“I cannot say that modern medicine and doctors save all patients. I firmly believe that God is who heals the diseases and we, doctors, only assist in the middle. Though I save a life of a patient with a heart attack in an emergency situation, I do not think that I contributed to it. Any doctor would have stepped forward to treat the patient, and they confront both the possibility of a good turn and the possibility of a bad turn. The doctor’s hand may have opened the blocked blood vessel, but it is God’s helping hand that affects the fate of life. That is why I do not flatter nor blame myself. I only try and do all I can.”

But that would be about older adults though?

Angina is a disease in which the coronary arteries become so narrow that blood supply to the heart muscle is not good enough. It gives you pain, but not as much pain to damage your muscles. Rather, heart muscles often open up a bypass to find their way back. That means that the disease becomes a chronic ischemic heart disease. Myocardial infarction, on the other hand, can be described as a rash in blood vessels. It suddenly grows angry, swells up and bursts. Not long after, blood clots accumulate, and the heart gets damaged without a chance to prepare. That is why myocardial infarction is more frequent in relatively younger adults in their early to mid-40s than older adults.

So it is your specializing field to open the blocked blood vessels then.

We usually refer to it as an interventional procedure. You place a stent in a clogged blood vessel to secure a space for the blood to pass smoothly. It applies not only to cardiovascular but also to the blood vessels through the legs and the aorta. Furthermore, congenital heart disease, like an atrial septal defect, can be treated in the same way. In the past, even if only one coronary artery is narrow, a major operation was performed to open the chest, but now, I would say that stenting has become the standard treatment. I think that the scope and the case will spread more and more in the future because the same effect we can obtain with a relatively small burden on the patients.

So, would that mean that you can be relieved once you receive the treatment?

Afraid not. Do not assume that everything is okay just because you just received an intervention. We can only do Interventional treatments with putting a metal device, such as an external stent or prosthetic valve, into the body. From the body, the foreign substance has come in. Until that takes place, to be precise, until vascular endothelial cells cover the surface, you need to give it some time. In the meantime, you need to take all kinds of medicine to prevent blood clotting. Sincerity in taking medications is no less important the procedure.

Foreign substances? So it isn’t always the best to put in?

In the past, the idea that it was better to widen the blood vessels once they became narrow was popular. Nowadays, it is common to put a stent only in a place where it is likely to cause a problem in function or to call a serious event in the future. It is not a guess, but a professional decision based on the exact test results. The lately popular, FFR (Fractional Flow Reserve) is one of them. It measures the blood pressure difference between the clogged blood vessels and determines the procedure if the deviation exceeds a certain range.

Intervention is known to be relatively easy, but it is also frightening. Is there a way to avoid it in advance?

Regarding coronary artery disease, it is helpful to manage risk factors well. As men are more susceptible to disease than women, or as genetic predisposition is evident, in some cases we cannot solve it by effort. However, there are other factors that, even with a little touch, can reduce the occurrence rate. These include smoking, blood pressure, and blood sugar. You need to be particularly careful if you or someone in your family has a disease. You have to move a lot as habits and manage hypertension and hyperlipidemia thoroughly. Lifestyle is important both to prevent heart disease in advance and to reduce the likelihood of recurrence.

We too have heard so much about blood pressure, but we also need to care as much about hyperlipidemia?

Drugs have been developed and started clinical treatment in the late '80s, so it is not a new thing. It is now well accepted that bad cholesterol, like blood pressure, has an important effect on cardiovascular disease. They already have revealed about how the cholesterol levels are different even though the dietary pattern is the same, and also how the frequency of atherosclerosis, often called arteriosclerosis, varies. Now that you have high cholesterol levels, just like blood pressure, it is common sense to use drugs to lower them to the normal range. Even if you are stable, you should continue to use medicines according to your doctor's prescription.

Interventional treatments are developed enough to put no more room.

Interventions related to coronary artery disease have already reached a significant level. From now on, quality improvement will continue. The stent, for example, is now not a metal, but a product made from a material that melts away gradually. Also, we expect that drug therapy will be developing as well. I hope that the field of interventions to treat structural heart diseases, such as heart failure or congenital heart disease will also have a dramatic development in the future.