Prevention of Cardiovascular Disease
Consumer Reports Letter Submitted to the Editor
sjIt is with great interest that I read your Consumer Reports article, “Take Charge of you Heart Health.” Let me preface the following words with the confession that I AM NOT A CARDIOLOGIST.
I am an adult medicine doctor who takes an intense personal and professional interest in the PREVENTION OF CARDIOVASCULAR DISEASE.
IN 2014, 24 years into my career as a physician, I was grieving the senseless loss of my father due to cardiovascular disease and frustrated that I could not achieve compliance with my patients to take the medications which would help decrease the nation’s number one cause of death and disability.
After much complaining to the universe I, fortuitously, landed a seat at the HASPA (Heart Attack and Stroke Prevention Alliance) conference. That day I learned about ALL the different technologies which would help me care for my patients’ vascular health. The cardiopulmonary exercise test, however, was the winner by far. Interestingly, there are 2 groups which use the test. Cardiologists who care for persons with congestive heart failure and athletes to improve their functional capability. The bike test tells the VO2 max which is each persons capability to use oxygen maximally.
Prior to the bike test we were attempting to achieve compliance by discussing risk factors. This was like trying to mix water and oil. A fair number of patient’s, if they had no OBVIOUS SYMPTOMS of cardiovascular disease, would tell me, “ All I need to do, Dr. B, is exercise and eat healthy.” Every year they would return heavier, transitioning fully into diabetes or have a heart attack.
Prior to the bike test we looked at cholesterol, blood pressure, sugar levels, family history, calculated risk scores and other risk factors. More than 50% of the time I would hear this, “Dr. Baksh, My strong personal philosophy is to do this naturally.” I have actually had patients pay THOUSANDS of dollars for supplements, spas, purging and other ‘natural remedies’ while resisting medical recommendations.
With the bike test, the answer is personalized and clear cut. This is YOUR VO2 max. You use oxygen optimally ..great. You use oxygen poorly…let’s fine tune the different areas where oxygen plays a role and recheck you in 6 months. Your level is <70%. Is that because of airway inflammation, anemia, cholesterol plaque buildup OR ALL OF THE ABOVE? Let’s find out the specifics, the details and then let’s sit down and discuss what exactly is going on. NOT SURPRISINGLY, THIS makes SENSE to each person. Not all patients “get it” and some, for what ever reason, decide not to have the tests. That’s okay too because, at the end of the day, we offer excellence of care and the patient decides if that fulfills their philosophy.
Other reasons it makes sense from a self care standpoint is that I am not sending patients to a cardiologist to have nuclear medication injected and then exposed to radiation (a test that is wrought with false positives and negatives) and you will not need to get an invasive procedure unless my ultimate evaluation (a CT angiogram) shows that you have a blockage. This is a very rare step. I have had to do this 2-3 times in the last 3 years.
Further, this makes great sense not only from a personal care standpoint. It resounds with wisdom from the viewpoint of national medical debt control.
It is well known that most of medical care costs is due to specialist care. Keep all the evaluation in the hands of the internists or family practitioners, strive for prevention, strive for longevity AND quality… superior quality of life based on fine tuning microvascular changes..then we truly have a multiple win situation.
Once again, I humbly confess, I am not a cardiologist. The person who has guided us through the studies and the science of this is Dr. Sundeep Chaudhry. When I have questions and concerns... I quickly reach out to him and his exercise physiologist Nick Menasco. It would be great if you could reach out to him if you wanted the specific scientific information surrounding this practical, sensible and cost effective testing
Though not a cardiologist I am a physician who has seen the inability of the current system to successfully achieve compliance in prevention of cardiovascular disease AND many forms of disease. I strive every day to understand how I can capture my client’s attention, develop compliance and RETAIN that interest and proactivity.
I invite you to take part in our Prevention of Cardiovascular Disease Program. See for yourself how these tests inspire and energize us to achieve cardiac health.
Husna R. Baksh, M.D.
Healthy Steps: Office of Internal Medicine