Medicine likes to trumpet its treatment of heart disease because it is possibly the only degenerative disease where the numbers of fatalities are falling. However, the self-congratulation is premature. Heart disease remains the number-one killer in the West, still dispatching some 40 per cent of us.

As WDDTY publisher Bryan Hubbard noted in this month’s cover story (July 2009), every 37 seconds in the US alone, someone’s heart fatally packs up. So, in our special report this month, we’ve taken a closer look at medicine’s treatment of heart disease to discern where exactly medicine is going wrong. What we found was nothing short of revelatory: in fingering cholesterol as the bad guy, medicine essentially is taking aim at the cavalry.

Far from being the enemy, cholesterol appears to be the body’s chief means of eleventh-hour cardiovascular repair. To my mind, heart disease is chiefly a disease of emotional pain. The famous American heart specialist Dr Dean Ornish discovered that smoking, obesity, sedentary lifestyle and high-fat diet only accounted for half of all heart disease.
No one risk factor appears to be more important than isolation—from other people, from our own feelings and from a higher source.

In a study of nearly 20,000 people observed for up to nine years, those who were lonely and isolated were two to three times more likely to die from heart disease and other causes than those who felt connected to others. The results were independent of risk factors such as high cholesterol, high blood pressure and smoking (Am J Epidemiol, 1988; 128: 370–80). Lately, scientists have been studying a phenomenon called ‘broken-heart syndrome’, where an emotional upset, such as the loss of a loved one, causes dysfunction of the left ventricle (the heart’s main pumping chamber). In one study, researchers at Johns Hopkins found that women with the syndrome, which often leads to heart failure, had none of the usual predisposing factors for heart disease. Indeed, bereavement and sadness had caused such high levels of stress hormones, particularly adrenaline, that they had ‘stunned’ the heart, literally causing it to break (N Engl J Med, 2005; 352: 539–48).

The role of social ties in heart disease were highlighted in the heart-attack statistics in Nevada vs Utah. As neighbouring states, their ethnic mix is similar and they both have similarly high education statistics, although Nevada is the more successful state, with 15- to 20-per-cent higher incomes. Nevertheless, their statistics on mortality from heart attack were on opposite ends of the spectrum. Nevada had one of the highest death rates in the country, while Utah was among the lowest.

The primary difference between the two states was the stability of the social structure and close-knit families in predominantly Morman Utah, compared with the high degree of broken and dysfunctional family life in Nevada. It was the weakening of the social fabric, concluded the researchers, that had the biggest influence on the difference in mortality (Fuchs V. Who Shall Live? New York: Basic Books, 1975).

In some native populations, heart disease is a rarity even when the inhabitants adopt Western diets. For instance, a group of researchers studying the native populations of the Solomon Islands found that they had no coronary heart disease or high blood pressure even after they’d adopted Western diets and religious practices. This puzzled the researchers until they discovered one area that had remained constant: the social ties and roles within the family (Circulation, 1974; 49: 1132–46).

So, rather than worrying about your cholesterol levels, your doctor should be more concerned about the most important diagnostic test of all: the state of your friendships.

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