oil. I feel better. I believe this diet will work. Oh, if I’d only started to eat better sooner!
29
My father lived to 93 years old because 15 years earlier he had a quadruple bypass. Otherwise, he was rapidly succumbing to silent ischemia with tiredness as his only symptom. We credit his longevity, not only to the extraordinary skill of the cardiac surgeon but to the fact that his primary care doctor also was a cardiologist who recognized the subtle symptoms he was exhibiting. I believe that older adults should be evaluated by a cardiologist every year or two, especially if they have known risk factors for CVD.
11
I was on the way out the door for my bike ride when I read this article. Almost deja vu; some recurring chest pain/tightness after active cycling, numbness in arms, seemingly more fatigued during exercise. History of family heart disease, healthy diet, good blood pressure and taking my 20 mg Simvastatin, but I'm 65.Thankfully, after contacting my physician, an EKG, recommendation to a cardiogist, and admission to Beaumont in Royal Oak, I received two stents in my LAD to correct a 90% blockage. That was 16 days ago. I agree with one reader's comment as to why a test of artery blockage should not be considered for diagnostic in high risk patients. Having said this, I have not yet seen my hospital bills to know the full cost.
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@Richard
I hope your bills don't cause a heart attack.
At age 51 and running half marathons pretty much monthly, it was shocking to me not to be able to run two miles without becoming exhausted, leading me to my doctor, more doctors, and finally six heart bypasses. I thought I was in the best shape of my life: perhaps. But genetics will out.
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@Ralph Women in particular should be aware of impacts of (male and female) family history and age, both very risk strong factors. My father and brother both died of heart disease at an early age, so despite my life-long fitness and heart-wise diet, I instinctively knew it would be when, not if. At age 68, my symptoms were typical for females: shortness of breath and tightness of throat. Luckily my heart damage was "microscopic," but I had 2 major blockages and received stents. Bottom line: never ignore symptoms.
8
@Ralph, genetics loads the gun, but lifestyle pulls the trigger. You can thrive, even with the worst genes, on a whole foods, plant-based, no oil diet. Watch Forks Over Knives on and What the Health on Netflix. Watch Eating You Alive. Then get to work and do it. It's the best and it will reverse heart disease. Read some of the other comments on this. Good luck!
4
I am glad to see this article mentions nutrition, though I don't think it goes far enough toward discouraging the consumption of meat, dairy and eggs. What the phrase "family history of heart disease" usually means is, family history of eating too many animal-based products. Too much salt and too little exercise are also common "family" problems. I strongly recommend Dr. Michael Greger's best-selling book, "How Not to Die" for more information. It is time to thinking about heart disease as an inherited disease and start thinking about how we can short-circuit the cycle through our own diet and exercise habits.
36
@Dan Frazier, YES!! Absolutely, thank you! Also, his website, https://nutritionfacts.org, is free, with lots of informative videos which present a review of science nutrition articles published in peer-reviewed journals and are very easily understood and entertaining, too. Links to the articles reviewed are also included. His foundation Nutrition Facts is a nonprofit, dedicated to informing the public about nutrition.
22
I don't know one person on cholesterol-lowering medicine who has not told me "It's genetic." Without even trying dietary measures first, they go for the drugs.
As if I don't notice they never even eat a salad.
I believe Nutritionfacts.org is Dr. Greger's site.
20
No mention of cost in this article implies that money is not an issue. A more complete story would have included out-of-pocket costs to the patient. It's great to be able to afford a top-notch heart surgeon. For most of us, this story belongs in the "Lifestyle" section for the rich. It's out of reach for most of our "Personal Health."
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@JTE For years, Ms. Brody has written column after column that ignores the reality of vast inequality in health care. Everyone, in Ms. Brody's world, lives in walkable city, has infinite resources and time to exercise and eat well, and everyone has completely and solely responsible for his health.
Why this is acceptable is beyond comprehension.
