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Sanjay Gupta MD
"The Last Heart Attack"
Aired November 24, 2012 - 16:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
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DR. SANJAY GUPTA, HOST: Everywhere you look, it seems a heart attack is just waiting to happen. More than a million heart attacks a year. That's one just about every 30 seconds -- just in the United States.
If you haven't had a heart attack yourself, you likely know someone who has.
I've got a secret to share: with what we know right now, we could see the last heart attack in America.
I've been investigating this for over a year. I've got lessons to share, things you need to know, things your doctor may not tell you.
(voice-over): I'm a pretty typical guy in his early 40s with a family history of heart disease. So I decided to go on a mission to never have a heart attack.
But how?
Dr. Arthur Agatston has guaranteed he can see trouble coming, years in advance.
DR. ARTHUR AGATSTON, UNIVERSITY OF MIAMI MILLER SCHOOL OF MEDICINE: So here is where the blood is flowing and this is lining.
GUPTA: Agatston is using an ultrasound to look for plaque in the carotid artery leading to my brain. A blockage here would cause a stroke and would be a sign I'm at increased risk for heart attack.
AGATSTON: Unless you do the imaging and the advanced testing, you are really playing Russian roulette with your life.
(on camera): You're actually going to look for what in my heart?
AGATSTON: Yes. For calcium which is part of the atherosclerotic process, the plaques in the heart. And if you're --
GUPTA: I've never had a problem, but you are looking for it anyways.
AGATSTON: Yes. And if you are heading for a heart attack in five, 10, 20 years, you already have plaque. It's a lifelong process.
GUPTA (voice-over): We all know plaque is bad. It blocks your blood vessels. Plaque is formed by LDL cholesterol in the blood, the bad cholesterol. Think of it as L for "lousy," building up on the walls of your arteries forming plaque. It can accumulate slowly, over time, narrowing the blood vessels like something building up inside a pipe.
This narrowing in the blood vessels leading to your heart can cause chest pain, called angina. It can also cause a heart attack.
Did you ever wonder how seemingly healthy people can have a heart attack?
This may surprise you: most heart attacks happen in people with no symptoms. In people whose arteries are less than 50 percent blocked.
Here's how: cholesterol can cause unstable bubbles or blisters of plaque to form in your arteries. These can be incredibly dangerous. Most are covered by a cap, but inflammation and stress can cause the cap to thin and rupture resulting in a clot that blocks the flow of blood to the heart.
Robbed of oxygen, the heart muscle can't function properly -- heart attack.
And therein lies the key, Agatston says. We can now find clues before heart trouble gets dangerous, even before the first symptoms.
AGATSTON: One of the best kept secrets in the country in medicine is that doctors who are practicing aggressive prevention are really seeing heart attacks and strokes disappear from their practices. It's doable.
GUPTA (on camera): And you're saying we -- with what we know right now, we don't have to have any more heart attacks in this country.
AGATSTON: I'll never say not any, but the great majority -- yes, absolutely.
GUPTA: It's the biggest killer of men and women, heart disease in this country.
AGATSTON: And it's completely preventable.
GUPTA (voice-over): Your body needs cholesterol. Actually makes it. It is in the lining of every cell in your body.
The liver sends out LDL cholesterol, and when everything works right the good, HDL, scavenges excess LDL and brings it back to the liver. You also get cholesterol in foods, things like meat, French fries, eggs, butter, desserts, ice cream.
Your cholesterol number is a good measure of what's in the blood. But here's the problem: it doesn't tell if you it is building up in the walls of your blood vessels forming plaque. It's the plaque that causes heart attacks.
AGATSTON: If you look in the coronary care unit at people that have heart attacks, the cholesterol levels of those who have heart attacks versus those in the street who have it are essentially the same.
GUPTA (on camera): That is kind of surprising, right, because you'll hear people exchanging their cholesterol numbers. And if it's low, they seem quite proud of it. If it's high, there's cause for concern. You say that that's -- you know what? You're not looking in the right place.
AGATSTON: That's essentially useless.
GUPTA (voice-over): Here's what does matter, Agatston says: the size of your LDL, or bad cholesterol particles. Larger LDL particles don't pose much of a threat because they pass through the blood vessels without sticking. It's the smaller LDL particles that are more likely to lodge in the walls of blood vessels and cause a build-up of plaque.
That's why the Dr. Agatston wants a blood sample.
(on camera): I don't think anyone likes getting their blood drawn.
(voice-over): He wants to find out if I have a lot of small LDL particles -- a sign that I could be prone to building up plaque no matter what my overall cholesterol number is.
