The Great American Heart Hoax

As alarmist as the title may sound, start reading this book and you'll get an understanding of a very disheartening (pun intended) reality of the deep-rooted flaws of cardiac intervention. Dr. Michael Ozner takes us a on a journey of why things are the way they are, why the system is so flawed and what we can do about it. Here are some highlights from The Great American Heart Hoax.

• We need prevention, not intervention.
• Heart surgeries are amongst the most commonly performed surgeries in the US - with more than 1.5 million angioplasties and coronary bypasses performed each year.
• About 70-90% of these surgeries are at best unnecessary.
• The process of plaque build-up (atherosclerosis) is a complex interaction of cholesterol, free radicals and inflammatory cells.
• Bypass surgery and angioplasty spawned a massive industry that has snowballed into a $60 billion per year industry.
• While interventional cardiology has boomed, the evidence of its effectiveness is simply not there. Evidence from the late 70's to present day has failed to show any significant benefit of coronary bypass surgery, angioplasty or stents. In major trials, none of these interventions has been shown to lower death rate or prevent heart attacks.
• Trials on angioplasties often resulted in worse outcomes compared to management with medication.
• Regarding pharmaceutical intervention, Dr. Ozner believes that the problem is not with the medications themselves per se, but how they are used and how they are sold.
• Medications should be used to reinforce healthy behaviors, not replace them.
• The CAT "scam": CAT scans expose patients to radiation equivalent to 750 chest x-rays.
• Dr. Ozner opines that CAT scans have their place but should NEVER be performed to screen for disease in those without symptoms. The FDA, American College of Radiology, American College of Cardiology and other prestigious associations back up Ozners' concerns.

The 10 Step Program

1. Follow a Mediterranean diet: Being the author of the "Miami Mediterranean Diet", no surprise that Dr. Ozner wholeheartedly (there I go with the puns again) recommends this pattern of eating.
2. Regular Exercise: It doesn't take much, but it is crucial for health.
3. Manage Stress
4. Take command of blood pressure
5. Control cholesterol
6. Reduce free radicals and oxidative stress
7. Avoid chronic inflammation
8. Prevent metabolic syndrome and diabetes
9. Have an annual physical exam
10. Avoid unnecessary diagnostic tests and procedures

General Comments

Overall I think the book is an eye-opener to the realities of cardiac care. I think for the most part, Dr. Ozner has some very sensible advice on diet and lifestyle that isn't terribly difficult to follow.

There are a few snags here and there that I take some issue with. They are as follows;

• Steps 4-8 are corollaries to the first 3 steps and therefore do not necessitate being "steps".
• Dr. Ozner curiously describes resistance training as "isometric", when isometric refers to resistance without changing joint angles.
• Dr. O is also kind of harsh on low carb diets and while he has some valid criticism, he goes on an unsubstantiated diatribe.

Despite these flaws, I think this is a very important book for anybody considering a cardiac procedure and a wake-up call for how we look at treating heart disease.