The heart prescription that's effective, cheap -- and under the radar

by By David Becker, M.D.

Published Nov. 25, 2016, 1:31 p.m. ET

If heart disease runs in your family, you might think there's not a lot you can do to improve your odds.

A new report in the New England Journal of Medicine did find the chance of having a coronary problem is 91 percent higher if you have chosen your parents poorly and have DNA markers on your chromosomes suggesting a higher risk.

But wait — there's good news here, too. It turns out that four lifestyle factors (not smoking, regular physical activity, avoiding obesity, and a healthy diet) are associated with a 46 percent lower risk of having a heart problem.

This means that millions of people have the power to outrun their genes.

This finding was a big deal recently at the annual meeting of the American Heart Association because it showed that prevention is far more powerful than anyone expected.

An unhealthy lifestyle, on the other hand, boosts heart problems even if you did a great job of choosing your parents.

The conclusion: Eating right, not smoking, and staying active really make a difference.

Another conclusion: Studies like this one that are funded by government and nonprofits, rather than drug companies, often don't get much attention, so this may be the first you're hearing of it.

The heart disease study that got more press took a very different perspective. Treating people who already have coronary artery disease with two different cholesterol-lowering medications (statins plus a new injectable drug called Repatha) resulted in super-low cholesterol levels. GLAGOV, as the trial is known, showed that blockages in the coronary arteries, called plaque, actually improved a tiny bit with treatment. Though the change was just 1 percent, study authors suggest that it means that LDL cholesterol levels (the so-called bad cholesterol) should be brought down to levels lower than ever, and there is no such thing as too low cholesterol.

This study was entirely funded by Amgen, which makes Repatha — a drug whose price tag of up to $16,000 a year has also been making headlines.

Cheap, effective prevention is the message of the genetics study. But, the sad truth is that very few people in our country are following the kind of lifestyle changes that resulted in beneficial changes. According to heart association statistics, 17 percent of us still smoke, just 32 percent weigh what we should, only 22 percent exercise regularly, and 23 percent follow a good diet.

A mere 3 percent of us do all of these things.

Aggressive medical treatment — after the damage is done — is the message of the second study. This also works, though not nearly as well, and the cost is huge.

The message is clear. Make changes in your life now, so you cut the chance that you'll need these powerful and expensive medications in the future. Our hearts have an amazing ability to respond positively to healthy changes, and it is never too late to begin.

Don't let advertising about exciting new drugs mislead you into thinking your own lifestyle efforts don't matter. Yes, it's great to know these drugs are available — but it's much better to never need them.