HealthLeader

An Online Wellness Magazine produced by The University of Texas Health Science Center at Houston (UTHealth)

Never Too Late

Lifestyle changes—at any age—can help heal your heart

Thirteen years ago, Joe Rivera didn’t look like a running heart attack. True, he had smoked at one time as a young man, but the 60-year-old ran marathons, and his yearly checkups showed nothing amiss.

Then the back pain hit. As an athlete, Rivera knew immediately it wasn’t the kind of pain a pulled muscle caused. When an EKG didn’t reveal a problem at his regular doctor’s office, Rivera went to a cardiologist, who performed an angiogram.

The verdict? Rivera needed an immediate quadruple bypass.

Twelve weeks later, he was running again, but he also had to take medications, including a statin to lower his cholesterol and two blood pressure drugs. So when Rivera found out about the Century Health Study from a friend, he didn’t hesitate to join the study.

In the past year, he lost 30 pounds and now has a healthy body mass index (BMI). He no longer takes one of the blood pressure medications and the others have been cut in half. Just as exciting for Rivera is he’s regained running speed. He’s thinking if he drops another seven pounds, he could compete in the 70-and-over group at the national triathlon level.

“I have a goal every day,” Rivera says. “I feel so much better.”

The Century Health Study at The University of Texas Health Science Center at Houston (UTHealth) looks at lifestyle factors, preventive health teaching and advanced heart imaging for diagnosing, preventing and treating coronary heart disease. The research team has funding to recruit 1,300 participants, and visits occur at the Weatherhead PET Center for Preventing and Reversing Atherosclerosis at Memorial Hermann-Texas Medical Center. Researchers at The University of Texas School of Public Health, part of UTHealth, will analyze the economic impact of the five-year study to assess whether patients are healthier, thus saving medical expenses.

Participants are randomly divided into two groups. One group continues with standard medical therapy by their doctor, including any recommendations for treatment based on diagnostic testing by their private physician. Study involvement consists of yearly visits with the program team for five years. These patients have periodic lab work and undergo exercise treadmill stress tests, as well as an assessment of their health risks. They meet with specialists, including a cardiologist, a nurse and a dietitian, and receive detailed information on managing risk factors such as diet, blood pressure, smoking, weight and exercise. Cardiac PET (positron emission tomography) scans are done at the beginning, at year two and year five of the study, but the results are not released to the patients until the end of the five-year period. These yearly visits, three PET scans, exercise treadmill stress tests and lab work are at no charge.

The second group receives PET scans at the start, in the second year and at the end of the study to show participants how their lifestyle choices and medical treatment are affecting blood flow in their hearts. They are shown the results of their initial PET scans, and they see the study team more often—six times during the first year and twice yearly for the rest of the study period. Those visits include physical exams, lab work at each PET scan visit, periodic exercise treadmill stress tests and consultations with specialists, including a cardiologist, a nurse, and a dietitian who provides guidance on healthy eating. As with the first group, these visits with the Century Health Study team are at no charge, as well as the PET scans, lab work and treadmill tests. Information is shared with their private physician.

According to the United States Department of Health and Human Services, cardiovascular  disease kills 2,200 Americans every day, totaling 815,000 each year, or 1 in every 3 deaths.

"Atherosclerosis is the No. 1 cause of mortality in the United States and in many developed countries. However, we have the evidence that this is, for the most part, an unnecessary tragedy," says Stefano Sdringola, MD, MPH, the study’s principal investigator and professor in the Division of Cardiovascular Medicine at UTHealth Medical School. "This is a condition that is mostly a consequence of our lifestyle that can be prevented. Even more, once it is present, we can fight back and heal from it."

Sdringola, an attending physician at the Memorial Hermann Heart & Vascular Institute, says the study is aimed at comparing the impacts of two therapeutic strategies in patients who are at least 40 years old and have certain cardiovascular disease risk factors, symptoms of heart disease or documented coronary heart disease.

“We sit down with (patients) and say, ‘Here's your heart. Here's your life. Here are your choices, and we'll help you,’ ” he says.

While medication and surgery help deal with the results of coronary artery disease, Sdringola says, the underlying problem—the buildup of fat in blood vessels—remains a threat if people don't change their behaviors.

"The pills do not substitute, procedures do not substitute, for healthy lifestyles," he says.

Rivera, whose father died of a heart attack at age 65, says changing how he ate has made a big difference. “I didn’t eat a lot of bad things, but I ate too much, especially carbohydrates,” he says. “I could eat eight slices of bread a day. The nutritionists worked with me to change the amount I was eating.”

He says he also has quit drinking energy beverages, which can increase blood pressure in some people. “I don’t need them anymore,” he says.

The highly accurate PET images serve as a powerful tool in showing patients the results of their choices, for good or ill. Virtually no other facility in the world uses PET imaging on a routine clinical basis to measure blood flow in the heart, says K. Lance Gould, MD, co-investigator in the study and director of the Weatherhead PET Imaging Center.

Such intensive services generally are not covered by insurance, Sdringola says, but insurers may look at the study's results and reconsider whether coverage would make good sense if the more aggressive strategy leads to long-term reductions in costs for medication, hospital stays and surgeries.

"Our goal is to put the patient back in the center of health care management," Sdringola says. "An educated patient can be motivated, committed to achieve these goals of longer and healthier lives that would benefit American society as a whole with reduction in the mortality and morbidity associated with this largely preventable disease."

For more information about the Century Health Study and how to apply for enrollment, visit www.centuryhealthstudy.org or call 713-500-5200.