When a 44-year-old male friend dropped dead the other day from a massive heart attack — no prior symptoms, no warning of any kind — I wondered if modern medicine could have done anything to prevent the tragedy. The answer I learned is that low-tech still beats high-tech hands down in preventing America’s No. 1 killer.
Low-tech means getting regular exercise, eating right and paying attention to cholesterol, blood pressure and the other risk factors for heart disease, and it also means moving fast to get to a medical facility with any symptoms whatsoever that might be signaling heart attack. Those are the proven ways to lengthen your life span and avoid early death.
But my friend didn’t have any symptoms or risk factors. What could he have done? That’s where high tech comes in, but the answers are not encouraging. The available treatments are expensive and not very effective for people without symptoms.
He could have had the gold-standard test for narrowed arteries in the heart: an angiogram. That’s an X-ray movie of the arteries that involves putting a tube into the groin, threading it up to the surface of the heart, and squirting dye through the tube to outline the inside of the blood vessels as high-speed multiple X-rays are taken. I’ve watched these movies for some of my medical malpractice lawsuits, and they are eerily fascinating: the dye looks like smoke as it pushes out of the tube and mingles with the blood in the arteries, which suddenly light up as if a switch has been turned on, with the heart quivering all the while behind the arteries.
The problem is that most of the time, angiograms on people without chest pain symptoms show nothing. Even when there are some symptoms, the angiogram is just as likely to turn up clean as a whistle, or with only minor narrowing, as it is to show serious disease.
A new study in the New England Journal of Medicine of 400,000 patients found that the odds of finding operation-worthy heart disease in patients getting a first-time angiogram without any known heart disease was only four in ten — which means that the $2,500 procedure was wasted on six of every ten patients.
Now, you might think that the angiogram can still be worthwhile if it shows some blockages that can be cleaned out. But that’s true ONLY IF those blockages are causing symptoms. The usual technique to unblock arteries — with a balloon and a wire scaffolding (stent) to hold open the artery — has been shown to work to relieve symptoms of chest pain, but it does NOT extend life in symptom-free patients. In those patients, it’s thought that the heart has already learned how to deal with the blockage by shifting blood from another supply.
Here is a very good article from Harvard Medical School on who should get the balloon treatment — called angioplasty — and who shouldn’t.
The bottom line: Angioplasty can save your life during a heart attack if it can be done fast enough to open the artery before permanent damage is caused to the heart muscle. But for symptom-free patients, angioplasty is worthless and exposes patients to the risk of dying from a complication of having wires and tubes poked into your heart. And for patients with non-debilitating chest pain, angioplasty doesn’t work any better than taking drugs and making lifestyle changes.
People who get chest pain and learn they have heart disease should think of the pain as a gift from on high: It’s given them a chance for a new lease on life. But for people like my friend whose first symptom is a fatal heart attack, there’s not much that medicine can do. We’re all fated to die at some time, and we haven’t learned how to defeat fate. We can and should pay close heed to getting plenty of exercise, eating right and doing other things to lower our risk. But the risk will always be there.