(on camera): Doctor --
(voice-over): You'll hear about my test result in just a bit. But next, a controversial diet. This 66-year-old woman skipped surgery to try and eat her way to heart health.
DR. CALDWELL ESSELSTYN, CLEVELAND CLINIC: We're never going to end the epidemic with stents, with bypasses, with the drugs, because none of it is treating causation of the illness.
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GUPTA (voice-over): Sharon Kintz is 66 years old, a retired private investigator from Canton, Ohio. A year ago, she had a heart attack, after a coronary artery became completely block.
SHARON KINTZ, HEART PATIENT: He said, for someone who had what you have, the only warning you usually get is death. And at that point, I really knew how lucky I was.
GUPTA: Like a lot of women, Kintz did not experience the classic chest pain, but rather, fatigue and a pain in her jaw.
KINTZ: He said you're going to have to have open heart surgery. He says I can fix you today. I can just take you right down to O.R. and I can operate on you right now.
My son was in there and he was ready to wheel me down to the operating room because he is frantic. You know, it's terrifying. GUPTA: What Kintz did next may surprise you. She turned the surgeon down cold -- said no to open heart surgery and decided to take a chance --
KINTZ: I bought some parsnips the other day. Always have sweet potatoes on hand.
GUPTA: Using food as medicine.
KINTZ: I love these. These are wonderful.
GUPTA: Kintz is betting her life on a controversial diet created by Dr. Caldwell Esselstyn, he's a general surgeon by training.
(on camera): You have some easy-to-remember adages about how people can decide what they should or should not eat.
ESSELSTYN: We know what they shouldn't eat. That is oil, dairy, meat, fish and chicken.
What do we want them to eat? We want them to eat all those whole grains for their cereal, bread and pasta, beans, vegetables -- yellow, red, green -- and fruit.
Now, what particular vegetables do we want them to have?
Bok choy, Swiss chard, kale, collards, collard greens, beet greens, mustard greens, turnip greens, Napa cabbage, Brussels sprouts, broccoli, cauliflower, cilantro, parsley, spinach and arugula and asparagus. And I'm out of breath!
(LAUGHTER)
GUPTA (voice-over): Nothing with a mother, nothing with a face. You can imagine the meat, egg and dairy associations think that's a terrible idea.
SHALENE MCNEIL, NATIONAL CATTLEMEN'S BEEF ASSOCIATION: Incorporating lean beef into the healthy diet can actually help you stick to a healthy diet because it's a food that people enjoy.
MITCH KANTER, EGG NUTRITION CENTER: Eggs are a source of 13 vitamins and minerals. Eggs are the gold standard when it comes to protein.
GREG MILLER, NATIONAL DAIRY COUNCIL: Well, dairy foods are very nutrient-rich. You get a lot of nutrients for every calorie that you consume.
GUPTA (voice-over): To be clear, Dr. Esselstyn is not a cardiologist. He has no special degree in nutrition. But when it comes to food as medicine, he's a true believer.
GUPTA (on camera): You know Sharon?
ESSELSTYN: Oh, yes.
GUPTA: Doctors recommended she'd have an intervention. She's not doing it. Is there a downside? Could she be putting herself at risk?
ESSELSTYN: No. I think that's an excellent question. And hundreds of patients, data now going back over 20 years and this most recent study about a decade, once they start eating this way, you'll make yourself heart-attack proof.
GUPTA: Heart attack-proof.
ESSELSTYN: We know that if people are eating this way, they are not going to have a heart attack.
GUPTA (voice-over): Esselstyn's food-based prescription puts him squarely against conventional wisdom which says diet only a part of a heart-healthy lifestyle.
(on camera): If a doctor were to say to me, look, heart disease is a food-borne disease, if you follow this diet, pretty strict diet, very restrictive, but in exchange, you're not going to have a heart attack -- what would you say to that? You agree with that?
DR. ALLAN SCHWARTZ, NEW YORK-PRESBYTERIAN/COLUMBIA: I would say that's an overstatement -- an oversimplification and overstatement of really what we're able to do. Even though I know there are people who say it.
GUPTA: I was curious about the science behind Dr. Esselstyn's claims. So, I dug up some of these peer-reviewed journals. They are small, just a handful of patients, but the results are pretty impressive.
In one study here, patients on the Esselstyn's diet and cholesterol- lowering medication had no heart attacks, had no coronary events of any sort after five years. And three-quarters of these patients actually saw their blockages get smaller.
You're not talking about just reducing your chance of heart disease. You're talking about potentially reversing heart disease.
ESSELSTYN: Oh, absolutely.
