Beyond the Mechanics of Cardiovascular Disease

review by Nancy Faass, MSW, MPH

, by Thomas Cowan, MD

Chelsea Green; White River Junction, Vermont

$24.95; 176 pp.

In this thought-provoking book, Dr. Thomas Cowan poses a series of questions about the nature of the heart, heart disease, and current paradigms in cardiology. These inquiries are placed in the context of his personal development as an integrative physician (initially in anthroposophy), his engagement with his own heart disease, and his development as a physician who has successfully treated heart disease for more than a decade. Dr. Cowan’s initial thinking was inspired by concepts such as Rudolf Steiner’s claim that the heart is not a pump. If not, then what is the heart? That has led to questions focused on semantics, with implications for clinical management. Why does “heart disease” refer to events or conditions of the coronary arteries – and conversely, why are events that occur in the myocardium (such as angina, unstable angina, and myocardial infarction) typically referred to as “coronary artery disease”?

In terms of intervention, a report cited from the Mayo Clinic indicates that bypass surgery, considered the gold standard, does not prevent future heart attacks. Rather, these surgeries tend to benefit primarily high-risk patients. (In most cases, the body has already compensated for the blockage by developing an extensive network of small collateral blood vessels, providing blood supply that is not revealed in angiogram reporting.) This line of inquiry raises further questions. Do angiograms reflect arterial spasms, rather than actual blockage? Further, if blocked arteries cause ischemia, cutting off the supply of oxygen to the tissues, why does documented assessment of oxygen in the myocardial cells during a heart attack show no oxygen deficit? Cowan also examines the role of statins, beta-blockers, nitrates, and other medications used in cardiology.

The reality of thrombosis in cardiovascular disease is clearly acknowledged, but Cowan points out that in no pathological study has thrombosis been found in more than 50% of deaths, which raises the question, why did the other 50% have a heart attack? Given risk factors that include being male, having diabetes (hyperinsulinemia and sedentary lifestyle), smoking cigarettes, and experiencing chronic stress, Cowan examines the role of autonomic tone and function in cardiovascular health.

“Using heart-rate variability monitoring, which offers a real-time, accurate depiction of the two branches of the autonomic nervous system, four studies have shown that patients with ischemic heart disease have, on average, a reduction of parasympathetic activity of more than a third… Furthermore, in about 80 percent of ischemia cases, there is decreased tonic activity of the parasympathetic.”

Individuals with normal sympathetic activity who experience an abrupt increase in sympathetic activity (due to shoveling snow or the shock of a stock market crash) do not suffer heart infarction. What is dangerous to human health is chronic deterioration of autonomic tone, a clear indication for lifestyle change. Dietary recommendations provided are in concert with those suggested by most integrative physicians. Additionally, Cowan uses less well-known remedies and therapies that he applies effectively in the treatment of cardiovascular disease. Ultimately, questions of the heart also incorporate a much broader context, a humanism that moves beyond mechanics.