In Search of "The Cure"

A reader wrote asking what he should do now that he has been diagnosed with heart disease. There is so much information about preventing heart disease, but is there a "cure"?

The bad news: Coronary disease cannot be "cured," I heard from Jeffrey Borer, MD, chief of the cardiovascular pathology and physiology division at Weill Medical College of Cornell University in New York City. However, it is possible to slow the progression markedly with modern medical therapy, and minimize secondary problems -- such as obstructions becoming severe or occurance of a heart attack -- with current surgical and catheter-based mechanical methods.

The Way to a Healthier Heart

The American Heart Association outlines six steps to a healthier heart, none of which really are "news." They are: Avoid tobacco smoke... monitor high blood pressure... eat food low in cholesterol and saturated fats... be physically active... maintain a healthy weight... and have regular medical exams. Stress management also is key.

And, Dr. Borer expanded on several of these recommendations with Daily Health News...

Eating right is a big part of controlling heart disease. Make sure you consume at least five servings a day of fresh fruits and vegetables... try to eat cold-water fish, such as salmon or mackerel, at least twice a week... incorporate more legumes and nuts into your diet... and limit your intake of fatty and cured meats, salty snacks and calories. Also broil, roast or boil foods instead of frying. As for alcohol, Dr. Borer says that there is no "standard" recommendation. Epidemiological data suggest that one alcoholic beverage per day (one ounce of "hard" liquor or one glass of wine, which some would insist should be red) seems to be efficacious. However, he points out, there has never been an appropriately designed and controlled clinical trial to test the alcohol hypothesis.

Exercise at least three times a week. According to Dr. Borer, the amount of exercise that can be tolerated safely by patients with heart problems varies with the type of disease (narrowing or blockage of the arteries, high blood pressure, congestive heart failure, etc.) and its severity. Doctors determine the exercise "prescription" that is right for each individual from objective exercise electrocardiography (most commonly, monitoring your heart while you work out on a treadmill). They advise exercise according to the heart rate at which evidence of ischemia or chest tightness and discomfort is first seen. Whether or not exercise prolongs life in patients with established cardiac disease is uncertain, notes Dr. Borer. However, it does help people feel better and thus can beneficially alter lifestyle in people with heart disease. He adds, however, that benefits can be attained only with regular exercise -- at least three times a week.

See your physician on a regular basis. The best frequency for visits depends on the problem, the patient and the doctor, observes Dr. Borer. In general, he sees people with chronic stable disease approximately once every six months when the problem is of moderate severity or worse. This frequency is necessary to monitor for drug toxicity, as well as to assess stability of the condition and/or need for changes in the management regimen. When patients are in any way unstable, frequency of visits may increase.

Take your medications exactly as prescribed by your doctor. Medications can be useful in relieving symptoms and preventing damaging or even fatal progression of heart disease. However, Dr. Borer cautions that all drugs have adverse as well as beneficial effects. They are prescribed when the physician is reasonably certain that, in any specific situation, the benefits outweigh the risks. The key to keeping the balance in favor of benefit when a properly selected drug is used is to follow the prescribed regimen and monitor for any side effects. Neglecting to take your medication may minimize any benefit and may create a risk for "rebound" effects, which can be very dangerous.

Dietary supplements. Dr. Borer says that there is no rigorous evidence to support the use of any dietary supplements, though many experts have challenged that it is the testing methodology that has been ineffective, not the supplements. Dr. Borer adds that data suggest the use of folic acid to reduce homocysteine levels, and there seems to be no downside to its use in moderation. Homocysteine is an amino acid in the blood. Too much of it is related to a higher risk for heart disease. Concerning vitamin E, recent data confirm what first was demonstrated by an earlier trial (albeit one using lower doses) -- there is no basis for administering vitamin E in the hope of beneficially impacting coronary artery disease.

Not a Cure, But a Solution

Although there is no cure for heart disease, there are many steps you can take to make it easier to live with. According to Dr. Borer, attention to the details of good medical care (diet, medications when appropriate, lifestyle modifications, etc.) always is a good idea and can significantly reduce the risk for coronary events among people with and without evident coronary artery disease.

Tomorrow, I will delve into naturopathic interventions that can help people live with heart disease.

Sources.

Jeffrey Borer, MD, Gladys and Roland Harriman Professor of Cardiovascular Medicine and chief, division of cardiovascular pathophysiology, Weill Medical College of Cornell University, New York. American Heart Association, www.americanheart.org