1: Heart disease remains our deadliest killer.
“It need not be,” Dr. Peter Attia writes in his excellent book Outlive. “With the right strategy, and attention to the correct risk factors at the correct time, it should be possible to eliminate much of the morbidity and mortality that is still associated [with heart disease].”
“Bluntly put,” he writes, “this should be the tenth leading cause of death, not the first.”
Despite how much we know about heart disease and the many tools we have to prevent it, “it still kills more people than cancer in the United States each year, many of them completely out of the blue.”
The bottom line: We are losing the war against heart disease. And it doesn’t have to be so.
The key is to start earlier and prevent heart disease rather than treat it once we have it.
Which illustrates the difference between traditional medicine, what Peter calls Medicine 2.0, and a new approach he refers to as Medicine 3.0.
Despite how prevalent heart disease is, “it is also more easily prevented than either cancer or Alzheimer’s disease, he writes. “We know a lot about how and why it begins and the manner in which it progresses. While it can’t exactly be cured or reversed the way type 2 diabetes (sometimes) can, it is relatively easy to delay if we’re smart and we get on the case early.”
“The fundamental problem, I believe, is classic Medicine 2.0: Guidelines for managing cardiovascular risk are based on an overly short time horizon, compared to the timeline of the disease.”
2: Peter offers himself up as Exhibit One.
Yesterday, we looked at his story. After the birth of his first child in his mid-thirties, Peter realized he would likely die of heart disease, having lost three uncles to the disease, including two in their forties.
He became concerned and did a CT scan. His calcium score was 6. Which meant he had “more calcium in my coronary arteries than 75 to 90 percent of people my age,” he notes. “I was only in my mid-thirties, but I had the arteries of a fifty-five-year-old.”
These results launched him on a years-long quest to understand heart disease.
“Looking back, it’s clear that I had quite a few of the major and lesser risk factors already checked off. “I didn’t smoke, which is perhaps the most potent environmental risk driver, and my blood pressure was normal, but I had other problems.
“As my calcium score revealed, I already had a small, calcified plaque in the upper part of my left anterior descending (LAD) artery, one of the main arteries supplying my heart. . .
“My waist size was on track to hit 40 by the time I turned forty, a clear sign of my metabolic dysfunction. Underneath my belt, I was likely accumulating visceral fat. I was also insulin resistant, an enormous risk driver for cardiovascular disease.
“Though my blood pressure was fine, I suspect it would have deteriorated fairly rapidly as I aged, as hypertension seems rampant in my family. I probably also had high levels of uric acid, which . . . is often found in the company of high blood pressure and other signs of metabolic dysfunction.”
3: The bottom line?
“I was still in my thirties, yet I likely already had all three of the major prerequisites for heart disease.”
Despite all of these signs, “because my calcium score was ‘only’ 6, and my all-important LDL (“bad”) cholesterol was ‘normal,’ the medical advice I received was . . . to do nothing.”
Which is precisely the opposite of what Peter did.
His curiosity led him to research, write, and publish his book. What did he learn? With lifestyle changes and medications, many of the conditions he experienced can be modulated or nearly eliminated.
One example: “The high prevalence of male centenarians on the island of Sardinia, for example, has largely been attributed to their ability to avoid or delay circulatory disease,” Peter notes. “Fewer Sardinian men die from heart disease between the ages of eighty and one hundred than anywhere else in Italy.
“If we could get it right,” he notes, “the potential payoff would be huge.”
More tomorrow.
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Reflection: What surprises me about Peter’s recommendations regarding heart disease?
Action: Talk to my Primary Care Physician about Peter’s work.
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