To the Editor: Many heart attacks avoidable
Written by W.E. Feeman, Jr,. M.D.   
Wednesday, 11 September 2013 09:48
The Center for Disease Control has just released report on the almost a quarter million avoidable deaths due to atherothrombotic disease (ATD, such as heart attacks and strokes).  Moreover, this newspaper carried a story on 6 September 2013 about a woman who suffered a heart attack at the end of her race.  All this begs the question: Why???
The population at risk of ATD can be readily and accurately predicted - so why are people having heart attacks and strokes?  ATD risk factor testing is easily available - so why do not people get their risk factors checked?  Why do some people just roll the dice and see what happens?  If people paid attention to their ATD risk factors, the people of Wood County might have the nice smooth decline in ATD mortality exhibited by other counties, such as Hamilton County, instead of the jagged decline (die-offs of the vulnerable ATD patients followed by a low rate of ATD deaths, followed by another die-off, followed by another year of low ATD deaths, and so on) exhibited by Wood County.
The National Cholesterol Education Program (NCEP) is now functionally extinct. Their latest - and long, long overdue - guidelines will not be published by the NIH.  Hopefully, with the NCEP a part of medical history, the tunnel-vision approach of the NCEP, focusing mainly - if not solely - on the "bad" (LDL) cholesterol will also be swept away, leaving the way open for a return to the Framingham Heart Study and a return to using the "good" (HDL) cholesterol as part of the screening and therapeutic tool. The atherogenicity (ability to cause ATD) of LDL is dependent on its associated HDL and on cigarette smoking and/or blood pressure.  The balance between LDL and HDL is the key to the prediction and prevention of ATD, right along with cessation of cigarette smoking and control of hypertension.
W.E. Feeman, Jr,. M.D.
Bowling Green

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