Abstract
One of the greatest health care challenges facing our generation is that of dealing with the rising tide of metabolic syndrome–related diseases, the majority of which are significant risk factors for heart disease. Modern medical approaches to cardiac disease care have tended to center around pharmaceutical interventions, angioplasties and coronary artery bypass grafts (CABG). Lifestyle medicine leaders have long called for a new view and different approach to what is predominantly a lifestyle-related disease.1,2
Broken Hearts: The Tangled History of Cardiac Care offers a historical perspective on this tension that is worth exploring. The author, David S. Jones, is a physician, but in this book he takes the role of a thorough historian. He begins by reviewing the development of both CABG and angioplasty, followed by the growing acceptance of the major cause of myocardial infarction being related to plaque rupture. He then clearly discusses the difficulties with CABG and angioplasty. Both of them treat atherosclerotic heart disease as if it is the result of a gradual accumulation of cholesterol, not plaque rupture.
The second part of the book delves into the complications of cardiac procedures, especially the cognitive aspects of these complications. Dr Jones looks at the evidence around post–CABG brain fog and postulates as to why this has not received much attention. This is then used as a platform to discuss how the medical culture operates and the challenge of producing definitive knowledge about the efficacy and safety of medical treatments.
Although the book does include some practical strategies that can influence patient and physician decisions around cardiac disease care, and there is also a solid discussion of costs and dollar flows and how these might affect care choices, the book is more of a story than a practical guide. Broken Hearts does not significantly address the actual causes of heart disease, and the opportunities for lifestyle medicine to contribute significantly in both reducing the incidence of myocardial infarction and providing a more effective and less risky set of treatment options. There is also no in-depth discussion of the value, or lack thereof, of medications such as statins in the overall prevention and treatment of heart disease.
Broken Hearts is a scholarly but engaging read. It is highly referenced and annotated, but it is written more for the public than for the scientist or health care practitioner. It is a story that is not told enough. The type of thinking that it encourages is what the health care culture and society as a whole should engage in more consistently.