A study presented at the American College of Cardiology meeting and published online in the New England Journal of Medicine has raised questions about whether the majority of people treated with a popular invasive procedure to reduce chest pain actually need the surgery. This study is turning up the spotlight on noninvasive prevention rather than surgical intervention, just as Dr. Arthur Agatston, preventive cardiologist and author of The South Beach Diet® does in his book The South Beach Heart Program. According to Dr. Agatston, who has been practicing aggressive prevention for many years, "this study is further evidence that we have been doing too much intervention and not enough prevention."
Following a trial involving more than 2,280 patients, researchers concluded that the use of surgical angioplasty and stenting (coupled with medication) provides no long-term advantage to a patient over a preventive treatment plan that includes appropriate medication, diagnostic testing, and lifestyle improvements. This news has stirred up controversy among the medical community. Over the past three decades the use of invasive angioplasty and stenting — a two-part procedure that involves manually opening a blockage by inflating a balloon at the end of a catheter and then using a wire tube to "prop open" the once-blocked artery — has become the initial strategy in the treatment of stable coronary artery disease. In fact, recent data indicate that more than 1 million coronary stent procedures are performed in this country each year, and nearly 85 percent of these procedures are elective. This finding comes as no surprise to Dr. Agatston, who says that for nearly three quarters of the patients who undergo stenting — those with stable heart disease — it may be unnecessary. According to Dr. Agatston, elective angioplasties and stents almost never prevent heart attacks. Practicing aggressive prevention is the more effective approach.
An Outdated Approach to Preventing Heart Attacks
Dr. Agatston likens this invasive approach for managing heart disease to a plumbing model. In The South Beach Heart Program, he explains that doctors formerly believed that the gradual growth of plaque narrowed the arteries and, thus, reduced blood flow to the heart. Eventually, a clot would develop, resulting in a heart attack. The logical solution seemed to be to open the artery with angioplasty and stenting (or to bypass it) to improve blood flow. But, as Dr. Agatston notes in his book — and as the latest studies confirm — the plumber's approach is outdated and inaccurate.
"While the great majority of patients are presently being treated according to this plumbing model, the treatment of the future belongs to doctors who I characterize as 'healers,'" says Dr. Agatston. "We now know that most heart attacks occur when a soft, cholesterol-rich plaque bursts, resulting in the formation of a blood clot that suddenly blocks the flow of blood to the heart. These soft plaques occur in the lining of the artery wall, not in the artery itself, which is why merely opening up a blocked artery will not prevent a heart attack or stroke," he explains.
The Smarter Way to a Healthier Heart
"The healer's approach that I present in The South Beach Heart Program is an aggressive prevention model that focuses on reducing the amount of soft plaque in the artery walls and improving the health of the arteries so that plaques do not form in the first place. Doctors who practice the healer's view, myself included, recommend a heart-healthy diet, regular exercise, advanced diagnostic testing to detect heart disease in its earliest and most treatable stages, and lifesaving medications," he says. This noninvasive approach was found to be more effective than stents in the latest study.
"I'll let you in on a big secret," says Dr. Agatston. "Physicians who practice aggressive prevention have seen heart attacks and strokes practically disappear from their practice. It's that simple — this approach can literally prevent heart attacks and strokes and save lives. My goal in writing The South Beach Heart Program was to speed the pace of the cardiac prevention revolution currently taking place in this country." To that end, Dr. Agatston has performed pioneering work in noninvasive cardiac imaging that has resulted in computerized tomography (CT) scanning methods and measures that bear his name: the Agatston Score and the Agatston Method, which are used to screen for atherosclerosis — and are recognized worldwide. The Agatston Score derived from the CT scan is the single best predictor of your risk for a future heart attack.
According to Dr. Agatston, studies like this continue to lend support to a noninvasive, aggressive prevention approach. "All of the latest research and evidence suggests that we already have the tools and knowledge to prevent the majority of heart attacks and strokes. Now we just need to put these methods into practice — and start saving more lives." For more information on Dr. Agatston's life-saving strategies, order your copy of The South Beach Heart Program today, or visit southbeachdiet.com.
Last Updated: 12/1/2008