Beating the Odds of Heart Disease 2015

Catey Carter, BSN, RN

Research Manager Century Study

The Weatherhead P.E.T. Center for

Preventing and Reversing Atherosclerosis

K. Lance Gould, MD Director

NO FINANCIAL CONFLICT OF INTEREST

Objectives

• Show the prevalence of coronary artery disease in the United States

• Describe basic physiology of heart disease

• Discuss cardiac risk factors

• Discuss what we are doing at the Weatherhead P.E.T Center to detect, prevent, stabilize and reverse CAD

The Heart – 4” diameter, 6” long

• Over 80 year lifespan, the heart:

– Contracts 3.4 billion times

– Pumps 61 million gallons of blood

– Pumps its own blood supply-coronary flow

– Never rests, adapts to extreme demands

– Replaces its components (protein) every month

– Associated with coronation, strength, love, generosity, courage, stamina

The Heart Pumping Volume

• Over 80 year lifespan of the heart:

– Pumps 60 million gallons of blood

– Equals 8,020,000 cubic feet of blood

– Could fill container 10” deep, 100” wide, 8020’long (1.52 miles)

Cardiovascular Disease in U.S. facts

• 36% of all deaths (1 every 2.8)

• 1 Heart attack every 25 seconds

• 1 death every 36 seconds

• Only 18% of coronary attacks are preceded by long-standing angina

Source: NCHS and NHLBI.

These data include coronary heart disease, heart failure, stroke and hypertension.

Prevalence of CVD in adults by age and sex (NHANES: 2005-2006)

A Total CVD

B Cancer

C Accidents

D Chronic Lower Respiratory Diseases

E Diabetes Mellitus

F Alzheimer’s Disease

CVD and other major causes of death for all men and women (United States)

Cardiovascular

Cancer

Cardiovascular

Cancer

Source: NCHS.

International comparison of spending on health, 1980–2005

* PPP=Purchasing Power Parity. Data: OECD Health Data 2007, Version 10/2007.

Average spending on health

per capita ($US PPP*)

Total expenditures on health

as percent of GDP

8 Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008

High expectations

Life Expectancy vs. Rate CV Death per 100,000 pop.

• Japan 82.7 • Australia 81.4 • Italy 81.3 • France 80.9 • Spain 80.5 • Canada 80.5

• UK 77.7 • Germany 77.4 • Ireland 76.8

• Poland 73.2 • Bulgaria 70.9 • Romania 69.9 • Russia 67.2

• United States 77.1

• Japan 170 • Australia 196 • Italy 218 • Spain 205 • France 183 • Canada 212

• UK 301 • Germany 270 • Ireland 337

• Poland 557 • Bulgaria 916 • Romania 770 • Russia 1167

• United States 289

Source: WHO/NCHS and NHLBI Revised 2010

Lifestyle, serum cholesterol and mortality

Kato H et al. American Journal of Epidemiology

(1973) 97:372-85

Comparison of cholesterol levels and coronary heart disease (CHD)

rates in Japanese living in Japan, Hawaii and San Francisco

JAPAN HAWAII SAN FRANCISCO

Serum cholesterol (mg/dL) 181 218 228

CHD rate (per 1,000) 25.4 34.7 44.6

• Detection: non-invasive test

• Coronary Angiogram

• Revascularization therapy

How we fight coronary artery disease

Standard treatment: The Cascade

Coronary angioplasty and stents (PCI)

Bypass (open heart surgery)

Why it does not work

“The Good Physician treats the disease; The Great Physician treats the patient who has the disease.”

-William Osler

1849-1919

Why PCI/CAB do not prevent most heart attacks

or death

Why we do it

“My Doctor gave me six months to live,

but when I could not pay the bill,

he gave me six months more!” -Walter Matthau

Current evidence

• Intensive LDL lowering with statin therapy may induce plaque regression and further decrease CV events when compared with standard goals

• Can we do better?

Looking for the “silver bullet”?

• Current pills

• New pills

• Drugs to New targets

• New ways of delivering drugs

• Costs…

• Benefits…

• Are we missing anything?

• Do we need a different approach?

Lifestyle

Bad family history?

May not always be easy….

PHYSICAL ACTIVITY AND CARDIOVASCULAR DEATH

…but it is worthwhile…

Regular Exercise

25

Houston Rodeo 3/2011

The Standard American Diet SAD

TEXAS 12/2012

THE “ULTIMATE” or….

…. “THE LAST” STATE FAIR EXPERIENCE?

KL Gould, Coronary Artery Stenosis and Reversing Heart Disease. 2nd edition (1999)

Types of cholesterol lowering

Healthy Diet

REWARD Prevention and

Regression

SCIENTIFIC EVIDENCE 2003-2009

Quality Research Brings National &

International Recognition

Plaque stabilization and regression to prevent most heart attacks or death

GOAL

Positron Emission Tomography: An accurate diagnostic and powerful motivational tool

ORIENTATION OF HEART

AND CORONARY

ARTERIES ON PET SCAN

P.E.T. Imaging of the heart: Red = normal blood flow

Imaging progression or regression of CAD by PET

409 patients - Sdringola et al. J Am Coll Cardiol 2003;41:263

PATIENTS AT THE CENTER OF HEALTH CARE

A Randomized Trial Of Integrated CAD Management By:

I. P.E.T. Imaging of the Heart

II. Medications To Goals

III. Healthy Lifestyle

Weatherhead Center for

Preventing and Reversing Atherosclerosis

University of Texas Medical School

•Target: 1300 participants

•Randomization:

Optimal standard of care or

Comprehensive risk factor management

•Follow-up: 5 years

•All participants: consult with study team every visit

•Risk factor assessment and consultation

•Electrocardiogram and exercise stress test

•3 blood tests for cholesterol, liver and kidney function (hsCRP)

•P.E.T. scan studies of the heart blood flow

•Diet evaluations and consultations

•Exercise consultation and risk factor modification with MD

•A service in addition to, NOT as an alternative to your MD optimal

medical care

All Century Patients will Receive:

•Can you participate in the study?

Study Entry Criteria

Documented Coronary Artery

Disease by

• Previous Heart Attack

• Angioplasty, Stent or

Bypass surgery

• History of Abnormal stress

test

Suspected or at Risk for Coronary

Artery Disease

•Diabetes and/or

•Multiple other CAD risk factors

with or without chest pain

symptoms

•Age >50

•Family history of CAD

•High total or LDL cholesterol

•High blood pressure

•Low HDL cholesterol

•Diabetes

•Cigarette smoking

•Coronary Calcification

Traditional Risk Factors for CAD

The final “take home” message for atherosclerosis prevention 2015

• A disease that YOU DO NOT HAVE TO HAVE

• Do not wait for symptoms or an abnormal stress test

• Do not expect others “to do it” for you

• We have to treat the patient who has the disease, not just the stenosis

• The “silver bullet” to win the battle against the #1 killer in U.S. is in risk factor modification by informed,

supported and motivated people!

Can intensive lifestyle changes prevent cardiovascular events and be

cost-effective?

“In a sense, this study is mainstream, but in another sense, it’s also 10

years ahead of its time. But it’s time 10 years from now becomes today!”

-KL Gould, MD

Diabetic Guidelines