FIRST A LITTLE NEW YEAR'S FUN & SARCASM
I, like many people with early heart disease, suffer from high lipoprotein(a) - about 140 nmol/l. Naturally, I spend a great deal of time looking for novel methods to reduce it. Unfortunately, the front line remedies like niacin and testosterone (estrogen if you are a woman) have only been marginally effective in my case. In perhaps the most twisted ignominy of Lp(a), many of the things that will reduce it will harm or kill you some other way. For Example, neomycin is an effective Lp(a) treatment but it has nasty kidney and nervous system side effects. Additionally, a relatively new study (http://circ.ahajournals.org/cgi/reprint/85/6/2034.pdf) has determined that tissue plasminogen activator (tPA) also drastically reduces Lp(a). Great, instead I'll just die from internal hemoraghing.
So what does this have to do with New Year's Eve? Well, it turns out that several other studies have found that high alcohol intake may reduce Lp(a) (for example http://invention.swmed.edu/cgi-bin/etblast/abstract_local?pmid=1827857&user=hobbs&application=2) and the same is true of severe burns and sepsis (http://invention.swmed.edu/cgi-bin/etblast/abstract_local?pmid=10764684&user=hobbs&application=2). So all I have to do to reduce my Lp(a) is get drunk on New Year's Eve and set myself on fire in a wild celebration. Lucky me!
NOW ON TO SERIOUS STUFF
All the studies I cited above are in what is the most complete compendium of research studies on Lp(a) I have ever come across. You can peruse this link http://invention.swmed.edu/frisc/faculty/hobbs/profile.shtml for hours on end to get the skinny on what is going on regarding Lp(a), both the weird and the wonderful.
Happy New Year!
Sunday, December 30, 2007
FIRST A LITTLE NEW YEAR'S FUN & SARCASM
Posted by HeartHawk at 5:26 PM
One of the most promising signs that the traditional heart disease "wait until broken and repair" medical model is slowly giving way to the prevention model is that more and more doctors are jumping on the bandwagon. Track Your Plaque recently ran an interview with Colorado prevention pioneer Dr. William Blanchet who independently arrived at the same conclusions and treatment strategies as Track Your Plaque author Dr. William Davis.
Back in September I took some shots at Dr. Richard Fogoros, a contributor to About.com's heart disease pages. At the time I mentioned what a pity it was because "he almost got it right!" I considered the flaw in his position to be the same as many cardiologists, a blind obsession with obstructive disease. My disparaging of Fogoros was a rehash about how traditional medicine waits until it finds coronary obstruction via stress testing, which is end stage heart disease, rather than finding - and treating - early stage heart disease after detection and tracking via heart scanning.
Despite my rather scathing accusations, Dr. Fogoros was kind enough to take the high high road and write to me explaining that his statements as posted on About.com were from 2003 and his views since then have evolved. He has more recently published a new and reasonably objective review of the traditional "repair" versus "prevent" debate that is raging in the medical marketplace.
Here it is. http://heartdisease.about.com/od/coronaryarterydisease/a/noninvasiveCAD.htm
I encourage everyone concerned with heart diease to read Dr. Fogoros' insightful analysis and decide which camp you want to be in, with the traditional "repair" folks, or the "prevention" team.
Thank you Dr. Fogoros. The Revolution continues!
Posted by HeartHawk at 4:30 PM
Monday, December 10, 2007
I often talk about clinical trials and, if you are not a numbers and statistics geek like me, the lingo can be downright confusing and the results difficult to properly interpret. Enter, MedPage Today to offer this little gem to bring you up to speed on understanding clinical trial geek-speak.
Posted by HeartHawk at 10:08 AM
In my last post I took Johnson & Johnson to task for their decision to push stents on the public. Kartik asked that I find and publish a video of the commercial for people to view. YouTube did not have it as of the date of this post but it is available by clicking this link.
It seems I am not the only one who is having ethical concerns.
From the New York Times
"Not surprisingly, the campaign has stirred criticism among doctors who oppose direct-to-consumer advertising of drugs and devices, and especially among doctors who contend that stents are being implanted too often in patients who might do better with other treatments."
From leading doctors
"It's deplorable," said Dr. William E. Boden, a professor of medicine at the State University of New York at Buffalo. "You've got to wonder whether it's a sign of desperation."
Raymond Gibbons, M.D. Mayo Clinic, "Angiopplasty should be reserved for patients who are refractory to medical therapy for chest pain."
Judith S. Hochman, M.D., of New York University School of Medicine, and P. Gabriel Steg, M.D., of the Centre Hospitalier Bichat-Claude Bernard at the University of Paris, concluded that "patients . . . who have failed to control symptoms remain candidates for revascularization, but percutaneous coronary intervention should not play a major role as part of a secondary prevention strategy."
And, of course, we have the COURAGE trial (the inspiration for this post's title)
which found that stenting is no more effective than non-surgical methods for managing stable (not in the throes of a heart attack) heart disease.
CLICK HERE to watch a short video explaining the COURAGE trial
Stent manufactures will stop at nothing to push their product on an unsuspecting public. Remember, the American College of Cardiology and New England Journal of Medicine actually sanctioned researcher and interventional cardiologist (fancy title for some stent pushers) Dr. Martin Leon for attempting to sabotage the COURAGE trial once it was clear that, contrary to his expectations, it would not support stenting as a superior therapy. More chilling is that Dr. Leon was considered an important and well-respected cardiologist who has held titles such as Chairman Emeritus and Founder of the Cardiovascular Research Foundation, Associate Director of the Center for Interventional Vascular Therapy (CIVT) at Columbia University Medical Center, Director of Clinical Research at the Washington Cardiology Center, Clinical Professor of Medicine at Georgetown University Medical Center, Director of the Catheterization Laboratories in the Cardiology Branch of the National Heart, Lung, and Blood Institute at the National Institutes of Health (that's a mouthful), among others.
Kinda make you wonder just who you can trust! You know, if this were just two "corn flakes" manufacturers competing in the marketplace I would say, "Have at it. Sell me YOUR corn flake." But this isn't about breakfast, it is about cutting people open, it's about life and death.
We all know what is going on here. Since the COURAGE trial and revelation about stent thrombosis, Cypher stent sales have plummeted. The Cypher Stent commercial is all about trying to get past doctors who have started to put the brakes on the overzealous implantation of stents. This, in a word, is DISGUSTING!
Posted by HeartHawk at 8:54 AM
Friday, November 30, 2007
There I sat watching Brett Favre and my beloved Green Bay Packers getting stomped by the Dallas Cowboys (so my BP is already high) and what do my eyes behold at the commercial break? Why none other than Cordis Corporation running a commercial touting their Cypher stent. The message being delivered while the band Guster is belting out its tune "C'mon" in the background is "If you have narrowed arteries that are limiting your activity, go see your doctor about getting a Cypher stent to open up those bad boys." What is most galling is their new slogan, "Life Wide Open." Yeah for about six months until your sirolimus-eluting stent produces another case of late stent thrombosis or the artery plugs up further down the line.
Nevermind that the COURAGE trial said drug and lifestyle changes are just as or more effective. Nevermind that stents DO NOT reduce your risk of having a heart attack or reduce the underlying disease that caused your arteries to narrow. Nevermind that stent insertion is a surgical procedure with significant risk of its own. Never mind that sirolimus-eluting stents have increased risk of stent thrombosis and you have to take Plavix for six months as a precaution (which has its own increased bleeding risks). Nevermind that relying exclusively on stents means you will likely need another and then another before your untimely death. No, go right out and have your doctor cut a hole in your side and snake our product into your heart all in the name of a short-term fix.
