A: Coronary Artery Bypass Surgery, although an extremely useful technique, is not a permanent solution to coronary artery disease. In fact, it is a palliative procedure that is able to prolong life. The underlying problem of coronary artery disease is atheroclerosis, an insidious process that starts in childhood and continues through life in a progressive, often inexorable fashion culminating in heart attack, stroke or peripheral artery disease if not aggressively treated.
Q. What is the treatment of atherosclerosis?
A. We used to think that the fundamental process is abnormal lipid deposition in heart arteries. Research has shown it is more complex than this: the heart arteries are inflamed and result in blood cells reacting to the initial inflammation resulting in further injury to the artery. The heart artery, to protect itself, tries to rebuild itself, resulting in abnormal growth within the artery wall. The damage to the wall causes abnormal lipid accumulation which we call atherosclerosis. Bypass surgery simply bypasses the most severely blocked areas in the artery but the process of atherosclerosis is not addressed with surgery. So what can we do to arrest if not ameliorate this process? Intensive dietary restriction (little to no fat/cholesterol intake), daily and regular exercise program, stopping smoking, and anti-lipid medications have shown to stop, if not reverse the atherosclerotic process. These measures remain the mainstay of my treatment advice to my patients. “An ounce of prevention is worth a pound of cure.”
Despite these measures, however, many patients continue to develop arterial disease. Some of these patients, unfortunately, end up requiring another bypass operation. This is the frustration of cardiologists and their patients. This means we have not isolated all the factors involved in this exceedingly complex disease: atherosclerotic heart disease. Consequently, the doctors work only begins after a heart bypass operation. A patient should follow up closely with his internist or family physician and cardiologist as required. Regular cholesterol and lipid panel checks and dietary counseling are only a part of the intensive follow-up process required after bypass surgery. If close follow-up is not done and if the patient does not follow the doctor’s recommendation closely, the unfortunate and almost certain outcome is another bypass operation, heart attack or death. It is my fervent hope as doctors that our patients don’t fall prey to these unfortunate consequences of this deadly, yet silent disease called atherosclerosis.