CNN Documentary Promises Screening and Vegan Diet Can Eliminate Heart Attacks 10

CNN’s Sanjay Gupta spent an hour on Saturday night promising that heart attacks can be prevented– but never mentioned statins. A good part of the program focuses on former president Bill Clinton and his adoption of a vegan diet– but fails to mention that Clinton stopped taking simvastatin in the years before he underwent bypass surgery.

In The Last Heart Attack (click here for a transcript) Gupta tells viewers that there are over one million heart attacks each year in the US and that he has the answer:

I’ve got a secret to share — with what we know right now we could see the last heart attack in America. I’ve been investigating this for over a year. I’ve got lessons to share, things you need to know, things your doctor may not tell you.

Gupta’s “secret” is basically intense screening with calcium scans, carotid ultrasound, and blood tests for LDL particle size. People at high risk should then follow a radical low-fat diet, along the lines advocated by Dean Ornish, Arthur Agatston, and Caldwell Esselstyn.

Gupta never mentions the lack of a solid evidence base for this program, and never mentions the cost or other risks of screening programs. Calcium scans get a rave review, but there’s no mention of radiation exposure.


Despite his entire year of research on the topic, Gupta somehow missed the wide divergence of opinion about the utility of these screening tests and widespread concerns about the practical barriers to implementing a radical low-fat diet. He never mentions that by most current guidelines a significant proportion of the population should not receive these screening tests.

Gupta almost never asks hard questions of his sources. Agatston makes the following statement but is never asked to supply evidence or confirmation.

One of the best kept secrets in the country in medicine is that doctors who are practicing aggressive prevention are really seeing heart attacks and strokes disappear from their practices. It’s doable.

And then there’s the fear-mongering, which once again goes unchallenged:

Unless you do the imaging and advanced testing, you are really playing Russian roulette with your life. (Agatston)

Hat-tip and more to Marilyn Mann

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10 comments

  1. practical barriers to implementing a radical low-fat diet.

    Let alone a vegan diet. Go into any standard restaurant in the country and you will be hard-pressed to find anything remotely balanced for the vegan. oh yeah, you can order a salad or a baked potato or oatmeal, but a vegetarian chili? Something with tofu? Nah gonna happen. I know. The daughter is vegan, and I am lacto-vegetarian (no eggs), and it’s a real pain in the ass. And I’m committed!

  2. Oh, and I really hate that “your doctor may not tell you” comment which only serves to stoke the conspiratorial fires that doctors don’t really want their patients to have a healthy lifestyle. Gupta FAIL.

  3. I second the hat tip to Marilyn Mann.

    Yes, in the absence of NNTs for any of these diets, it is all essentially showbiz. I’d say the same for statins for primary prevention, btw. The great majority of pts have no idea of NNT, and I’m not sure how many prescribers do either. Presumably, that would be part of making a rational choice.

    Meanwhile, low-fat does not equal vegan; Ornish is one among many programs–not only a diet and, to its credit, probably better studied and with more more honestly studied (with modest outcomes, at best); Ca scans have yet to prove the claimed benefit, as noted.

    Medical “journalism” seems to be getting increasingly pitiful. It’s heart-breaking.

  4. As someone who teaches writing among other things [typos notwithstanding], I also have to comment on: “…you are really playing Russian roulette with your life.”

    Is there a less portentous form of “Russian roulette”?

  5. A coronary calcium score can be done at very low millisieverts. It might help stratify risk and suggest who should take statins. The vegan diet isn’t going to work for most people.

  6. Even though I am a staunch supporter of lifestyle changes to reduce our crushing burden of cardiovascular risk, one must realize these radical diets are difficult, if not impossible to sustain. For most people, quality of life is restricted, because food must be prepared home for best results.
    While CAC scoring is extremely valuable in assessment, the mere ordering of the exam in practices does not automatically “eliminate” CV events, simply because even using best aggressive evidence-based current therapy there is significant residual risk (about 70% with statins) which has not yet been eliminated. The pharmacological failure rate precludes some of the successes claimed. Finally, while CAC may be done at acceptable radiation exposure, the fact is that this state-of-the-art equipment is not universally available, and the heterogeneity of radiation for all CACs currently done far exceeds the possible minimum. The cumulative radiation in patients for all CT scans and related procedures is now a public health problem.
    Richard Kones MD

  7. Where is the evidence that cumulative radiation from CT scans and related procedures is now a public health problem? Some evidence points to decreased cancer rates among people receiving CT scans. None, that I am aware of, points in the other direction.

  8. Concern about public health aspects of actual radiation dose, uncritical use of CT scans, number of CT scans performed on a routine basis and in EDs, and perception of the risks with respect to benefits has discussed in many forums, among which are pediatric, emergency, radiologic, and cardiovascular sources.

    Some are
    Brenner et al. Radiology 2011;261:193-198; Picano and Matucci-Cerinic Rheumatology (Oxford) 2011;50:1537-1539; Dauer et al. Am. J. Roentgenol. 2011;196:756-761; Mettler et al. Am. J. Roentgenol. 2011;196:616-618; Coakley et al. Am. J. Roentgenol. 2011;196:619-625; Davies et al. BMJ 2011;342:d947-d947; Larson et al. Radiology 2011;258:164-173; Redberg Arch Intern Med 2010;170:584-584. Redberg Arch Intern Med 2009;169:2049-2050; Amy Berrington de González, et al Arch Intern Med. 2009;169(22):2071-2077. Perspectives (2 authors) N Eng J Med 7/1/2010; Coursey Applied Radiology. 2008;37(3):22-29; AMA News 12/11/2011 and 1/7/2008.

    Searching in Medscape to include all sources there will bring up a review by RC Semelka: Patients, Caregivers, and the Danger of Imaging Studies: The Four Horsemen of the Radiology Apocalypse and What Must Be Done with references. I also believe there are other discussions by him as well.

    The topic has been the subject of lay articles in USA Today, Wall Street Journal, and the N Y Times, among dozens of others in smaller newspapers.

    It must be added that collectively, none of the above deny the overwhelming benefit of CT imaging. Imaging has been one of the advances in medicine that has brought us “out of the dark ages.”
    Richard Kones MD

  9. As an addendum to the above, the current view of exposure to unnecessary radiation during CV scanning is summarized in Steve Nissen’s editorial in JACC, Jan 24, 2012, during his discussion of the added information afforded by doing coronary CTA on patients already known to be at high risk based upon calcium artery scores. He notes the additional radiation is substantial, equal or more than 12 mSv on average (600 chest x-rays), but falling in centers with the latest technology. The radiation burden from CTA is 3 to 7 times that of diagnostic catheterizations. Although debated, such exposures will “predictably increase” cases of malignancies. Further, since serial procedures are likely in such settings, a higher standard for anticipated benefits must be held for procedures that involve radiation.
    Richard Kones MD

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