Heart health depends on healthy behaviors

Everyone knows that the heart health of Americans is dismal. Obesity, diabetes, and high blood pressure are all on the rise.

For now, technological advances in cardiac care continue to maintain, or in some cases, lower the death rate from heart disease. Squishing blockages, ablating abnormal heart tissue, and installing cardiac devices have successfully kept the abysmal lifestyle habits of so many at bay. Despite all the fury of modern technology — or maybe because of it — many continue to fail miserably on the front end, that is prevention.

A recent article in the Wall Street Journal, from a noted Ivy league prevention expert, purports vascular age as another means to tell patients of their poor blood vessel health. On a positive note, this piece educates us on the role of the blood vessel, particularly the seemingly inert, but highly susceptible to inflammation inner lining, known as the endothelium. Correctly proclaiming the endothelium as the crux of heart health is a good thing.

Also, telling an unhealthy 40-year old that he has the artery health of a 64-year old is certainly a novel idea that is more elegant and maybe a bit more eye-opening than just telling him he is fat, out of shape and now has diabetes. As far as educating goes, the vascular age thing is quite good, but it is still only education, not motivation.

In 2010, can anyone American not know about heart healthy behaviors? Education on heart disease is ubiquitous; even substituted for smart policy decisions, like Louisville’s chief doctor who opposed banning toxic trans-fats in favor of educating the public on their danger.

As is the case with most able-bodied, non-dabbling electrophysiologists, I can ablate SVT, atrial flutter, and implant pacemakers and ICDs with greater than 95% efficacy. Even PAF can be successfully eliminated two-thirds of the time. Yet, despite trying hard (really hard), I fail more than 90% of the time to get patients to change their heart healthy behaviors. Nine in ten patients return just as fat and sedentary as they were at the time of my previous lecture on heart health.

In heart health, getting people to know is not the issue, rather the issue is in implementation of the plan. The treasure at the end of the rainbow, is a mechanism or strategy that affects people’s lifestyle choices. Somehow, something. or someone needs to find a way to motivate people to change their lifestyle. This is the holy grail of heart health. The solution is before us in clear view.

Politicians, MPAs, MPHs and the like all talk about health care savings of this plan or that plan, but can you imagine the savings if there was a major change in population behavior. Imagine the savings if masses of people stopped smoking, started carving out time for 30 minutes of exercise, leaving the table still able to walk upright, and going to bed on time. Imagine the health of our youth if we had mandatory gym class every day, healthy food in the cafeteria and healthy parent role models.

John Mandrola is a cardiologist who blogs at Dr John M.

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  • http://www.mcgath.com GaryM

    Prohibition of unhealthy foods is not a “smart policy decision.” If people cannot be trusted to individually make good decisions for their own lives, how can they be capable of collective good decisions for other people’s lives? The path of prohibition drives people to illegal sources, whips up “wars” that waste law enforcement resources and endanger the innocent, and takes away people’s freedom to balance their choices as they see fit.


    I totally agree about the lack of responsibility for personal health behavior. But until we start truly “calling out” these morbidly obese people on their behavior, nothing will happen.
    It is politically incorrect to point out to people that they should not smoke and that they are fat but their behaviior costs all of us billions of dollars that could and ethically should be spent on other health care needs.
    Law enforcement can ticket those without seat belts or without appropriate child seats in their car- I am volunteering to be a fat cop and issue citations to the morbidly obese.

  • madoc

    Dr. John M—What action are you recommending at this time?

  • http://www.milanmooremd.com Milan Moore MD, MPH

    Thank you for taking a stand. As subspecialists, we come to a point where we realize that, as the parable goes, we are jumping in and pulling drowning individuals from the river while we should be making a effort to address the factors that are pushing them off the bridge and into the water in the first place. As you point out, some of them are jumping in of their own accord. I applaud you.

    Milan Moore MD, MPH

  • http://totalgoodhealth.com/ Healthy Living

    It’s been a couple of months that I found out my LDL levels are soaring and my blood sugar is about to cross over to the positive side. I really want to eat healthy but it has always been a challenge to me. I didn’t even know where to start. After reading this post, at least I know where to start now.

    • Taylor

      A good place to start is to shop the perimeter of the grocery store. Don’t buy processed and packaged foods. Buy fresh fruit and vegetables (it’s also cheaper than all the packaged crap). Then use the fresh ingredients to cook meals at home. Also, cut out soda and other sugary drinks. Drink water. Enjoy dessert, but a small amount and not every night.

  • HJ

    “Buy fresh fruit and vegetables (it’s also cheaper than all the packaged crap).”

