Medicine has created an imaginary divide between sickness and health. We described health as merely the absence of an identified disease.
In other words, you have heart disease or you don’t. You have cancer or you don’t. You have celiac disease or you don’t. Admittedly, over the years we’ve gotten better by identifying “pre” states. Pre-hypertension. Pre-diabetes. Pre-osteoporosis. Pre-cancerous.
These “pre” states were created less to educate you about needing to make better choices and more to identify the point at which the benefits of medicating a condition outweighs the risk of side effects. Just in case you think this sounds cynical, read up on the history of osteopenia (“pre” osteoporosis). It’s a little scary to see how much we all are duped by the drug companies when it comes to our health (NPR has a great overview of the process that went into building a drug market for osteopenia).
There is nothing wrong with using the label of “pre” when it comes to chronic disease. I use it all too frequently with prediabetic patients in my office. But to me, the “pre” is a warning sign that you need to get your act together because you are well on your way to any number of chronic diseases. We should NEVER rely on drugs for any type of “pre” condition. Never. Lifestyle changes are the only recommendation that should be on the table at this point. It is up to you to make the right choices.
One condition that we do not generally tack the “pre” label on is heart disease. Sure, we love to tell patients they are at risk because they have high cholesterol or high blood pressure or not exactly optimal body weight. But again, I think patients view this as an “off or on” situation. Just because you have high cholesterol does not really mean that you have heart disease. It only means that you are at a greater risk of having a heart attack.
This is an outright misunderstanding of the way heart disease works in our body. Having a heart attack or stroke is merely the end process of decades of abuse on your blood vessels. Almost the proverbial straw on the camel’s back. Would you make needed changes if you knew you were a single straw away from the end of your life?
Some still would not, thinking that they would be lucky enough to escape this outcome.
With that in mind, I would like to bring your attention to this particular study. In it, researchers looked at 405 men and 813 women with three important factors:
- They had, for some reason, suspected coronary artery disease.
- They had NO previous history of coronary artery disease.
- They had no evidence of coronary artery disease on cardiac stress testing.
You may very well match this group of participants. These patients would essentially have been given a clean cardiac bill of health after the tests were negative. But the researchers didn’t stop there. They looked at how well the blood flow moved through the coronary arteries using more specialized testing. Here’s what they found as they followed this group of patients over the next 1.3 years:
- 51% of men and 54% of women demonstrated some type of damage to their coronary arteries.
- For every 10% increase in coronary flow reserve (basically healthier blood flow to the heart muscles) there was a 20% drop in the risk of major cardiac events.
- In a small group who were evaluated in more depth (307 women and 97 men) who had no hardening of the heart arteries on CT scanning 44% of men and 48% of women still had damage to the heart vessels.
In other words, these patients, who had normal cardiac testing, were well on their way to having a heart attack. And this was a large chunk of the patients in the study. I’m sure that these patients thought that “everything was ok” and continued to go about their merry little life thinking everything was peachy-keen.
We need to understand, as a society, that a very large chunk of us are already on the “pre” heart disease pathway and that damage to the very blood vessels supplying the critical nutrients and oxygen to the muscles of our heart is already occurring. Until we change our attitude towards heart disease and understand that it is a spectrum heart disease will continue to be this country’s #1 killer.