What Cordis (a Johnson and Johnsn Company) is doing is UNCONSCIONABLE! We already have unscrupulous cardiologists running "cath factories." Now Cordis is egging on heart disease sufferers to pester their doctors to put more stents in and being disingenuous in the process by not telling the whole story. Tough shit if there are better ways to manage heart disease. We only make money when stents are used.
Stents are for acute situations. There are better, safer, and more effective ways to reduce stable angina than surgical intervention. Shame on Cordis for playing the "quick fix" card and putting profits ahead of patient well-being. Perhaps they should watch this commercial.
Or this one!
Just when ya think you've seen it all!
Posted by HeartHawk at 7:29 PM
Ever wonder about HDL reverse cholesterol transport and how it works to reduce plaque. Now, this is a pure commercial play by the drug giant Merck and normally I would not pass it on, but they have put together a pretty cool animation about the mechanism by which HDL removes cholesterol from artery walls. Here is the link http://www.totallipids.com/total_lipids/totallipids/mechanism_of_action/index.jsp
They also have an amimation that explains why we sometimes get that nasty flushed feeling when we take niacin. Do ya think they spent all this money on the cool animations out of the kindness of their hearts? Or, do ya think that maybe they are setting us up for some new presciption drug that raises HDL without the flushing side effect?
Hmmmm, I wonder - NOT!
Posted by HeartHawk at 7:23 PM
Thursday, November 15, 2007
I have had many long-winded arguments with Dr. Davis of Track Your Plaque but I'll be damned if he isn't right again! I kind of raised an eyebrow over one of his articles titled "Fasting: Fast Track to Control Plaque" until this study recently released at the American Heart Association Scientific Sessions entitled "People who skip meals: are they better off?" corroborated his position.
The study provided fascinating evidence that suggests a fast as short and sweet as skipping two consecutive meals provides additional protection against heart disease. Dr. Benjamin D. Horne, Ph.D., M.P.H., study author and director of cardiovascular and genetic epidemiology at Intermountain Medical Center and adjunct assistant professor of biomedical informatics at the University of Utah in Salt Lake City offered two provocative quotes ...
“Fasting was the strongest predictor of lower heart disease risk in the people we surveyed."
based on the possible theory that ...
“When you abstain from food for 24 hours or so, it reduces the constant exposure of the body to foods and glucose,” he said. “One of the major problems in the development of the metabolic syndrome and the pathway to diabetes is that the insulin-producing beta cells become desensitized. Routine fasting may allow them to resensitize — to reset to a baseline level so they work better.”
OK, seems reasonable. Now, my next question is "Exactly how often do I have to "reset my baseline level?" Call me anything (and people do), just don't call me late for dinner.
Posted by HeartHawk at 2:22 PM
Sunday, October 28, 2007
Let's make this clear yet again. Needing a stent, any stent, is a prevention failure. But, they are effective life-savers once you are "over the edge." Perhaps the COURAGE trials (which showed that non-interventional therapy was as effective as inteventional therapy for non-acute heart disease sufferers) has helped pushed technology in the right direction.
The TRIAS HR study has shown that the new Genous R stent to be as or more effective in patients at high risk for restenosis than paclitaxel drug-eluting stents. What is noteworthy about the Genous stent is that it has been bioengineered with a coating that attracts Endothelial Progenitor Cells (EPCs). The idea is that the stent will form a natural endothelial lining similar to healthy arteries. Recall that it is the one-cell thick endothelial lining that regulates artery dilation (by producing nitric oxide) and provides a protective barrier. Once that lining is compromised the atherosclerotic process begins.
Of course, this whole area of innovation begs the question, "Can a method be devised to get EPCs to damaged endothelial sites BEFORE lesions become acute and require a stent?" If so, you might be talking about a REAL cure to heart disease before too long!
Given that hearts in my family are genetically predisposed to fail at age 65, that gives them about 13 years to figure it out.
Posted by HeartHawk at 10:56 AM
Saturday, October 27, 2007
I spend a great deal of time exposing members of the traditional medical community who, for one reason or another, remain rooted in the "stone age" of cardiovascular care. Perhaps they are lazy, have a profit motive or are, sadly, simply ignorant. Happily, there are a few who get it like those associated with the Society for Heart Attack Prevention and Eradication (SHAPE).
The SHAPE docs have been taking quite a bit of heat for promoting heart scanning and calcium scoring as the new standard for detecting and managing heart disease. They have recently fired back at their major critics such as Dr. Michael Lauer and the Cleveland Clinic Journal of Medicine with this rebuttal.
Shape doctors such as Dr. Harvey Hecht, Dr. Arthur Agatston, and Dr. Matt Budoff understand the simple truth. Using risk factors such as the popular Framingham Risk Score can tell you if you MIGHT have heart diesase. Heart scans tell you if you DO have heart disease. If you have a non-zero calcium score you must:
1. Understand YOU HAVE HEART DISEASE. There are no ifs, ands, or buts. Deal with it!
2. You need to find out WHY you, specifically, have heart disease. The risk factors for MOST people is unimportant. What is YOUR specific cause or causes.
3. You need to take measures to counteract YOUR specific causes. Starting treatments (like statins) just because they help some or most people is just plain stupid if your specific problem cannot be helped (or is less than optimum) by the treatment.
Slowly, but surely, the truth about heart disease prevention and reversal will prevail. Heart scanning and lipoprotein analysis are proving to be the first two steps.
The truth shall set you free from heart disease!
Posted by HeartHawk at 7:31 PM
Saturday, October 13, 2007
This just in from the cutting-edge of traditional medical research.
"The addition of an omega-3 fatty-acid supplement to statin therapy in patients with persistent hypertriglyceridemia significantly reduced triglyceride levels and non-HDL-cholesterol levels, all without a significant increase in LDL-cholesterol levels."
YA THINK?!! Now tell me something I DON'T know. It never ceases to amaze me what the traditional medical community regards as "news." But what really irks me about this latest study is the following.
1. They only care about studying compounds as they relate to patentable prescription drugs like statins.
2. They only studied a prescription form of Omega-3 fatty acids when you can easily achieve equivalent doses with cheap, over-the-counter, equivalents.
3. They persist in maintaining "it is not clear what clinical benefit would arise from further lowering triglycerides in patients with levels between 200 mg/dL and 500 mg/dL."
It is bad enough that the FDA does not approve Omega-3 supplementation in patients with triglycerides below 500mg/dl, now we get this "old news" study that, despite its "revelation," will continue to bolster the hopelessly inept FDA. Hell, Dr. Davis of Track Your Plaque recommends a triglyceride level of 60mg/dl while these guys are still speculating about 200. One of the lead researchers even suggests that effects on LDL particle size has a threshold BELOW 200 (more non-news)!
It is pretty clear to me that this study is nothing more than an attempt to create a market for prescription Omega-3 products and take a share of the huge market for the non-prescription Omega-3 supplements. I can't wait for more "breaking news" from traditional medicine, even if it will be at least 10 years late!
Posted by HeartHawk at 4:22 PM
Thursday, October 4, 2007
I continue to be nothing less than impressed with the intelligence and insight of the commenters on this blog. The blog was started as an outlet to vent my frustration with what I see as cardiological malpractice and to hopefully help others by sharing my experiences. Instead, it is slowly developing into a community of ideas on the subject driven by mostly thoughtful comments from those who both agree and disagree with the way I state my case.
