If you’re one of the 226 million Americans who take prescription drugs to treat heart disease or other conditions, a new genetic test called MyPGt can help your healthcare provider personalize your care, so you get the safest and most effective medications at the right dose. Soon to be available at the Heart Attack & Stroke Prevention Center, the test checks for gene variants that affect your response to hundreds of commonly prescribed medications.

Not only can your results help you avoid drugs that don’t work, or are likely to cause side effects, but the one-time saliva test can also offer guidance on medications that may be prescribed in the future, thus enabling your provider to fine-tune your medical care throughout your life, based on your unique DNA. Here’s a closer look at MyPGt and why the BaleDoneen Method recommends it as part of our precision-medicine approach to heart attack and stroke prevention.

What is precision medicine?

Instead of using a “one-size-fits-all” approach to healthcare, precision medicine, also known as “personalized medicine,” is a leading-edge approach, long used by the dynamic BaleDoneen Method, that bases treatment and disease prevention on each person’s unique genes, lifestyle and environment. Pharmacogenetics (PGt) is the study of how a person’s genes affect his or her response to medications.

BaleDoneen takeaway: What works for one patient may not work for another, so all treatments must be personalized for each unique individual, instead of basing decisions about which medication to prescribe on the average results from a large clinical trial.

How does the MyPGt test work?

Your healthcare provider collects a sample of your DNA, using a simple oral-rinse method, and sends it to the MyGenetx laboratory for analysis. You will also be asked for a list of your current medications, so a personalized report can be sent to your provider. The test covers many genes that determine how your body processes a wide range of common medications, including those often prescribed for heart disease, high blood pressure, chronic pain, depression and other disorders.

BaleDoneen takeaway: What’s exciting about this one-time test is that the results are available forever, since your genes don’t change. As new medications are considered for heart attack and stroke prevention, all can be filtered through this matrix before prescribing to make sure there are no adverse effects or drug interactions for that patient.

What could I learn from this test to improve my healthcare?

Here’s an example of how MyPGt testing could be helpful, says Dave Vigerust, PhD, chief science officer of MyGenetx Clinical Laboratory. “Let’s say you need a statin to lower your cholesterol. The traditional approach is to prescribe a low dose and gradually adjust it up or down, trying to find the sweet spot. However, you might have a gene variant that makes that statin ineffective for you or increases the risk for side effects, such as severe muscle pain. Without this test, it could take weeks or even months of trial-and-error, and many medical visits, to find the right statin and the most appropriate dose.”

In addition, adds Vigerust, some patients have genes that cause them to metabolize certain drugs faster than average, so they need a higher dose, while others process those drugs more slowly and need a lower dose to avoid adverse reactions.

BaleDoneen takeaway: Results from the test take the guesswork out choosing the right prescription drugs and dosages for each individual, which could lead to faster and safer medical care to protect and enhance your arterial health.

Most Americans make New Year’s resolutions — and setting goals to improve health, such as exercising more, typically top the list. This is a great time to focus on taking optimal care of your most important muscle: your heart. Large studies suggest that following an excellent lifestyle can reduce your risk for heart attacks and strokes by nearly 90%.

Embracing healthier habits can be simpler — and more fun — than you might imagine. The BaleDoneen Method’s “prescriptions” for better heart health include laughter, hugs with your significant other and a daily “dose” of dark chocolate.  We also have easy ways to get more exercise, proven tactics to shed extra pounds (even if you’ve struggled with weight loss in the past) and other science-backed strategies to improve cardiovascular wellness. Here are seven heart-smart resolutions and how to keep them in 2019 — and beyond.

