Question: My husband has four blocked arteries but beat the "widow maker" and has developed collateral circulation. His cardiologist thinks that he is a good candidate for medical therapy, diet, exercise, and rehab. His most recent blood test found an LDL of 100, HDL of 47 and triglycerides of 128.
Everyone thinks he is crazy not to have the surgery and that he is in denial. I don't know what to think, or if I should insist that he has the surgery. What do you think?

Dr. Hibberd's Answer:

You have a cardiologist who is keeping up with current recommendations. In multi-vessel heart disease where collateral flow has been established and is sufficient to supply the oxygen and nutrient demands of the heart muscle under stress, the long-term survival of effective medical management versus bypass appears to be at least equivalent or perhaps better.

The "widow maker" refers to disease of the left anterior descending artery (LAD) — the main coronary blood vessel that supplies the heart. Fortunately, it has developed collateral flow. The whole idea of bypass grafting is to "bypass" or bridge the diseased segment to allow unimpeded delivery of oxygen and nutrients to our heart muscle. He has already accomplished that by collateral flow. Also, stenting open a long-term blockage rarely stays open.

Continue with the preventive measures your cardiologist has advised. Aim to reduce the LDL to less than 80, and boost that HDL to over 60 if possible, so plaque regression may occur. Control other risk factors that may apply, especially stopping smoking. If your blood pressure is elevated, controlling this close to 120/80 will also help prevent further vascular disease.

Avoid listening to friends for medical advice. That is why you have a cardiologist, who clearly knows what is best for both of you.