1: Heart disease is a sly, slow-moving, stealth-like killer.
It “unfolds very slowly—not over two or three or even five years, but over many decades,” Dr. Peter Attia writes in his powerful book Outlive.
Yesterday, we explored how teenagers who passed away from other causes were found to have lesions and plaques in their arteries.
“There is a considerable period of time when the disease is not harmful,” Peter writes.
And then, after a long buildup, it becomes lethal.
“Dying from cardiovascular disease is certainly not inevitable,” he notes. Yet, “nearly all adults are coping with some degree of vascular damage, no matter how young and vital they may seem, or how pristine their arteries appear on scans.”
2: The problem we face?
“Most doctors consider it ‘overtreatment’ to intervene if a patient’s computed ten-year risk of a major adverse cardiac event (e.g., heart attack or stroke) is below 5 percent, arguing that the benefits are not greater than the risks, or that treatment costs too much.”
Peter argues that ten years is much too short a time horizon: “If we want to reduce deaths from [heart] disease, we need to begin thinking about prevention in people in their forties and even thirties.”
Previously, we looked at Peter’s personal story. Because he had three uncles who died from heart disease, including two in their forties, he decided to have a calcium scan when he was thirty-six.
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.”
Yet, “my ten-year risk was incalculably low—literally,” he writes. “My parameters could not even be entered into the models. So, it’s no wonder nobody was alarmed by my findings.
“Despite my calcium score of 6, my ten-year risk of a heart attack was far less than 5 percent.”
Peter did not stand still, however. Through lifestyle changes and medicine, he aggressively fought against the slow-moving disease.
Seven years after his initial scan, he had a CT angiogram (a better, higher-res scan), which exhibited the same small speck of calcium but no further proof of additional soft plaque elsewhere.
He did another scan six years later, and the result was the same. “Thus, at least at the resolution of the sharpest CT scanner commercially available, there is no reason to believe that my atherosclerosis has progressed over thirteen years.
“I have no idea if this means I’m free from risk—I frankly doubt it—but I no longer fear dying from cardiovascular disease the way I once did.”
His long-term, comprehensive plan of action for prevention is paying off. “I feel a lot better now, at age fifty, than I did at age thirty-six, and my risk is a lot lower by any metric other than age.”
3: What lessons can we learn from Peter’s story?
He started early, well before traditional medicine, what he calls Medicine 2.0, would have suggested any intervention.
“Yet most physicians and cardiology experts,” he writes, “would still insist that one’s thirties are too young to begin to focus on primary prevention of cardiac disease.”
Peter and other physicians and scientists are challenging Medicine 2.0. In a 2018 JAMA Cardiology paper coauthored by Dr. Allan Sniderman, he compared ten-year versus thirty-year risk horizons in terms of prevention.
Their analysis, Peter notes, “found that looking at a thirty-year time frame rather than the standard ten years and taking aggressive precautionary measures early—like beginning statin treatment earlier in certain patients—could prevent hundreds of thousands more cardiac events, and by implication could save many lives.
“For every seven people who are put on a statin at this early stage, we could potentially save one life.”
Statins reduce the primary causative agent in the disease process: apoB. “The sooner we lower apoB exposure, thus lowering risk,” Peter notes, “the more the benefits compound over time—and the greater our overall risk reduction.”
More tomorrow!
________________________
Reflection: What surprises me about Peter’s research regarding heart disease?
Action: Talk to my Primary Care Physician about Peter’s work.