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Treating Heart Disease

  • The News is Getting Better

  • So you’ve had what doctors call a “cardiac event” – a heart attack, or just the warning signs that indicate your arteries are narrowed or blocked. You’ve moved into a new category, where attention to your heart health should be paramount.

    MyLifeStages talked with our cardiac experts to find out the latest approaches to treating heart disease once discovered.

  • The Latest on Surgery

  • Surgical treatment of blocked arteries saves lives. The original, traditional approach of a Coronary Artery Bypass Graft (CABG) takes veins from another part of the body and sews them onto the heart, literally bypassing the blocked and narrowed artery(ies). It can mean the difference between life and death for those with severe heart disease.

    Over the past decade, however, less invasive procedures have been developed - opening blocked arteries from the inside, using tiny balloons to press open the vessel and sometimes inserting tiny “stent” devices to prop the artery open. Angioplasty and stents also save lives, and can return patients with severe symptoms to pain-free functioning. The emphasis on CABG lessened as the number of stent procedures grew.

    But current thinking is that not every patient with a blockage may even need surgery, according to Dr. Patrick Coleman, cardiologist with Sutter Santa Rosa Regional Hospital. “The advent of very effective drug therapy has impacted the field tremendously. Now some patients may do fine without a stent. That’s a conversation to have with your doctor.”

    Dr. Gary Milechman, cardiologist at California Pacific Medical Center, agrees that “not every narrowed artery must be surgically opened. With the right medications and good control of blood pressure and cholesterol, patients may manage their coronary artery disease without entering an operating room.”

    And even after surgery, a patient is not “fixed,” notes Dr. Reetu Sharma with Sutter Roseville Medical Center. “Patients with CAD must approach it as a life-long condition. Attention to lifestyle – diet, exercise, stress – combined with the right medications, will be needed to keep their disease in check.”

  • New Medications

  • In the 90s, a new weapon against CAD was introduced: cholesterol- lowering medications, called statins. All of our experts agree on one point: Statin drugs work.

    “There have been many different outcome studies with people on statins, and every study has shown fewer "cardiac events" - heart attacks and strokes - in people taking the cholesterol lowering medication,” notes Dr. Milechman. “While many in my Bay Area community are reluctant to take medications, I have to tell them that these drugs will have a positive impact and can even reverse plaque build up in their arteries.”

    Dr. Coleman agrees: “Patients taking statin drugs have fewer actual heart attacks and strokes. That has been demonstrated, in scientific studies, repeatedly. And that is the measure of success – not whether you have a blockage in your artery, but whether that blockage leads to a disabling event, or death.”

    Dr. Coleman notes that the success of statins even caused the end of some double-blind, comparative studies. “After the success of the statin in reducing disease and death, it became unethical to conduct a study where a placebo was substituted. The evidence of statin success was too strong.”

    Dr. Sharma is also an advocate of statin drugs for patients already diagnosed with coronary artery disease. “I strongly encourage my patients to take statins. You want to minimize your risk of a heart attack or stroke. We start on the smallest dose and look at the impact on cholesterol levels, adjusting as we go.”

  • Lifestyle Changes

  • Our experts also agreed on one important point: Lifestyle changes still matter. Heart disease is a complex mix of things you can’t change – a genetic tendency toward high cholesterol or CAD – and things you can change.

    Despite amazing medical advances, despite lifesaving surgeries and effective drugs, your healthy heart will still require some things of you. You will need to pay attention to what you eat, every single day. And it will respond best to regular exercise. And these good habits apply to everyone – before a heart disease diagnosis, and certainly after.