Affairs of the heart

Not relying purely on preventive measures is being considered a better strategy for heart patients

Published: Sunday 15 June 1997

CONTRARY to the conventional wisdom that prevention is better than cure, here is a case where cure certainly outweighs the benefits of preventive measures. According to a study done at the Department of Harvard School of Public Health, Boston, us, 70 per cent of the overall decline in deaths in heart patients was attributed to the use of clot-dissolving drugs like streptokinase and tissue plasminogen activator and surgical procedures like angioplasty and bypass surgery. Dietary changes in the general population aimed at preventing heart disease accounted for only 25 per cent of drop in deaths between 1980 and 1990 (journal of American Medical Association, Vol 277, No 7).

The Harward analysis shows that medical and surgical treatments have been more important in the real drop of heart-disease deaths in recent years than wide spread changes in other means of prevention, at least in the US. The researchers employed a computer simulation state transition model of heart diseases for people in the US between ages 35 and 84 years.

Maria Hunick, who led the research group, said that she was quite surprised at the outcome of the study that medical treatment had a larger impact than prevention on the incidence of heart disease. This finding is significant as coronary heart disease is still a leading cause of death in India as well as most of the developed world.

However, the study does not suggest that preventive measures like cutting down or stopping smoking and watching diet carefully to avoid fat-rich foods do not contribute to the positive health of the population. They are still important. This study only shows that treating people with heart disease has a greater effect.

Which is why Hunick specially cautions against slackening measures, particularly public health education that would help even in a small measure the overall number of people developing heart disease. However, this study did not correlate the decline in deaths from treatment with the money spent in the groups who took preventive precautions in terms of life style change and those who did not bother. Some, measures left out included exercise, taking of aspirin and oestrogen, well known preventive steps against heart disease. According to Hunick, they account for only a minuscule portion of decline in deaths.

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