Invasive procedures vs. lifestyle changes

[Alisande]

My husband, an overweight diabetic smoker, had a nuclear stress test that showed a blockage in one vessel and a possible spot on the heart.  We've scheduled an angiogram, and he expects that further procedures (angioplasty?  bypass?) will be necessary.  He stopped smoking immediately after the stress test, but no one has talked to him about diet and exercise.  The emphasis is all on surgical intervention.

When my dad was 45 he had severe angina.  He couldn't walk up a subway ramp without taking nitroglycerin.  In those days cardiac procedures weren't done, so he was firmly instructed in lifestyle changes.  He wasn't overweight, but he smoked and ate lots of saturated fat.  He gave up both, and "cholesterol" was a household (dirty) word when I was a child.  My dad reversed his heart disease, eventually playing tennis and riding a bicycle, and lived to be 90.  He died of prostate cancer.

Are any blockages today considered reversible with lifestyle changes alone?  It seems as though medication is the least invasive recommended treatment.  Is this because it's felt patients can't be trusted to be strict with themselves regarding diet and exercise?

Your advice is appreciated.

Thanks,
Alisande

[whickey58]

After having read up completely on Dean Ornish work, Pritikin, McDougal and others, I went with total lifestyle changes and thus far have reduced my chol to 130.  The only continuing difficulty is blood pressure, slightly elevated and I am working on that with diet as well. If you can operate without meds, why not give the lifestyle a chance first. Meds have side effects we don;t need for life if we can avoid it.

[HealThySelf]

If you read carefully, you will see that I am an advocate of ace inhibitors and calcium channel blockers.

I do not think that beta blockers, although effective against bp and advocated after a heart attack, are a good choice for physically active people trying to arrest their coronary artery disease, unless they are being used to treat and arrythmia.

I also don't think that blood thinners including coumadin and plavix are conducive to recovery from coronary artery disease for physically active people who are doing the right things to maintain healthy blood.

Also, although effective against BP, I don't believe diuretics are a good idea for people trying to get healthy.  Can draining the water from all of the body's cells be a good idea?

But regardless of what I think, I never comment until after the CCF doctors respond.  Also I am not a doctor, only someone with severe coronary artery disease trying to recover and lead a healty life.  People should take my writings in that context.

I believe that your profession, at least as far as cardiologists and cardiac surgeons, is somewhat a misguided culture that many times does more harm than good.  Some of the drugs prescribed may prove good for a narrow endpoint, but be counterproductive for overall and longterm health.  The overpractice of stenting sets many people up for bypass surgery and a long nightmarish road of revascularization procedures.  Although sometimes necessary, bypass surgery is tremendously overpracticed to the point of being criminal in many cases.

I hope that you grow up to be an enlightened physician and not one in lockstep with your hidebound culture.  Please learn to question rather than assuming you are doing the right thing, because it is sanctified by your profession.  Remember that, given a chance, the human body has tremendous restorative powers and your goal should always be to put those powers to work for you.

[eduncan]

Hi,
As a medical student and future physician, I am concerned about some of the discussion on this page.  Many of the drugs that are being discouraged (ACE Inhibitors, Beta Blockers, Ca Channel Blockers) are life sustaining for patients who are suffering from heart problems.  I would encourage non-physician NOT to give specific medical advice (you do not know this patient's medical history, physical exam findings, and lab results).  I would encourage every patient posting on these boards who is concerned about their medications and overall health to call their physician and talk about it.  If you don't understand the words that your doctor uses....ask him or her to explain it again in words that you understand.  Again, please don't give medical advice if you aren't a doctor, and don't discourage people to use drugs that may be saving their lives.  Thank you.

