When the cardiologist sent Carol Georges home to live out her few remaining months, her heart was pumping out 15 percent of its volume with each beat. Doctors start panicking when it drops to 20. "They didn't give me much hope at all," she said. A heart transplant seemed to be the only option.

 "Well, there are often other ways," Dr. Narinder K. Saini told her. Georges, who lives in Maysville, Ky., had heard about Saini from a sister-in-law in Springfield, where Saini practices preventive cardiology. Four months later, her heart was pumping more than half its volume.

 Bypass surgery wouldn't have helped any better, her local doctor told her, and she probably couldn't have survived it.

 Conventional medical approaches to heart disease have their limits, Georges has learned in the 3 1/2 years since her grim prognosis at age 59. They save many lives, but Saini cites considerable evidence supporting less expensive and more effective regimens that add stress management, improved nutrition, aerobic exercise, vitamin supplements and new diagnostic tests to the standard arsenal of drugs, angioplasty and surgery. Even so, few patients are offered these broader therapies.

 "Thirty to 40 percent of the vessels opened up in angioplasty clog up again within six months," Saini said. "That's because people aren't eliminating the cause of the problem." The widely used protocols are even less successful at identifying the problem early enough to be readily treatable. "Classic risk factors," he said, "explain only 50 percent of heart disease."

Saini, too, was trained to view patients' complaints in terms of whatever drugs and surgery would relieve them, until he found himself on the wrong end of a stethoscope. Told he could live only a few weeks without bypass surgery, Saini instead spent the next six months learning and using the techniques he now prescribes for his patients. The program reversed his heart damage, as he explained in his book, Create a Healthy Heart: I Did It, Why Don't You? "We work with the patient's regular physicians," he said, including the psychologist, nutritionist and other staffers at his Springfield Health and Fitness Center Heart Disease Prevention Clinic. "We try to show people the power they have in healing themselves."

 Saini also consults patients one day a week at the Ohio Academy of Holistic Health's new holistic heart care center in Xenia. That's where he'll lead a daylong $125 seminar Saturday called Beyond Heart Disease: Prevention and Reversal.

 He'll no doubt share a favorite cartoon, in which a man is frantically mopping a flooding floor. "Have you tried turning off the faucet?" he's asked.

 "The first thing I tell people is that bypass surgery and angioplasty are mopping up the floor," Saini said. "But I cannot expect a patient to turn off the faucet until I tell him where his faucet is."

 Teaching people how to turn off the faucet

 To do that, he orders a psychological profile, dietary analysis and lipoprotein screen. The blood screen measures the size and number of the proteins that carry cholesterol, along with the basic cholesterol counts and other components associated with heart disease.

 From those results, he pinpoints the combination of stress, hostility, blood fats and sugars, smoking, obesity, inactivity and social isolation that's damaging the person's heart.

 The psychological profile is most important, Saini said. "The program is 60-70 percent stress management. Even now, people don't realize how much stress can kill you."

 There's no escaping stress, but heart patients can often take better control of the body chemicals that respond to it. Some of them use up their adrenaline, the primary stress-response hormone, faster than they can produce it.

 "Cortisol is the adrenal gland's backup," Saini said. "But if you release cortisol over and over, it injures your coronary arteries." Excessive cortisol scrapes up the blood vessel's inner wall, which then traps debris that can clog the artery, just like too much bad cholesterol or not enough good cholesterol. "So if you treat the cholesterol without doing something about the stress, you get nowhere."

 Too much cortisol also depletes the body of serotonin, a pleasure chemical, which ties diet and exercise in with stress. Eating sugar or fat is one way to generate serotonin, Saini said. "Aerobic exercise has the same effect."< As stress and heart disease became clearly connected, Type A personalities, characterized by aggressiveness, ambition and impatience, were considered the greatest risk. But that covers more than half of American adults, Saini said. "There had to be more to it."

 Clinical depression and anxiety turned out to be more specific liabilities. So did pessimism. But hostility was the behavior most strongly correlated with heart disease, in research from Ohio State University, the University of North Carolina and others.

Heart patient's profile

 When Saini evaluated his 31 patients whose heart disease had flared up more than once in 1994-99, he found their average cholesterol levels were fine. But 29 of them had a combination of hostility, isolation, stress and Type A personality that he called a "Toxic-H stress profile."

 Stress reduction sounded like a great idea to Georges, but her reaction was more or less, "what planet do you live on?" She was driving 50 miles each way to teach at Morehead State University and countless more to supervise student teachers in 23 counties. Weekends were the only time she saw her home in daylight.

 "Every time you get into a stressful situation," Saini told Georges, "stop and think, is this worth dying over? If it's not, get out of that situation and walk away. If it's worth dying over, OK, then go ahead."

 Her Type A personality wasn't necessarily bad, Saini said. He had one, too. But she had to learn to control it better. "I want things done now, and I want them done right, and the world doesn't operate that way," she said.

 That same Type A personality drove her to keep saying, " 'This is not going to beat me,' " she recalled. "I believed you've got to work like everything depends on you and pray like everything depends on God."

The day she started walking for exercise, her goal was to reach the first light pole on the path around a small lake. It was no more than 200 feet, she said, but "I was huffing and puffing by the time I got there." Every day, she tried to reach one more light pole. About two months later, she was walking 3 1/2 miles twice a day.

 "I hadn't walked seven miles collectively in 50 years," she said. As it turned out, Saini said she was pushing herself too hard again.

 "After you exceed your aerobic heart rate, it becomes harmful," he told her. The heart rate should stay between 60 percent and 80 percent of maximum, which is 220 beats a minute minus a person's age. At that level, exercise burns fat and sugar while increasing good cholesterol levels and serotonin. Above that rate, a person burns muscle, including heart muscle.

Drugs vs. lifestyle

 The diet wasn't exotic. Cut way down on fats and sugars, all simple carbohydrates. Eat a lot of whole grains, beans, fresh fruits and vegetables, fish and ground flax seed for essential fatty acids - the elements of a Mediterranean diet. The June 1999 issue of Circulation reported a 70 percent reduction of heart flare-ups among former heart attack patients who followed a Mediterranean diet in a 46-month study.

 "We get only a 30 percent reduction with statins," Saini said of the most effective cholesterol-lowering drugs. "We can treat 60-70 percent of cholesterol problems with niacin, which is vitamin B3. It's amazing what we can do the holistic way that isn't being used."

 But cholesterol drugs generated more than $10 billion in U.S. sales last year, up 22 percent from 2000. Lipitor was the top-selling prescription drug brand, Zocor fourth. The drug industry spends large sums touting the importance of these products, Saini said. There is no niacin industry.

 More studies are verifying the effectiveness of broader, holistic heart treatment every year, but Saini said research is lacking into how much money it saves. Without that, he expects health plans to keep rejecting his requests to cover his programs to reverse and prevent heart disease. Even then, he said, they'll have little incentive to cover preventive care as long as employers change insurance companies every few years.

 "The way most people find out they have heart disease is they have a heart attack," Saini said. "If you use a prevention program, you're spending $4,000 instead of $52,000 or more for bypass surgery."

 Georges credits Saini with saving her life.

 But her battle goes on. She still takes Lipitor and medicine for blood pressure. She still fits daily walks and a slow-food diet into an active life with a part-time job.

 "I still try not to get stressed out," she said. "It's not easy. The diet is not easy. The exercise is not easy. I hate it. But I have to do it. I ask myself, do I want the alternative? I don't."