GUPTA: The lay wisdom is that once you develop these plaques, they're there, you're stuck with them. Try not to let them get worse. Is that faulty thinking?
ESSELSTYN: I think it's absolutely faulty thinking.
GUPTA (voice-over): Here's a picture Esselstyn likes to show of a heart patient with a blocked coronary artery, and here's that same patient after going on a plant-based diet.
You see the way the blockage has almost disappeared?
A year after her attack, Sharon Kintz says she feels great. Check out those moves. A year ago, simply walking is enough to wear her out. With the diet, there's one question you have to ask, can she keep it up? (on camera): I asked Sharon Kintz to meet me here in New York City. You know, cooking at home is one thing, but eating on the road, eating on the run -- well, that's quite another. As the old saying goes, if her diet can make it here, it can make it anywhere.
Forty-sixth and Broadway, please?
Sharon, how are you?
All right. So, here's another restaurant.
KINTZ: OK.
GUPTA: I'm going to take some advice from you. You look at a menu like this -- tell me what comes to your mind.
KINTZ: The majority on there I'm not going to eat.
GUPTA: So you just focus in on the salads?
KINTZ: No, not really. I could have the baby spinach leaves minus the chicken. I could have the peaches, the strawberries. Forget the walnuts. And --
GUPTA: Is this a restaurant that you would --
KINTZ: Oh, yes.
GUPTA: You could come in and --
KINTZ: If I was hungry, you bet.
GUPTA: You can get a meal here.
KINTZ: You bet I could.
(on camera): Sharon, do you think this diet can make you live longer?
KINTZ: Well, I hope so. I hope I get to see you retire.
GUPTA: I have a feeling you're going to have to live a very long time, which I hope you do.
KINTZ: I hope I do, too. Yes. I think -- well, you know what? If it doesn't -- if I don't live longer, I know I'm going to live more of a quality life.
GUPTA: Coming up: Former President Bill Clinton opens up about his own bad heart and his brush with death. And he tells me he's now a vegan. That's right, a vegan.
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(BEGIN VIDEOTAPE) GUPTA (voice-over): A survey by the American Heart Association found 40 percent of Americans believe their hearts are in great shape. The real number: fewer than 1 percent.
Former President Clinton can relate. He passed all his White House physicals. But just four years after leaving office, it took a quadruple bypass operation to save his life.
WILLIAM JEFFERSON CLINTON, 42ND PRESIDENT OF THE UNITED STATES: I was lucky I didn't die of a heart attack.
GUPTA: Former President Clinton, like too many people, was busy.
And for years, he ignored warning signs from his heart. But in 2004, during an exhausting book tour, there was something different.
CLINTON: I had a real tightness in my chest when I was getting off the airplane and the only time I'd had it unrelated to exercise.
GUPTA (on camera): We're here outside New York Presbyterian Hospital. In just a couple of hours, President Bill Clinton, former president, is scheduled to undergo surgery.
CLINTON: So I immediately went down to our local hospital and they did a test. They said I got real problems. They hustled me down to Columbia Presbyterian and they confirmed the determination that I had serious blockage and needed the surgeries.
GUPTA (voice-over): Doctors immediately knew options were limited. The 58-year-old Clinton needed to have his chest opened, his heart stopped, and surgery performed.
DR. CRAIG SMITH, NEW YORK PRESBYTERIAN HOSPITAL: There's no medical treatment for reversing the obstructions that had already formed in his blood vessels.
CLINTON: I got Hillary and Chelsea there. All I remember is it's happening fast and everybody who cared about me was scared and I felt rather serene.
GUPTA: On Labor Day, in 2004, Mr. Clinton had four blood vessels bypassed.
SMITH: Starting this morning around 8:00, he had a relatively routine quadruple bypass operation. We left the operating room around noon and he is recovering normally.
CLINTON: It had hurt like the devil for about three weeks. It hurt so much that I had a hard time even watching movies, much less reading. And then when I started again to exercise, and I forced myself out. I mean, like the first day, you know, trying to walk a half block, one or the other, I was really trying to push myself into doing the therapy, there was that period when you're just not sure you can come back.
GUPTA (on camera): Did you confront your mortality? CLINTON: Oh, yes. But I lived with it. I'm -- you know, when I was in elementary school, I was fascinated by cemeteries, and I used to walk in the cemetery in the little town where I was born where my father and my grandparents are buried, now my mother buried, and I used to go visit them, and read the headstone and see when people were buried there and when they lived and how long they lived.
It was different for me. I was -- I grew up knowing that I couldn't live forever. I grew up knowing that people I loved would die, because my father died before I was born. So I never had the fear, the terror of my own mortality.