1. Fit in fitness.  New government guidelines for physical activity emphasize one key message: All of us can improve our health by moving more — any time, anywhere. Instead of vowing to exercise every day for the rest of your life, commit to doing it for a month, then take that success forward for another 30 days. Also figure out what would make working out more appealing — would dancing to music make it a “fun break?” Would an exercise buddy help — or a group session? And clip on a pedometer: Doing so motivates people to take 2,000 extra steps (one extra mile) per day, a study at Stanford University found. The new guidelines advise getting at least 150 to 300 minutes of moderate intensity aerobic exercise per week or 75 minutes of vigorous intensity aerobic exercise, plus muscle-strengthening exercise on two or more days a week. Check with your medical provider before starting a new fitness regimen to make sure it’s appropriate for you.
2. Slim down. If getting to your ideal weight seems daunting, start with a more modest goal. Losing as little as 7 to 10 pounds reduces risk for type 2 diabetes (a major risk factor for heart disease) by up to 70%, even if you are already prediabetic. To make it easier to shed those stubborn extra pounds, try tracking what you eat. In a study at Stanford University, people who keep a food diary lost twice as much weight as those who didn’t keep any records. We call it a “BLT journal” — write down every bite, lick and taste. Many people are surprised at how many hidden calories they take in (even when preparing meals). There are several free apps that make it easy to keep a food diary, even when you’re on the go. For more inspiration, check out our blog post about 7 heart-smart weight loss tips that really work.
3. Tame tension. Did you know that chronic stress is a major risk for developing cardiovascular disease (CVD)? A large study conducted in 52 countries around the world found that psychological factors (including stress) nearly tripled risk for a heart attack. Even newer research suggests that chronic tension is just as hazardous to your arterial health as smoking! As we recently reported, mindful meditation is one of the best ways to defuse the toxic effects of tension. Laughter is also relaxing and boosts blood vessel health, studies show. Try laughter yoga, which combines self-triggered mirth with yogic breathing to draw oxygen deep into the body. Also embrace the cuddle cure: Researchers from University of North Carolina report that holding hands — or even a 10-second hug from your significant other — significantly reduces tension, heart rate and blood pressure. And it feels good!
4. Shake the sugar habit.  Consuming just one or two sugar-sweetened beverages daily — such as energy drinks, fruit drinks, soda or coffee drinks — raises risk for a heart attack or dying from CVD by 35 percent, a Harvard study found. Instead, quench your thirst with our refreshing fruit and herb infused water recipes. While most sugary foods should be avoided, there is one sweet treat that’s actually good for your heart: In a study of more than 9,000 people, those who ate an average of 7.5 grams of dark chocolate (one small square) daily were 39% less likely to suffer a heart attack or stroke than those who averaged 1.7 grams or less daily. An even bigger study found that eating small amounts of dark chocolate trimmed diabetes risk by 31%.  
5. Safeguard your smile — and your arteries.  Did you know that taking great care of your teeth and gums could actually save your life? In a large study of older adults, those who hadn’t seen a dentist in the previous year had a 50% higher death rate than those who got dental care two or more times a year. Here’s why it’s important to get checked for gum disease: A recent BaleDoneen study was the first to identify oral bacteria from gum disease as a contributing cause of CVD. This research could revolutionize how dental providers diagnose and manage gum disease, which affects the majority of U.S. adults over age 30. Also check out our easy four-step plan to optimize your oral health and prevent heart attacks.
6. Eat the rainbow. Did you know that eating a variety of colorful fruits and vegetables can have amazing benefits, including lowering your risk for heart attack, stroke, high blood pressure, diabetes and several forms of cancer? What’s more, eating certain vegetables may be linked to better memory and longer life, recent studies suggest. Yet fewer than one in ten adults eat the recommended amount of these nutritional powerhouses, according to the CDC. One easy way to reach your goal: Fill half your plate with fruits and vegetables at each meal.
7. Get a heart health screening. Eighty percent of strokes — and 70% of fatal heart attacks — occur in people who had no previous symptoms. Yet these catastrophes are potentially preventable with early detection and treatment, highlighting the potentially lifesaving value of the comprehensive, personalized evaluation the BaleDoneen Method offers. To directly check each patient for hidden signs of arterial disease, we use leading-edge lab and vascular imaging tests, including a painless, FDA-approved ultrasound exam of the neck called carotid intima-media thickness or cIMT.  Two recent peer-reviewed studies have shown that our evidence-based, precision-medicine approach effectively detects, treats and prevents CVD, helping people avoid heart attacks and strokes, even if they have previously suffered one or more of these events or have high genetic risk.