    I don’t know where you shop but a box of mac and cheese costs $1.45 while a head of romaine lettuce costs $1.69. 18 oz of Oreos cost $3.00 while 18 oz of russet potatoes cost $4.39. A gallon of milk $3.29 – a gallon of soda-$3.80.

    • Taylor

      I tend to shop at Trader Joes, but go to Giant, Harris Teeter, and even Whole Foods for a few things. I only for myself I spend about $150 a month on groceries. I make a list before I go buy things like bread, spinach, cucumbers, black beans, oatmeal, quinoa, peanut butter, bell peppers, avocados, bananas, strawberries (in season, cheap), and other fruits on sale. I could spend $20 a week if I only shopped at Trader Joes. Sorry, but oreos and mac and cheese are not food. It’s total crap and in the long run you will pay more out of pocket for your health from eating that stuff. And why would you buy soda?! Water is free. Also a box of mac and cheese will feed how many? Two people? You can make a salad for four from a head of romaine when you add in other vegetables. A cucumber costs like a dollar.

  • http://wellescent.com/health_blog Wellescent Health Blog

    By no means is achieving patient motivation for prevention limited to ensuring heart healthy behaviors. People lack motivation in various aspects of life including their health in general. While scaring some people will work to get them to take action to improve their health, evidence from research studies is showing that people respond far better to incentives. The real trick in achieving prevention efforts, and it is a hard one, is finding the ways to consistently motivate and provide incentives for patients to look after themselves.

  • http://www.drjohnm.blogspot.com DrJohnM

    Thanks for the thoughtful comments all.

    I felt bad about my persistent complaining about the obesity epidemic, and as such, a few weeks ago, I put my chips in and committed to my plan–as if I were the Surgeon General. http://drjohnm.blogspot.com/2010/08/if-i-was-surgeon-general.html Sorry for linking my own site, but my plan is too long winded for this comment section.

    Incentives for making good lifestyle choices are not politically correct to speak of, but would surely be more effective than what we are doing now. The resilience of obesity and sedentarism, as witnessed on the front lines of American cardiac care is breath-taking. Our present methods of implementing healthy behaviors is failing.


  • zzz05

    where i work, employees get all these financial incentives for better health, not to mention all the communications encouraging us to take care of our health. then you go down to the cafeteria, and a big slab of greasy pizza is $2.50 and the equivalent weight of salad costs $3.50.

    • Taylor

      Well, this is the typical American thinking! It’s a DOLLAR difference people. I guarantee you will save A LOT of dollars in the future if you pay a dollar more and get the salad now, or eliminate the problem altogether and pack a healthy lunch.

  • http://www.weightlosscoachingmd.com Melanie Lane MD

    A huge part of the struggle to improve the health of Americans arises from the fact that medicine is practiced in a way that is totally disempowering for patients. Patients believe that it is their doctor’s responsibility to make them healthy and whole, which is not only unrealistic, it is impossible.

    Physicians are expected to hand hold patients through everything. You can’t just give someone an order for a mammogram and tell her it is time for her breast cancer screening; you must also explain that failure to have cancer screening performed on schedule could result in untreated and undiagnosed cancer and that cancer is bad for you and could lead to surgery, disfiguration, pain and death. This is ridiculous!

    People are waiting for someone else to inspire them and motivate them, and somehow we physicians have allowed this burden to be placed upon us. The reason we can’t motivate our patient to change is because motivation is an inside job that only the patient himself can generate.

    I propose having patients sign a form right from the beginning of the relationship with their new doctor stating that they understand that they are responsible for their own health, happiness and well-being. If they don’t take their medications as directed or don’t follow through with their doctor’s recommendations, the doctor is not responsible for a poor outcome. Ideally the physician then reviews this with the patient in the exam room annually, or more frequently as needed.

    I suggest asking patients if they have a plan for healthy living/aging. People create financial plans, why not a healthy living plan? Also, ask your patient, to name three things that they are currently doing to improve/maintain their health. If you really want to up the ante, ask, “What are you doing to improve the health of your family, school, and community?” If this takes too much time at the visit, create a handout to send home with them to get them thinking about what they could be doing to get the most out of their lives.

    Let’s start putting the power to affect change back where it belongs: in the hands of our patients.

    • Taylor

      Well said! I totally agree, as patients we should take responsibility for our own health. We don’t ask our accountant to assume total responsibility for our finances, do we? No, we work with them. Many expect others to take responsibility for their lives, decisions, health, etc and it shouldn’t be that way. I especially like your suggestion of a healthy living/aging plan!

  • stephanie

    I think people should listen what their body has to say for neglecting your health or heart could lead into a lot of problems in the future. there is no harm in taking good care of ouselves for it would yield into a lot benefits in the future.

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