The following article was printed yesterday regarding President Bill Clinton’s recidivistic event.  We feel it necessary to comment on Dr. Yancy’s statements below.

Clinton undergoes angioplasty

Doctors say former president, who underwent a quadruple bypass in September 2004, had a clogged artery.


Two stents resembling tiny mesh scaffolds were placed inside the artery as part of a procedure that is common for people with severe heart disease.NEW YORK — Former President Bill Clinton, who had quadruple bypass surgery more than five years ago, was hospitalized Thursday to have a clogged heart artery opened after he was suffering chest pains.

The 63-year-old Clinton was “in good spirits and will continue to focus on the work of his foundation and Haiti’s relief and long-term recovery efforts,” said an adviser, Douglas Band.

Secretary of State Hillary Rodham Clinton traveled to New York to be with her husband, who had the procedure at the same hospital where his bypass surgery was done in September 2004. At that time, four of his arteries were blocked, some almost completely.

In an angioplasty, doctors thread a tube through a blood vessel in the groin to a blocked artery and inflate a balloon to flatten the clog. Stents often are used to prop the artery open.

“It’s not unexpected” for Clinton to need another procedure years after his bypass, said Dr. Clyde Yancy, cardiologist at Baylor University and president of the American Heart Association.

The sections of blood vessels used to create detours around the original blockages tend to develop clogs five to 10 years after a bypass, Yancy said.

“This kind of disease is progressive. It’s not a one-time event, so it really points out the need for constant surveillance,” he added.

BaleDoneen Method:
Patients with known heart disease, who are treated by the BaleDoneen Method of heart attack prevention, continue to live well without the need for repeat procedures (stents or by-pass surgery) such as those used to treat former President Bill Clinton earlier this week.  The BaleDoneen Method stops the progression of atherosclerosis, the disease from which Clinton suffers, by determining the underlying cause of each patient’s disease and then treating it aggressively, case by case, through the employment of genetics, biomarkers and B-mode cIMT testing.  The team of Bale and Doneen believe heart attacks and ischemic strokes can be prevented using their method which goes beyond the ‘standard of care’ commonly practiced in the United States.  Their cost effective method is garnering attention across the country.

Bale and Doneen’s review of President Clinton’s recent situation:
We believe this type of recidivistic work can be prevented.  With the standard of care, this type of repeat intervention IS expected and necessary.  When someone has the need for a cardiovascular procedure, such as the bypass President Clinton had in 2004, it is imperative to step back and find out WHY the individual had heart disease in the first place.  It is essential to uncover the root cause of the disease.  There are many root causes of disease such as insulin resistance, lipo (a), vitamin D and myeloperoxidase.  These issues are frequently not assessed by the standard of care.  If the root cause is not uncovered and treated appropriately, the disease will smolder along and eventually result in another invasive procedure.  It would be interesting to know if President Clinton’s health care team assessed for the above root causes.

Several commentators over the last two days have mentioned the genetic force of this disease.  We couldn’t agree more with this statement.  Fortunately we have numerous genetic tests available to guide optimal medical therapy in an individual patient.  Again, the standard of care does not call for the assessment of these genetic tests.  If these factors are not assessed, the patient will not receive appropriate therapy to halt his or her atherosclerotic disease process.  Genetic tests that we have been using clinically for several years include: ApoE genotype which guides individualized dietary advice; the KIF6 gene which has therapeutic impact regarding statin therapy; LPA genetic variant which has clinical impact regarding the value of aspirin treatment.   These genetic influences are also root causes of disease and their elucidation moves us into the era of very personalized medicine.  Unfortunately, the standard of care does not call for their assessment.  Again, we are curious if these genetic tests were performed in President Clinton’s situation.

We also agree with Dr. Yancy that surveillance IS necessary.  The type of monitoring is extremely important and it is imperative that it goes beyond simply the imaging of the lumen diameter.   Arguably the most important factor to monitor regularly is the degree of arterial inflammation.   We have excellent tests available to accomplish this task.  These include: hsCRP, microalbumin/creatinine ratio, Lp-PLA2 and myeloperoxidase.  It is imperative that all of these are assessed to give adequate insight into the stability of the disease.  It would be interesting to know if all of these markers were being assessed in President Clinton.  It is also important to monitor the actual atherosclerotic disease response to the therapy.  In many cases, this can be easily and effectively accomplished with the carotid intima media thickness test (cIMT).  The cIMT can identify plaque in the arterial wall.   In patients, like President Clinton, if the cIMT shows soft plaque, it implies that the disease is not responding adequately to the treatment.  We are curious if President Clinton’s health team monitored him on a regular basis with the above biomarkers and carotid IMT testing.

We believe that our method of prevention (The BaleDoneen Method) can stop the progression of atherosclerosis.  We have been practicing this method clinically for over a decade.  We have had many patients come to us after having coronary bypass grafting and with our method of medical management, none of them have required further interventions nor have any of them perished from heart disease.

We invite President Clinton and others in his situation to step beyond the standard of care and move over to the BaleDoneen Method of heart attack and stroke prevention.  Unlike Dr. Yancy’s statement regarding President Clinton’s need for more invasive work being the norm, we believe the BaleDoneen Method allows people with known heart disease to live well, without repeat procedures.