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Prevention is the "Art of War"
Post Date: February 1, 2009Author: Edwin J Dean, MD
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In “The Art of War” ancient Chinese author Sun Tzu said: “If you know vascular disease and know yourself, you need not fear. If you know neither vascular disease nor yourself, illness, disability, and premature death will surely come.” This month is Heart Health Awareness Month which is the month to focus on the war against vascular disease, the leading cause of heart attacks, strokes, congestive heart failure, high blood pressure, rising health care costs and death in the United States. It is incredibly common – most men and women will develop disease- yet very preventable. The key to prevention is awareness and early detection.
A Confession. Sun Tzu was not a doctor and did not actually mention vascular disease in “The Art of War” but the book is one of the oldest books on military strategy in a world and throughout the ages has had a huge influence on military and business thinking, and beyond. The subject matter was war -a matter of life and death, and the road to either safety or ruin. Similarly, vascular disease is a subject of life and death and a road to improved or deteriorating health. If you are going to “Win the War”, you need to know about vascular disease and your risks.
KNOW THE ENEMY
The term vascular disease commonly refers to the buildup of cholesterol in the artery walls. This buildup is called plaque and overtime can obstruct the flow of blood to vital organs such as the heart, brain, and kidneys and causes dysfunction. It is sludge that not only clogs but can explode with catastrophic results. The graphic shows the progression of vascular disease.
Soft Plaque Kills. Cholesterol deposits in the artery wall can begin early in life and mostly progresses without symptoms. Some plaque collections however are like ripe pimples, called (vulnerable) unstable soft plaque, that can rupture into the artery where the blood flows. This event causes a blood clot to form that closes off the artery which leads to a sudden heart attack or stroke. In fact nearly 2/3 of sudden heart attacks occur from such unstable plaque even though there was minimal obstruction before it ruptured. Unfortunately, nearly 50% die from their first heart attack.
Stealthy Deadly Enemy. Soft Plaque creates the ticking time bombs that can go off at any time. Before it ruptures, soft plaque is difficult to detect by simple testing. Traditional cholesterol testing alone does not go far enough. Two thirds of the people with their first heart attack have what would be considered normal or good cholesterol. Fortunately a combination of radiographic imaging and blood tests more accurately uncovers hidden risk from soft plaque. The Heart CT plus biomarker blood tests including the new Plaque test can uncover higher risk for this stealthy murderous plaque. If these tests indicate increased risk, you can do something about it.
Once Detected, Attack the Enemy. Vascular disease and soft plaque can be prevented, stabilized or reduced through variety of cholesterol modification, exercise and dietary strategies. These can be surprisingly simple and effective in early disease. The key is to detect increased risk as early as possible and increase prevention measures as appropriate.
KNOW YOURSELF
As Sun Tzu suggested, the Art of War against vascular disease requires that you know yourself as well as the enemy. Since vascular disease is silent in the early stages, advanced screening is the key to knowing your risks, weaknesses and strengths. Everyone is at risk during their lifetime and should consider advanced screening.
High life time risk for vascular disease. By age 35 10% of men have significant plaque and by age 50, 45% are affected and a few have died or had their first heart attack. By age 85, 99% have plaque. Women are also at risk. In fact, it's the leading cause of death in the U.S. for both women and men. Any amount of plaque is potentially dangerous so as you can see nearly everyone is at risk at some point in their lives and therefore everyone should address the problem early.
Start with the Heart. Vascular disease occurs throughout the body but it is in the heart arteries that the disease is most likely to kill you and lead to long-term health consequences such as congestive heart failure. The heart is also where early preventive screening is most effective in the form of a Heart CT. This test combined with blood tests can detected early disease long before the health consequences manifest. Treating early heart disease with a heart healthy regimen improves overall health and decreases some other seemingly unrelated diseases such as diabetes, memory loss, and some cancers to name a few.
Start Screening Early. The question of when and how aggressively to implement prevention strategies can be answered by early, accurate and periodic screening. For men advanced screening should be considered at age 35-40 and earlier if risk factors such as family history of vascular disease exist. Women risks often lag men’s by 5-10 years. They should start age 40 -50, but again, earlier if risk factors – obesity, sedentary lifestyle, smoking, high blood pressure, diabetes or family history exist.
Early Screening for Early Prevention. If your advanced heart health testing is normal, this can give you peace of mind. Studies have shown people in this category have a very low three to five year risk of heart attack and stroke and may not need repeat testing in this time frame. If your screening is abnormal, it can be a kick in the pants and an indication to step up prevention and monitoring. It is much easier to prevent progression than to reduce existing disease. Early interventions are often simpler and less expensive than late interventions. There are many effective and inexpensive medications and supplements at this stage. Combine these with diet and lifestyle changes and you can improve your quality of life and slow down the aging process. Obviously early prevention measures are easier and far more pleasant than late stage strategies that may include bypass, CPR and picking out a coffin.
Beware of misleading tests. As mentioned earlier, cholesterol testing by itself is an inadequate screening test. A recent screening of a local emergency services group found that in the 40-50 year age group, 45% had vascular disease. Of those, 90% had not been previously identified even though they had received comprehensive annual physicals. Likewise, stress testing and heart ultrasounds are not adequate to pick up early vascular disease. These tests have their important diagnostic uses but do not detect early vascular disease. In fact they can be completely normal despite extensive unstable soft plaque. Unfortunately, patients often misinterpret a “normal test” as a “clean bill of health” and miss an opportunity to treat early disease or stabilize one of those unstable plaque pimple time bombs.
Advanced Screening Available. Using a combination of computerized imaging of the heart, biomarkers in the blood and direct evaluation, Heart Health Screening can pick up vascular disease and risk factors long before the disease progresses and before a fatal or debilitating heart attack or stroke. It is a streamlined assessment tool that empowers you to take control of your preventative health. It is not a simple fix for vascular disease, but it removes many of the traditional barriers to advanced screening for the early detection of this common yet preventable problem.
Knowledge is power in the Art of War against vascular disease. This Heart Health Awareness Month spread the message that prevention means instead of being reactive and waiting for illness or catastrophe to show up you can be proactive and look for the first signs of vascular disease and alter the unchecked progression of disease. Remember do the right tests early. Go forth as Heart Health Warriors and conquer.