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Book attacks heart disease with science



Published: Mon, June 13, 2005 @ 12:00 a.m.



He suggests seven strategies that have been backed by strong evidence.

By GARRET CONDON

HARTFORD COURANT

For more than a century, cardiovascular disease has been the No. 1 killer of Americans. With one of us dying of heart disease every 34 seconds, it's no wonder the media are full of programs, potions, diets, research studies, would-be cures and preventive measures all aimed at keeping the ticker going. The problem is that it's hard to make sense of this torrent of information.

"You have to understand the difference between things strongly supported by medical evidence and things which you might be taking a bet on -- like vitamin E," said Dr. Harlan Krumholz, a professor of cardiology, epidemiology and public health at the Yale University School of Medicine. Ten years ago, he said, some scientists had a hunch that vitamin E supplements might protect against heart disease. "We now know it doesn't work," he said.

Expert guide

Krumholz is the author of the recently published paperback "The Expert Guide to Beating Heart Disease" (HarperCollins, $14.95), a book for people who want to focus on scientifically proven behavior and treatments that can reduce the risk of heart disease and minimize its impact on people who have already been diagnosed.

In a remarkably terse bit of writing, Krumholz lays out seven science-backed strategies that address what he calls the "bread-and-butter" issues that people need to consider when dealing with coronary artery disease. The seven key areas are: controlling blood pressure, managing cholesterol, getting fit, achieving a healthy weight, controlling blood sugar, quitting smoking and taking charge of medications.

Throughout the book, Krumholz encourages patients to give lifestyle changes a shot. For example, he writes that those with blood pressure in the "high-normal" range (systolic 130-139, diastolic 85-89) "should give a drug-free strategy a chance to work" because it can save individuals the cost and possible side effects of medications. Such a program includes losing weight, limiting alcohol intake, getting regular exercise, reducing salt intake and stopping smoking.

Author's analysis

Krumholz doesn't neglect blood pressure medications; in fact, he explains the various classes of pressure-lowering drugs, how they work and what their side effects may be.

He takes a similar approach with each of the seven topics and follows each section with questions and answers that are the fruit of clinical experience at Yale, such as "Can eating more fiber, nuts, soy or garlic lower my cholesterol?" (There is not enough evidence to recommend such foods as first-line approaches to lowering cholesterol.)

There is even a chart in which Krumholz assigns three stars to such proven approaches as taking a beta-blocker and assigns a question mark to such tactics as drinking black tea.

Giving power to patients

People who concentrate on the high-percentage moves can not only become healthier, according to Krumholz, they also can become patients who are better able to be partners with their physicians.

"There are a lot of people who feel buffeted by their condition and the health-care system, and [they are] put into a depressed condition where they're victims and they're waiting for someone to tell them what the next test they need to take is," Krumholz said. "We need to balance the power here a little bit and make people understand the great importance of their engagement in their care."

Krumholz said that it's important that patients know what really works as well as what they can live with and what they're willing to do. Physicians can write prescriptions, but even the most tyrannical doctor can't compel patients to take them. As Krumholz observes, about half of the pills prescribed for heart disease never get swallowed. Ultimately, it's up to the patient.

"All of this is trying to give some of the power back to the patient and families," he said.




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