"Anonymous" (a scan technician) recently replied to my last post "It's STILL the Plaque, Stupid!" decrying how heart scan results are often misinterpretted by doctors who alternately tell really sick patients to ignore the results or blindly rush them to the cath lab for no good reason (and I think also in reply to a comment by "Bix"). The money quote from the comment was "You wouldn't consider a "small amount" of cancer to be normal, why do you think this disease is any different?" Of course, I will be stealing this line in the future!
Oh, and to all you "Anonymouses" out there, take credit when you say something brilliant!
Posted by HeartHawk at 8:24 AM
Wednesday, September 26, 2007
I like About.com. In fact, I use it to keep up on my Spanish. But, just as with Yahoo!, it leaves a lot to be desired in terms of heart health advice. Since I took the time to "go off" on Dr.Margolis at Yahoo! Health, it's only fair I treat the drivel being pushed by Dr. Fogoros at About.com with the same disdain. Such a pity too because he ALMOST got it right.
The good doctor attempts to answer the provocative question, "EBT (Ultrafast CT) Scans - Godsend, or Scam?" in the About.com: Heart Disease section. He actually does a pretty good job explaining everything until he gets to the real meat of the issue; the efficacy of using heart scans to track heart disease. Unfortunately, like many other traditional practitioners, he remains blinded by the hopelessly outdated fixation on OBSTRUCTIVE heart disease.
For many years heart disease theory and practice was centered on treating heart disease like a "plumbing" problem. You simply test the coronary arteries for flow and if it's adequate everything is just fine. If not, you hope you catch it in time and call "roto-rooter." Everything was focused on finding and fixing obstruction to flow. But a not-so-funny phenomenon kept occurring. People would pass their stress test and then die of a heart attack the next day! What the hell?
It is now known that most heart attacks actually occur at sites with no symptomatic or even detectable flow obstruction. Unstable, previously undetectable "silent" plaques rupture exposing their lipid core to blood, a clot forms, and bang, you're dead! The bottom-line is that what you need to know is NOT the amount of obstruction you have but your total PLAQUE burden. A heart scan will tell you this, a stress test or even a catheterization often WILL NOT.
Dr. Fogoros completely misses the point when he laments that a heart scan does not have the power to accurately predict who has an obstruction at any given instant. That is what a stress test is for. It will tell you if you currently have obstructive heart disease and are in imminent danger of dying immediately. However, it will not tell you a thing about what will happen at any point in the future - like tomorrow! A heart scan is the most accurate predictor of your risk for future heart attack.
Here is the bottom-line. Get a freakin' scan heart scan. If your score is zero, throw a party. If it is non-zero find a doc who understands what your risk is, how to determine the root cause of whatever is causing the problem (hint: High LDL cholesterol is not the most common problem), and put together a program to treat your root causes. Get a yearly repeat scan to see if your plaque burden is growing or shrinking. If it has been arrested or starts reversing - again - throw a party. This means your heart attack risk is almost as low as a zero score. If it is growing, you need to be more aggressive in your current program or change it. The key here is that without a follow-up scan you have no idea of what to do next.
So stop worrying about obstructive heart disease (OK, so don't worry quite so much). Focus on plaque burden.
Plaque is Where It's At!
Posted by HeartHawk at 11:00 PM
Tuesday, September 25, 2007
WOW! The recent comments elicited by my latest blogs on PCI demonstrate a profound concern and understanding about the dilemma of heart attack prevention versus intervention. It does my heart good (pun intended) to realize there are so many people out there who not only give this issue thought but are willing to share those thoughts. Thanks go out to Dr. Walton-Shirley and Dr. Davis for taking time out of what I am certain are very hectic schedules and the legion of commenters like Bix, wccaguy, warren, and the ever-enigmatic "Anonymous."
This issue has many real life similarities. For example, even though my parents, teachers, insurance agent, and Smoky the Bear all extol the virtues of fire prevention, it is still nice to know the fire department is only a call away to bail you out when you do something stupid (like when I went into my backyard to pitch a few golf balls while waiting for a pan of oil to heat up on my oven top). The same could be said for heart disease prevention except for the fact that, unlike fire prevention, figures of authority preaching prevention are few and far between. It leads the conspiracy theorists among us to wonder if this peculiar situation is a matter of incompetence or perhaps planned obsolescence! Remember, it was not that long ago that Detroit purposely designed cars to need expensive repairs after several years.
So what to do? On the one hand preventionists have a hell of a point, the technology to prevent most heart attacks exists today and is simply not being made available on a widespread basis. On the other hand, we have a large segment of society that either blindly follows outdated health practices or are simply to dumb or lazy to take responsibility for their health. What do we do, let them die? (Darwinists might argue that this is a valid option).
I believe the comments made on this blog point the way. Yes, let's continue to develop fast, cost-effective rescue measures for the unlucky few who infarct despite prevention or those too blind to help themselves. But, at the same time, let's DEMAND that the medical establishment educate and discipline itself to practice modern prevention. Let's have the interventionalists actively put pressure on their own colleagues to balance their practice with prevention and throw out the ones who operate "catheterization factories." There is no room in medicine for putting unethical profit and "God complexes" above lives. Remember, even if there were an interventionalist in every "pot" and a cath lab in every "garage" many people would still die needlessly.
So, there's my compromise. Any takers?
Posted by HeartHawk at 3:41 PM
Wednesday, September 19, 2007
Back in June I wrote a rather scathing blog that took Dr. Walton-Shirley to task for her position on Primary PCI. She was understandably upset that I would read into her comments something that she claims was either misread or simply not there and wrote this comment to take me to task.
I guess I really cannot blame her for being upset that I used her as the latest scapegoat for the failing medical establishment, but, I felt, and still do, that my position on the medical community as a whole was right on the money. So, in an effort to set the record straight on numerous fronts, let's get down to the nuts and bolts of my position. Then YOU can decide.
1. First, let's all understand something. In any debate there are two sides and both sides must anchor their end of the spectrum. Dr. Walton-Shirley feels the best use of time, talent, and money is to build more cath labs and train more people in how to use them so that IF you have a heart attack, you stand a better chance of being pulled back from the brink of death. Unfortunately, you have to first let people get so sick that they are about to die. My position is to use those same resources to prevent such disasters from happening in the first place. Take your pick. You cannot spend the money twice.
2. My role in this melodrama is to be as aggressive and relentless as the other side. This is not Little League. Like it or not this a "blood-sport" and that is not just a metaphor. People's lives and quality of life are at stake. I am not above spilling a little blood of my own along the way.
3. In my blog I praised Primary PCI as a wonderful tool. I miss my mother, my grandfather, and my uncle and wish a cath lab had been across the street when they were in the throes of their heart attacks. But, I wish, even more, that they had access to enlightened medical care 5-10-20 years before those sudden, life-ending events, care that would have PREVENTED them having a heart attack in the first place.
4. My biggest complaint is the complete lack of self-policing within the traditional medical community. There are ways to effectively prevent and treat heart disease that simply are not being disseminated by the so-called guardians of our health. I have had top-flight, (previously) trusted internists and cardiologists make the following statements to me and my relatives.