If you think you’re too young — or too healthy — to have a heart attack, a recent cautionary tale published in The New York Times may change your mind. The article’s author, Trymaine Lee, never considered himself to be at risk for heart disease — until he suffered a near-fatal major “widow-maker” heart attack at age 38. “ ‘You hit the lottery,’ one of the cardiologists who saved my life told me,” wrote Lee, a physically fit nonsmoker with no family history of heart disease or early death. “The worst kind of lottery.”

The article also reports that rates of heart attacks have increased in younger adults. In a study of more than 28,000 people hospitalized for heart attacks between 1995 and 2014, 30% were between ages 35 and 54, with a 5% rise over that period in the number of younger heart attack victims. Here’s a look at common misconceptions about heart attacks — and the facts you need to safeguard the health of your most important organ.

Myth: If your cholesterol levels are normal, you won’t have a heart attack.

Fact: A national study of 136,905 people hospitalized for a heart attack found that nearly half had “optimal” levels of cholesterol and nearly 75% had levels that fell within recommended targets. The blood test these patients typically receive sounds comprehensive: Known as a “lipid profile” or “coronary risk panel,” it checks levels of total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides.

As we recently reported, according to this test and other standard methods of evaluating cardiovascular health during annual checkups, celebrity fitness trainer Bob Harper was the picture of health, yet suffered a massive widow-maker heart attack at age 52. A year later, the mystery of Harper’s seemingly inexplicable heart attack was solved when he received a $20 blood test that is not routinely used by American medical providers. It checks for a common, inherited cholesterol disorder: elevated levels of a blood fat called lipoprotein(a) or Lp(a). We wonder if Lee has been checked for this dangerous disorder, which triples risk for heart attacks, according to three studies of nearly 45,000 people. Elevated Lp(a) also magnifies risk for having heart attacks or strokes at a young age.

Myth: If you had a heart problem, it would be detected during your annual physical.

Fact: Lee’s article reports that heart disease was never mentioned during any of his annual checkups, so he never worried about it. In a recent study of 3,501 young heart attack survivors ages 18 to 55, nearly all of the patients had a least one risk factor and 64% had three or more. Yet only half of the patients knew they were at risk before their event! Even fewer reported that their medical provider had ever discuss risk modification, such as lifestyle changes that might have prevented their heart attack!

While we don’t know what technique, if any, Lee’s doctor used to evaluate his heart health, practitioners of standard care typically use “risk calculators” to estimate how likely their patients are to develop heart disease. However, a number of studies have shown that these calculators can be dangerously unreliable. For example, a 2015 study of more than 5,000 adults published in Journal of the American College of Cardiology found that most initial cardiac events do not occur in people considered at “high risk” based on these scoring systems. Lee would appear to be a case in point, since he reports that he does not have high cholesterol, high blood pressure, diabetes or any family history of heart problems.

Unlike standard care, the BaleDoneen Method does not rely solely on risk factor analysis. Along with checking our patients for a wide range of red flags for cardiovascular risk, we also use advanced laboratory and imaging tests to directly check each patient for hidden signs of arterial disease, which often causes no symptoms until it becomes severe enough to trigger a heart attack or stroke.

Myth: Root canals are a leading cause of heart attacks.

Fact: A recent video on Netflix that references the BaleDoneen Method as the premier cardiovascular prevention program in the country misrepresents our teachings about oral health, specifically root canals. The video also asserts that root canal treatment is one of the top causes of heart attacks and claims, falsely, that we advocate removal of root-canal treated teeth. In reality, we take no position for or against root canals. However, our method does place a strong emphasis on oral-systemic wellness as a key component of heart attack and stroke prevention. In fact, your dental provider can be a potentially lifesaving member of your heart attack and stroke prevention team!

A recent BaleDoneen paper published in the peer-reviewed journal, Postgraduate Medicine, identifies oral bacteria from periodontal (gum) disease as a contributing — and potentially treatable — cause of heart disease. Ask your dental provider to check you for gum disease, a chronic oral infection that affects about half of adults over age 30. Also discuss the best ways to improve and protect your oral health. We advocate that cardiovascular prevention patients be tested for high-risk bacteria, using diagnostic tests that measure oral pathogens through DNA analysis, including OralDNA, OraVital and Hain Diagnostics. We also recommend that root canals be evaluated with 3D imaging to make sure that no hidden infection goes undiagnosed and untreated.

