Saturday, February 18, 2012

HEART 411 by Marc Gillinov and Steven Nissen

Many of our colleagues claim that there are two types of people in the world: people who have coronary heart disease and people who are going to get it.... Our goal is to create two new classifications of people: those who have been successfully treated for coronary heart disease, and those who have avoided it altogether. 
--Marc Gillinov and Steven Nissen in Heart 411 

I grabbed Heart 411 just as soon as I heard of it (it was published January 31). Less than six months ago, I had open heart surgery at Cleveland Clinic, America's top-ranked heart hospital, where Dr. Gillinov is a cardiac surgeon and Dr. Nissen is chair of the department of cardiovascular medicine. I'm doing well, thank you, but I still have lots of questions. I figured these doctors would be able to answer them.

It's a wonderful book, though as it turns out, Gillinov and Nissen didn't really write it just for me. They wrote it for people who have heart disease and don't know it (but could easily find out), and for people who are very likely to develop heart disease (but don't need to), and for people who have had surgery for heart disease at least once and will probably need to have it again ...  and again (but could put a stop to the pattern).

Perhaps as much as 90 percent of heart disease, they are convinced, is entirely preventable (the other 10 percent is hereditary or, like my problem, congenital: such problems can be fixed, but can't be prevented). Alas, they write,

we heart doctors tend to "fix" the plumbing problem of the moment and then move on rapidly to the next one. All too often, patients become "cases" ("Can you check on the 80 percent left main coronary artery obstruction in cath lab number 4?") rather than people in desperate need of advice and counseling.
Doctors Gillinov and Nissen want to fill the gap left when the last "kindly, unhurried, gray-haired gentleman with a white coat, a black bag, and a stethoscope" left our doorsteps and began practicing high-tech assembly-line medicine. They want to sit down and chat with us about our risk factors, our food and drink, how we exercise, our emotional life, the medicines we take, whether we need surgery or can avoid it ... and lots of other things (check out the table of contents by clicking here, then clicking "Search inside this book").

This could have been a dreary read, as serious as, well, a heart attack. Fortunately, it isn't. The book is designed for easy reading and reference, with lots of subheadings to help us find what we're looking for ("Questions to Ask Before You Have a Heart Test") and to interest us in information we might not have thought to ask about ("Good Vibrations: Do Positive Emotions Provide Cardiac Protection?"). Flipping pages, we'll find frequent sidebars with fascinating factoids ("Why We Put Salt in Our Food," "Three Simple Household Routines Help Prevent Obesity," "Cardiovascular Disease in Mummies").

Even better, the authors are good writers. I don't think they used a ghost; Gillinov mentions his love of writing, and the diction lacks the airy chirpiness that characterizes so much ghosted material. Their explanations are clear and simple, free of technical jargon so laypersons will not have to struggle to follow. They tell lots of stories, and tell them well. They even have a wry sense of humor. This book can be used for reference, of course, but it's so interesting that you might want to just sit down and read it straight through.

Ignore the subtitle. It isn't really The Only Guide to Heart Health You'll Ever Need (I'm sure the authors were surprised when the publishers came up with that one). As they write on page 196, "Medical researchers periodically uncover new evidence that results in profound changes in our approach to heart disease.... We must accept that today's wisdom may seem foolish tomorrow." That's why Chapter 9, "How to Tell Fact from Fiction: Sorting Through the Medical Evidence" is so important. If you're like me  (and 61 percent of other Americans), you go online to find answers to your medical questions. Unfortunately, a huge percentage of what we find there is purest junk, and even the reputable studies can be hard for a layperson to evaluate. A skeptic by nature, I thought I knew how to sift through internet information and come up with truth, or at least facts. I figured I didn't need this chapter, but I read it anyway - and I learned a lot that will come in handy even when this book is long out of date.

Throughout the book the authors do plenty of fact-checking themselves, advising us on which popular beliefs to keep and which to toss. Is fat bad? Not necessarily. Is wine good? Could be. Are generics and brand-name medications equally effective? Depends on the medication. Should you have a physical exam before beginning an exercise program? Maybe not: consider these factors.

I have just one bone to pick with the authors: their analysis of hormone replacement therapy is flawed. Yes, the Women's Health Initiative studies came up with damning evidence against Prempro, but Gillinov and Nissen use those studies to damn all long-term hormone replacement. What is true, however, of orally administered hormones made from equine estrogens is not necessarily true of transdermally administered hormones made from bioidentical plant sources. In fact, subsequent research reported in the British Medical Journal, a publication rated highly by Gillinov and Nissen, shows that there are indeed differences in HRT that need further exploration.

But bless Gillinov and Nissen, they never come across as know-it-all M.Deities. They know they are writing to intelligent, informed readers, and they treat us with respect - an amazing feat for people who spend most of their waking hours looking at people wearing hospital gowns.

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