- (after a routine cholesterol panel) "I have seen 50 patients today and your LDL cholesterol is lower than all of them. Now stop worrying." (NOTE: My doctor said NOTHING about my abnormally low HDL cholesterol nor, given my family history, do more than a conventional Friedewald lipid panel).
- (after my brother was tested at my urging - not his doctor's - and diagnosed with high lipoprotein(a)) "Here, take this statin. It's magic!" (NOTE: Statins are completely useless for reducing lipoprotein(a))
- (after my first nuclear stress test) "There is no evidence of any obstructive disease. I would not do anything at this point." (NOTE: It has been established that you can have extesive CVD with no detectable obstruction)
-(a conversation after an uncle's triple bypass) "ME: Too bad you didn't have a heart scan. UNCLE: I did, seven years ago. My score was 1200 but my doctor said as long as my stress test was OK to ignore it." (NOTE: 1150 of the 1200 was in his LAD, the only artery receiving - count 'em, not 1, not 2, but 3 bypasses)
- (2 weeks before my mother's fatal heart attack) "Congratulations, you passed your physical. Looks like you escaped your family's curse."
These were not schmucks but the best physicians we could find (and I'm damned good at it). Sorry, but I am not exactly the trusting sort anymore. In fact, I am as mad as hell!
SO WHERE IS THIS ALL GOING?
I do not fault Dr. Walton-Shirley for studying hard, working late, saving lives, and espousing ideas to save even more lives. If her ONLY intent was to make Primary PCI more available my ONLY question is whether this is the best use of resources. However, I am totally frustrated when the medical establishment continues to blindly put the cart before the horse. Dammit, it is just wrong to constantly beat the drum for more heart procedures when the overwhelming majority of them can be avoided. How about a little balance?
So, thanks for all the hard work and please do keep saving lives Dr. Walton-Shirley. As someone whose style is to be aggressive I admire the fact that you cared enough to fire back. Perhaps this will be the start of a wonderful professional relationship. We owe it to everyone to work together and limit "friendly fire." In fact, if I see your next published editorial is about cutting-edge prevention I guarantee I will write an equally effusive blog about a doc who "gets it." God knows we need more of them. But, don't be too surprised if I still get a little irritated when your colleagues fail to speak out about prevention and malpractice within your own ranks. But, I guess that's my job.
Posted by HeartHawk at 9:35 AM
Tuesday, September 18, 2007
I hate to gloat (so I lie) but this breaking news just came in.
A few days ago I took Yahoo Health expert Dr. Margolis to task for suggesting in his health quiz that Vitamin D was of no value for fighting heart disease. Guess again! Experts like Dr. William Davis have been extolling the virtues of Vitamin D supplementation for well over a year now. He credits D with remarkable instances of heart scan score reversal when used in conjunction with his Track Your Plaque program (note that honest brokers of heart health information will never promote a single "magic bullet" because there ain't no "one size fits all" answer in this game).
Anyone who still doubts the efficaciousness of Vitamin D should take notice of the study recently released by Drs. Autier and Gandini in the September 10th issue of the Archives of Internal Medicine. They found that doses of Vitamin D ranging from 300IU to 2000IU correlated with decreased risk of ALL CAUSE mortality (that includes heart disease, cancer, etc.) with no toxic effects. The study was a meta-analysis of 18 independent trials involving 57,311 participants.
Of course, this study does not have the power to differentiate effectiveness against any specific disease (say CVD for example) or determine recommended doses. The good doctors leave it to future studies to ferret out that information. But, considering the size of the study, it is a sure 20 to 1 bet (the study used the standard 95% confidence interval) that something phenomenal is going on.
So let me say it for the hundreth time. Traditional medicine is hopeles sly behind the curve when it comes to heart disease prevention and reversal. Unfortunately,they are largely invested in letting you get so sick you have to buy their surgical interventions and drug therapies. You have to dig and dig deep, gleaning information from many sources, in order to to have fighting chance to beat heart disease. Yes, there are quacks looking to snow you. But, if you don't fall hook line and sinker for every gimmick and snake oil salesman, if you do your research and believe in hard data over anecdotal instances, if you find praticitioners and patients with a history of success over years rather than days, if you just use COMMON SENSE, you can, and will, beat heart disease.
Now go take your Vitamin D!
Posted by HeartHawk at 11:24 PM
Friday, September 14, 2007
Posted by HeartHawk at 10:40 PM
Thursday, September 13, 2007
The latest debate about relative risk ratios and antioxidants reminds me about how traditional medicine relies on all manner of risk factors to determine how to treat heart disease. However, risk deals only with might or could happen. Yes, if you have high LDL cholesterol, low HDL cholesterol, or any number of other risk factors you might have heart disease. But, why live in the world of "maybe" when you could know exactly whether you have heart disease, how serious it is, and whether what you are doing is effective in treating it?! Get a heart scan and you will know for certain. As Homer Simpson would say, "DOH!"
The efficicacy of heart scans is no longer in question. Recent studies, statements by the AHA, the SHAPE guidelines all agree - heart scans are the best predictor of heart attack. I have always been impressed by the powerful statements issued by noted and independent heart disease experts and researchers.
Dr. Steven Nissen, Cleveland Clinic: "We now know that 95% to 99% of the heart disease occurs at sites WITHOUT artery narrowing. Thus, the old tests we perform to detect narrowing and blockages have really misled us. We miss over 95% of the heart disease that causes heart attacks."
Dr. Harvey Hecht, The Heart and Vascular Institute: "plaque imaging is ...not to be confused with risk factors, which merely estimate a probability of developing atherosclerosis. Rather, [plaque imaging] directly measures atherosclerosis, irrespective of the presence or absence of risk factors; it provides the final common denominator and is the most powerful predictor of cardiac events."
Regardless of cholesterol or the supplements you may or may not be taking, settle the question. Get a heart scan and, if you have a non-zero score, repeat it every year to see if you are gaining or losing ground. The plaque that is the root cause of heart disease can be treated - but only if you know how much you have!
Plaque, it's not just for teeth anymore!
Posted by HeartHawk at 11:58 PM
Tuesday, September 11, 2007
Given all the commotion over the WACS Antioxidant Study, I contacted Dr. Nancy Cook who served as the lead bio-statistician on the study. She has agreed to let me publish her verbatim replies to a number of questions that are central to the debate. Here they are!
HeartHawk: What was the significance of setting the noncompliance threshold at using 2/3 of supplied study agents?
Dr. Cook: The threshold of 2/3 was pre-specified, but not particularly based on biologic activity. However, I can say that most of the women in the study either took all (or at least 90%) of the study pills or none. We didn't have many at intermediate levels, so the exact choice of cut point would probably not make much difference to the analysis.
HeartHawk: Please comment regarding the significance of the improved risk-ratio for Vitamin-E when noncompliant subjects were censored.
Dr. Cook: It's true that some significant effects emerged in our analyses censoring on noncompliance. This analysis, though, is not intent-to-treat, and can be subject to bias since those who take the study pills are likely to be very different from those who don't. It's also possible that intervening changes in risk factors are related to the lack of compliance, possibly differentially by treatment group (similar to confounding by indication). The outside use of these supplements also needs to be taken into account. The analysis censoring on compliance thus needs to be interpreted with caution. The results among compliers could be due to this self-selection bias, to a true preventive effect in those who keep taking the vitamin E regularly, to a possible early effect that goes away with time, or to a false positive finding due to the multiple comparisons. At this point we can't separate these out. So, while some of the findings for vitamin E are indeed tantalizing, they don't hold up to strict statistical or clinical trial standards. And the body of evidence for anti-oxidant trials in general has largely been disappointing. The most straightforward interpretation is based on our primary result, that there is overall no effect of this particular supplement on the composite endpoint. We cannot trust the secondary analyses to be reliable at this point.
