Although we all agree that an ounce of prevention is worth a pound of cure, in everyday life we place our hopes much more on curing diseases than on preventing them. Governments can be defeated because of problems related to the healthcare system, like waiting lists that are too long or overflowing emergency rooms, but never because there isn’t enough prevention.
It’s therefore not accidental that our healthcare system is mainly oriented toward treating diseases while prevention is overlooked. According to the Canadian Institute for Health Information, in 2013 only 5.1% of the total healthcare expenditure in Canada was for public health, which encompasses activities related to health promotion and prevention, a proportion clearly inadequate to counter the damage caused by smoking, obesity, and a sedentary lifestyle.
Like most of my colleagues, I chose to specialize in cardiology because I wanted to save lives and alleviate the symptoms of patients who have cardiovascular disease. Medical progress achieved during the past century has given modern medicine an impressive arsenal of drugs, imaging techniques, and intervention procedures that have prevented an incalculable number of premature deaths and contributed to an increased life expectancy.
Although this progress is impressive, cardiologists are the first to realize the limits of this curative approach every day. For example, even though we can usually save patients in the acute phase of a heart attack, it’s much more difficult to treat the underlying causes of the attack — the process of atherosclerosis that attacks the interior of the coronary arteries, which nourish the cardiac muscle. As a result, even if they are out of danger in the short term, patients who have had an acute heart attack and do not deal with the problems that caused the disease (poor diet, sedentariness, smoking) risk having a second heart attack and, ultimately, developing heart failure, which will undermine their quality of life.
In other words, modern medicine is excellent and unequalled for treating events that suddenly put a person’s life in danger, but its effectiveness remains limited in the face of chronic diseases that develop insidiously over decades.
Experts agree that lifestyle is one of the main factors in the development of chronic diseases. For example, the decrease in mortality observed since the 1970s in people with cardiovascular disease is due not only to medical advances but also to improvement in certain lifestyle habits, in particular the significant decline in smoking in the last fifty years. Unfortunately, it’s thought that these recent gains will be cancelled out by the negative effects of obesity and junk food, and we are already beginning to glimpse the first signs of an increase in the incidence of cardiovascular disease in young people. In an editorial that appeared recently in the medical journal JAMA Cardiology, Dr. Donald M. Lloyd-Jones of the Department of Preventive Medicine at Northwestern University in Chicago underlined that the gains made in the last fifty years will be erased by the largest epidemic of chronic diseases in the history of humanity. Since 1985 we have, in fact, witnessed steady increases in obesity and diabetes, affecting every age group in society and contributing to a resurgence in cardiovascular disease, especially in young adults. What’s more, recent data show that the incidence of heart attacks has not decreased in the last ten years in men ages 30 to 54 and that it has actually increased among women in this age group.
This is an alarming situation. One serious problem our society faces is that healthy life expectancy, without incapacitating illness, has not increased as fast as total life expectancy. For example, in Canada life expectancy is 79 years of age for men and 83 for women, whereas healthy life expectancy is just 69 for men and 71 for women — a difference of ten and twelve years, respectively. A great many people will spend the last ten or twelve years of their lives in poor health despite medical progress. This situation may get worse in coming years because of the dramatic increase in obesity and the chronic diseases resulting from it.
Fortunately, despite the seriousness of the problem, many studies have shown that the majority of chronic diseases, and especially cardiovascular disease, can be avoided or greatly delayed by making simple lifestyle changes. These studies tell us that we must not just give up: we can avoid the premature onset of diseases associated with aging and thus dramatically improve our quality of life. Our lifespan has its limits, but taking action to shorten the period of late-life disability as much as possible lets us maximize the potential of human life. .
For more than three decades of clinical practice and research at the Montreal Heart Institute (MHI) and its prevention centre (the EPIC Centre), I have been in a position to see, every day, the degree to which people who decide to profoundly change their lifestyle can improve their health and quality of life. The effects are often impressive: many patients who complete a secondary prevention program after a heart attack or surgery say they are in much better shape than before their cardiac event because it triggered major changes in their lifestyle.
The aim of this book is to share with you my belief that chronic diseases, and cardiovascular disease in particular, are not inevitable and that it’s possible, by changing our habits, to live a long and healthy life.