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Ask the Doctor: Can you really prevent heart disease?
Harvard Heart Letter
July 2007
Q. Is the heart-health message wrong? Pretty much everyone knows by now that they can “prevent” heart disease by not smoking, losing weight, exercising, watching their cholesterol and blood pressure, and eating right. So when they do all that and still get heart disease, they are baffled and may feel cheated. Is this emphasis on prevention unrealistic and misleading? Is it actually possible to prevent heart disease, or can you just slow it down?
A. It is very discouraging when you do all the “right” things and develop heart disease or have a stroke, while other people who do many of the “wrong” things keep on trucking without a hint of cardiovascular disease. It isn’t a failure of the prevention message, but a problem of perception and our incomplete understanding of cardiovascular disease. I say a problem of perception because, over the long haul, many more people who followed heart-healthy habits are still around in their 80s and 90s than people who didn’t, but this long-term shakeout is tough to see. And there are some factors you can’t control, like your genes, that contribute to heart disease and stroke in ways we don’t yet fully understand.
Preventing heart disease is, indeed, possible. The proof comes from autopsies conducted at the end of World War II in people who had lived at the edge of starvation. The arteries in their hearts showed virtually no atherosclerosis. Few people are going to go that far to ward off heart disease. Modern Western diets make it hard to avoid a fair amount of saturated fat and extra calories, and few people are as active as humans are probably meant to be. That means true prevention of atherosclerosis is out of reach for many people.
The next best thing — slowing the growth and spread of atherosclerotic plaque (a common denominator of many cardiovascular diseases) — is within everyone’s grasp. It’s worth noting that you don’t need to melt atherosclerosis completely away to dramatically decrease your chances of a heart attack or stroke. The goal is to prevent cholesterol-filled plaque from rupturing, a key event that leads to the formation of blood clots that can block a coronary artery and cut off blood flow to the heart or brain.
Doing the things you mentioned — not smoking, losing weight, exercising, controlling your cholesterol and blood pressure, and eating right — are essential steps for keeping heart disease at bay. Alone and in concert with drug therapy, they can stabilize plaque so it is tougher and less likely to rupture. Depending on how aggressively you pursue these options, they can even shrink plaque.
— Thomas Lee, M.D.
Editor in Chief, Harvard Heart Letter
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