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Medication Is Not a Quick Answer

Alternate title:
Medication Is Not a Cure for Flawed Lifestyle

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 18 in the July 13, 2011 issue of Mississauga News
entitled: Medication Is Not a Cure for Flawed Lifestyle
Reprinted on page 17 in the August 29, 2012 issue of The Mississauga News
under the feature: Health & Beauty, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

Direct to consumer advertising has throngs of patients showing up at my office asking for multiples of cholesterol testing in the hopes that the results may vindicate a poor life style.

The tests are done in the fasting state to check your genetic predisposition. It is useless as a marker of your diet, but for some it continues to be a contest.

“Smart ads” on the tube suggest that taking a pill will make up for the poor lifestyle. We are continually refining our knowledge of what causes heart attacks and how to prevent them.

It seems that the heart attack rate in our society continues to increase despite millions of people taking cholesterol pills now. Equating over eating junk food and obesity with heart attacks is a tad too simple.

Thinking that fat blocks arteries until they are choked off is also an over-simplification. I see lots of obese seniors who seem to have made it to ripe old ages.

Thanks to television, most of us consider cholesterol to be evil. A recent study published in The Lancet caught my eye. They found that for the majority of patients taking lipid lowering drugs without any other health problems, there seemed to be no clear benefits. Of interest is that this is the largest consumer group. To some degree, the blame probably falls on us doctors.

This is not to suggest that if you have had a heart attack, are diabetic or have heart disease that you should stop. The point is that lifestyle changes are probably the most important, but hardest to achieve factors.

The different sub-types of cholesterol are manufactured by our bodies for specific uses. They do not simply float around and cling to the side of our arteries. In some people, this is the case, and there is enough plaque produced to significantly alter flow.

When blood flow cannot deliver enough oxygen to the heart, symptoms such as pain or breathlessness occur and something must be done. Things like enlarging the artery size with a stent or by-pass surgery are utilized. But heart attacks are often caused by blood-clots occurring in the arteries.

How these clots are formed used to be a bit of a mystery. Our main arteries are three-ply structures. Excess cholesterol sub-particles, such as VLD-L, can lodge in the middle layer producing bulky structures called atheroma.

Most of these atheroma don’t really reduce flow significantly. What can happen is that the inner artery lining called the endothelium might sustain a micro-tear. When that happens, the body responds just like it does to any cut. Inflammation cascades and various cell types arrive to attempt repair, and platelets form clots thinking that bleeding is occurring. These clots stop the flow of blood and can result in the damage that is seen with a heart attack. The clots can be dissolved with clot-busting drugs if given quick enough.

The process produces elevations in certain particles such as C-Reactive Protien(CRP), troponin and histamine. Many of these particles have been investigated as possible predictors of impending heart disease, but little evidence exists to promote their usefullness in this regard. Most predictive indices incorporate multiple factors.

The best solution to worrying about your heart is to take a good look at your life-style. Lose the first two pounds as the next step to better health. Thinking that medication is a quick answer to patch flaws in our lifestyles is a sure sign of health trouble.

Related resources:

Healthy Lifestyle Halves Heart Failure Risk by Jennifer Warner, WebMD Health News, Reviewed by Elizabeth Klodas, MD, FACC. "Men who follow a healthy lifestyle may cut their risk of heart failure in half. Researchers say it's the first time a large study has shown that modifiable lifestyle factors, such as diet, exercise, alcohol use, and smoking, can have a significant impact on the lifetime risk of congestive heart failure."

Heart Disease: 5 medication-free strategies to help prevent heart disease from Mayo Clinic. 1. Don't smoke or use tobacco. 2. Exercise for 30 minutes on most days of the week. 3. Eat a heart-healthy diet. 4. Maintain a healthy weight. 5. Get regular health screenings: Blood Pressure, Cholesterol levels, Diabetes Screening.

Effect of lifestyle on death and disease from Bandolier, University of Oxford, Medicine.ox.ac.uk.

Lifestyle changes help prevent heart disease, stroke from Times Colonist.

Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial by Ornish D, et al. Abstract. Pacific Presbyterian Medical Center, Sausalito, CA.

Preventing Cardiovascular Diseases - Including Heart Disease, Stroke, Transient Ischaemic Attack (TIA) and Peripheral Vascular Disease from Patient.co.uk. "The root cause of most cases of cardiovascular disease is a build-up of atheroma - a fatty deposit within the inside lining of arteries. Lifestyle factors that reduce the risk of forming atheroma and developing cardiovascular diseases include: not smoking, choosing healthy foods, a low salt intake, regular physical activity, keeping your weight and waist size down, and drinking alcohol in moderation."

Heart Disease: Lifestyle and home remedies from Mayo Clinic.

More Evidence in Favor of Healthy Lifestyle in Prevention of Cardiovascular Disease. Science News from ScienceDaily.

Heart Failure: Lifestyle Changes. Reviewed by Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. "Up to half of patients hospitalized for heart failure are back in the hospital within 6 months. Many people return because of lifestyle factors, such as poor diet, failure to comply with medications, and social isolation."

Lifestyle diseases from Wikipedia. "Lifestyle diseases . . . appear to increase in frequency as countries become more industrialized and people live longer. They can include Alzheimer's disease, atherosclerosis, asthma, cancer, chronic liver disease or cirrhosis, Chronic Obstructive Pulmonary Disease, Type 2 diabetes, heart disease, metabolic syndrome, Crohn's disease nephritis or chronic renal failure, osteoporosis, stroke, depression and obesity."

Diet and Lifestyle Changes Prevent Heart Disease, Cancer, Diabetes and Alzheimer’s. Posted by John Phillip, Optimal Health Resource. "Lifestyle therapies that include proper nutrition, stress management, regular physical activity and maintaining a healthy body weight are key elements in the prevention and treatment of many chronic diseases. Heart disease, diabetes, cancer, stroke and dementia are all strongly influenced by fine tuning diet with plenty of raw organic foods and taking advantage of regular moderate physical activity."

Heart Disease: Genetics or Lifestyle? by Dr. Jonny Bowden.

● < href="http://www.brads-healthy-lifestyle.com/heart_disease_lifestyle.html">Lifestyle and Heart Disease: How to Prevent Heart Disease. A Public Lecture by Meir Stampfer, M.D., Dr.P.H.Linus Pauling Institute Research Report.

Prevention of Coronary Heart Disease by Diet and Lifestyle by Daan Kromhout, PhD, MPH; Alessandro Menotti, MD, PhD; Hugo Kesteloot, MD, PhD; Susana Sans, MD, PhD. From Circulation.

Obesity and Heart Disease by Robert H. Eckel, MD. A Statement for Healthcare Professionals from the Nutrition Committee, American Heart Association, in Circulation.

How Does Obesity Cause Heart Disease? From eHow.

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