GUPTA: How do you know that you're healthy? I mean, first of all, would you call yourself healthy now?
CLINTON: Well, I think I'm healthier than I was. You know, I lost 20-something pounds. And I feel good. I actually have, believe it or not, more energy. I seem to need -- when I do sleep, I sleep better. But I seem to need less sleep to function at a reasonably high level than I did on the other diet.
I'm really out of shape, though.
GUPTA: I mean, you talk about the fact that you love to eat.
CLINTON: You know, I like the stuff I eat. I like the vegetables, the fruits, the beans -- the stuff I eat now I like. I like It.
GUPTA: Do you call yourself a vegan now then?
CLINTON: Well, I suppose I am if I don't eat dairy or meat or fish, you know?
GUPTA: So, you've cut all that out. I mean, you --
CLINTON: Once in a while, literally in well over a year now, at Thanksgiving, I had one bite of turkey.
GUPTA: I mean, you're doing this for your health.
CLINTON: Yes.
GUPTA: Is that why you're doing it?
CLINTON: Absolutely.
GUPTA: Mr. President, how are you?
CLINTON: Great.
GUPTA: Last time we spoke a few weeks ago, you said you were going to be really strict on the diet. You're doing pretty good job, you said.
CLINTON: Yes, I'm doing it -- I'm more strict now.
GUPTA: Are you? CLINTON: Yes.
GUPTA: So --
CLINTON: Yes. By the time I have my 65th birthday, I want to weigh what I did when I went home from law school in 1973.
GUPTA: Wow.
CLINTON: That's what I'm working on.
GUPTA: That's a grand ambition. I like that. How much was that? Will you tell us?
CLINTON: I weighed -- I got down to 185.
GUPTA: All right.
CLINTON: Now, I got down -- when Chelsea was married, I weighed about 192, which is what I weighed when I graduated from high school. Anything under 195 was my optimum weight my whole life.
But in the summer of '73, we had a scorching hot summer and I ran three miles a day, at the hottest hour of the day, which I could do back then, in order to make the pounds go off and it was the first time since I was 13 years old that I had weighed 185 pounds. I'm going to try one more time to make it.
GUPTA (voice-over): And coming up: the pictures don't lie. And I learned that my arteries are young or old.
(on camera): I'm going to find what fate has to offer me.
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GUPTA (voice-over): So what about me? I have a family history. Am I heart attack-proof?
(on camera): So, a couple weeks ago, I met up with Dr. Arthur Agatston to get a full workout, to gauge my likelihood of actually having a heart attack.
AGATSTON: Sanjay, good to see you.
GUPTA: Time to find out -- time to see what fate has to offer me.
AGATSTON: Sure. We had some good news when we did the imaging.
GUPTA: Right.
AGATSTON: You had no plaque on your coronary arteries on the calcium score. GUPTA: Right.
AGATSTON: That your carotids were really like a spring chicken, very young.
GUPTA: I like that. Yes.
AGATSTON: Someone who's on his 20s.
GUPTA: Someone made a comment to me that this is sort of a four-year guarantee that I don't have a heart attack. Would you agree with that?
AGATSTON: Yes. I'd extend it to five to seven years.
GUPTA: Five to seven -- but you would say, based on what you've already seen before we go over this, five to seven years if I'm feeling chest pains, probably not a heart attack.
AGATSTON: Right.
GUPTA (voice-over): More good news. Looking at my LDL, the bad cholesterol, Dr. Agatston tells me they are mostly large particles, the kind that don't build up as plaque in the blood vessels.
(on camera): Putting it my whole picture together now, the imaging, all my laboratory test -- what can you tell me?
AGATSTON: You are at low risk for future heart attack, even though there is some family history. And, clearly, the lifestyle that you maintain your weight, that you do the exercise, has helped to decrease your risk.
GUPTA (voice-over): If diet and exercise can make someone like me low risk for a heart attack, even with a strong family history, that's encouraging.
CLINTON: I don't think there's any question that not only could we be past our last heart attack, but the vast majority of people, even my age, if they are prepared to change their diet, exercise a little more, could actually reverse a lot of their blockage.
ESSELSTYN: It is possible to keep everybody from having a heart attack with education, with knowledge, with information. Now, the question becomes, are people going to do this?
GUPTA (on camera): I hope I have given you food for thought today. And if all this makes you want to overhaul your diet, especially if you are a heart patient, you should talk to your doctor.
Look, we got a long way to go in this country. But I hope you'll join me. So, together we can work for "The Last Heart Attack."
I'm Dr. Sanjay Gupta. Thanks for watching.
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