Myth: If heart disease runs in your family, there’s not much you can do to prevent heart attacks.

Fact: As discussed more fully in the BaleDoneen book, Beat the Heart Attack Gene, about 50% of Americans carry genes that raise their risk for heart attacks and strokes, such as 9P21, often called “the heart attack gene.” For more than a decade, our method has used genetic testing both to identify people at genetic risk for heart attacks and also to guide personalized treatments to prevent them, such as a diet based on your DNA. Our evidence-based, precision-medicine approach has been shown in two recent peer-reviewed studies to effectively detect, prevent, stabilize and even reverse arterial disease, helping our patients avoid heart attacks and strokes.

Moreover, a large body of research shows that an optimal lifestyle can dramatically reduce your risk for heart attacks, even if you carry high-risk genes. For example, a recent study of nearly 500,000 people with genetic risk for heart disease found that among participants at the highest genetic risk, those who got the most cardiovascular exercise (such as jogging, biking, running, brisk walking or other aerobic workouts), slashed their risk for heart disease by nearly 50%! Conversely, physical inactivity kills nearly 5.3 million people prematurely each year, another recent study found. Talk to your healthcare provider before starting a new exercise regimen to make sure it’s right for you. For more research-based fitness news, also check out our blog post, “What’s the Best Exercise to Reduce Your Waistline & Heart Attack Risk?”

Now back on the campaign trail after suffering a heart attack in October, Sen. Bernie Sanders faces ongoing questions about his health. “ ‘Heart attack’ is a scary word,” the 78-year-old acknowledged during an interview on ABC’s “This Week.” However, he emphasized that he was “feeling very well,” and was confident in the care he’d received, which included implanting two stents to reopen a blocked coronary artery.

Prior to the heart attack, Sanders, like 70% of people who suffer these events, was apparently unaware that he was in any cardiac danger. In 2016, he released a letter from his doctor saying that he had no history of cardiovascular disease (CVD), a condition that claims the lives of 2,300 Americans every day — one every 38 seconds. Yet these tragedies don’t have to happen. Please join us in the fight against this stealthy assassin by reading and sharing this important message: CVD can be detected, halted and even reversed with proper diagnosis and treatment!

Heart Attacks and Strokes Are Preventable

Every 34 seconds someone in the U.S. has a heart attack or stroke. Very often, people who suffer these events were previously unaware they had CVD, the leading killer of men and women. The BaleDoneen Method offers a unique, precision-medicine approach to detecting, preventing and treating CVD that has been shown in two recent peer-reviewed studies to halt or reverse the disease — and rapidly shrink arterial plaque by more than 50 percent.

How do we achieve these results? Unlike standard care, which is based on checking patients for certain risk factors, the BaleDoneen Method also uses advanced laboratory and imaging tests to directly check all patients for hidden signs of arterial disease, which often develops silently over many years until it gets severe enough to trigger a heart attack or stroke if untreated.

A 6-Step Plan That Can Save Lives, Hearts and Brains

Our precision-medicine approach to heart attack and stroke prevention has six components:

