When normal is dangerous…

Contributing Columnist

Normality can be lethal.

That’s the conclusion of a new, large VA study of heart disease. Tens of thousands of veterans with chest pain were catheterized to check for their level of cardiac artery narrowing.   Those with “non-obstructive” heart disease – with narrowing of 20-70% of any coronary artery – died at a much higher rate than those with little or none.

But the “non-obstructors” were not treated aggressively. Because of their “normal” studies, many were not treated aggressively at all – though those with two or more “non-obstructed” arteries died at around four times the expected rate.


What Is To Be Done?

As Jane Brody points out in a recent article in the NY Times, medication options include aspirin and statins.

Aspirin is a particularly attractive choice. Aspirin’s decrease in cancer deaths is much more powerful than its ability to stop cardiac deaths – a fact few in the public know. Aspirin does cause bleeding, yes. But it’s cheap, easily available, and might  save millions of lives. Guidelines for statins – liberally interpreted by guideline writers with ties to drug companies – make it that virtually everyone over sixty-five will be “recommended” statins. Such  advice is probably wrong. Still, American lifestyle leads to a lot of heart disease, and statins have a big role in overcoming cardiac deaths in the populations.

But other means should help more.

Health is synonymous in many minds with medical care. The VA study and thousands like it should strike a blow at that mindset. For too long, health care has been determined by what treatments and procedures are backed by large economic actors – and how much they pay.

Looking instead to a four fold path to health – physical, mental, social and spiritual – should produce far more benefits to heart patients – and most of the population.

People who walk get less heart disease. People who eat a Mediterranean or similar diets get less heart disease. People who routinely sleep at standard hours get less heart disease.

From the standpoint of mental well-being, seeing the world in terms of solutions – not problems – works well. This cognitive approach really cuts down on depression, a major risk for heart disease.

It’s also been known for decades that the more friends (real face-to-face friends, not necessarily the Facebook variety,) colleagues and acquaintances one has, the less the risk of heart disease. That’s the social option to well-being – a very underutilized part of public health.

Last, when people have a sense of meaning and purpose in their lives, there is less heart disease. And members of religious communities for example, show fewer cardiac deaths.

How much is the “health care industry” incentivized to provide people the knowledge to get healthy through physical, mental, social and spiritual well-being? Just about zero.

Sorry, folks. If health is the goal, you’ll probably just have to do it yourselves. Your physicians will be too worried trying to meet numerical guidelines to deal with the real facts – that the population’s health is determined not by medical care, but how you live.

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