[hvacman305]

Your post regarding your husband rang my bell.  I had developed some very poor health habits, which included heavy smoking, poor diet, overweight, no exercise, high cholesterol, high BP and thrived on high stress levels.  In February of 2000 I had a heart attack.  I smoked 1.5 packs of cigarettes a day, was 50 pounds overweight, total cholesterol was 292 with poor ratios, and told that this was my second, not my first heart attack. It was also discovered I had type II diabetes.  I was shocked, and ashamed that I'd let this 59 year old body down.
     I have completely changed my behavior and my health.  When asked how I made these  huge lifestyle changes, I always reply, "it is easy to change your negative behaviors when you watch a wire being fished through your heart."  I also took all the drugs that were prescribed, including Atenolol, Altase, diuretics, lipitor and niacin.  However, I also insisted on close monitoring of my health, including blood tests every three months.  
     As my exercise regimen increased and as I lost weight and my BP dropped, Antenolol was dropped from the cocktail as it limited physical activity and wasn't needed.  Soon it was discovered my cholesterol levels were normal (165) but my liver scores were nasty, and Lipitor was dropped; further tests and niacin was dropped and the liver scores stabalized, and I started taking Welchol.  I'm back to normal cholesterol and liver function.
    So... In my case, it started with changing behaviors; I lost 55 pounds, exercise daily, eat a healthy diet of vegetables and fish.  Careful blood testing and medical evaluation is a part of the cure as well.  There are great drugs out there, but I'm a big believer in careful monitoring as they have these wonderful diagnostic devices, and it is silly not to utilize them.  Now, I wish I could make this diabetes go away, it is a whole different story, and really hard to control.    

[Risen]

Well I finally see another has tinitus probably from meds. Sure is an aggrovating prob but nothing to match heart arrhythmias I have as well. I am off all heart meds now, after a heart attack 5 months ago. I was havin reactions to the meds and the cardiologist said I could try with out the direct heart meds although I take lipator, niacin (perscription dose) and potassium. I wonder and wait for the Tinitus to start going away. Thanks for letting me know I am not the only one with tinitus caused by meds. Gary M

[HealThySelf]

Doctors tend to prescribe beta blockers and diuretics for BP because they are cheap and effective against that one end point without reqarding side effects.  Beta Blockers are also a recommended treatment for anyone suffering a heart attack.

Beta blockers work on your autonomic system, slowing down your heart and lessening the intensity of the heart beat.  Other BP drugs such as Ace Inhibitors and Calcium Channel Blockers relax the smooth muscle of the vascular system.  I personally don't believe that fooling with your autonomic system is a good idea.

The second leg of my recovery is exercise.  I walk an hour every day that I work and usually hike or ski from 5 to 10 miles on Saturday and Sunday.  I found that Atenolol was counterproductive to that effort.  It was harder to exercise and it eventually caused episodes of near syncope which were very distressing.

Although diuretics have recently come in favor again, it's a really stupid idea to drain water from every cell in your body.  That might reach the BP goal but at a cost of overall health, especially if you depend on physical activity for recovery.

It may be harder to control BP with Ace inhibitors and CCBs, but they are a better choice for overall health.  Recent studies have shown that most people need at least 2 drugs to contol BP.  After trying several drugs a combination of Norvasc + Altace has proven effective for me.

Remember that every doctor has their own ideas of what drugs are good.  A lot of times that info comes from a lot of sources including the drug company salesman.  Many times they are behind on the research and not very educated on the various drugs.

I found that If I wanted to save myself I had to research all of the drugs myself and develop an effective cocktail to stop my disease and hopefully regress it over time.

As for the Tinnitus, I don't know which drug might be causing it.  Although I am a total believer in Niaspan, perhaps it could be that drug.  There are several web sites which give info on drug induced tinnitus.  Perhaps you can find a list of drugs that cause it at one of them.

[nadia]

Risen,
I am comforted to hear that others are dealing with some of the same side effects as I am.  After 3 months of this I don't expect it to go away anytime soon, so my goal is to stop taking the med altogether and control it with lifestyle change.

Healthyself,
Thank you for the added information.  It has really made me re-evaluate the continuation of this medication.  I am hoping to begin an exercise routine soon, which might enable me to go med free.

[HealThySelf]

A few months after my heart attack, I developed episodes of PVCs or PACs.  They were somewhat distressing.

