CW: A safe and potent anti-inflammatory?

Those interested in the treatment of heart disease reveled in some very important news this week. News which further strengthens the position that heart disease may be assailable without implanting titanium into our bodies.

A group of researchers from the Mayo Clinic (Rochester, MN) reported–without much fanfare–that patients enrolled in an old-fashioned cardiac rehab program after having a cardiac stent had a much lower risk of dying. The magnitude of risk reduction in this observational trial of nearly 2400 patients approached an eye-opening 45%.

Let me repeat: even after a “simple” stent, not necessarily a heart attack, or major bypass surgery, cardiac rehab was associated with lower death rates!

What adds to the coolness of this study was that the treatment
studied–cardiac rehabilitation (cardiac rehab, or CR)–is simple, inexpensive, safe and free of any industry conflicts–except perhaps the treadmill makers–or doctors (see disclosure).

I emphasize trials like this because in the hoopla of talking about the next pill–or contraption–to treat heart disease, we tend to forget important basics.

This most important (and highly relevant) ‘basic’ principle was rightly pointed out by the senior Mayo researcher, Dr Randal Thomas, (as quoted in the heartwire piece):

I think it is important for clinicians, patients and providers to realize that PCI–Percutaneous Coronary Intervention–is not a cure for heart disease.”

The idea that action verbs like squishing, stenting or even sucking-out-clot do not prevent heart attacks or improve longevity isn’t intuitive. But it is true; study after study shows that relieving a blockage may improve chest pain or shortness of breath (laudable goals, for sure), but doing so does not lower the risk of death or another heart attack.

That’s because the real cause of heart disease isn’t the blockage; the blockage is the manifestation. The underlying cause of heart disease is inflammation, and its effects on the wall of the artery! Getting at this root cause would be akin to finding the location of Indiana Jones’ chalice. My thesis holds that the holy grail of Cardiology isn’t behind all those snakes, or buried deep in a tomb, or in scary maze. It’s closer than most of us think.

Oops…See…I am wandering off topic again. Back to biology.

Enter programs like cardiac rehab.

The benefits of cardiac rehab provide patients with more than just
the ‘fitness-related’ adaptations of regular exercise. Sure, fitness is important, but patients that buy-in to cardiac rehab also get the psychological support of group training, one-on-one counseling, and lots of education. Studies show that this anti-inflammatory gumbo makes them more likely to take their (evidenced-
based) medicines, and maintain healthy lifestyle choices. Smart people might call the effects of cardiac rehab: diverse, comprehensive and even pleomorphic. I like ‘anti-inflammatory gumbo’ better.

And now, Dr Thomas’ study strongly suggests even lower-risk, cardiac stent patients, enjoy the benefits of immersion into cardiac rehab.

Folks, this isn’t just about cardiac rehab.

It’s about the big picture: the key to knocking heart disease off the top of leading killers is to more vigorously treat the root causes of inflammation. Things like eating too much, moving too little, sleeping less well, and even employing lousy strategies in dealing with everyday stress.

How many more studies do we need?

JMM

Disclosure: It is true that heart doctors who have ownership in cardiac rehab centers stand to gain if more patients are enrolled in rehab. But…Given the current health of our society, I would argue substituting treadmills and counseling for stents might make sense.

3 comments

  1. So, in the free medical advice category, are the deleterious effects of inflammation on the endothelium reversible? If one takes the ingredients out of the inflammatory stew, is one left with artery walls in whatever state they happened to be in (with the associated elevated level of risk) or does one revert over time to a relatively healthy artery (with a risk level closer to the pre-inflammatory than to the post-inflammatory level)?

    PS. thanks for the new word…pleomorphic.

    1. There is good data to suggest that the health endothelium (artery walls) is changeable . I believe this to be true, as I have seen it happen to the rare patient who completely embrace the anti-inflammation lifestyle.

  2. Very nice. Another intersection between the two great loves of my life, medicine and fitness (after my darling wife, of course). You’ll find about 500,000 Crossfitters who agree with every word printed above. Benefit of fitness…check (Greg Glassman has gone as far as to equate fitness and health). Anti-inflammatory diet changes…check (fish oil is Rx’d). Group dynamic leading to accelerated gains and health…check.

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