The Politics of Heart Disease
By John J. Pippin, M.D., F.A.C.C.

This opinion piece was published Sept. 15, 2004, in the Buffalo News.

Forget swing states or butterfly ballots. The decisive factor in this year’s biggest political contest may be Bill Clinton’s emergency bypass operation. When the former president went under the surgeon’s knife, the Democrats forfeited one of their most formidable campaigners. But some observers are also concerned about Vice President Dick Cheney, who maintains a hectic schedule despite a long history of heart problems.

Could this be the first presidential campaign decided by cardiovascular disease (CVD)? If so, it probably won’t be the last. As a cardiologist, I know that our nation’s politics—and broader social landscape—may be dominated for decades to come by a rising tide of CVD and other chronic diseases.

Simply put, a disaster is on the way. According to one estimate from experts with the American Heart Association, the prevalence of heart disease in the United States may double by 2050.

Cardiovascular disease is already the nation’s leading cause of death. Who hasn’t had a friend or relative killed or disabled by a heart attack or stroke? In fact, CVD claims more lives each year than the next five leading causes of death combined. Even survivors face serious challenges: Coronary heart disease is a leading cause of premature, permanent disability in the U.S. workforce.

The last few years have brought some good news. Heart disease mortality rates appear to be falling, apparently thanks to increasing use of preventive treatments and medical interventions like the bypass surgery undergone by Clinton. Such aggressive approaches have helped many heart attack victims survive and even resume fairly normal lives.

But if heart disease rates increase as dramatically as some predict, many more will die, despite the best efforts of skilled surgeons. And there will be other costs. As more patients undergo expensive operations and are prescribed cholesterol-lowering statin drugs, the resulting financial burden could pose an enormous challenge to our health care system.

Can this crisis be averted? I believe it’s possible, but only if all of us—from our political leaders to the voters who elect them—take decisive action. Better eating habits and more active lifestyles are critical. In particular, Americans have to consume more fruits and vegetables and less fat and cholesterol.

Unfortunately, the trend seems to be in the other direction. In March of this year, researchers from the Mayo Clinic came before a meeting of the American Heart Association to present a study showing that fat and cholesterol consumption are on the upswing. As a result, the researchers predicted a sharp increase in heart disease rates.

High-fat, meat-heavy diets also feed the obesity epidemic and the rapid spread of type 2 diabetes and hypertension. All three conditions are dangerous in their own right, but they are also strong risk factors for heart attack and stroke.

Now consider what happens to people who take the opposite approach: a low-fat vegetarian diet. A study published last year in the Journal of the American Medical Association found that a meat-free diet high in soluble fiber and soy protein lowered serum cholesterol concentrations about as effectively as statin drugs. Other research has found that people adopting a low-fat vegetarian diet see a significant drop in cholesterol levels in just six weeks. A recent review in the Journal of the American College of Cardiology confirms what many heart specialists have been saying for years, that normal human cholesterol levels are much lower than the vast majority of Americans are able to achieve. Such levels are achieved and maintained by eliminating animal fats from the diet, and human populations that do so do not develop atherosclerosis.

Unfortunately, most Americans hear very little about the benefits of good eating habits. Why? Because the public education budgets of government agencies and nonprofit health organizations are dwarfed by the money spent on advertising by burger chains. Special interest groups representing the dairy and meat industries have their way with the agencies and panels that determine school lunch programs, dietary guidelines and farm subsidies. Politics and economics consistently overrule science and health.

This widespread ignorance and deception lead to widespread disease—and only a dramatic turnaround can head off a health care calamity. Does America have the willpower to make the necessary changes? That’s a tough question. But what is clear is that diet-related maladies will be one of the most challenging issues facing our nation’s leaders—regardless of which political party manages to sidestep heart disease and win the November elections.

John J. Pippin, M.D., F.A.C.C., is the director of cardiovascular medicine at Cooper Clinic in Dallas, and a member of the Physicians Committee for Responsible Medicine.

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