But now after 3 years my heart strong and steady as a rock.  So they can be a temporary condition as your heart remodels after the MI.

I just continued exercising and working the rest of my program.  I got so healthy that I have only had one small cold in the last three years and my heart feels perfectly normal.

Good Luck.

[nadia]

Hi,
  I am curious why you feel that beta blockers are not a good idea.  I am 40/f and had what doctors felt could be a heart attack last November.  My blood tests were indeterminate and they could not confirm or deny that I had one.
  I have been put on atenolol (low doses). I have had tinnitus ever since.  My diastolic BP readings do occasionally become elevated and I  also have paroxysmal tachycardia.  I use the medication to control this.
  The cause of my problem is still being investigated, but I want to be careful about the medication I am using.  If you have any useful info about this beta blocker, please let me know.

[HealThySelf]

Remember that stents are forever - if they fail they can't be taken out.  Many times they just set a person up for bypass surgery.

Also, it's not blockages that kill a person, it's the rupture of lipid rich plaques which form a clot in the coronary arteries causing heart attacks and sometimes death.  If you remove the lipids from those plaques and dry them out the risk is dramatically lowered.

I had a heart attack 3 years ago followed by a failed attempt at angioplasty.  It was discovered that my right coronary artery was 100% blocked.  A year later a subsequent attempt at angioplasty was aborted because a "cratered" plaque was discovered in my left main artery.  Both times I was pressed for bypass surgery and given a dire prognosis if I didn't have it.

I treat the disease like a chronic condition, agressively control my blood pressure and lipid readings (cholesterol) with drugs, watch my weight, and exercise every day.  After three years, I feel perfectly normal and have more physical capability than I did when I was 35 years old.  

Ulike in your father's day there are drugs available today that can stop coronary artery disease in it's tracks.  Researchers at the University of Washington have proven that a combination of statin drugs and high dose Niacin will stop and reverse CAD over a period of 5 years.

Lipid readings are still the best indication of cardiac risk.  The first line of defense should be a statin drug like Lipitor.  I take a cocktail of 3 cholesterol drugs Lipitor + Niaspan + Welchol which has reduced my total cholesterol from 220-240 to 110.  My ldl is now 50.  I strongly advise getting your cholesterol numbers way down if you are at high risk.

Also your husband's goal should be to develop a totally healthy body and healthy endothelial system.  Good diet, daily exercise, lower stress, weight control, Vitamins and supplements, lots of fruits and vegetables, not much meat, etc.

I have also learned that there are some drugs that you shouldn't take if you want to be healthy.  For me, these include beta blockers and blood thinners.

Once you start with the surgical procedures you are committed.  If problems arise you will get in deeper and deeper.  

Remember that your husband walked 40 miles into the woods with his bad habits.  A doctor can't give him a magical cure.  He must walk 30 miles back out of the woods if he wants to live a long healthy life.

Good Luck.

[MinnieM]

How great that your Dad gave up all the bad things and lived to 90.  My dad would be 90 years old this year.  He had severe angina and could hardly walk but he kept smoking those &^$%^$%&^ Camel Cigaretts and ate all the fatty things. He died at the age of 39 and left 3 babies and a wife who worked her butt off to support us.  My Dad's dad lived to be 85.  He did not smoke and watched what he ate as Grandpa was a diabetic.

I firmly believe that often times...heart disease can be prevented and reversed.

God Bless.

[CCF-M.D.-RCJ]

Alisande,

Thanks for the question.

Your husband absolutely needs "lifestyle intervention".  Cessation of smoking is a great first step.  Control of his diabetes, eating a sensible diet, controlling any blood pressure elevation, and controlling high cholesterol levels would also be recommended.  Exercise is usually recommended, but this is done on a case by case basis.  Exercise may not have been recommended yet because the doctors are waiting to see if it is safe for your husband to exercise.

I think that both approaches (invasive and lifestyle) are equally important.  Please ask your doctors for guidance.

Hope that helps.