â€œIâ€™ve been one of the people pioneering the concept of preventive cardiology," Budoff says, "We need to find the process at a very early stage when itâ€™s most treatable. And get the individual to never have that heart attack, never need that stent, and never need that bypass surgery.â€
An ounce of prevention is worth a pound of cure.
The age-old proverb that avowing it’s easier to stop something from happening in the first place than to repair the damage after it has happened. It’s also the philosophy of Matthew Budoff, MD, FACC, professor of medicine at the David Geffen School of Medicine, and director of cardiac CT at the Division of Cardiology at the Harbor-UCLA Medical Center.
Budoff has dedicated his professional life to ending heart disease, a goal that has grown out of his frustration with the field’s approach to cardiology, where he says the approach has been to find the problem late and then treat it aggressively. In other words, wait until the patient needs bypass surgery, or a stent, and then take aggressive action.
“That’s obviously too little too late,” Budoff says. “I’ve been one of the people pioneering the concept of preventive cardiology. We need to find the process at a very early stage when it’s most treatable. And get the individual to never have that heart attack, never need that stent, and never need that bypass surgery.”
Budoff traces his initial interest in medicine to an unusual experience in high school. While other students were dissecting frogs or similar specimens, Budoff’s teacher brought a human cadaver into the classroom and the students took turns picking the cadaver apart. It was 11th grade, and it piqued his interest in medicine.
“I think [the teacher] was the only one in the country at the time to be able to arrange that,” Budoff recalls.
His affection for cardiology came out of the opportunity it provided to do something good for people.
“I would say for 95 percent of patients we can improve them, maybe improve them to the point of going back to a full life,” Budoff says. “So, they come in with an acute heart attack, or really bad heart failure, and we can fix it. And not all fields have that capacity to really fix the underlying problem like we can in cardiology.”
Getting to know
It was 10 years ago when a colleague introduced Budoff to Wakunaga of America, a company that engages in the “research development, manufacture, and marketing of medicinal herbs and supplements.” He wasn’t a “big believer” in garlic therapy at the time, but he decided to conduct a randomized trial.
“It worked,” Budoff recalls. “Then we did a larger trial. And we did a third trial, and a fourth trial. And every single trial demonstrated a benefit. I’ve become a believer, and I use it now in my own clinical practice as part of my preventive strategy to put people on garlic therapy.”
But not just any garlic. You can’t simply overpower food preparation by adding extra doses of garlic. The process of cooking garlic, Budoff explains, whether it’s diced, chopped or sautéed, may disrupt the active components.
“I prefer the aged garlic, the one that we studied, not only because we did all the trials with it, but also because it’s very well regulated as far as how much active components are in each pill,” Budoff says.
It’s also odorless, he points out, so patients don’t smell bad when they’re taking these garlic supplements—an important consideration for their spouses and significant others.
A simple test
Budoff has also spoken in positive terms of the 2015 documentary The Widowmaker, which focuses on a “conspiracy of silence” around heart care. The film includes conversation about the heart scan, or coronary calcium scan, which Budoff describes as “a very non-invasive test that literally takes five minutes” and works like a mammogram of the heart.
“It tells us unequivocally you have the process,” Budoff says. “It’s going on in your body, it’s building up. Or, your arteries are clear, don’t worry about coronary artery disease for the next five years. And that’s really where we are today. We have that ability to see into the heart and know who to treat.”
Budoff says he doesn’t know of a preventive cardiologist who doesn’t use a heart scan or equivalent test in their practice today. That’s because it helps eliminate the biggest problem in cardiology today: knowing who has the disease.
“We can make estimates from large studies, like saying, you have a 50 percent likelihood of developing heart disease,” he explains. “But wouldn’t it be better to look into the heart and say, ‘You have or you don’t have the disease?’ So I think it’s not only critical, but it has to be part of your strategy if you want to be a good preventive physician.”
Learn to disconnect
Budoff advises people to “disconnect from the electronic world once in a while,” and he practices what he preaches.
Once a year Budoff and his wife join another couple on a catamaran and sail for about a week, no wi-fi. He says it’s the only way he can fully relax.
“When I’m relaxing by a pool and my phone is next to me, then I’m still getting e-mails and texts and phone calls,” he says. “It’s relaxing, but it’s not completely disconnected. When I’m on a boat in the middle of nowhere, I can’t connect, and I find it very healthy.”
One of the keys, he says, is to plan ahead. He makes certain that he has no imminent deadlines for the day he leaves on vacation or the day he returns. He admits to bringing his laptop to quickly download email if they get into port to ensure there’s nothing urgent from one of his patients. But other than that, he tries to block out everything out.
“You know, if you’re without your phone all of a sudden, you’d rather be without clothes than without your phone in some situations,” Budoff says. “But I think people have to fully disconnect to really be able to recharge.”