Texas Medical Center

Study Uses Visual Coaxing to Reverse Heart Damage

HEART HEALERS—From left, Stefano Sdringola, M.D.; K. Lance Gould., M.D.; and Nils Johnson, M.D., team up to help people heal their hearts in an ongoing clinical trial at Memorial Hermann-Texas Medical Center.

By Deborah Mann Lake  | UT Health Science Center at Houston
and Burke Watson

In August 1980, a Houston man in the throes of a heart attack became the first in Texas to receive a clot-busting drug delivered through a catheter by physicians at The University of Texas Health Science Center at Houston.

Among the members of that pioneer team three decades ago was K. Lance Gould, M.D., cardiology professor at The University of Texas Medical School at Houston. He created the first 24-hour catheter lab with clot-busting services in the country. The results from the first patients were published the April/June 1983 issue of the journal Vascular Medicine.

Now, Gould is in another battle to prevent coronary artery disease and acute heart attacks. He's conducting the Century Health Study at the Weatherhead PET Center for Preventing and Reversing Atherosclerosis at Memorial Hermann-Texas Medical Center.

In this study, participants see images of their ailing hearts, provided through positron emission tomography, or PET scanning. The thought is that seeing damage done to the heart through poor lifestyle choices will motivate participants to shape up and get healthy.

The images of his not-so-healthy heart made an impression on one study participant, Kenneth "Buddy" Conant. But they made an even bigger one on his wife Carolyn.

"She said, 'I'm going to have to bear down to help you'," Conant remembered.

The clinical trial builds on research published in 2003 in the Journal of the American College of Cardiology that showed heart patients who are motivated to improve their health through diet, exercise and medication are three times less likely to suffer a coronary event than those who just take medication.

Virtually no other facility in the world uses PET imaging on a routine clinical basis to measure blood flow in the heart, said Gould, co-investigator of the study and director of the Weatherhead PET Imaging Center.

"We're looking into the heart and we can see how people have been eating for the past 15 years," said Gould. "We sit down with patients and say, 'Here's your heart. Here's your life. Here are your choices, and we'll help you'."

Conant is among more than 200 people currently taking part in the randomized study. The research team's goal is to recruit 1,300 participants.

"I was up around 210 pounds and I dropped to 165 before I even knew it," said Conant, who began eating more lean meat, including venison, with his wife's talented cooking skills. "I'm wearing size 32 pants again. I was up to a real snug 38, fixing to go to 40. I never in my wildest dreams thought I'd have a 32 waist again. That's what I wore in high school. My stomach is even flat!"

The dramatic improvement means much more to Conant than just appreciating his slimmer form in the mirror. His father died at age 59 during heart-bypass surgery and Conant underwent an angioplasty in 2006. He's maintaining his weight which has leveled off around 170 pounds and his blood pressure has dropped enough so that doctors have discontinued his use of metoprolol and decreased his dosage of lisinopril.

Heart disease is the No. 1 cause of death in the United States, killing 2,400 Americans every day, or about one person every 36 seconds.

"However, we have the evidence that this is, for the most part, an unnecessary tragedy," said Stefano Sdringola, M.D., a principal investigator for the study and attending physician at Memorial Hermann Heart & Vascular Institute. "This is a condition that is mostly a consequence of our lifestyle that can be prevented. Even more, once it is present, we can fight back and heal from it," said Sdringola, who also is an associate professor of medicine at the UT Medical School.

To enroll in the study, participants must be at least 40 years old and have certain cardiovascular disease risk factors, symptoms of heart disease or documented coronary heart disease. They will be randomly divided into two groups. Patients continue to see their own cardiologists or family physicians for cardiac care and the study will share information with them. There is no cost for Century team visits, stress tests, PET scans or lab work.

In the first group, participants will undergo a full heart health assessment and have yearly visits with the Century study team for five years. They will meet with specialists including a cardiologist, a nurse and a dietician and receive basic information on managing risk factors such as diet, blood pressure, smoking, weight and exercise. Cardiac PET scans are done at several points throughout the study, but will not be shown to the patients until the end of the five-year period.

Participants in the second group will be shown the results of their PET scans to see how their lifestyle choices and medical treatment are affecting blood flow in their hearts. They also see the study team and specialists more often – six times during the first year and twice yearly for the rest of the study period.

Researchers at The University of Texas School of Public Health will analyze the economic impact of the five-year study. Programs to help individuals achieve healthy lifestyles generally are not covered by insurance, Sdringola said, but insurers may look at the study's results and reconsider whether coverage would make good sense if the more aggressive strategy leads to long-term reductions in costs for medication, hospital stays and surgeries.

"Our goal is to put the patient back in the center of health-care management," Sdringola said. "An educated patient can be motivated, and committed to achieving these goals of longer and healthier lives that would benefit American society as a whole by reducing the mortality and morbidity associated with this largely preventable disease."

For more information about the Century Health Study, visit www.centuryhealthstudy.org or call 713-500-5200.