Lower Your Heart Risk

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Lower Your Heart Risk

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The cardiologist Sandeep Jauhar has become a Dante of modern medicine, with his earlier memoirs, “Intern” (2008) and “Doctored” (2014), casting the progress from training to career as a path studded with suffering, indignity and ethical hazard. His latest book, “Heart: A History,” is something of a “Paradiso,” pointing to the field’s brightest and noblest stars while recognizing just how much darkness is still left in the firmament.

Contemporary cardiology, Dr. Jauhar notes, is coming off a perhaps unrepeatable century of success. Since 1950, deaths from cardiovascular disease have declined by 60% in the U.S.—meaning that, every year, more than a million Americans who would have died under midcentury care survive. Today a host of advances—drugs that lower cholesterol and blood pressure, implantable defibrillators, catheterizations to unclog arteries, and even heart transplants—have turned many forms of heart disease into manageable illnesses rather than death sentences.

Now, however, Dr. Jauhar believes that the field “in its current form might have reached the limits of what it can do to prolong life.” For years, hospitals have raced to decrease “door-to-balloon time”—the delay from arrival to the deployment of a catheter for patients suffering heart attacks—on the dictum that “time is muscle,” with cardiac cells suffocating by the minute. Yet a 2013 study found that, beyond a certain point, additional rapidity may not increase survival. New and much-lauded (and pricey) drugs for heart failure improve mortality and hospitalization rates by only a few percentage points. And the number of cardiac transplants performed annually has stagnated. Where do we go from here?

Poignant and chattily erudite, “Heart” shuttles between scholarship and memoir to relate this continuing epic, the uneasy companionship between humans and our most metaphorized organ. Dr. Jauhar offers brief biographies of luminaries—such as John Gibbon, inventor of the heart-lung machine, and Werner Forssmann, pioneer of cardiac catheterization—that are sympathetic but not hagiographic.

Yet if medicine is to advance, it may be driven less by single superstar intellects than by methods of intensive and searching inclusivity. Dr. Jauhar discusses the famous Framingham Heart Study, in which researchers have followed residents of a Massachusetts town since 1948 to detect disease patterns, in one early example of learning from an entire population. Though flawed in its assumption that the results from its mostly white, middle-class subjects would be applicable world-wide, it provided the first evidence of smoking and cholesterol as risks for heart disease.

But we can do better. The Masala study of South Asians in the U.S. (mentioned in a footnote in Mr. Jauhar’s book) seeks to answer similar questions, this time for a group that other studies have excluded, underrepresented or buried under statistical noise. Many South Asians who die of heart attacks have no risk factors at all under the Framingham model. What such “mystery” cases need is less a super-sleuth than sustained epidemiologic attention.

Where “Heart” shines is in charting another crucial shift that sounds like a throwback but might well be cardiology’s next wave: attending to the mind-body problem. Interest in the connection between so-called affective traits and heart disease languished after the discrediting of the 1950s “type-A personality” hypothesis—essentially, a psychological profile invented by a pair of cardiologists in a rather improvisatory attempt to explain why so many executives had heart attacks.

While results of this early personality-typing research proved shaky, a more rigorous 1981 study found that a startling number of patients with life-threatening arrhythmias had suffered acute psychological stress the day of their attacks. This July, a small but provocative study demonstrated better outcomes for patients who had been prescribed an antidepressant after a heart attack.

Dr. Jauhar is careful to couch these findings in politically neutral terms, but they are ripe for more polemical interpretations. To a libertarian-minded reader, they are evidence that patients can increasingly be captains of their cardiologic fate, that self-knowledge and proactive management can mean survival. (Cardiac rehab centers that used to be long walls of treadmills are now just as likely to have yoga mats, meditation rooms and talk therapy.) To a progressive reader, such mind-body data shows that chronic stressors such as inequality and prejudice are not just unfair but literally poisonous to the heart.

What’s clear to all, though, is that, as Mr. Jauhar writes: “We will need to shift to a new paradigm, one focused on prevention—turning down the faucet rather than mopping up the floor.”

Source: Laura Kolbe, ‘Heart: A History’ Review: At the Bleeding Edge, The Wall Street Journal, September 14, 2018.

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Last Updated : Wednesday, June 2, 2021