Put your heart into prevention

Don’t depend on drugs alone to keep your heart healthy. It takes an all-out effort to make a difference.

If your cholesterol-lowering medicine is doing its job, there’s no harm in eating ice cream, chips, or the occasional juicy steak, right? Shouldn’t your daily pill be able to cover your dietary indiscretions?

It all depends on how determined you are to keep from having a heart attack or stroke.

There’s no question that the drugs in the family known as statins fight high cholesterol. They also do other things to fight the artery-clogging process known as atherosclerosis. Statins get such good press that it’s easy to be lulled into thinking they’ll cover a middling diet. An important new study should burst that dream.

At the University of Texas Medical School, researchers followed more than 400 men and women with chest pain (angina) or other forms of coronary artery disease. Some of them did little to control their cholesterol levels. Others gave cholesterol control a decent try by taking a statin and following a standard heart-healthy diet, or by following a very strict diet. Those in a third group went all out—they adopted a strict diet, exercised, and took a statin.

The all-out approach was the clear champion. During the five-year study, only 1 in 20 of the people in this group had a heart attack, underwent a procedure to open or bypass cholesterol-narrowed arteries, or died of heart disease. Rates of such cardiovascular problems ballooned in the medium effort and do-nothing groups.

Supercharged stress tests (which use positron emission tomography) done at the study’s start and again two to three years later showed much the same thing. In the high-effort group, blood flow through the coronary arteries had actually improved, while in the other two groups it continued to decline. (Journal of the American College of Cardiology, Jan. 15, 2003, Vol. 41, No. 2, pp. 263–72)

A cautionary note is in order. This wasn’t a randomized trial, in which men and women were blindly assigned to one strategy or another. Instead, the participants were grouped according to what they chose to do after being diagnosed with coronary artery disease. It’s certainly possible that something other than these different approaches—something that the researchers didn’t measure—led to the different rates of cardiovascular problems among the groups.

Then again, it’s possible that what you see is what you get, and that the combination of mindful changes in lifestyle and statin therapy offers the best of both worlds.