Coronary Artery Disease

I grew up with a copy of the Merck Manual in my home. I didn’t read it much myself, but my father was something of a hypochondriac, so he was always reading it. The thing about the Merck Manual is that it, like the Bible, contains no jokes. It is a very serious book. If you are looking for information about a particular disease, the Merck Manual probably has a no nonsense, very clinical, and authoritative discussion of it. At least that is the way I remember it used to be.

Yesterday I was looking for information about diagnosing narrowing of the arteries. I ran across this article in the Merck Manual online that says, “Doctors diagnose angina largely based on a person's description of the symptoms.” This is very interesting to me. That’s a little subjective, isn’t it? I thought they would give you an MRI, shoot some dye into your blood stream, something like that. In all fairness, though, if you scroll down the page a bit, there are other methods of evaluating coronary artery disease. I just thought it was funny that doctors would rely on patients to diagnose angina, but as I said, there are no jokes in the Merck Manual.

Then, however, the article goes on to say that “Treatment begins with attempts to slow the progression of coronary artery disease or to reverse it by dealing with risk factors.” Dealing with risk factors means quitting smoking, eating a low-fat diet, exercising, and losing weight, among other things. That is amazing. According to this you are supposed to be able to slow or reverse heart disease by dealing with these risk factors. And the thing is, I am already doing all these things. I quit smoking 23 years ago; I became a vegetarian, and cut out a lot of fat in my diet (particularly trans fat) about 6 years ago; I have been exercising since I quit smoking; and I lost about 12 pounds recently, down to about 140 (BMI of 21.9, which is right in the middle of “normal weight” BMI) so in theory I am already doing all I can to prevent progression of coronary artery disease and avoid having a bypass operation, which was one of my main motives in dealing with these risk factors in the first place.

Let me say that Dr. Dean Ornish advocates pretty much the same thing (dealing with those risk factors) in his book on reversing heart disease. I have been sort of following his recommendations for about five or six years. From what I have seen, Ornish has not gotten very good press recently. In fact, a lot of articles that came out several weeks ago loudly trumpeted the fact that Atkins beat Ornish in a study on losing weight. Ornish published an article in Newsweek that attempted to rebut many of those claims. None of that really matters to me, though, because from what I now understand, the Merck Manual agrees with Ornish. That is good enough for me.

As I say, I have been following Ornish for some time now. (I admit that I have been eating a little too much fat recently, mainly from olive oil and pistachio nuts, but I think I’m going to change all that. I think I am going to seriously limit my fat intake like I used to do and see what happens.) On the whole, though, I plan to continue doing what I have been doing. I seem to be doing all the right things. I wasn’t sure before, but I feel a lot better now that I’ve read it in the Merck Manual.


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