HeartHawk: Any thoughts or comments about what WACS results may intimate about the value of naturally occurring antioxidants in foods as compared to supplements in any dosage or combination.
Dr. Cook: It's true that not everything is known about anti-oxidants, either by type or in combinations. As suggested in the discussion in the paper, some scientists have suggested that other forms of the anti-oxidants (eg. gamma- vs alpha- tocopherol) may be more beneficial. It's also possible that it is a combination of nutrients that has an effect. At this point it seems from a vast array of observational studies that diets high in fruits and vegetables are protective, which has also been supported by intervention studies such as DASH. So perhaps we haven't been studying the right form of anti-oxidant, or maybe a combination is needed, or maybe it is other nutrients in fruits and vegetables that are protective. There is still a lot that is uncertain. The best advice to the public is to eat a diet high in fruits and vegetables as well as to follow other healthy lifestyle habits, such as exercising regularly, rather than relying on supplements.
Thank you for your time and interest Dr. Cook!
Posted by HeartHawk at 9:55 AM
Sunday, September 9, 2007
Hey, Hey! Looks like old "Hawky" hit a nerve with my jab at antioxidants! That's great because it's an area that deserves considerable debate given the fact that many of us consume significant amounts of them. Thanks go to "Captnsaj" and "Anonymous" for getting the debate going. Let's see where it goes!
First, let me confirm I am not an antioxidant "hater." Although, I do think Linus Pauling's and Mathias Rath's advice about ingesting mega-doses of Vitamin C is kinda loopy. What I AM saying is that, statistically, the WACS Study says they are not effective at reducing CVD. Lord knows I believe in the value of supplements and have had my share of disagreements with the drug companies. Drug company funding is ALWAYS problematic in any study but WACS was funded by the National Heart, Lung, and Blood Institute.
It seems Mike Adams is taking the lead in attacking the WACS study. So, for the time being, I will play devil's advocate and take the opposite side. Here goes ...
1. Let's start by refuting Mike's claim the study supports the use of antioxidants. In fact, the ONLY conclusion it draws is they are no more effective than placebo. The two exceptions were the findings that Vitamin E reduced risk once non-compliant subjects were removed and was duly noted in the report. However, the study produced dozens of statistical findings and the only one that showed statistical significance (just barely with a P=0.04) was the use of Vitamin E in women with confirmed prior CVD (but not women with risk factors but no confirmed CVD). There was also a "suggestion" Vitamin E in combination with Vitamin C should be looked at for effectiveness as reducing stroke risk as it showed statistical significance (P=0.o3). Frankly, when you generate that many statistics on a sample population, one or two may produce a false positive (in fact, statistics say it is likely). You have to consider the overwhelming body of statistics generated.
2. One needs to understand a little bit more of the math behind statistics. The study said the relative risk ratio (RR) for heart disease related events (heart attack, stoke, revascularization, and death) was not improved by any of the supplements. The key is to look at the confidence intervals (CI) and "P" values for each statistic. When P values exceed the "significance level" (o.o5 in this case) or the CI encompasses the value "1" then statisticians assume the null hypothesis is not rejected. In other words the tested agent did not produce any result that could not be explained by other than random chance. Note that the P values are all far greater than 0.05 in almost every case and the CI's encompass "1". In the few cases where marginal significance was achieved, the P values where only modestly below 0.05. Normally, I like to see these values in the range of 0.001 to 0.01 before I completely reject the null hypothesis. Required reading at this point should be Chapter 3 of Steven Milloy's treatise SCIENCE WITHOUT SENSE: The Risky Business of Public Health Research. There is also a good layman's description of the subject at http://sportsci.org/resource/stats/pvalues.html
3. Mr. Adams claims that non-compliant subjects were used to "dilute" the results. Unfortunately, that is not neccesarily the way statistics work. I put a call in to Dr. Nancy Cook the bio-statistician that oversaw the project. Perhaps she will provide more data. The example Adams gives where 50% of the test subjects did not receive "sandwiches" is a little outrageous and does not correspond at all with the way the WACS Study was run. I might also add that even using his fictitious example, the efficaciousness of "sandwiches" would still be borne out using the WACS statistical methodology.
4. Mr. Adams makes patently ridiculous statements like "If we taught people the truth about nutrition, they wouldn't need prescription drugs!" and "Drugs don't make people healthy." Tell that to all the people who died of infections or lost limbs before the advent of antibiotics (yeah, I know what you are thinking, but ANYTHING can be over-prescribed and misused). These sorts of patently false claims leads me to discount much of his other rhetoric.
5. Most drugs are simply purified and concentrated forms of naturally occurring substances. And just because a supplement is not a prescription agent does not mean it is not a drug. In fact, supplements like L-Carnitine require a prescription in Canada. Also, I doubt the Vitamin C Mr. Adams takes is distilled from oranges. It is likely made in a big chemical plant just like all the drugs he rants about. Finally, he mentions what he feels to be relatively low doses used in the WACS study. Linus Pauling routinely advises doses like 10 grams of Vitamin-C. How is THAT natural?
As always, the truth is somewhere in the middle. That is why I always advise people get their info from multiple sources - even zealots like HeartHawk and Mike Adams!
As for me, what the heck, I say hedge your bet. If you got the time, inclination, and money, a daily dose of 1000mg C and 400IU of E can't hurt. In fact, the WACS study makes a point of saying that it did not find any dangerous effects as were found for Vitamin E in earlier studies. Just don't expect any miracles!
More comments are encouraged!
Posted by HeartHawk at 9:58 PM
Tuesday, August 21, 2007
The WACS (Women's Antioxidant Cardiovascular Study) followed 8171 women over an approximately 10-year period to study the effects of antioxidant supplements Vitamin C, Vitamin E, and Beta-Carotene. Their conclusion was that none of these supplements improved cardiovascular outcomes in any combination as compared to placebo. The study also added Folic Acid about half-way into the experiment.
While the study authors were quick to single out and pan antioxidant supplements, they did not go so far as to exclude dietary sources of these vitamins. The implication (in my mind) is that small amounts of antioxidants may provide some benefit but that benefit cannot be magnified by loading up on antioxidants via supplements. Keep in mind, nobody refuted the finding that cholesterol oxidation plays a significant factor in atherosclerosis. They simply said that supplementing dietary sources of the studied antioxidants provides no benefit. But, they also determined that, contrary to other findings, these supplements did little or no harm.
A big fat "I told you so" goes to Drs. Linus Pauling and Mathias Rath (yeah, yeah, I know, they used FAR less than what YOU recommend and didn't include L-Lysine and Proline in the study).
Posted by HeartHawk at 10:41 PM
Wednesday, August 8, 2007
Yet another study confirms that diets composed of low Glycemic Index (GI) foods are better for both lipid management and weight loss. But, by only stressing GI they overlook the other half of the equation, Glycemic Load (GL). Put simply, it's not just how high the GI is of a particular food but how much of the high GI component is in the food product per gram or unit volume consumed.
GI is a measure of how quickly the carbohydrate portion of a food is converted to glucose and raises blood sugar. High GI foods raise your blood sugar rapidly and provoke a rapid and equally high insulin response. The body really hates this! However, GI is ONLY a measure of rate of change, not how much glucose/insulin is actually generated.