• Education. Knowledge is power! Our patients learn how heart attacks and strokes actually happen. A common misconception is that arterial disease is a plumbing problem, like grease clogging a kitchen sink, causing an artery to become so obstructed that flow of blood stops, resulting in a heart attack or stroke. However, studies show that these events occur when plaque inside the artery becomes inflamed and ruptures explosively, leading to the formation of a clot that blocks the flow of blood to the heart or brain. Most heart attacks occur in arteries that are minimally blocked by plaque, with the clot creating the rest of the obstruction.
• Disease. Early detection and treatment of arterial plaque is a key element of our evidence-based approach to prevention. We use advanced laboratory and imaging tests to directly check each patient for hidden signs of CVD, including a painless 15-minute ultrasound exam called carotid intima-media thickness (cIMT). A recent study of more than 10,000 people found that adding cIMT and the presence of plaque to traditional risk factors dramatically boosted the accuracy of 10-year predictions of heart attack and stroke risk. This FDA-approved imaging test can detect plaque at an early, highly treatable stage in people who look and feel healthy, such as our patient Wayne Williams. Although Williams, then 48, had normal blood pressure and cholesterol, a CIMT test detected plaque. Without treatment, he would have had an 83 percent chance of having a heart attack or stroke by the time he was 58. “I learned then that [CVD] is a silent killer,” he told Fox News. Today, after four years of personalized treatment with our method that included medications, lifestyle changes and supplements, the plaque in his arteries is completely stabilized, enabling him to live well without fear of a heart attack or stroke
• Fire in the arteries. Chronic systemic inflammation, which we call “fire,” has been shown to be both a cause and an important treatment target for heart attack and stroke prevention. We use a “fire panel” of inexpensive blood and urine tests to check inflammatory markers. In 2017, results of the CANTOS trial published in the New England Journal of Medicine reported that anti-inflammatory therapies reduce risk for heart attack, stroke, other cardiovascular events and cancer by up to 50 percent. We also recommend natural ways to “fireproof” your arteries.
• Root causes. To put out fire inside the arteries, it’s essential to find out what’s causing it. For someone like Sen. Sanders, identifying the root cause is essential to prevent another heart attack. One possible culprit is his history of gout, since a 2018 study linked this inflammatory form of arthritis, which affects nearly six million American men and two million women, to increased risk for heart attacks, strokes and death from cardiovascular causes. An earlier study found that men with gout are 26 percent more likely to have heart attacks than those without it, even when other cardiovascular risks are taken into account. Our method checks for a wide range of root causes, including insulin resistance (the hidden cause of about 70% of heart attacks), metabolic syndrome, high blood pressure (the leading risk factor for stroke), sleep disorders and a dangerous cholesterol most doctors don’t check, even though it has been proven to actually cause heart attacks! One of our recent studies has been described as “landmark,” because it was the first to identify oral bacteria from gum disease as a contributing cause of CVD.
• Optimal goals. Just as a top-quality construction company may exceed the building code to make homes and offices even stronger and safer from fires, earthquakes and other catastrophes, in some cases, the BaleDoneen Method sets higher standards for treatment and prevention than those set by standard medical care. Work with your healthcare provider to set optimal, individualized goals to modify each of your risk factors. This approach, rather than one-size-fits-all goals set by the standard of care and based on average results from large studies, leads to superior outcomes and more effective heart attack and stroke prevention.
• Genetics. Basing care on each person’s unique genetic makeup is the ultimate in precision medicine. The BaleDoneen Method has used genetic testing for more than a decade both to identify patients with inherited risk for heart attacks and strokes and to guide the best personalized treatments of those risks, including a diet based on your DNA. In a 2018 study, we have also identified an easy, inexpensive way to lower heart attack risk for people who have type 2 diabetes, based on a one-time genetic test. Another recent study revealed that if people at genetic risk for CVD stay physically fit, their risk drops by about 50%, highlighting the amazing power of an optimal lifestyle to keep your heart healthy, no matter what is written in your DNA.

“Let food be thy medicine,” wrote Hippocrates centuries ago. But which foods should you choose to protect the health of your heart, brain and arteries — and which ones should you avoid? In 2017, an analysis of American dietary patterns linked eating suboptimal amounts of ten foods and nutrients — too much of some and not enough of others — to nearly half of deaths from a cardiometabolic disease (CMD), such as heart disease, stroke or type 2 diabetes.

Conversely, people who ate the recommended amounts of the ten foods had the lowest risk for CMD, according to the study, which was published in Journal of the American Medical Association (JAMA). Since then, however, new studies have yielded sometimes contradictory findings about these foods, leaving Americans confused about the best and worst dietary choices. Here’s a look at the latest nutritional wisdom about these foods and how to optimize your diet for cardiometabolic wellness.

