An Ounce of Prevention

by Amit Khera, MD, MSc

Heart Talks

Heart Disease is Preventable

Although Benjamin Franklin was referring to fire safety in his famous saying “an ounce of prevention is worth a pound of cure,” these words certainly apply for heart disease. When I was a resident in Internal Medicine, I distinctly remember taking care of a 45-year-old man who was admitted to the hospital for his 7th heart procedure to fix blocked arteries. I couldn’t help but wonder how he developed such malignant coronary artery disease and thought that there must be a better way to keep him from having these recurrent problems.

Over a decade later, our Preventive Cardiology Program at UT Southwestern continues to focus on these two issues: Why do some people develop heart disease and not others, and what are the best ways to prevent heart disease and its complications? For the latter, it is quite clear that heart disease is indeed preventable. Studies over the last decade have shown that for those who can achieve health levels of major risk factors (normal blood pressure, cholesterol and blood glucose levels, and non-smoking) the chance of having a heart attack is almost 80% lower than those with unhealthy levels of these risk factors.

However, achieving these healthy levels is not always easy and the approach has to be individualized. For example, the practical plan for exercise and dietary changes for a busy executive who constantly travels is quite different than the plan for someone with a more regular schedule but who is restricted by orthopedic issues or other medical problems. Each individual has to determine his or her own best plan, but strategies which have been proven to work are setting specific goals, keeping logs of food intake and physical activity, and focused problem-solving for barriers that arise. We use a team approach here involving physicians, a dietician, nurses, and physician assistant to craft and monitor these individualized plans.

Some Patients Require a Different Playbook

For most people, keeping risk factors at healthy levels and maintaining good lifestyle habits will stave off heart disease. However, there are some, like those with a strong family history of heart disease, those with rare genetic disorders or extreme risk factors levels, or even those like the young man I mentioned who develop heart disease at a young age, where the usual treatments and recommendations won’t be enough. These patients require a different playbook. Fortunately, there are emerging tests and treatments, as well as new knowledge about rare diseases, that provide valuable treatment options for these individuals.

The Preventive Cardiology Program uses all the resources available to us including scientific discoveries on campus, novel treatment strategies, and experts at UT Southwestern and around the country to treat these challenging patients. Unfortunately, what I see far too often in my practice is risk factors that went undiagnosed or warning signs that were ignored until heart disease was far advanced and much more difficult to treat. The best advice that I can provide all individuals is to know your own numbers and pay attention to warning signs, because an ounce of prevention is worth a pound of cure.