Healing the Heart
Preventing and Reversing Heart Disease

Every 33 seconds one person dies from one of America's most deadly diseases - heart disease.

Dr. K. Lance Gould, professor of medicine and cardiology at The University of Texas Medical School at Houston and director of the Weatherhead PET Center for Preventing and Reversing Atherosclerosis, says that fatalities reach nearly 1 million people each year, more than any other illness. Of these deaths, more than 550,000 are attributed to heart attacks, 50 percent of which are first time and fatal.

Dr. Gould says the origins of his approach to managing coronary heart disease non-invasively began in 1965 during his medical training.

"I became interested in measuring coronary blood flow," says Dr. Gould. "At that time, coronary arteriography was still developing. Therefore, initially I intensively studied the fluid dynamic characteristics of coronary artery stenoses, and in the process, discovered the phenomenon of coronary flow reserve. As I studied coronary flow reserve, the possibility of pharmacologic stress and non-invasive perfusion imaging evolved to our current stage."

In 1985, Dr. Gould developed a non-invasive way to manage coronary heart disease that overcomes many of the drawbacks of traditional therapies. His approach is based on two key concepts: Positron Emission Tomography for diagnosis and follow-up and dietary-behavioral-pharmocologic treatment for prevention and reversal of atherosclerosis, the result of cholesterol building up in the walls of coronary arteries.

"We were finding patients with early coronary atherosclerosis by PET, and no symptoms, and these patients were destined to have clinical heart disease unless it was prevented in them personally as individuals," Dr. Gould says. "That initial program has evolved through several stages in both diet and pharmocologic treatment in keeping with scientific advances."

With the advent of PET, Dr. Gould and his team are able to diagnose heart disease with 96 to 98 percent accuracy, permitting treatment even before symptoms appear. Positron Emission Tomography non-invasively creates three-dimensional images of the blood flow and/or metabolic activity of the heart using a safe, short-lived radionuclide.

The diagnosis of atherosclerosis by PET is remarkably accurate. In one way it is better than the arteriogram because it can identify effects of diffuse coronary atherosclerosis that are not detectable by coronary arteriography, which, for diffuse disease, has an accuracy of about only 21 percent. PET reduces expenses and risk by avoiding unnecessary invasive procedures. Finally, follow-up PET scans definitively indicate whether there is progression or regression of coronary heart disease, determining if more vigorous treatment is needed.

"In my clinic population, coronary events, including myocardial infarction, unstable angina, balloon angioplasty, bypass surgery or death, are markedly reduced by as much as 90 percent," Dr. Gould says. "The event rate in my clinic patients is reduced to or even lower than the general population of comparable age and sex."

The second key concept of the Coronary Disease Reversal Program at the Weatherhead PET Center uses an approach combining all the major therapeutic steps - a very low-fat diet, cholesterol lowering drugs, smoking cessation, exercise and stress management - to halt progression or optimize regression, and minimize future clinical events.

Dr. Gould says components of the program are individually planned for each patient, depending on his or her time constraints, work demands, lifestyle and personal preferences, thereby increasing compliance. Successful reversal of cardiovascular disease requires the emotional commitment to manage one's own health, understand the fundamentals, and abide by them, by incorporating the major therapeutic steps.

Patients of the program are provided with follow-up support for one year by after hours on-call availability for questions or problems, in person or by phone, motivation and monitoring by a variable mix of outpatient clinic visits and home lifestyle rehabilitation. There is no single, fixed or rigid regimen, diet or method to which individuals must conform. Unlike other programs, multiple subspecialty consultations, special equipment or facilities, group interaction, classroom meetings, unnecessary clinic visits or excessive time demands and disruptions of busy schedules are avoided in favor of integrating essential lifestyle changes and medical management into daily life.

"Most patients are able to comply with the program specifically because it is individualized rather than being a rigid dietary-pharmocologic regimen imposed on everyone having different personalities, different needs, limitations and strengths," Dr. Gould says.

Dr. Gould adds, "For those patients who control lifestyle factors less well, I utilize aggressive pharmocological treatment. For those patients with successful control of lifestyle factors, the dose of pharmocologic agents is reduced so that optimal outcome is achieved in either case, but by somewhat different means."

Consequently, PET and medical treatment are economical approaches to treat heart disease, with costs per patient totaling $6,300 for a PET scan, medication and the follow up program in the first year. By comparison, the total costs for physician and staff services for coronary bypass surgery and balloon dilation are $65,000 and $35,000, respectively.

Dr. Gould has written a book about his methods, recently published in paperback by Rutgers University Press. Heal Your Heart - How You Can Prevent or Reverse Heart Disease, available directly from Rutgers University Press, can also be found at some of the larger retail bookstores.

For more information regarding The University of Texas at Houston Weatherhead PET Center for Preventing and Reversing Atherosclerosis, which remains the largest center of its kind in the United States, visit their Web site at http://pet.med.uth.tmc.edu.

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©2006 Texas Medical Center

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