Eat More of These Five Foods

• Nuts. People who eat nuts regularly have a lower risk for developing heart disease or experiencing cardiovascular (CV) events, such as heart attacks and strokes, compared to those who rarely or never eat nuts, according to a study of more than 210,000 men and women. Although the tasty treats are high in calories, they can also help people avoid long-term weight gain or obesity, other research shows. Moreover, eating almonds or hazelnuts may raise HDL “good” cholesterol, while pistachios help lower triglycerides. The BaleDoneen Method recommends eating a palmful of nuts daily, preferably tree nuts with skins, such as almonds, walnuts, hazelnuts and pistachios.
• Fish. The omega-3 fatty acids in seafood have a wide range of cardiovascular benefits, including helping prevent heart disease, stroke, heart failure and sudden cardiac death; reducing triglycerides, blood pressure and chronic inflammation; and improving insulin sensitivity. The best sources of omega-3s are oily fish, such as salmon, herring, sardines, tuna and lake trout. The American Heart Association (AHA) recommends eating at least two 3½-ounce servings of non-fried fish per week.
• Fresh vegetables. A diet high in these nutritional powerhouses could add years to your life. A new study presented at the Nutrition 2019, the annual meeting of the American Society for Nutrition, suggests that globally, low intake of vegetables is the culprit in more than 800,000 deaths from heart disease — and about 200,000 deaths from stroke — per year. The USDA advises eating two to three cups of veggies daily. Yet only one in ten adults consumes the recommended amount. An easy way to meet your goal is to fill half of your plate with vegetables and fruit. For optimal CV benefits, the BaleDoneen Method suggests “eating the rainbow” of colorful produce.
• Fresh fruit. Do people who eat a lot of veggies, such as the Chinese, get any extra cardiometabolic benefits from eating fresh fruit? A study of more than 510,000 adults in China, where fresh fruit intake is very low, found that those who ate it daily had 36 percent lower risk for heart attack and stroke than those who ate no fresh fruit. Another recent study found that people who ate higher amounts of fresh fruit had a lower risk for diabetes. Among those who were already diabetic, the study also reported reduced rates of diabetes-related deaths and other complications in those who ate more fruit. As we recently reported, fresh fruit also lowers blood pressure and helps prevent obesity. Fruits with proven CV benefits include blueberries, apples, tomatoes and pears.
• Whole grains/High-fiber foods. People who eat the most fiber (found in whole grains, fruit and veggies) have a 56 to 59 percent lower risk of dying from cardiovascular disease (CVD), infectious diseases or respiratory disorders, according to a study of nearly 400,000 people ages 50 and older. An even larger study found that for each extra 10 grams of fiber people ate daily, their risk for death from any cause fell by 10 percent. The USDA recommends eating 14 grams of fiber for every 1,000 calories adults consume daily (about 25 grams a day for women and 38 grams daily for men).

Eat Less of These Five Foods

• Salt. The AHA recommends a limit of no more than 2,300 mg. per day of sodium and ideal limit of no more than 1,500 mg. for most adults. Cut back on the “Salty Six:” bread and rolls, pizza, sandwiches, cold cuts and cured meats, soup and burritos and tacos, all of which typically contain high levels of sodium. Limiting or avoiding packaged, processed foods, which are typically high in salt, may lower your blood pressure or help you avoid hypertension in the first place, the AHA reports.
• Processed meats. People who eat the most processed meat — such as bacon, beef jerky, salami and other deli meats — have a higher risk for CVD. A study published in JAMA linked processed meat consumption to 57,766 deaths from CMD in 2012. What’s more, eating as little as one hot dog or a few strips of bacon daily raises colon cancer risk by 20 percent, according to a new study published in International Journal of Epidemiology (IJE). Processed meat has also been tied to increased risk for cancers of the breast, pancreas and prostate.
• Sugar-sweetened beverages. Consuming just one or two sugar-sweetened beverages daily – such as energy drinks, fruit drinks, soda or coffee drinks – raises risk for a heart attack or dying from CVD by 35 percent, diabetes risk by 26 percent and stroke risk by 16 percent, according to a recent Harvard study. Sweet drinks have been called “liquid candy” and rank as the top source of added sugar in the U.S. diet. Quench your thirst with plain or sparkling water flavored with a spritz of lemon or lime or try our refreshing fruit and herb infused water recipes.
• Red meat. Recently, conflicting studies have stirred debate about the effects of red meat. In the IJE study discussed above, eating 2½ ounces or more of red meat per day raised colon cancer risk by 20 percent. However, controversial new “guidelines” published in Annals of Internal Medicine in November contend there is not enough scientific proof of harm to tell people to cut back on red meat. This paper by a panel of nutritionists contradicts the federal government’s Dietary Guidelines for Americans, recommendations from the World Health Organization and other medical groups, and numerous studies pointing to the health benefits of eating less meat and more plant foods. The BaleDoneen Method joins these authorities in continuing to advise patients to limit red meat. Healthy sources of protein include seafood, legumes (beans and peas), nuts, oats and low-fat dairy products, while leafy, green vegetables are an excellent source of iron.
• Saturated fat. For 50 years, saturated fats were demonized as the No. 1 dietary culprit for arterial disease. Two major studies report that the effect of cutting down on saturated fats depends on how you replace them. Swapping them with healthy fats (such as those found in oily fish, olive oil, most nuts and avocados) or high-fiber carbs (such as whole grains) may benefit heart health, while replacing saturated fat with refined carbs (such as baked goods or sweets) is likely to do the opposite. In fact, as we recently reported, sugar is actually worse for heart health than saturated fats.