GL is a measure of the grams of carbohydrates in a quantity of food times its GI (divided by 100) and is a better indicator of how the body will respond to eating it. You can eat low GI food and still provoke a high insulin response if you eat enough of it. Similarly, eating small amounts of a high GI food may do little damage.
But foods are not composed purely of carbohydrates. There is another factor that must also be considered, carbohydrate density. For example, corn, and therefore popcorn, has a high GI. That would suggest popcorn is a food to avoid. However, popcorn is mostly air and does not contain many carbohydrates per unit volume. While the few carbohydrates in popcorn does indeed have a very high GI, you have to eat a fair amount to raise blood sugar.
Compare a cup of watermelon to a cup of high-fructose sweetened soda. Both have an identical volume. Watermelon also has a slightly higher GI than soda (72 versus 68). Yet a cup of watermelon has a GL of less than 1/3 that of soda simply because it is less than 1/3 as carbohydrate dense as soda. You are far better off consuming a cup of watermelon than a cup of soda even though watermelon has a higher GI.
I suppose if you are dealing with simpletons who cannot comprehend math or portion size you simply tell them to avoid high GI foods entirely. If you consider yourself a simpleton then just ignore this rant! Otherwise, pay attention to GL rather than GI.
Posted by HeartHawk at 8:10 PM
This is the kind of statistical nonsense that makes a numbers guy's blood boil (like mine). A recent study by a researcher at the Boston University School of Medicine found that persons who drank more than one soft drink per day had a higher risk of developing the dreaded "metabolic syndrome" and IT DIDN'T MATTER IF THE SOFT DRINK WAS SUGAR FREE. Of course, the bonehead media jumped on this paradoxical statement as they always do to generate provocative headlines. And, of course, the conclusion is, in a word, BULLSHIT!
Of course, we all know that metabolic syndrome is a major heart disease risk and that it has grown to epidemic proportions largely because of Americans (especially kids) consume a great deal of sugar and processed carbohydrates. So let's set a few things straight and rehash once again how figures lie and liars figure.
First, the study never said that sugar-free soda caused metabolic syndrome. It merely stated there was an association. I wish I could remember the name of the medical researcher who offered this great analogy.
"Everytime a plane flies over my backyard, my dog barks at it. Everytime my dog barks at a plane it continues to fly away and does not land in my backyard. Therefore, while I can say my dog's bark is ASSOCIATED with planes not landing in my backyard, I cannot say my dogs bark CAUSED the plane to fly away." Get the picture? Barking dogs clearly scare away postmen, robbers, cats, and rabbits but not airplanes even though from, a statistical association standpoint, the observations may be identical.
The same is true in this instance. It is likely that people who consume soft drinks of any kind are more likely to engage in other high risk behavior that IS causal (like eating a Big Mac and fries). But does that mean it makes no difference if you drink Diet Coke or regular Coke? HELL NO! But, that's not the way the press writes it.
Sheesh! It never ends.
Posted by HeartHawk at 10:30 AM
Tuesday, August 7, 2007
Because I am so close to Track Your Plaque (TYP) and author Dr. William Davis I have been reluctant to be too effusive about the TYP heart disease reversal program on this blog for fear of losing my objectivity. But at some point, when a concept keeps proving to be right you have to finally give in to the notion that perhaps, just perhaps, a guy is on to something.
First, it was the begrudging admittal by the American Heart Association that heart scans really are effective measures of heart disease. TYP was the first to incorporate heart scans as the basis for developing personalized heart disease reversal programs.
Next, TYP was on the cusp of recognizing the potential of several novel treatments like L-Arginine and Vitamin D.
Then TYP starting seeing tremendous amounts of heart disease reversal in their clinical practice (double-digit reversal percentages are common under the TYP program in a universe where even a 1% reversal may mean a HUGE reduction in heart attack risk) .
But the final straw for me was the latest Stanford University School of Medicine study proving the efficaciousness of the bedrock TYP 60/60/60 principle (lipoprotein targets 0f 60 LDL cholesterol, 60 HDL cholesterol, 60 Triglycerides). The HDL and Triglyceride targets were never really in question but there had been much concern that an LDL level of 60 or less might actually be harmful (cancer risks were the primary concern). The Stanford Study of 6000 persons laid this worry to rest showing that, even at LDL levels as low as 40mg/dl, all cause mortality dropped almost 50%. The joke among the researchers was that "you can't be too rich or too thin or have too low a cholesterol level."
The TYP program continues to be right time after time after time. I am one of the most skeptical guys in the world. Dr. Davis himself will tell you I constantly challenge his work (OK, in the past it may have bordered on harrassment). But, geez, I am a numbers guy. When you are right this many times in a row, it just can't be dumb luck. I guess that makes me a Track Your Plaque partisan. At least I'm warnin' ya!
Track, Smack, and Jack That Damn Plaque!
Posted by HeartHawk at 11:46 PM
Sunday, July 15, 2007
I recently came across this little gem as I was doing research for the article I mentioned in my previous blog. It's a radio interview of Dr. Davis debating with a "Neanderthal" Harvard School of Medicine professor about the value of heart scans. Davis pretty much chews up the poor, knuckle-dragging, old-school cardiologist. This is a "must hear" primer on how to approach heart disease. I'm going to suggest that Davis consider posting it in the open content area of the Track Your Plaque website.
CLICK HERE to listen (this is a .ram file so you will need the free RealPlayer to play). It's a twenty minute interview so, unless you download the file to your computer before playing, it takes a while to queue up - be patient.
Posted by HeartHawk at 1:24 PM
The answer? Finishing my latest expose' as a feature article for Track Your Plaque. You can find it by clicking this link The Bankrupting of American Healthcare: $20 Billion, Many Lives Lost Each Year. It's in the open content area so you don't have to be a member to read it.
WARNING: Being a numbers guy I went a little nuts but the functional cost calculator I put at the end of the article lets anyone change my assumptions and run their own "what if" scenarios. I can't wait for people to start throwing stones at my calculations. Fire away!
Posted by HeartHawk at 1:14 PM
Tuesday, June 12, 2007
A recent headline at WebMD's Medscape site proclaimed "It Should Be the Right of All Americans to Have Primary Percutaneous-Based Intervention for Acute Coronary Syndrome" (http://www.medscape.com/viewarticle/557124?src=mp).
In the accompanying editorial, Dr. Melissa Walton-Shirley calls for the "greatest push in the history of American cardiac medicine" in order to "improve accessibility to primary percutaneous-based intervention" (angioplasty, stents, etc.). She suggests that "All invasive cardiac laboratories with access to interventionalists should be urgently brought into programs that will allow for appropriate support staff training ..." given the "Improved pharmacologic therapy, better stent platforms, and the advancement of wire technology."
Now, let me get this straight. According to "Doctor" Walton-Shirley "It Should Be the Right of All Americans" and we should have the "greatest push in the history of American cardiac medicine" to cut people open and snake wires up their chests after she, and other "doctors" of her ilk, let their patients become so diseased that they have a heart attack simply because we have great "technology" to fix it.
I HAVE A BETTER IDEA DOCTOR WALTON-SHIRLEY!!!
I believe "It Should Be the Right of All Americans" and there should be the "greatest push in the history of American cardiac medicine" to provide access to even more remarkable "technology" that provides early-detection and treatment for heart disease BEFORE they have no other alternative than to go under your BUTCHER SHOP care! That IS what doctors are SUPPOSED to do, isn't it?
