February Surprise


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February
The Numbers Tell the Story


Over 1.5 million angioplasties and coronary bypass surgeries are done annually in the U.S., which makes heart surgery among the most commonly performed surgical procedures for men and women. This would be fine if these procedures worked. Although heart surgery can be lifesaving, truth is that they benefit only a small fraction of the millions who undergo them. For the majority -- an estimated 70%-90%, these procedures are unnecessary. Harsh words, yes, but unfortunately true.

Here are some more telling numbers and facts:

• Americans are seven times more likely to undergo coronary angioplasty and bypass surgery than in Canada and Sweden, but the number of people who die from cardiovascular disease in these countries is nearly identical to this country.

• Bypass surgery and angioplasty have never been shown to prolong life or prevent heart attacks in the majority of patients.

• Lifestyle changes and medical treatment has been proven over and over again in numerous studies to significantly decrease heart attacks and prolong life.

The sad truth is that most heart disease patients are sold a bill of goods by a cardiology industry that has too much of a self-interest in making sure that as many people as possible are treated with expensive surgical procedures, instead of a far less expensive program of lifestyle changes and, if needed, cardiac medication.

It concerns me that countless patients are subjected every day to unnecessary surgery. But what makes it worse is that these procedures can be harmful. Although cardiologists hasten to assure their patients that these procedures are time-tested and safe, all invasive surgery carries risk. In fact, the mortality rate from bypass surgery ranges from 3%-5%. This percentage may sound insignificant, but not when you consider that a half-million people undergo these procedures each years. In addition, an estimated 25%-30% of angioplasties fail and need to be redone; eventually, many of these angioplasty patients will require bypass surgery.

Bypass surgery carries significant risks. Up to 80% of patients may experience cognitive difficulties after surgery, which is especially devastating to many elderly people who already may be experiencing memory problems. People who undergo bypass surgery are nearly four times more likely to suffer a subsequent stroke and are also vulnerable to infection. Angioplasty is also not risk-free; complications include heart attack, stroke, the need for emergency bypass surgery and infections.

How Did The Emphasis on Surgery Come About?

Ironically, the problem that too much heart surgery is being done came about as a consequence of the fact that, in the 1960s and 1970s, there was great progress made in the surgical treatment of coronary heart disease and other life-threatening cardiac ailments.

This brings me to a very important point. Not all heart surgery is a hoax. Not at all! Over the past 30 years, tremendous strides have been made in the surgical treatment of many once-fatal heart problems. Today, heart surgeons perform heroic work, saving babies with once-fatal congenital heart defects. Cardiac surgeons can repair an aorta that ruptures, replace diseased heart valves, and save patients in the throes of massive heart attacks that would previously have killed them. These are just a few examples of the wonderful advancements in cardiac surgery, which has brought with it unparalleled life-saving achievements.

My concern isn't with heart surgery when appropriate, but with the countless procedures performed that are inappropriate. These procedures subject patients to needless risk when they would have been far better off having their condition treated with aggressive lifestyle changes and medical therapy. Yet countless patients daily undergo heart surgery despite the lack of evidence that they will live longer or have fewer heart attacks.

This is the story of how heart surgery developed, mushroomed and became entrenched, despite any evidence that it was effective for the vast majority of patients.

Back in the 1950s, when President Dwight D. Eisenhower had his heart attack, little could be done for people with heart disease and cardiologists could often watch only in frustration as their patients were killed by heart attacks. It was known that heart attacks were caused by blockages in the coronary arteries and also that surgeons were able to successfully use long, thin, artificial pipes to successfully bypass blockages in the legs. So, in the late 1960s, an operation was developed that involved transplanting a vein from one part of the body -- in this case, the leg, and using it to create a route around the blocked coronary artery, allowing blood to flow through it to the heart muscle. This operation became known as coronary artery bypass surgery. The procedure took off and the rate of it quickly soared. In recent years, the number of bypass operations declined, due to the mushrooming popularity of angioplasty, but, still, nearly a half-million of these procedures are performed annually in the U.S.

Around the same time as bypass surgery was taking off, a young German cardiologist named Andreas Gruentzig came up with a way to widen blocked coronary arteries without resorting to bypass surgery, which is major surgery. His procedure, known as angioplasty, involved insert a balloon-tipped catheter, or tube, into the coronary artery. When the balloon was inflated, it flattened the plaque, (the material forming the blockage) against the walls of the artery, widening it, so the blood could flow through it. I was a young cardiologist in training then, and I'll never forget the excitement that rippled through the cardiology community when Dr. Gruentzig first displayed X-ray images, showing before-and-after pictures of blocked, and then unblocked, coronary arteries. The "after" photos looked wonderful. I, like many of my colleagues, was amazed! After I finished my cardiology fellowship, I came to Baptist Hospital in Miami and performed one of the first balloon angioplasties there. I was still high on the procedure, but, before long, I became bothered when I saw patients, who had supposedly undergone successful procedures, coming back again and again. This was happening in hospitals all over the country. It soon became obvious to me that angioplasty was not the cure-all for which I had hoped.

Around that time, as I was growing disenchanted with coronary bypass surgery and angioplasty, I learned about the Seven Countries Study, a landmark 20-year study by Dr. Ancel Keys which found that a diet low in saturated fat and processed food, which was to become known as the Mediterranean-style diet, was associated with a low incidence of heart disease. Then, as the years passed, and more studies demonstrated the flaws of heart surgery, and others showed the benefits of lifestyle treatment, like the Mediterranean- diet and lifestyle, I became convinced that prevention was a superior approach for the majority of patients with coronary artery disease. But, for most of the rest of the cardiology industry, the rush to perform as much bypass operations and angioplasty procedures continued unabated. And it still does.

©2009 Michael Ozner, MD

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Michael Ozner, MD, FACC, FAHA, is the author of The Great American Heart Hoax: Lifesaving Advice Your Doctor Should Tell You About Heart Disease Prevention (But Probably Never Will.) (Published by BenBella Books; 978-1-933771-54-0) For more information please visit www.drozner.com. Dr. Ozner is one of America's leading advocates for heart disease prevention. Dr. Ozner is a board-certified cardiologist, a Fellow of the American College of Cardiology and of the American Heart Association, medical director of Wellness & Prevention at Baptist Health South Florida and a well-known regional and national speaker in the field of preventive cardiology. He is the medical director of the Cardiovascular Prevention Institute of South Florida and symposium director for "Cardiovascular Disease Prevention," an annual international meeting highlighting advances in preventive cardiology. He was the recipient of the 2008 American Heart Association Humanitarian Award. Dr. Ozner is also the author of the BenBella Books title The Miami Mediterranean Diet.

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