What’s the Best Diet to Protect Cardiometabolic Health?

Rather than advise a one-size-fits-all diet based on the average results from large studies, the BaleDoneen Method recommends a diet based on your DNA. We use genetic tests to identify the optimal eating plan for each patient. Ask your healthcare provider for more info on the two genetic tests discussed below. Using them to guide your dietary choices can help you lower your risk for heart attacks, strokes and diabetes:

• Apo E genotype. This test analyzes your Apolipoprotein E (Apo E) genotype, which influences both your lifetime risk for heart disease and the best diet to avoid it. The results can be used to determine the optimal amount of fat in your diet and whether you should limit or avoid alcohol. A diet based on your Apo E genotype fights the leading risk for heart attack and a major risk for stroke: abnormal lipid levels. Studies show that eating the right foods for your Apo E genotype raises levels of HDL (good) cholesterol and lower levels of LDL (bad) cholesterol and triglycerides.

Haptoglobin genotype. If you have type 2 diabetes, this test can reveal if you have a genotype that quintuples risk for heart disease — and guide precision-medicine treatments to almost eliminate this risk, a peer-reviewed recent BaleDoneen study reported. If you are not diabetic, you can learn if you have a genotype linked to increased risk for intestinal, autoimmune and inflammatory disorders and if you’d benefit from a gluten-free diet and probiotics.

Common invasive heart procedures, such as stents and bypass surgery, are no better for preventing heart attacks and death in people with stable coronary artery disease (CAD) than medications and lifestyle improvements, according to a large, federally funded clinical trial that has been hailed as one of the most important studies in cardiology. The findings could transform medical practice, spare many heart patients the hazards of unnecessary surgery and reduce healthcare spending by $570 million — or more — each year.

While stents and bypasses can be lifesaving for people who are in the throes of a heart attack, these procedures only treat a few inches of the more than 60,000 miles of blood vessels in our bodies. For people without emergency symptoms, excellent medical care and healthier habits offer the benefit of treating the entire arterial system at a fraction of the average $25,000 cost for stent implantation or $45,000 for a bypass. Here’s a look at some key takeaways from the study — and what they mean for the millions of Americans with CAD.

What was the purpose of the study?

The $100 million ISCHEMIA clinical trial was designed to compare two approaches to treating ischemia (reduced blood flow to the heart due to plaque buildup inside the walls of the arteries that supply it with blood). This disorder is called CAD, ischemic heart disease or coronary heart disease and ranks as the most common form of cardiovascular disease, the leading killer of American men and women. 

In some cases, CAD can cause stable angina, chest pain or discomfort that typically occurs with exercise or emotional stress. (Unstable angina is a medical emergency that usually causes unexpected chest pain when the person is at rest. A common cause is blood clots resulting from the rupture of a plaque deposit, putting the person at high risk for a heart attack if untreated.)

How was the study conducted?

