The Path To Health
Cardiovascular diseases are the most common threat for death during this period of modern medicine. Heart, vascular, and stroke disease is not only the leading cause of death in the United States, but the entire world, especially developed areas.
What We’ve Learned
Our country, and other interested countries, have pooled private and public resources in hopes of characterizing and successfully treating cardiovascular diseases. The good news is we’ve seen a reduction in heart disease over the past decade, but the exact reason why is unclear.
However, one thing holds true- we’ve learned much over the past 50 years.
• Contributors- We better understand the role of genetics, both inherited tendencies and conditions. Tobacco use, cholesterol and other lipid levels, and hypertension affect cardiovascular health. Additional factors, such as: chronic inflammatory diseases, physical inactivity, Diabetes Mellitus, undesirable stress and depression, socioeconomic status can contribute toward cardiovascular diseases.
• Lifestyle- We’ve identified specific habits that impact the development of heart disease and stroke. Low fat diets, a happy lifestyle, and regular physical activity significantly reduce cardiovascular events in studied populations. A person’s race, personal habits, nationality, and heritage also play a role.
• Medications- Selective medications and medication groups (statins, angiotensin inhibitors, and improved beta blockers) also statistically decreased one’s risk.
• Therapies- Noteworthy therapies (specifically the Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention), had surprising benefits to those with ischemic heart conditions. However, the promise of these expensive therapies pales in comparison to the advantage of preventative care as a whole.
While we can’t pinpoint an exact reason for the decrease in heart disease, the answer is likely a blend of unique characteristics. Therapies, lifestyle choices, and medications work together to be effective. Patient education and a personal responsibility toward health can’t be underestimated in cardiovascular improvement.
What I’ve Observed
More difficult to characterize, and likely more important, is what affects us as individuals. I realize my personal observations do not hold the same weight as those made from stringent research protocols. However, I’ve concluded that some factors are more important than others in an individual. It is nearly impossible to study individuals and their care when administering treatment research on a general population. This is where the relationship between a specialist and patient is beneficial.
• Common Therapies- For some individuals, I’ve found cholesterol to be their largest risk. For others, it’s cigarette use. It may be Diabetes Mellitus or an inflammatory disease in yet another. In the case of stroke, it may be hypertension or atrial fibrillation. The point is, for all these conditions, we’ve established beneficial and somewhat “by the book” therapies.
• “Individual-specific” Therapies- Other specific disease conditions, such as the treatment of lipoprotein subfractions or the interdependence of conditions, are less clearly understood in terms of therapies. A physician is left to insight and “the art of medicine” when prescribing therapies for less-established and lower-frequency conditions. While there are some standard combinations of therapies recommended, the threat of side effects from this “shotgun approach” are still lower than the risk.
It’s important to note that all therapies, common and more individual-specific, have potential side effects. Some serious, others not so serious.
Checks and Balances
The benefit of our modern medical age is, once a heart disease diagnosis is made, a somewhat standard approach is implemented. Multiple specific medications and classes of medications are prescribed to lower risk. Physicians are evaluated through confidential medical reviews regarding their quality of care when prescribing standard therapies. Compensation is now tied to these quality measures, which further protects both the patient and physician.
I’m hopeful the next major medical advances will identify strategies for an individual, rather than a population. It’s possible that some of our cookbook therapies may in fact be detrimental to an individual in terms of their side effects. We anticipate advances in genetic study to pinpoint appropriate individual therapies. Our research experts are making good progress on this.
Whether we can achieve this goal for all individuals during our lifetime remains to be seen. Until then, our quality is based on an expert consensus of specific prescribed regimens and published guidelines.
I support and subscribe to these regimens and guidelines. I understand their benefit and have read many, if not most, of the landmark studies on which these guidelines are based. Our professional societies (AHA and ACC, among others) update me with these published guidelines and do a wonderful job circulating them.
A Note to My Patients
As educated on prescribed regimens and guidelines as I aim to be, the population I treat are the patients that choose me as their personal cardiologist. My role is to treat the individual before me and under my care. We are all different. I’ve seen self-motivated patients have wonderful results with alternative but convincing approaches. This seems to fit their individual lifestyle and family better than a general population-based approach.
I’ve discussed unique approaches with many of my patients. My role, as I see it, is to recommend standard and guideline-based therapies through proven cardiovascular research methods to lower risk and benefit patients. I believe that is the standard of care necessary to be a personal physician. However, I’ve also had the pleasure to work with patients who, through personal education and reflection, can make individualized decisions with my insights and guidance. That is my real passion- to work with so many wonderfully unique individuals. Different lives, values, medical conditions and personal situations.
My wish for my patients is for them to be personally motivated to learn about their conditions and help me guide their personal therapy. We place a high value on patient education in this practice. I believe my patients’ outcomes reflect this emphasis.
I understand there are some patients who believe they have more important matters than improving their health. I do my best in my recommendations for these patients. Many, if not all, of us are facing tough times in our lives and families. Bettering these situations may be the most powerful step for improved individual health.
As always, I look forward to discussing the standard and latest exciting therapies for individual patients and specific conditions. There’s an explosion of information coming, leading us to an improved approach toward individualized medicine. I’ll keep you posted.