Many physicians take the wrong approach to treating cardiovascular disease (CVD). They treat the symptoms and ignore the disease.
    "Most patients with cardiovascular disease get procedures like a bypass or angioplasty," said Steven Masley, MD, medical director of Carillon Executive Health, an outpatient health service of St. Anthony's Health Care Center in St. Petersburg, Fla. "That's nice, except that interventional cardiology does nothing to affect the disease progress. Cardiac interventions are great at preventing angina, not so great at preventing lethal events."
    Speaking to a standing-room-only crowd at the American Academy of Family Physicians Scientific Assembly, Dr. Masley maintained that cholesterol-lowering medications are more effective than procedures at preventing future events such as heart attack, stroke, and death. And that lifestyle and nutrition are even more effective than medications.
    "We don't have to wait for end stage disease to make a difference," he said. "We can prevent most cardiovascular events from happening. Family physicians are probably in the best position to make a difference by limiting the occurrence of disease and events in the first place."
    Physicians have a choice, he continued. They can wait for coronary flow obstruction and obvious symptoms, by which time one third of patients will be dead and one third will have had an MI from plaque rupture. Or they can analyze risk factors, assess cardiac flow, and assess plaque, then help patients adjust lifestyle and diet to minimize future events.
    More than 50 CVD risk factors have been identified, but cholesterol, diabetes, smoking, hypertension, and obesity account for 80% of events, Dr. Masley said.
    Exercise treadmill testing is a useful cardiac screen and measure of fitness. Every increased minute in fitness on a Bruce Protocol is associated with a 10% drop in future CVD events.
    Stable plaque can be imaged with CT or electron beam tomography scans, but carotid intimal media thickness (IMT) measures both old and new plaque very effectively. Thus, IMT testing appears the more useful measure of noninvasive testing for plaque thickness and regression, Dr. Masley said.
    Therapy goals include LDL reduction, reversing metabolic syndrome, adding beneficial foods to the diet, changing fat intake, decreasing LDL oxidation, decreasing clotting, improving arterial function and blood pressure, adding supplements, managing stress, and making lifestyle changes. The net effect is to stabilize or reduce plaque, thus reducing CVD events.
    Many of the goals can be achieved most effectively with diet and exercise, Dr. Masley said. Steps such as increasing soy and other bean consumption, adding garlic and onions, switching from saturated and hydrogenated fats to unsaturated and monounsaturated fats, moderate alcohol or chocolate consumption, and adding dense, unprocessed grains and vegetable carbohydrates are important moves in the right direction. Adding exercise increases fitness, reduces obesity, and helps reverse insulin intolerance in muscle cells, which reverses metabolic syndrome.
    "We should be managing CVD more than referring to cardiologists," Dr. Masley said. "We are the people who can make a difference."