Heart: An American Medical Odyssey Read Online Free PDF

a lower-fat diet:
    Eat less fat meat, fewer eggs and dairy products. Spend more time on fish, chicken, liver, Canadian bacon, Italian food, Chinese food, supplemented by fresh fruits, vegetables and casseroles.
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    As the nation’s diet changed, so did its addiction to cigarettes.According to the American Lung Association, at the turn of the last century, Americans smoked 2.5 billion cigarettes per year. Over the next several decades the US population tripled, but cigarette consumption increased by a factor of 250, peaking at 640 billion cigarettes sold in 1981.
    Despite a greater than 50 percent decline in the prevalence of smoking over the past fifty years, 46 million people in the United States currently smoke, and the drop in tobacco use has not occurred with equal vigor in all socioeconomic groups. For instance, although the overall prevalence of tobacco use in adults is about 21 percent, it is about 28 percent for those with less than a high school education, those living below the federal poverty line, and those with no health insurance.
    Several years ago a sixty-five-year-old obstinate smoker in my practice with severe coronary artery disease inquired whether my sister had been able to stop smoking. This patient, who resumed smoking after multiple operations, including both heart and leg bypass surgeries, knew that my older sister, Melanie, also struggled with smoking, a habit she hesitated to abandon for fear of gaining weight.
    “Yes,” I told her. “As a matter of fact she did quit.”
    My patient’s eyes brightened, and a smile came across her face when she asked me how Melanie did it.
    “She got lung cancer,” I replied, mustering all the verbal tenderness of a punch in the nose.
    Melanie didn’t fit into any of the disadvantaged groups. She was well educated and had an MBA in marketing, she wasn’t poor, and she did have health insurance, but she started smoking when she was a teenager and she couldn’t stop. Currently, about one in five US high school students smoke, and each day about four thousand kids under theage of eighteen try cigarettes for the first time. About a third of those who become regular smokers ultimately will die as a consequence. When Dick Cheney attended Natrona County High School in Casper in the 1950s, more than half of American high school students smoked.
    Once begun, smoking is an extraordinarily difficult habit to break. The American Cancer Society estimates that only 4 to 7 percent of people will succeed in quitting on any given attempt, a statistic that increases to only about 25 with the aid of medications like nicotine patches, bupropion (Wellbutrin), or varenicline (Chantix). For many patients, however, a heart attack is a potent behavioral modifier, and at five years following the event, about half the patients who smoked prior to their heart attack remain abstinent from tobacco.
    We now know that cigarette smoking is unsafe at any dose.There are more than seven thousand chemical substances in tobacco or tobacco smoke, including hydrogen cyanide, cobalt, benzene, and arsenic. The complex chemistry of cigarette smoke likely contains many more carcinogens and hazardous constituents and results in increases in blood pressure, coronary plaque deposition, arterial wall injury, and the propensity for blood to clot, a perilous mix increasing the likelihood and decreasing the age at which coronary disease will develop. On average, active smokers experience their first heart attack five to ten years earlier than people who have never smoked.
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    On a hot July day in 2007, my smart and successful sister, a woman who loved fashion, family, and all things wonderful, died at age fifty-two. Her cancer was in no rush, first taking Melanie’s left lung and a piece of her esophagus, then her ability to eat or talk, and then her ability to breathe without a ventilator. My sister had the longest ICU stay of any patient I have ever come across in my