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  • Eric Goulder, MD, FACC

Heart Talk – April 2022

The Lifesaving Treatment Many Cardiologists Don’t Prescribe


Joe I. used to lead a very limited — and rather lonely — life. “I wasn’t healthy enough for any sustained physical activity, including sex or even going out on a date,” says the retired real estate broker from Granbury, Texas. “I had such severe chest pain that I couldn’t even walk from my house to the car without taking nitroglycerin — and I needed it so often that I had to ration the 100 pills that my insurance plan allowed me every month, so I didn’t run out.”


His symptoms were so severe that specialists advised a heart transplant. But Joe balked. “I wasn’t sold on the idea that I needed a new heart when I’d never had a heart attack.”


However, he worried that he’d run out of treatment options. He’d already undergone quadruple bypass for his coronary artery disease (CAD), dramatically improved his lifestyle, and was taking several medications — yet kept getting sicker. Was there anything left to try, short of getting a new heart?


Determined to Avoid His Father’s Fate


Joe feared that he was on the same tragic trajectory as his father. “He died at age 62 from a heart attack, five years after his quadruple bypass surgery — and I knew that if I didn’t find the right treatment, I was rapidly approaching a point at which my life would also be cut short,” recalls Joe.


Joe’s battle with arterial disease began when he developed angina while hiking. Also known as angina pectoris, angina is chest pain due to insufficient flow of oxygenated blood to heart muscle. This painful symptom affects about 10 million Americans, with about 500,000 new cases each year. The most common culprit is CAD, which can lead to narrowing of the arteries that supply the heart.


Then 57, Joe was treated with open heart surgery and a quadruple bypass. He was the same age as his father had been when the older man had undergone these procedures decades earlier. Afterwards, he spent six weeks in cardiac rehab, receiving education on healthy lifestyle changes to enhance recovery after cardiac surgery. Determined to avoid his father’s fate, he quit smoking, dramatically changed his diet and began working out regularly.


A Seemingly Miraculous Recovery


“During cardiac rehab. I told the nurse that I knew this treatment would help slow down my disease, and I might live a little longer, but I thought my heart would get me in the end,” recalls Joe. “She said that physicians used to think all they could do was keep patients from getting worse, but the BaleDoneen Method had had success in halting and reversing this disease.”


Initially, however, lifestyle improvements seemed to do the trick. Before long, Joe, an avid nature photographer, felt well enough to resume his favorite activities: hiking, kayaking and training his German short-haired pointers for bird-dog competitions — physically challenging events that required following the fast-moving dogs through rough terrain on horseback to find hidden birds.


Terrifying Test Results


However, this seemingly miraculous improvement lasted only 18 months. Not only did the angina return, but it became so severe that despite nitroglycerin and several medications, even the slightest exertion left Joe in agony. His cardiologist ordered heart tests — with shocking results. “First I was told that I had new blockages, which I kind of knew, then the cardiologist said that two of the vein grafts in my bypasses had totally failed,” he says.


“The cardiologist — with a heart surgeon standing next to him — said that if they tried putting in new grafts or stents, it might cause a heart attack,” recalls Joe. “He also said that I might not even survive the surgery. That really shook me and my family started crying,” adds the divorced dad. “I told my sons and their wives that maybe this was what it boiled down to, but I wanted to get a second opinion. I felt that the cardiologist wasn’t looking at why I’d gone downhill so fast.”


Even on medication, reports Joe, “my blood pressure was staying at 150/90, and I’d done enough research to know that wasn’t normal. But when I asked the cardiologist about it, he’d say, ‘For your age, that’s a decent number. You can live with that.’ I felt that I was being herded along, like a sheep in a pen, from one surgical intervention to another. Basically, I was being told that I’d drawn a bad hand in life and all they could do was put in a new heart.”


Optimal Medical Therapy: An Excellent, But Underused Treatment for Arterial Disease


Joe had attended a lecture about the BaleDoneen Method and hoped it could help him. However, he also had a fatalistic attitude about his long-term prospects for survival and worried that it might be too late to turn his disease around.


When Joe began his treatment with the BaleDoneen Method 14 years ago, we prescribed an evidence-based treatment approach that has been shown in many excellent studies — including large, randomized clinical trials (the gold standard of scientific research) — to save lives by preventing heart attacks, strokes and other devastating complications of CAD. Called “optimal medical therapy” (OMT), it combines an optimal lifestyle with drug therapy to treat arterial disease and the conditions that spark it, such as high blood pressure, chronic inflammation, and high cholesterol.


OMT has been shown to be just as effective at preventing cardiovascular events and early death from heart-related causes as painful, invasive, and expensive procedures — such as using bypass surgery or stents to restore blood flow to clogged vessels: an approach called revascularization.


Indeed, the scientific evidence supporting OMT is so overwhelming that in 2012, it was formally endorsed in medical guidelines jointly issued by the American Heart Association, the American College of Physicians and other leading medical societies.


New Proof that Optimal Medical Therapy Works


In 2021, a major clinical trial called SYNTAX reported that OMT dramatically improved long-term survival in patients like Joe, who had undergone revascularization procedures, such as quadruple bypass surgery. Indeed, the study found that patients who received this guideline-recommended treatment, starting soon after their surgery, were 53 percent more likely to be alive ten years later than those who didn’t get OMT! The findings were published in Journal of the American College of Cardiology.


Conducted by an international team of cardiovascular specialists, the study included 1,472 patients who were tracked for up to 10 years. In an interview with the medical press, one of the study’s authors, Dr. Patrick Serruys, stated that the study offered compelling data for providers to tell heart patients that OMT “is the best insurance for extended survival.”


Dr. Serruys and his team defined OMT as receiving four types of heart medication: an antiplatelet drug (to help patients avoid blood clots that could cause a heart attack or stroke), a statin (to lower cholesterol and reduce inflammation) and two types of blood pressure medication that also reduce stress on the heart: a renin-angiotensin system inhibitor and a beta blocker.


A Happy Heart and Happy Life


OMT medications combined with an optimal lifestyle for the treatment of patients with CAD have been cornerstones of the BaleDoneen Method since its inception in 2001. Joe, now 73, credits our

evidence-based, personalized therapies with saving his life. During the first year of treatment, his blood pressure gradually dropped from 150/90 to 120/80 — a pressure he really can live with. He also worked to improve his fitness and started following a gluten-free diet based on his DNA.


Little by little, as we gradually switched him to the medications that are the cornerstones of OMT, his health improved. By the second year of treatment, he no longer needed to ration his nitroglycerine pills, because he rarely needed them. By year three, all his health metrics, including his weight, were in the normal range and he was able to resume his favorite hobbies.


“I can go on hikes and ride horses all day in bird-dog trials without any chest pain,” says the Texan, who shared his story in the new BaleDoneen book, Healthy Heart, Healthy Brain. “If I hadn’t found these treatments and the BaleDoneen Method, I doubt I’d still be alive today. My health experience is an example of what can be achieved with a program of preventive care and lifestyle changes.”


Not only has Joe far outlived his father, but his heart has healed in other ways. Now that he’s healthy again, he’s rediscovered the joys of romance and sex: “I have a significant other and feel very grateful to be sharing my life with someone I care about deeply.”


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