About 1.6 million Americans undergo heart bypass surgery, angioplasty or stent procedures annually—even though there's no evidence that these procedures prolong life or prevent future heart attacks in the majority of patients.

The three-year survival rate for most patients who have had bypass surgery is almost exactly the same as it is for patients with heart disease who don't have surgery.

Good news: With medications and lifestyle changes, the vast majority of patients with heart disease can reduce the risk of a future heart attack by up to 80%—without undergoing expensive and risky procedures.

Flawed Approach

More than half a million Americans die each year from heart disease. The majority suffer from coronary artery disease (CAD). This is caused by atherosclerosis, a condition in which a buildup of fatty deposits (called plaque) in the coronary arteries causes blockages that restrict blood flow to the heart. The plaque may rupture and result in a blood clot in the artery, which can shut off the blood supply and lead to a sudden heart attack.

Many doctors View CAD primarily as a plumbing problem. When imaging tests reveal blockages in the arteries, their first instinct is to clear out the "gunk," whether or not a patient is experiencing troublesome symptoms.

This approach is often flawed. Most bypass and stent procedures are the equivalent of cosmetic cardiology. They make blood vessels appear healthy but do little to reduce heart attack risk. In fact, most heart attacks are caused by tiny blockages that can be hard to detect and these blockages often are not in the blood vessels that triggered all the concern in the first place.

Surgical procedures are risky. The mortality rate from bypass surgery ranges from 3% to 5%. More than 50% of patients may experience cognitive difficulties after surgery, and patients who have bypass surgery are nearly four times more likely to suffer a subsequent stroke. Those are poor odds for procedures that don't necessarily prolong life or make patients healthier.

Medical Bypass

Some patients—those with unstable CADdo require intervention, such as bypass surgery or a stent procedure.

Example: A person with critical blockages in multiple coronary arteries and a weak heart muscle.

Most patients with CAD, however, are stable and unlikely to benefit from a bypass or stent. They are the best candidates for what might be called a medical bypass. With medications and lifestyle changes, most of these patients can eliminate symptoms (if any) and reduce heart attack risk. Only in rare cases, if symptoms get worse, would one of these patients need to consider medical intervention.

One key factor in cardiovascular health is to have an ongoing relationship with your doctor—he/she can advise you on the best steps to take to prevent and treat heart disease. He may recommend that you…

  • Follow a Mediterranean-style diet. Eat lots of fruits, vegetables, whole grains and legumes...olive oil instead of butter or margarine ...several servings of fish weekly..and no more than a few weekly servings of lean meats.

The landmark Lyon Diet Heart Study, which followed more than 600 participants for almost four years, showed that people who ate a Mediterranean diet instead of a typical American diet had a 50% to 70% reduction in recurrent cardiovascular disease.

  • Relax with yoga, meditation, exercise, etc. Doctors don't always ask patients about stress which is why it is sometimes called the "forgotten" risk factor for heart disease. People who successfully manage stress can significantly lower blood pressure and the risk of heart disease. Stress management also lowers the risk for arrhythmias (heart rate irregularities).
  • Exercise daily for 30 to 45 minutes. It is one of the best ways to maintain a healthy weight and prevent or control diabetes and high blood pressure. Regular exercise raises levels of HDL "good" cholesterol. It also can contribute to weight control which can reduce inflammation in the blood vessels, a risk factor for CAD.

All forms of exercise are beneficial. Aerobic exercise, such as brisk walking, is the best choice for most people because it doesn't require a high level of fitness to do it.

  • Get your cholesterol checked—and take cholesterol-lowering medication if necessary. Everyone should have a blood test for cholesterol annually. Research indicates that aggressive lowering of LDL cholesterol helps reduce risk of heart disease and death from CAD.

Bonus: Cholesterol-lowering statin drugs also reduce inflammation in the blood vessels.

  • Take a baby aspirin daily. It helps prevent platelets from clumping together and forming clots that can block blood flow to the heart. The anti-inflammatory effects of aspirin are also beneficial. Since aspirin may cause gastrointestinal upset and/or bleeding, talk with your doctor before initiating aspirin therapy for CAD prevention.
  • See your dentist twice a year. Studies have shown that patients with periodontal disease—gum inflammation that can result in tooth loss—have a higher risk of heart attack and stroke than those without it.
  • Get more omega-3s. Most Americans are deficient in omega-3 fatty acids, Omega-3s lower inflammation and triglycerides, a fat that can put you at risk for heart disease. Omega-3s reduce the risk of arrhythmias and heart attack. Sources of omega-3s include cold-water fish, such as salmon, and plant sources, such as walnuts and flaxseed. Or ask your doctor about taking a fish oil supplement.

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