Funded by the National Heart, Blood and Lung Institute, the trial included 5,179 men and women from 37 countries who had moderate to severe ischemia, making the study more than twice as large as any previous study of its kind. About two-thirds of the participants had frequent or daily angina at the start of the study, while the rest had no chest pain. About 40% of the patients had diabetes. The median age of the patients was 64. 

All of the participants received optimal medical therapy (OMT) consisting of cholesterol-lowering statins, low-dose aspirin, blood pressure drugs and other medications, along with lifestyle advice to help them adopt healthier habits. Half of the patients were randomly assigned to receive coronary angiography (an invasive x-ray test used to evaluate blood flow in coronary arteries) and if appropriate, invasive treatments, such as stents to prop open constricted areas in their coronary arteries or coronary artery bypass surgery to reroute blood around such areas. 

The other group of patients received OMT alone. For example, one participant in this group told The Washington Post that he switched to a mostly vegan diet, took a regimen of pills and exercised several times a week with an elliptical machine, hiking and golfing. He also reported that he felt much better after receiving OMT alone, was able to travel and enjoy an active lifestyle and was “glad to have avoided more extreme interventions.” 

The OMT group was only treated invasively if their symptoms got worse or they had heart attacks. The invasive group took powerful anti-clotting medications for six to 12 months after their surgeries. The stents used in the study also contain drugs that are slowly released to reduce risk that the blockage would recur.

How well did these treatments work?

During the study, participants were tracked for up to seven years and monitored for five types of events: heart attack, death from cardiovascular causes, resuscitation after cardiac arrest or hospitalization either for unstable chest pain or heart failure. Overall, there were no differences in rates of these five events between the OMT and interventional groups, the researchers reported. 

However, six months into the study, the group that had invasive procedures had a slightly higher rate of heart attacks than the OMT group (5.3% vs. 3.4%). Four years into the study, the results flipped and a slightly higher rate of cardiovascular (CV) events was reported in the OMT group (13.9% vs. 11.7%). By the end of the study, there were no significant differences in the rate of CV events, heart attacks or cardiovascular-related death. About 14% of people in each group experienced cardiovascular issues at some point during the study, which began in 2012.

The study found that people with angina had greater improvement after invasive procedures, compared to those who were treated with pills and lifestyle improvements, such as quitting smoking, increasing exercise and dietary changes. Among patients who reported daily or weekly chest pain at the start of the study, 50% of those treated invasively were angina free a year later, versus 20% of those treated with OMT. Those without angina has no changes in the quality of their lives after the procedure.

What did the researchers conclude?

“In line with evidence from prior studies, our results suggest that routine use of heart procedures was not superior in reducing risk for the five-part disease endpoint or death overall compared to treatment only with optimal medical therapy,” stated ISCHEMIA trial chair Judith Hochman, MD, who presented the results at the AHA annual meeting. 

“On the other hand, patients symptomatic to start that got heart procedures, over the years, had fewer symptoms and felt better,” added Dr. Hochman, who is a professor of medicine and senior associate dean for clinical sciences at NYU Langone Health in New York City.

“Based on our results, we recommend that all patients take medications proven to reduce the risk of a heart attack, be physically active, eat a healthy diet, and quit smoking,” stated ISCHEMIA co-chair David Maron, director of preventive cardiology at the Stanford Prevention Research Center at Stanford University.

The study adds to earlier research, including the landmark 2007 COURAGE clinical trial, that has also shown OMT to be as effective as invasive procedures for the prevention of heart attack and death from cardiovascular causes. Several subsequent studies have had similar findings. In 2012, a systematic review and meta-analysis of eight randomized clinical trials (the gold standard of scientific research) found that coronary stents offer no benefit over medical treatment for prevention of death, nonfatal MI, unplanned revascularization or angina in people with non-acute CAD.

The ISCHEMIA study findings suggest that many of the 1 million Americans who undergo stent and bypasses procedures each year could be safely managed at far lower cost with OMT. About one-third of these procedures are performed on patients with stable CAD. Medications for CAD have improved over the past several years, increasing this group’s prospects for safe, successful treatment without the risks and high cost of heart surgery.