Heart disease is almost unique among chronic diseases for its preventability, says cardiologist Dr. Milan Gupta.
Gupta, who works at Osler Cardiology Associates Inc., told attendees at Benefits Canada’s Chronic Disease at Work conference in May that while he spends most of his time treating patients who already have cardiovascular disease, an increasing amount of resources in the field is going into measures designed to stop its spread.
“It’s always easier and smarter and more cost effective to prevent disease than to treat it once it’s established,” he said.
According to Gupta, studies have shown it’s possible to cut the chance of contracting heart disease by up to 65 per cent by controlling some of its major risk factors, which include high cholesterol, high blood pressure, obesity and smoking.
“So theoretically, if we could wipe out these risk factors, whether it’s through healthy living or with the addition of medication, we should be able to eradicate half to two-thirds of all cardiovascular disease,” said Gupta. “That’s incredibly powerful, because you can’t say that for many other diseases. You can’t say that for cancer, you can’t say that for neurological disease, but you can for cardiovascular disease.”
The start of Gupta’s own career coincided with one of the biggest breakthroughs in medical knowledge surrounding heart disease: the discovery that lowering the low density lipoprotein cholesterol level of people at high risk of the disease significantly cuts mortality risks.
Within two decades, cholesterol-lowering statins became the most studied class of drug in the world, he said. At the same time, the link between lower cholesterol and lower cardiovascular event rates has solidified, and medical groups such as the Canadian Cardiovascular Society have consistently reduced the threshold for a cholesterol level requires medical management.
Despite those advances, prevention is easier said than done, according to Gupta. Plunging mortality rates for patients with heart disease seen since the mid-1990s have now begun to flatten, partly due to the increasing prevalence of obesity among younger Canadians.
In addition, he says persistent doubts about the safety of statins have proved hard to shake, despite studies suggesting they’re safer than taking an aspirin a day.
“Statins have been maligned in the media and in the lay literature, because so many are taking statins that people feel we are medicalizing society,” said Gupta.
An online search of the term statin will show they “will cause hair to grow on your knees, they cause cancer, they cause you to become stupid. All of these things are false,” he added. “But they affect patients’ willingness to take or stay on these drugs.”