I will never forget that meeting. I was in the middle of my cardiology fellowship, speaking to the physicians and the cardiologists in training about prevention—specifically, about the endothelium. This is the lining of the arteries that is supposed to protect us from developing plaque and atherosclerosis. I was excited, even reverent, about the exciting potential of focusing on the endothelium. I remember telling the group, in all my youthful enthusiasm, that if we could figure out how to assess its health and evaluate it, and subsequently treat it, then we would never get heart disease. We could avoid all the surgeries and sickness and premature deaths and the decision to stent or not to stent. I went on to describe that if we were also able to lower blood pressure, cholesterol, and elevated blood sugar through the practice of basic lifestyle changes, we could keep the arterial lining healthy. Just imagine—this strategy could help us totally prevent the number one killer of all Americans! 

This was in 1999 and, quite frankly, I did not get the reception I imagined. Those doctors were just not that interested. What really interested them were these fancy new stents that had just came out. When placed inside the arteries, these stents kept the arteries open at the points that looked like forks in the road. The word was that these “bifurcating stents” were going to solve the problem of those complicated lesions and save lives. 

But I just didn’t get it. Why would you do an invasive procedure to fix one damaged spot when the problem was systemic? Why would you rely on a stent, to “fix” your patient, when you know that heart disease is a disease of the endothelium, and the endothelium occurs throughout the entire body, not just at that one spot? I remember asking the question, and I especially remember eyes being rolled. I remember that I felt stupid and embarrassed. And now…I want an apology.

The latest trial to rock the cardiology world, and that is bound to overhaul treatment strategies as we know them, is called the ISCHEMIA trial. This trial of over 5,000 patients showed that for those patients with stable coronary artery disease, treatment with medication and lifestyle changes was just as effective in preventing subsequent heart attacks as an invasive procedure to place stents or do bypasses. 

Well…it seems I was right after all! I hate to say I told you so, but…is it really so surprising that the number one cause of death—which we know is caused largely by lifestyle—could also be prevented with lifestyle? That invasive cardiac surgeries may not be as necessary as we thought, especially in those people with mild or absent symptoms? You know that dancing emoji in the red dress? That’s me right now!

Why does this matter so much and why am I dancing? I’m dancing because the message I have been putting out there for decades has concrete and compelling validation, in spite of what has been considered the standard of care. I’m dancing because this news means patients can feel empowered to save their own lives. It’s the difference between deciding to stent or not to stent. It means fewer major surgeries and procedures, and less medical debt. Suddenly, the playing field feels more level because heart patients all over the world don’t have to be at the mercy of surgeons and skilled interventionalists to achieve wellness. They can protect themselves, manage their own blood pressure, cholesterol, sugars, and weight, and keep their own endotheliums flexible, strong, and healthy. Instead of checking in to a hospital, they can check into their gyms, get active, and make better dietary choices. 

Because it’s just as effective, 

All that being said, understand that I am not discrediting the use of stents completely. In cases of cardiac emergency, they can indeed save lives. But now we know that they are not the best preventive strategy, and we know it because good science tells us so. 

So what are you waiting for? What kind of future do you want? Do you want to look ahead at the potential of invasive surgery, or the potential of a long, heart-heathy life? Or having to make the difficult choice to stent or not to stent? I know that the holidays are coming, but it’s always something, isn’t it? There is always an excuse. If it’s not Thanksgiving, it’s Christmas, and if it isn’t Christmas, it’s New Year’s, or Valentine’s Day, or a birthday, a wedding, an anniversary, a party, a dinner with friends. Life is full of excuses to indulge, but what do you want more—a momentary pleasure or a future full of wellness? 

There is always going to be a something, so listen to me closely: One of the largest studies ever done on managing heart disease just tagged you. You’re “it”! The power to heal your heart is in your hands. 

It’s taken 20 years, but at long last, my choice to work from a place of prevention feels cutting-edge. This is where my heart lies, and now I have one more big reason to fight for the power of lifestyle changes to alter the future of patient health. There are tests out there to measure your risks. There is prevention-driven research that shows us the way. There are anatomic, functional, metabolic, genetic, and physiologic markers that can help guide us in our pursuit of prevention. It’s been 20 years since I started on this path…it’s hard to express how good it feels, that the research has finally caught up to what I have always known in my heart. 

Thank you to my brave colleagues for making this study happen. They put a spotlight on a paradigm that is going to change everything, and that flies in the face of a profit-driven healthcare industry. They took the focus off of the treatment strategies, and put the bright lights directly where they belong: right on you. 

So what are you going to do about it? You’ve got this. Now, if you need any help getting there, feel free to call or write to me. I will be waiting for you.