Success in heart health stems from the simple…

The solution is so easy.  It sits right before our eyes.  The methodology is known.

Small Steps to Heart Health was big headlines in today’s WSJ.  As if the secret was revealed.

The report succinctly argues that simple lifestyle choices, like daily exercise and better nutrition are surprisingly successful. Shocking! As an illustration of a model patient, they used the example of an overweight interventional cardiologist (a squisher) who caught the health bug.  By making better food choices and exercising on a daily basis, he was able to glean huge gains in objectively measured parameters of heart health.

The review cited three studies from this Spring’s ACC meeting.  All three studies revealed that more aggressive pharmacologic management of medical conditions was not always better.  There exist many examples of this phenomenon, but the specifics here were:

In diabetes, more medicine to aggressively control blood pressure made little difference.  In high cholesterol, adding a fibrate to statin therapy did not lower heart attack risk.  In permanent AF, the strategy of using lower dosages of medicine for heart-rate control was equivalent to present day recommendations for strict heart rate modulation.   

Translation:

More medicine cannot substitute for life’s simple choices. Although pills have undoubtedly enhanced the lives of many, they will never replace the importance of the big three components of health: good food, good sleep and good movement.  Really, it is that simple.

Our challenge as doctors is not just in telling our patients of the fruits of healthy living.  Most already know. The real challenge is infecting our patients with the “healthy-living” virus.  So many in America–and especially Kentucky–remain immune.

In the implementation of healthy living, doctors might need help.  Thus far, we are not doing so well.

Even with my motivational pitch at full throttle, successful infection of the healthy-living virus is a rarity.  I will continue to try, though the futility of the effort creeps closer and closer with each successive failure.

Frown.

JMM

2 comments

  1. Could you please expand upon this statement?
    In permanent AF, the strategy of using lower dosages of medicine for heart-rate control was equivalent to present day recommendations for strict heart rate modulation.
    I do not understand what is meant by this sentence. Thx.

  2. In many cases, AF is associated with excessive heart rates. Controlling the ventricular response of AF is one of the three major tenets of therapy: stroke prevention, "rhythm" control and "rate" control. Medicine is used to slow the rate of AF.

    Presently, most have felt that "strict" HR control (<80 beats at rest and <110 with exercise) should be the goal. This most recent study, published in NEJM shows that in their cohort, allowing more lenient HR control (up to <110 at rest) is not associated with worse outcomes.
    http://content.nejm.org/cgi/content/abstract/362/15/1363

    The larger point was that adding more medicine is not always the best strategy. Exercise and cardiovascular fitness is known to slow the heart rate. It can do so in AF as well, and therefore, I recommend daily exercise to my permanent AF patients.

    JMM

Comments are closed.

Success in heart health stems from the simple…

The solution is so easy.  It sits right before our eyes.  The methodology is known.

Small Steps to Heart Health was big headlines in today’s WSJ.  As if the secret was revealed.

The report succinctly argues that simple lifestyle choices, like daily exercise and better nutrition are surprisingly successful. Shocking! As an illustration of a model patient, they used the example of an overweight interventional cardiologist (a squisher) who caught the health bug.  By making better food choices and exercising on a daily basis, he was able to glean huge gains in objectively measured parameters of heart health.

The review cited three studies from this Spring’s ACC meeting.  All three studies revealed that more aggressive pharmacologic management of medical conditions was not always better.  There exist many examples of this phenomenon, but the specifics here were:

In diabetes, more medicine to aggressively control blood pressure made little difference.  In high cholesterol, adding a fibrate to statin therapy did not lower heart attack risk.  In permanent AF, the strategy of using lower dosages of medicine for heart-rate control was equivalent to present day recommendations for strict heart rate modulation.   

Translation:

More medicine cannot substitute for life’s simple choices. Although pills have undoubtedly enhanced the lives of many, they will never replace the importance of the big three components of health: good food, good sleep and good movement.  Really, it is that simple.

Our challenge as doctors is not just in telling our patients of the fruits of healthy living.  Most already know. The real challenge is infecting our patients with the “healthy-living” virus.  So many in America–and especially Kentucky–remain immune.

In the implementation of healthy living, doctors might need help.  Thus far, we are not doing so well.

Even with my motivational pitch at full throttle, successful infection of the healthy-living virus is a rarity.  I will continue to try, though the futility of the effort creeps closer and closer with each successive failure.

Frown.

JMM