Why not treat everyone for heart disease?

DOCTOR DEBATES

Some experts insist it's time that most people start taking common drugs to lower their risks.

TWO RESPECTED doctors claim they've found the ultimate tools to prevent heart disease. Their advice: For the rest of your life, take combination of drugs designed to lower your risks.

The medical establishment still says people who want to lower their risks should concentrate on eating healthy foods and exercising. But the maverick doctors, who arrived at their conclusions independently, argue that lifestyle changes should take a backseat. Why? One reason is that most people fail at them. "You can't change 50 years of habits, and even if you do, the impact on your risk is very small," says Jonathan Sackner Bernstein, M.D., director of the Heart Failure Prevention and Treatment Program at North Shore University Hospital in Manhasset, New York. Instead, Sackner Bernstein recommends in his new book, Before It Happens to You, that people of all ages who show any signs of heart disease take drugs to lower their blood pressure and cholesterol. And his thresholds for such signs-blood pressure above 115/75 and total cholesterol above 160--are much lower than those largely seen as healthy today.

Meanwhile, Peter Salgo, M.D., associate director of the Open Heart ICU at New York-Presbyterian Hospital and clinical professor of medicine and anesthesiology at Columbia University, contends in his new book, The Heart of the Matter, that lifestyle changes alone simply won't prevent heart disease. He recommends that people start taking three drugs around age 40: statins to cut cholesterol; aspirin to fight inflammation and prevent clotting that causes heart attacks; and a course of antibiotics to fight the respiratory bug Chlamydia pneumonia (not the same as sexually transmitted chlamydia), which infects more than 50 percent of Americans. He points to research showing that the germ, which infects heart blood vessels, causes inflammation linked to heart disease.

These unorthodox strategies may sound familiar. Last summer, British researchers proposed a similar idea, dubbed the "PolyPill," and said it could save hundreds of thousands of lives. It would combine a statin with several blood pressure medications, folic acid, and aspirin. Drug companies are mulling the idea.

Mainstream medical organizations, though, are reluctant to de-emphasize common preventive strategies. They worry that people might mistake the pop-a-pill approach for a license to overeat or smoke. "We shouldn't be giving pills until we take care of the lifestyle issues that modify risk," contends Robert Bonow, M.D., immediate past president of the American Heart Association. Plus, critics note, the drugs aren't cheap, and there are risks. Bonow says side effects (such as bleeding from aspirin) could kill thousands.

But the authors point out that the risks for any individual are minimal. Simply taking a lot of vitamins, Sackner Bernstein adds, might be riskier.

Look for this debate to heat up as doctors keep searching for new ways to fight heart disease.

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By Eric Steinmehl

EDITED BY Adam Martin

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