11
@JTE
A 73 year old patient would be eligible for Medicare coverage for a medically necessary surgery like a cardiac bypass. If he had supplemental coverage his out of pocket costs would be minimal. Top notch surgeons are more likely to be found in high quality facilities like university teaching hospitals which accept patients with traditional Medicare coverage.
4
Pointless comment.
1. I have health insurance as I assume the writer does and a vast majority of the readership. Yes, I have committed the sin of being middle class and having good health insurance.
2. New York State has excellent Medicaid coverage for cardiac surgery and yes many poor people in this state have this type of surgery and pay nothing as in zero dollars for medical bills.
3. Rather upsetting that this is the most popular comment.
4. In the summer of 2017 I had two cardiac surgeries. I am on Medicare and have supplemental insurance. Mt. Sinai in Manhattan was the hospital. The procedures were 100% successful, the doctors and the nursing care superb.
I never saw a bill.
5. Ms. Brody’s article is excellent and will help save many lives.
4
To me, the real question is how do you find a cardiologist with superb qualifications? Especially in an urgent situation.
102
So the upshot is...stay in shape and take lots of pills to make numbers happy, but if you’ve got the genetics for heart disease it may do you no good?
15
@Di Not necessarily. Without the exercise and pills he might have had a heart attack 20 years earlier like other family members.
10
@Di, pills will change your numbers, but won't make you live longer. Also, you can't out-exercise a bad diet. You can reverse this (cheaply), by eating a whole foods, plant-based, no oil diet. Only way to go, with a mountain of science behind it. Read the many other comments here on this way of life; it's the only thing that works and word is finally getting out about it. Bill Clinton woke up when his bypasses clogged up after only a few years.
2
Perhaps we don't know as much as we think we do about what is or isn't a "heart healthy" diet. For the majority of the population, there is little good evidence on the benefits of salt restriction, and _no_ good evidence on the benefits of restricting naturally fatty foods.
Perhaps there are one or more undiscovered "x factors" in what is already a multi-factorial disease.
78
@The Pooch "Undiscovered 'x factor'" aka. genetics.
6
@Someone
Absolutely, genetics plays a role, and there may be undiscovered gene variants which protect or predispose from heart disease. But other "x factors" could be things like immune disorders, infections, nutrient deficiencies, exposure to a toxin, etc, etc.
The story of stomach ulcers is informative -- everybody "knew" that ulcers were caused by stress and spicy food. Until the discovery of the H. pylori bacterium infecting the stomach wall...
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@The Pooch, I've followed your comments over the years, and watched you gradually become more and more skeptical of diet advice. I'm surprised that Jane Brody isn't more skeptical. Perhaps she is, but can't simply throw up her hands. I remember her advice from back in the rice cake days. I too think there will be X factors - but they may well be environmental.
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Likely I'm being dense, but . . . If "thoracic arteries. . . seem to be immune to atherosclerotic buildup,” why is it necessary for Jeff to adopt a heart-healthy diet? I know healthy is better than unhealthy, yet isn't he at less risk of a dangerous heart event than in the past? Perhaps the left main coronary artery isn't necessarily the only maker of widows.
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@Malcolm Carter
Well, one does have more than one coronary artery...
But more to the point, this piece is simplistic ....and in some instances, is quite overly optimistic- verging on delusional, even given that it's general public audience.- for e.g., the assertion that a 73 yo, with a strong family history, and symptomatic CAD, will go on to an uneventful, post-CABG/healthy life is a stretch....and a long one at that.
In my experience, 'good results' last about 8 years-n a lot less in the less than good results group, of which there are more than a few......
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There are other arteries in the body that can kill us if they clog-- carotid for example. Anyway, heart-healthy is jargon. there is no diet that's good for the heart but bad for other parts of the body. Can we just call it a healthy diet?
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@Margaret Excellent point !!!
Good article and it helps to exercise, be trim, not have diabetes, hypertension or high cholesterol. Artery screening is a big plus which should be done at age 70 and a good idea earlier depending upon if you have a family history of cardiac disease.