'South Beach Diet' Doc Focuses on the Heart

The first "South Beach Diet" book in 2003 had an immediate impact on a fad-driven, weight-conscious world, but now author Dr. Arthur Agatston is back with a new book challenging America to rethink its approach to heart disease and focus on prevention.

In "The South Beach Heart Program: The 4-Step Plan That Can Save Your Life," published Wednesday, Dr. Agatston says America's health-care system relies too heavily on expensive invasive procedures—the "plumbing" model of cleaning out arteries after they're clogged. He outlined his case for prevention to NEWSWEEK's Julie Scelfo. Excerpts:

NEWSWEEK: When most people think of coronary-artery disease, they imagine plaque building up over time in an artery until the hole is so tight it needs to be bypassed or opened with stents. Is this wrong?
Dr. Arthur Agatston:
That's the "plumbing" model and it's what I learned in medical school—that the arteries are like pipes and the plaque builds up like sludge until the pipe is completely blocked. It turns out that view is completely wrong. Instead, the plaque or sludge really develops like a little pimple in the vessel wall, but instead of filing with pus, it fills with cholesterol. Blood flow remains normal until the plaque "pimple" ruptures. The body's healing process includes creating a blood clot, and if the clot is big enough, it suddenly blocks the artery.

Is that a heart attack?
Yes, that's what a heart attack is. The clot blocks the artery, and the heart muscle can no longer get blood and oxygen.

So does this mean stents and bypass surgeries are the wrong treatments for coronary-artery disease?
The logical response to the "plumbers" model of the heart was opening the vessels before the sludge closed the artery 100 percent. For cardiologists, the holy grail was to find arteries that were 70 percent blocked and to do something. What we realize now is those spots we are opening with stents are not the soft plaque pimples that are actually killing us. Instead they are spots where plaque ruptured and healed without ever blocking the artery completely. The healed plaque do not progress to cause heart attacks. Instead, it's those "pimples" that are like little ticking time bombs because they blow up suddenly and cause a sudden and devastating blockage.

So what's the solution?
The solution is better diagnosis of who's harboring these little ticking time bombs and then treating aggressively with diet and exercise changes and medication. Non-invasive imaging like heart scans will generally show plaque years before you have a heart attack or stroke. If you are 45 years old and heading for stroke in 5 or 10 years, you will already have plaque in the vessel wall.

Part of your program is getting the right diagnostic tests. What are those tests?
You can see evidence of ticking time bombs by getting a calcium score, which is recommended by the American Heart Association for people who are at moderate risk for heart disease. There are another whole series of blood tests that identify other risk factors such as our bodies' underlying inflammation or the size of our cholesterol particles. There are many others—we describe them in the book—and they give doctors a better guide of which medications will prevent heart attacks in each individual patient.

Step four of your program for people at risk for heart disease is getting the right medications. Are people taking the wrong ones?
It's not that they're taking the wrong medications but a lot of people don't want to take medications and don't appreciate how well these things work. The first generation of cholesterol and blood pressure medication in the 1970s—you had to take them many times a day, they had a lot of side effects, toxicities and they were less effective. We're all for doing it naturally if you start other preventative measures on time. But if you're at risk, the newest generation of medications for blood pressure and cholesterol are really outstanding.

You say doctors and hospitals are paid more to treat disease than to prevent it. What do you mean?
Once people have chest pain or a heart attack, there are all kinds of invasive procedures and diagnostic tests that come into play that doctors are reimbursed well for. The system evolved that way because we didn't know much about prevention, so we [cardiologists] treated heart disease after the fact. Over the last 5, 10, 15 years, we have learned how to prevent heart attacks and strokes, but it takes time with patients in the office, and the insurance reimbursement for a doctor's time is very low. Primary-care doctors' overheads are very high. So primary-care doctors find it hard to make ends meet to pay their overhead, and spending time with a patient for prevention becomes a financial strain for the doctor.

You describe your approach to cardiology as being a "healer" instead of a "plumber." What's the difference?
Once we know who has ticking time bombs, we can heal them. If we start diet and lifestyle changes early enough, the patient will probably never run into a problem. If they are more at risk, lifestyle changes are combined with medication and with that, you can literally heal the soft plaque pimples or cholesterol pimples in the vessel wall and prevent heart attacks and avoid surgery. The cosmetic-surgery approach to coronary arteries—making them look nice with balloons and stents—doesn't really work. That's going after the wrong plaque, the kind that has already ruptured and healed, and is no longer a threat. We're spending billions of dollars going after wrong plaque!

How do people find healers as opposed to plumbers?
You have a talk with your physician. If the physician doesn't show an interest in prevention, we suggest getting a referral to a preventive cardiology clinic at a major medical center. They have them in any city. But we hope patients can partner with their own doctors.

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