Now, don't get me wrong. Percutaneous intervention is a wonderful technology that can save the lives of acutely diseased patients. But the priorities, if not position, of Walton-Shirley is so grisly and perverse I don't know what else to say. For her, the solution to heart disease is to demand the opening of more butcher shops rather than demand the institution of pervasive early-detection and prevention programs. What next, expand the distribution of leeches in hospitals? Wake-up and join the 21st century, would ya?
Posted by HeartHawk at 5:46 PM
Thursday, June 7, 2007
A recent report in the Journal of the American College of Cardiology (http://content.onlinejacc.org/cgi/content/short/49/23/2231) authored by Drs. Leo Marcoff and Paul Thompson proclaims, "The routine use of CoQ10 cannot be recommended in statin-treated patients." Let's take a moment and review key findings from their abstract and see if we come to the same INANE conclusion. Italicized items are quotes. Items in parenthesis are my admittedly sarcastic comments.
1. Statins block production of farnesyl pyrophosphate, an intermediate in the synthesis of ubiquinone or coenzyme Q10 ... (So, we agree that statins reduce production of Co-Q10.)
2. This fact, plus the role of CoQ10 in mitochondrial energy production, has prompted the hypothesis that statin-induced CoQ10 deficiency is involved in the pathogenesis of statin myopathy. (Hmmm, that seems to make sense too!)
3. We identified English language articles relating statin treatment and CoQ10 (Translation: We did no original research of our own.)
4. Statin treatment reduces circulating levels of CoQ10. (So, we agree on that too.)
5. ... data on intramuscular CoQ10 levels in symptomatic patients with statin-associated myopathy are scarce. (So, the bottom-line is you really do not have much data to base ANY sort of recommendation.)
6. Mitochondrial function may be impaired by statin therapy, and this effect may be exacerbated by exercise (OK, I'm still with you.)
7. Supplementation can raise the circulating levels of CoQ10, ... (What am I missing? It seems you agree that Co-Q10 supplementation will raise bioavailability.)
8. ... but data on the effect of CoQ10 supplementation on myopathic symptoms are scarce and contradictory (Yeah, you already said you don't really know ANYTHING for certain in item 3.)
9. We conclude that there is insufficient evidence to prove the etiologic role of CoQ10 deficiency in statin-associated myopathy (You keep telling us you don't really know - we BELIEVE you!)
10. ... well-designed clinical trials are required to address this issue (Well DUH!)
11. Nevertheless, there are no known risks to this supplement and there is some anecdotal and preliminary trial evidence of its effectiveness. (So, then why would you NOT recommend supplemental Co-Q10 in an attempt to save your patients the pain and debilitation associated with statin-related myalgia?)
12. Consequently, CoQ10 can be tested in patients requiring statin treatment, who develop statin myalgia, and who cannot be satisfactorily treated with other agents. (WTF?! OK, now I am really confused! Holy contradiction, Batman!)
Gee whiz, what was their idiotic conclusion again? Oh,Yeah.
"The routine use of CoQ10 cannot be recommended in statin-treated patients."
Excuse me, but do I look stupid? What kind of crap are these guys peddling? Did they miss the lecture on deductive reasoning? Did their mothers drop them on their heads when they were infants? Somebody please tell me how simpletons like these two manage to pass their medical boards?
To make matters worse, this ridiculous, off-the-hook statement is the headline in one my favorite online cardiological news sources (http://www.theheart.org/viewArticle.do?primaryKey=794465&nl_id=tho05jun07).
This type of sloppy and insane research and reporting should be EXHIBIT 1 in my constant rant that you have to get your information from multiple sources and use your own reasoning. Just because someone lists "doctor" or "reporter" as their title does not guarantee they have an even an ounce of common sense. Trust your own mind and body. I will keep taking my Co-Q10 for one simple reason - it hurts when I don't!
Give me a break,
Posted by HeartHawk at 11:12 AM
Wednesday, May 9, 2007
Dr.Davis of Track Your Plaque likes to emphasize the benefit of having a positive attitude when battling heart disease. Well, here is some additional optimism. Researchers are continuing their search for the "Holy Grail" of heart disease and have found yet another gene-marker for heart disease on human chromosome 9 (you may recall my earlier blog on another gene marker - it is a good refresher on genomics). Better yet, the discovery was made independently by two separate labs which greatly increases its validity. The abstracts for the two studies can be found at http://www.sciencemag.org/cgi/content/abstract/1142842v1 and http://www.sciencemag.org/cgi/content/abstract/1142447v1 while a synopsis of both pieces of research appears on Medscape at http://www.medscape.com/viewarticle/556019?src=mp (free membership needed to access).
What is most interesting is that the DNA sequence is not part of any known gene so it does not code to produce any protein. These areas were once thought to be nothing but "junk" DNA but this discovery leads credence to the theory that these areas serve some yet unknown purpose.
Of course, just knowing you have the gene sequence or "SNP" (my daughter tells me to say "snip" if you want to speak like a savyy biochemist - you can read more at my earlier blog on another heart disease gene) would be useful. A company in Iceland reports it hopes to have a home test kit on the market in about one year. However, the real prize is to develop techniques to alter heart disease genes to render them harmless. Once all the genes for high cholesterol and other heart disease factors factors been identified and can be corrected, heart disease will truly be cured - and with no drugs!
We are getting closer every day!
Posted by HeartHawk at 2:49 AM
Friday, April 27, 2007
I recently completed another one of those online "Heart Disease Risk Analyses" that are becoming more and more frequent on hospital websites (You can find this particular one at https://inspirahealth.com/apps/nahrs/index.htm?hospID=103). They all involve filling out an online questionnaire asking questions about height, weight, blood pressure, cholesterol, etc. They then electronically compare your answers with the motherload of all heart health studies, the Framingham Heart Study experience.
Now, don't get me wrong, the Framingham Study is the "motherload" of all heart disease risk analyses. It has an unbelievable amount of data catalogued over decades of experience. It's problem, like most risk analysis of this ilk, is that all it tells you is your risk. It does not tell you whether you actually have heart disease. BUT A HEART SCAN WILL!!!
For example, my risk for developing heart disease, based on all the data I supplied, was a mere 9%! Nine percent?!!! My actual risk for heart disease is 100%! I have it and it has been confirmed by a half dozen heart scans over the last six years! If all I did was take this online test I might still be eating McDonald's hamburgers and fries for lunch everyday.
This type of health care practice is INSANE! Look, all the "risk factors" tell you is whether you might have heart disease. Regardless of risk factors and "probabilities" the answer is maybe "yes" and maybe "no." There are plenty of people like me with low "risk factors" that still have heart disease and others whose risks are high yet never develop heart disease. A heart scan will tell you with damn near 100% certainty whether you do or do not.
It amazes me that so-called health care professionals still engage in such "hocus pocus" (perhaps for profit, maybe). Remember, I am still a numbers guy. Risk factors are a wonderful tool when you do not have the means to determine an outcome with any certainty. BUT, THIS IS NO LONGER THE CASE WHEN IT COMES TO HEART DISEASE. Stop the insanity. Get a heart scan and learn the truth. Gee whiz! This ain't rocket science!
Posted by HeartHawk at 4:41 PM
Wednesday, April 18, 2007
I once asked Dr. William Davis of Track Your Plaque fame if he could use only one supplement what it would be. He quickly answered, "Fish Oil!"
