The Expert Guide to Beating Heart Disease: What You Absolutely Must Know
Harlan M. Krumholz, MD
262 pp. New York, NY: Harper Resource, a division of HarperCollins Publishers; 2005. $14.95. ISBN 0-06-057834-3. Available in paperback.
This new paperback provides welcome help for the field of preventive cardiology at a time of real need. Evidence-based research over the past 20 years has defined highly effective therapies to prevent and modulate the progression of coronary heart disease in patients at risk. Practitioners who counsel and care for these patients have learned that the battery of lifestyle and drug interventions demonstrated to produce these benefits requires a successful partnership between a physician (or RN or RD) aware of the evidence-based guidelines and an informed patient who understands something of the nature of the disease and the rationale for the therapies prescribed. Only in such a setting can we expect consistent patient adherence to the multiple therapies required to actually achieve the benefits defined in studies and trials.
Although most who care for such patients could cover the information needed to produce compliance-enhancing understanding in our patients, the pressures of current practice erect significant barriers. Simply put, having the luxury of adequate time to impart all of this detailed information and to do so at a pace that allows assimilation is increasingly a rarity. In this setting, we have learned that many patients follow through with indicated therapies incompletely, ineffectively, or for too short a time to realize the documented outcome benefits possible.
Dr Krumholz’s excellent book can fill an important niche in dealing with this problem. He is a leader in the field of outcomes research and has written in clear and easily understandable language for the layman. The 5 chapters deal in orderly fashion with the spectrum of heart disease prevention. Chapter 1, “Understanding Heart Disease,” presents a simple discussion of the atherosclerotic process, the symptoms of coronary artery disease, the range of diagnostic tests available, and a clear exposition of the concept of risk factors, both modifiable and nonmodifiable. It then lays the basis for the patient’s role, as a partner with the physician, in adhering to the program and monitoring results.
Chapter 2, “Seven Key Strategies in Taking Charge of Heart Disease,” moves thoroughly but clearly through the subjects of blood pressure control, cholesterol management, physical activity and fitness, weight control, diabetes and blood sugar management, smoking cessation, and finally a detailed section on medications not covered in the previous sections, including aspirin and anticlotting agents, β-blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, and cholesterol-lowering agents. For each group, there is clear information on guideline recommendations, side effects, and risk versus benefit. Dr Krumholz’s many years of promoting the use of evidence-based decision-making in the development of treatment guidelines is manifest throughout this excellent chapter. In each section, care is taken to promote specific reference to the relevant guidelines of the American Heart Association/American College of Cardiology, National Cholesterol Education Program, American Diabetes Association, etc.
The remaining 3 chapters amplify helpful details on pertinent subjects beyond the major risk factors. “Beyond the Key Strategies” covers diet in considerable detail and then moves on to alcohol, vitamins, stress management, hormones, etc. “Research and Emerging Therapies” covers a wide range of treatments for which evidence is not mature enough to base firm recommendations or write guidelines. These range from implantable cardioverter defibrillators in heart failure and resynchronization to HDL drugs, gene therapy, and inflammatory markers. The author presents a handy “grading” system with icons for each treatment discussed, which ranges from “proven benefit” to “unclear effect” to “no benefit” or “possibly harmful.” The last chapter, “Staying Well and Prepared,” emphasizes monitoring techniques and other helpful tips for maximizing results of a treatment program.
These fact-filled chapters are followed by several useful appendices, which provide models and forms for monitoring blood pressure and weight, working up to an exercise program goal, use of the Seattle Angina Questionnaire, drug interactions, and a clear review of the purpose and “workings” of many cardiac tests and procedures. Finally, there is an excellent glossary of cardiac terms and concepts, as well as extensive references (ie, 40 pages!).
This handy volume is presented in a fashion that allows a patient to personalize selection of topics, learn the pertinent facts quickly and easily, and refer back to it as a follow-up (and reinforcing!) reference. As a piece of “mother-in-law research” (which would, ironically, make almost any good outcomes researcher’s eyes roll), I gave this book to a personal friend who is intelligent and accomplished in his own field but has no medical training, aside from interest in the considerable health information that is in the press these days. Two days later, he gave it back with this comment: “This was really clear and easy to understand—and I’ve got to tell you, I thought I knew a lot about this stuff, but I learned something new on almost every page!” I consider that summation quite a positive “review” indeed from a member of the intended target audience.
Personally, I would suggest that all practitioners dealing with prevention in heart disease patients and those at risk consider adding this book to their recommendations for those patients. I believe it will substantially enhance the much-needed process of “getting the message across” and thus, support increased persistent adherence to therapies by the patient. This should, in turn, help produce the improved clinical outcomes that the many trials of recent years have promised.