Latest Reading – "State of the Heart: History, Science and the Future of Cardiac Disease"

Photo courtesy of Aga Khan University

Both my father and grandfather died of heart disease. My grandfather had rheumatic fever as a child which weakened his valves. He died in his 40s, peacefully while taking a nap after lunch. My father told me he had an argument at work, a factory where he was the foreman. He came home for lunch and my father thinks that the stress from work, may have been what pushed his heart over the brink. My father, Charles Kralovec, survived his first heart attack. He had bypass surgery and a surgical stent placed in one of his arteries. He lived for another 10 years and passed away from a heart attack while serving as a lector at a funeral at St. Cecilia’s Church in my hometown of Caspian, Michigan at the age of 78. Even though I am not biologically related to them (I am adopted) I’ve always been aware of heart disease.

I really enjoyed reading Dr. Haider Warraich’s State of the Heart: Exploring the History, Science and Future of Cardiac Disease. Dr. Warraich is a Harvard Medical School cardiologist and Pakistani immigrant to the USA. He uses his patients to introduce all aspects of heart disease. It is amazing the medical advances that have prolonged the lives of millions of people. Cardiovascular diseases are the leading cause of death in the USA and worldwide. Heart disease is almost double the rate of cancer as a cause of death worldwide and slightly higher than the rate of cancer in the USA.

Heart disease has been on my mind lately because my doctor and I decided for me to start taking statins after my yearly physical this summer. I always score “borderline” risk when it comes to total cholesterol with a 14-year average score of 225. Warraich made me feel much better about this choice as he is very enthusiastic about the wonders of this class of lipid-lowering medications. It is the most commonly prescribed medication in America with soon, 1/3 of all Americans older than 40 will be taking a statin. Atorvastatin, Lipitor is the bestselling drug of all time. I liked that a Japanese doctor, Akira Endo, was one of the key researchers to discover statins. Warraich ranks Endo’s discovery with Fleming’s discovery of penicillin.

“…the most important means to improve and prolong life we have ever developed as a species”

I hope my daily 10mg tablet will lower my LDL cholesterol, which commonly leads to atherosclerotic plaques lining blood vessels. I was glad to see that Warriach’s research showed raising HDL likely doesn’t change risk for heart disease. My average score of 38 for HDL is just below the at-risk range (>40). I will continue to watch my weight, exercise and not smoke to see if my HDL can stay above 40. Some other aspects from the book I would like to remember are as follows:

  • Heart disease is just as common in women as men. Estrogen does offer protection to women, so they experience more heart disease post-menopause.
  • High blood pressure is the real threat for heart attacks, more so than cholesterol as a risk factor.
  • Work stress is linked to higher rates of heart disease.
  • The coronary arteries, the vessels that feed oxygenated blood to the heart are the most common vessels for heart attacks.
  • Cardiology is the most competitive field among internal medicine specialties.
  • Often medical research is just as flawed as educational research. I think it is for the same reason. It is difficult to treat humans like lab rats and conduct unbiased experiments.
  • Chest pain is the most common symptom of a heart attack. Doctors also can do an EKG or check for troponin levels in the blood.
  • “Patients older than 65 with heart failure in the USA admitted to the hospital live for only an average of 2 years.”

The book helped me realize the amazing structure and role of the heart. It is amazing that the heart can generate electricity. The pacemaker section in the lining of the heart is controlled by a small electrical charge that is transported cell-to-cell. It is such a small amount that it would take 70 hours of heart operation to collect enough energy to charge an iPhone. The heart is also one of the few organs that you can see working. Most organs do their business on the microscopic level.

The future of treating heart disease will be very interesting. Warraich predicts we will eventually have a 100% artificial heart that distributes blood through the body. Doctors are advancing in this area, with Left Ventricular Assist Devices (LVADs) a battery-powered implant that pumps a damaged heart.

I suggest listening to the interview Dr. Warraich did with NPR’s Terry Gross to learn more about the book.

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