Is the Present Therapy for Coronary Artery Disease the Radical Mastectomy of the Twenty-First Century? | Caldwell Esselstyn, MD | 09/03/10

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Editor's Note: The following is an article by Caldwell Esselstyn, Jr. MD which appears in the current American Journal of Cardiology.

To fully grasp how so many smart, right-minded people could get it so wrong, it might help to start with a quick review of medical history. Take the radical mastectomy, conceived by William Halsted1 in the late 19th century. The procedure was intended to remove all cancer cells of the breast, the overlying skin, the underlyingmuscle, and regional lymph nodes (Figure 1). It was mutilating, permanently disfiguring, and no more effective than less radical, less disfiguring procedures. Still, because of the prestige and respectHalsted commanded as a teacher of surgeons, his disciples defended and taught the radical mastectomy at the most revered medical colleges. His extreme surgery was perpetuated for almost a century, until challenges by courageous physicians in Europe2,3 and America,4 along with a prospective randomized study by Dr. Bernard Fisher,5 finally sounded the death knell of this standardized surgical error of the century.

The 21st century analogue to this unfortunate chapter is the interventional and pharmaceutical treatment of coronary artery disease. This approach results in significant mortality, morbidity, and unsustainable expense. Neither the procedures nor the drugs that accompany them treat the cause. Standard care for coronary artery disease is nothing more than palliative. The purveyors of this treatment acknowledge that it is but a stopgap therapy. And as in the case of the radical mastectomy, there is a far more effective, cost-effective, and sustainable treatment. It's simple: advocate a lifestyle of plantbased nutrition, make a bold leap toward a world free of heart disease, and lessen our use of scalpels and drugs.

There is widespread agreement that the Western diet of processed oils, white flour, dairy, and meat progressively causes endothelial dysfunction and injury, diminution of nitric oxide, increased vascular adhesion molecules, endothelial permeability, low-density lipoprotein oxidation, foam cell formation, generation of reactive oxygen species, plaque cap thinning, and plaque rupture, which lead to clinical events. Contributing risk factors include a family history, hypertension, smoking, hypercholesterolemia, diabetes, metabolic syndrome, and obesity.

Medications commonly used for this illness include ! blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, statins, anticoagulants, and aspirin. The interventions include angioplasty with or without bare-metal or drug-coated stents, atherectomy, and coronary artery bypass surgery. Exercise may be prescribed and smoking cessation encouraged. Some patients may receive nutritional advice froma dietician or nutritional therapist, who often lacks knowledge or training in disease prevention and reversal.

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