Unless you are paying entirely out-of-pocket for a heart surgery, you will not usually get final say over which surgeon you get.

The surgeon, however, will have final say over what they actually do when they open you up.

And their preferences, it seems, can make all the difference:

MAG vs SAG

When doing coronary artery bypass grafting, (CABG), surgeons may prefer to do multi-arterial grafting (MAG) or single-arterial grafting (SAG).

Recently, there was a study analysing more than a million Americans who underwent CABG on Medicare over an 18-year period, looking at outcomes for MAG vs SAG.

The superficial news: those who received MAG had much better long-term survival chances than those who received SAG.

However: this may be less to do with the relative merits of the procedures themselves, and more to do with the preferences of the surgeon.

The “eyeball test”

If surgeons look at a patient and think they will not have many years to live after surgery, they may opt for the SAG, as the long-term benefits of the MAG will only manifest in the long-term.

This may seem a little self-defeating (indeed, maybe you won’t live to see the long-term if you don’t get the surgery type with the longer-term survival chances), there can be other factors involved, that may make surgeons more interested in your short-term survival chances.

Or you might just not have enough donor artery tissue available to pick and choose; after all, a person having a coronary artery bypass quite possibly won’t have great arteries in their arm or leg, either.

Or a person could be missing limbs (a common complication, given the comorbidities of both peripheral artery disease, and diabetes).

See also: How To Stay A Step Ahead Of Peripheral Artery Disease

Why it might be ok that things are like this

When factoring in surgeon preference for MAG or SAG as an instrumental variable, no significant difference in long-term survival was observed. This may explain inconsistencies with randomized controlled trials like the Arterial Revascularization Trial (ART), which also found no survival benefit of MAG over SAG.

Also, MAG recipients were generally younger, healthier, and from more resourceful areas, which likely had a further impact on MAG-giving decisions, and/but at the same time, may also have increased survival chances for reasons other than that they got MAG rather than SAG.

Here’s a pop-science article that goes into more detail about this:

Surgeon preferences may explain differences in CABG survival rates

How to look out for yourself, and advocate for yourself

…or your loved one, of course. Now, having a coronary artery bypass surgery of any kind is not a fun activity; it will be dangerous, it’ll be stressful before and after, and the recovery will often not be an easy time either. However, it is possible to learn more about what is going on / what will happen, ask the right questions, and get the best options for you (which may not always be the same as the best options for someone else).

We wrote about that in more detail here:

Nobody Likes Surgery, But Here’s How To Make It Much Less Bad

Take care!

Olives boast a special molecule that’s neuroprotective in several ways, as well as being structurally identical to dopamine metabolite:

Introducing hydroxytyrosol

Things that start with “hydroxy-” and/or end in “-ol” are often not astonishingly healthy, but this one is!

It’s approved as safe by the FDA, EFSA, and the AESAN at typical dietary levels of up to about 51 mg per day.

Hydroxytyrosol (HXT) is a phenolic compound (polyphenol, specifically a simple phenolic alcohol belonging to the family of secoiridoid-derived polyphenols found in olives and olive oil. It’s one of the key antioxidant compounds responsible for many of the health benefits associated with extra virgin olive oil.

As for its established benefits: it’s antioxidant, anti-inflammatory, anti-cancer, anti-diabetic, antimicrobial, cardio-protective, neuroprotective, cognition-enhancing, and immune-modulatory.

Most recently, a research team from Spain (Dr. Lorena Martínez-Zamora et al.), investigated specifically its neurovascular and neuroimmune effects, in other words, how it relates to the health of the brain’s blood vessels, and the brain’s clean-up crew.

What they found:

❝HXT protects endothelial and neural cells by lowering oxidative stress, maintaining nitric oxide availability, stabilizing the blood-brain barrier, and improving neural connectivity. A key pathway is Keap1-Nrf2-ARE activation, which boosts mitochondrial antioxidant defences and limits oxidative DNA and protein damage. HXT also dampens brain inflammation by reducing microglial cytokine release and suppressing NF-κB/MAPK and NLRP3 inflammasome signalling—mechanisms implicated in Parkinson’s disease.❞

Translating from sciencese:

The cited human trials link HXT or HXT-rich olive oils to better vascular function, reduced inflammation, and improved cerebral blood flow. That’s correlation, though. In terms of causality, what’s been established is that daily intakes around 7–15 mg improve endothelial cell health, while single doses of 30–60 mg improve protection against free radicals.

Furthermore, HXT-rich olive extracts have been shown to improve memory, psychomotor speed, and attention–memory coupling in older adults, and supported mitochondrial health.

And where it mentioned Parkinson’s disease, that bit is because HXT is structurally identical to the dopamine metabolite DOPET, and thus helps regulate healthy dopamine levels.

You can read about this in full, here: Novel Ingredients: Hydroxytyrosol as a Neuroprotective Agent; What Is New on the Horizon?

Protection against stroke?

This is the part that’s not yet proven, but looks very promising.

Hydroxytyrosol might help protect against stroke, due to how it protects the brain’s blood vessels, most notably:

• Boosting the body’s natural antioxidant defences through the aforementioned Nrf2 pathway, helping arteries stay flexible and resilient under stress
• Keeping blood vessels healthy by preserving nitric oxide, which is vital for supporting healthy blood flow, and prevents the buildup of damaging plaque
• Dialing down overactive immune responses in blood vessel walls, reducing the slow-burning inflammation that often leads to stroke

In fewer words: hydroxytyrosol acts like a molecular shield—keeping the brain’s circulation strong, stable, and better protected against both blockages and bleeds.

For how all this ties together, see also the closely related: What’s Your Vascular Dementia Risk? ← includes actual numbers and a risk calculator tool and things like that

Want to learn more?

Check out:

• Black Olives vs Green Olives – Which is Healthier?
• All About Olive Oil (And: Is “Extra Virgin” Worth It?)
• Olive oil is healthy. Turns out olive leaf extract may be good for us too

Enjoy!