Atherosclerosis - plaque build up in your arteries

Atherosclerosis - the underlying cause of heart attacks and strokes. It is the number 1 cause of premature deaths and disabilities in adults over the age of 45.

Preventable Deaths

Scenario 1. A jumbo jet crashed in the outskirt of a major city killed all 300  passengers. News breaking headline gets the television and Internet coverage worldwide. CNN is there to cover minute by minute developments. This event receives daily coverage for a week or longer.

Scenario 2. Everyday in the US, 10 jumbo jet-loads of American die and another 10 jumbo jet-loads survive heart attack and stroke that cost the economy $1.2 billion. That’s a bigger news but it gets no coverage. They are largely preventable. Why is this ignored? When a celebrity suffered a heart attack, it might get a 30 second coverage that day.

Atherosclerosis - causes a tremendous total economic burden in the US which is estimated at $550 billion annually and rising.

AHA Statistics Oct2017

Stare at these numbers for a few minutes and let them sink in. And ask yourself, what if there is a way to reduce these numbers by a third? What would happen? It is doable.

Atherosclerosis - the goose that lays the golden egg. It supports, sustains and fuels the growth of a large cardiovascular healthcare industry.

Natural Course of Atherosclerosis

The natural course of atherosclerosis is that it starts early and progresses silently for many years and decades in many arteries in the heart and in the brain until suddenly a plaque ruptures causing a clot to form quickly, clogging the artery and causing a heart attack or stroke depending on the artery’s location.

Before statin drugs became available, treatment was limited and waited until angioplasty, stent placement or heart bypass surgery is needed. 

Stop Plaque Progression

Statin drugs opened the door to prevention by preventing plaque rupture, stopping plaque progression and inducing plaque regression. Reversing heart disease, if detected earlier, has become possible.

But this revolutionary approach will wait. The large cardiovascular healthcare industry is not willing to give up a large guaranteed revenue stream in exchange for better patient outcomes. Nearly two decades will pass; many millions will die and suffer; hundreds of billions will be spent in disease care and hundreds of billions will be earned by the cardiovascular healthcare industry.

Atherosclerosis Clinic - why there is only one in the US.

ACC President 2004-2

In 2004, the president of the ACC said that cardiologists were not preventive because they made a lot of financial investments in the interventional treatment of cardiovascular disease. He warned that the evolution to a more preventive approach is inevitable, like it or not. And it will not come painlessly.

Our industry was not ready, but I was ready in 2001.

2015 ACC President Dr. Williams

After 14 years, in 2015, the ACC president, Dr. Kim Williams, said “It is time to turnoff the faucet instead of just mopping the floor.” 

I was willing to “shoot myself in the foot” to find out if I could do exactly that. I did. No regrets.

Our current healthcare system including Medicare is terminally ill. Cardiologists, like myself, need to shoot themselves in the foot if they want better outcomes for their patients, while they also lower healthcare cost. Does anyone wonder why aggressive heart attacking stroke prevention is not widely available.

A new healthcare model must emerge to replace the current system. I have a small but a working best practice model that can be scaled up. A network of Atherosclerosis Clinics can be developed nationwide. 

© Rolando L. deGoma MD  2018     Princeton Preventive Cardiology & Cholesterol Clinic     Capital Cardiology Associates    Allegiance Health Group