Complete Health Reporting: Check the Fridge Before You Open the Medicine Cabinet
What would be the single best way for you to lower your chances of having a heart attack?
Statins? Stents? Angioplasty?
How about less salt in your diet and more fruit? And let’s not forget those cigarettes you still sneak when you’re feeling a little stressed.
Studying the impact of lifestyle changes can be harder because of the difficulty to control for a wide variety of factors and the inability in some cases to test against a placebo. (How do you trick people into thinking they are going on a five mile run every day?)
Writing about the impact of lifestyle changes can be hard, too, and often seems to be less interesting than scientists exploring the outer limits of medicine to find a new treatment. Always keep this in mind, though: Pills, devices and surgeries are often not the best option for most people. No pill is going to counteract a pack-a-day habit. No surgery is going to restore organs wrecked by alcohol abuse. Often diet and lifestyle modifications can have a greater impact on someone’s health.
Dr. Frank B. Hu and Dr. Walter Willett at Harvard School of Public Health wrote one of the benchmark studies on the topic in 2002, published in the Journal of the American Medical Association, and helpfully titled, “Optimal Diets for Prevention of Coronary Heart Disease.” They concluded:
Substantial evidence indicates that diets using nonhydrogenated unsaturated fats as the predominant form of dietary fat, whole grains as the main form of carbohydrates, an abundance of fruits and vegetables, and adequate omega-3 fatty acids can offer significant protection against CHD. Such diets, together with regular physical activity, avoidance of smoking, and maintenance of a healthy body weight, may prevent the majority of cardiovascular disease in Western populations.
But that doesn’t mean everyone heeds that advice, of course. Seven years later, researchers from the Department of Cardiovascular Medicine at the National Heart and Lung Institute at Imperial College London published a study based on the EUROASPIRE surveys. These surveys captured the habits and health outcomes of more than 8,000 patients across Europe from 1995 to 2009. What the researchers found was sobering.
In that 14-year span, the proportion of smokers remained about 1 out of every 5 people. Obesity had shot up from about 25% of the survey group to 38%. High blood pressure had barely budged. The only positive sign of progress was a significant reduction in cholesterol.
So what did the researchers recommend? More drugs? More surgeries? No. They wrote:
These time trends show a compelling need for more effective lifestyle management of patients with coronary heart disease. Despite a substantial increase in antihypertensive and lipid-lowering drugs, blood pressure management remained unchanged, and almost half of all patients remain above the recommended lipid targets. To salvage the acutely ischaemic myocardium without addressing the underlying causes of the disease is futile; we need to invest in prevention.
It’s important to note that the EUROASPIRE surveys were funded by nearly every major drug maker on the planet: Merck Sharp & Dohme, AstraZeneca, Bristol-Myers Squibb, Pfizer, Sanofi-Aventis, GlaxoSmithKline, Servier, Merck/Schering-Plough and Novartis.
And yet study after study based on the EUROASPIRE surveys comes back to this same central message. We can’t medicate our way out of bad habits. This doesn’t mean there aren’t important roles for pills. The big drop in high cholesterol found in the 2009 study I mentioned is attributed in large part to better use of statins, which are generally agreed to be a major advance in battling heart disease. But a clinician would be remiss in putting a patient on a statin and not talking with them about smoking, diet and exercise.
And sometimes the best option for treatment is simply no treatment at all. I’ll write about that in my next post.
Have your own ideas for writing about non-medical approaches to better health? Write askantidote@gmail.com or @wheisel on Twitter.
Image by Phillip Brewer via Flickr