From a heart health perspective, 2008 will prove to have been a turning point. It was a year in which we witnessed the beginnings of a major transition in thinking about heart disease. Let me explain.
I look back at 2008 and sense that, as a nation, we are starting to embrace the notion that heart procedures are not the answer to heart disease.
Roll back memory to the 1980s and 1990s. Remember all the glitzy, high-tech TV ads and news reports about the newest hospital procedures, hospital staff in scrubs gushing with their newest technology, robotic devices, laser technology, etc.? Technology was the theme: what was newest, most sophisticated, who was first with the best new device.
2008 marks a time of change. I believe that many of us no longer expect that the newest technology from high-tech hospitals will help us become healthier. In fact, we have come to increasingly recognize that hospitals are businesses trying to grow their bottom line (despite maintaining the façade of charity with names like St. somebody-or-other). They are also subject to high-tech errors.
Instead, we have begun to look at lifestyle, nutrition, and nutritional supplements in earnest. Contrary to many health dead-ends that preceded, some real firepower is emerging in these areas. I believe that 2008 marks a pivotal time for booming acceptance of these ideas.
From where I sit, the past year has been an exciting time. Among the most important heart health developments in 2008 include:
- The broad recognition of vitamin D's power─If there was one thing that is going to transform heart health─and overall health─of the American public, it is the recognition of the power of vitamin D. For heart health, vitamin D raises HDL cholesterol, reduces triglycerides, reduces blood sugar, and exerts potent anti-inflammatory effects. (I suspect that there is also a direct heart attack-reducing and/or atherosclerotic plaque-reducing effect, as suggested by several epidemiologic observations, but this has yet to validated in a properly-conducted clinical trial.)
- Skepticism that heart health will come in pill form ─ sure, cholesterol drugs reduce bad LDL cholesterol and reduce heart disease risk. There's even the JUPITER study that demonstrated 55% reduction in cardiovascular events with Crestor® 20 mg per day in people with "normal" LDL cholesterols (≤130 mg/dl) and increased c-reactive protein, a measure of inflammation (≥2.0 mg/dl). But the proliferation of "a pill for this, a pill for that" mentality is giving way to a return to more natural means of doing things. Sadly, the consequences of just following the conventional path of take a drug as the sole approach to heart disease prevention was more than amply demonstrated by the loss of the popular talk show host, Tim Russert, to heart attack at age 58. Mr. Russert would be happily still hosting his Sunday show had a few extra health steps been taken (and it wouldn't have involved hospitals!).
- A decline in death rate from heart disease─In December, the American Heart Association proudly reported a 30% reduction in death from heart disease. But the news was tempered by increasing concern that the booming obesity epidemic will fuel an eventual rise in risk, along with a trend to involve younger and younger people. So we still have our work cut out for us. (One of the priorities is to get away from the notion that a low-fat, high-carbohydrate diet is good for us. This notion, as characterized by the USDA food pyramid with grains occupying the widest bottom─6-13 servings per day─in my view is a major contributor to the obesity and diabetes epidemic. This needs to change.)
- Growing recognition that environmental exposures increase heart disease risk─Bisphenol A from polycarbonate plastics (recycling codes 3 and 7, hard plastic baby bottles and water bottles) were shown to increase heart disease risk by 40%; outdoor pollution from automobile exhausts and noise pollution from traffic were both connected to increased risk for heart disease in several studies in 2008. The message is clear: a cleaner, more natural life can help avoid many exposures that lead to heart disease.
I regard 2008 as a hopeful year, a year in which a sense of self-empowered health was being regained. My prediction for 2009, dire economic predictions notwithstanding, is that tools for gaining heart health are going to get better and better.