Many have touted the heart health benefits of the Mediterranean Diet (high in fish products) or simply taking fish oil as a supplement. Now, the new JELIS study (PubMed Abstract, HeartWire Article), an 18,645 participant study over 5 years shows that major cardiac events are reduced 19% when fish oil is used to supplement a low-dose statin regimen.
This finding could be a real boon to many heart disease sufferers who cannot tolerate high-dose statin therapy!
Posted by HeartHawk at 4:04 PM
Sunday, April 15, 2007
Yes, another study is out and cocoa is the clear winner over tea as far as lowering blood pressure is concerned. In a study recently released in the Archives of Internal Medicine (see the free PubMed Abstract), the polyphenols (the group composed of phenols and the more abundant and popularly known flavonoids) in cocoa products (such as dark chocolate) produced significant reductions in both diastolic blood pressure (-4.7 mmHg) and systolic blood pressure (-2.8 mmHg) as compared to tea (both black and green).
The study made some rather dubious claims that the drop in blood pressure was comparable to monotherapy with either beta-blockers or ACE inhibitors but my limited experience (I don't have high blood pressure) suggests that is a bit of a stretch (i.e. most people I know have significantly greater drops on prescription drugs). But, hey, it's nice to know a little cocoa goes a long way. The authors were also quick to point out that this only works if the cocoa calories ingested did not exceed a healthy total caloric intake. Sorry, you cannot pig out and then eat chocolate to get healthy. If you take a cocoa supplement you must cut back an equal number of calories elsewhere!
Posted by HeartHawk at 12:16 AM
Saturday, April 14, 2007
The 'Eagle Eye' is a new recurring blog item that will look at cutting edge research into the root causes and potential 'cures' for heart disease. The latest item is the research into the 'kalirin' (KALRN) gene and the 'Rh0-GTPase' signaling pathway. The abstract can be found at http://hum-molgen.org/NewsGen/03-2007/000023.html Let's break it down in layman's terms for all those who slept through Bio-Chem lecture with special thanks to University of Wisconsin Honors Bio-Chem major - and my daughter - Caitlin (you didn't really think I was that smart did you?).
Researchers looked at chromosome 3q13-21 (a specific section of a human DNA strand), a site already established as playing a role in early onset atherosclerosis. We remember (yeah, sure) that DNA is simply a 'biological program' for creating the basic proteins that make up living organisms. It is composed of a long sequence of nucleotides (a fancy word for a group of four chemical compounds adenine, cytosine, guanine, thymine abbreviated A, C, G, and T respectively) that are organized into what we know as 'genes'. These sequences of A, T, C, and G, our genes, determine what proteins are made (thousands of them) and ultimately determine what the end result of the process is (an artery for example).
The researchers also considered little glitches in our genes called 'Single Nucleotide Polymorphisms' (SNP). SNPs are simply gene sequences where a single nucleotide (remember A, G, C, T) is replaced with another, incorrect, nucleotide. SNPs in genes sometimes code to produce the same protein, but they can also create subtle differences that are beyond the space in this blog to describe.
Finally, researchers used the '1-LOD-unit-down' method which is a statistical method of determining whether a gene is likely to be linked or associated with another gene in a given chromosome (wonks can review Genetic Linkage for a complete description and the math).
Now to the good stuff. Here is what they found.
A strong association between SNPs and heart disease was found in the KALRN (kalirin) gene. Three SNPs in the kalirin gene in particular were found in patients with early-onset heart disease. The kalirin gene is also responsible for the inhibition of 'inducible' (i.e. endothelial) nitric oxide synthase (iNOS/eNOS) which we all know regulates artery dilation (the body synthesizes endothelial nitric oxide from l-arginine which is why this is such a popular supplement). Finally, researchers discovered the kalirin gene is part of the Rho-GTPase signaling pathway that regulates behaviors such as clotting (see http://atvb.ahajournals.org/cgi/content/full/22/6/1029), reverse cholesterol transport (see http://www.jlr.org/cgi/content/full/47/1/78), and arterial stenosis (see http://ajpheart.physiology.org/cgi/content/full/278/6/H1733)
What does this all mean?
The bottom line is that if you find ways to manipulate the kalirin gene or its manufactured proteins you may be able to do things like increase eNOS (like we do with l-arginine), improve the reverse-cholesterol transport efficiency of HDL, inhibit the formation of the clots associated with heart attack, and affect the process by which arteries accumulate plaques. One study (see http://circres.ahajournals.org/cgi/reprint/97/12/1232.pdf) found that statins actually inhibit Rho-GTPases which might account for the additional or pleiotropic effects they have beyond LDL cholesterol reduction. Realistically, commercial applications of these findings are at least 5-10 years away. So work extra hard with what you've already got and buy that extra decade! There is more than this exciting research already in the pipeline. LET'S BEAT HEART DISEASE TO A PULP! The way to do it is one day at a time.
Posted by HeartHawk at 4:09 PM
Thursday, March 29, 2007
It seems my "venom-laden" tirade against Angioprim ruffled a few feathers! So, I'll swear off the swearing (for a few weeks anyway) and get to the point in a, ahhhh, kinder and gentler way. Yeah, that's the ticket! I say chelation therapy and it's proponents are FULL OF SHHHHH . . . OCKINGLY misguided and perhaps even larcenous motives. Most of what I have to say can be found here:
Perhaps the whole thing will be settled when then alternative medicine boys finish their first real study found here.
Of course, they are almost five years in and you would think if anything positive came up you would have some early evidence!
Posted by HeartHawk at 7:04 PM
Tuesday, March 27, 2007
So instead I'll swear a lot. NOTICE: IF YOU HAVE SENSITIVE EYES READ NO FURTHER . . .
OK - I WARNED YOU!! I AM PRESENTING ANOTHER LAME DUCK AWARD AND IT WON'T BE PRETTY!
While doing some research on exercise-induced hypertension, I bumped into this abomination on the web www.yourticker.com . Peruse it if you must but it is about the greasiest, lie-filled, Goddam pile of crap I have come across in quite a while (and those invectives are just a warm-up).
The latest HeartHawk "Lame Duck" award goes to "Angioprim the Original Liquid Oral Plaque Dissolver" hailed as "the most effective method to clean blocked arteries and renew health without surgery, stents, needles or hazardous drugs." MY ASS!
These little butt-monkeys go on to claim thousands of customers over ten years have "proven its effectiveness in opening blocked arteries." Geez, where are the signed affidavits and angiographic evidence? You say you have none? WELL NO SHIT! IT'S BECAUSE YOU'RE TELLING GODDAM LIES! These flesh-sacks actually have the audacity to publish what they claim is a list of customer telephone numbers you can call for testimonials. Well guess who these ass-hats REALLY are? THEIR F*CKIN' SALES REPS! I don't know what pisses me off more, being lied to or treated like an idiot. Note to the Angioprim marketing department: you might want to consider asking the pot-heads who program your website to change your URL query-string variable from "RepID" to something the average ASP programmer like myself can't decipher. The illusion really disappears when you call one of the numbers and the phone is answered something like, "ACME Distributors." What a bunch of morons, but, we already knew that.
Now here is the kicker. What do these lying SACKS OF SHIT want to bill you for a standard "Primary Cleaning" pack of Angioprim? Hey, only $399 (more if they manage to set the hook deeper)! Can you say, "BITE ME?!" They even have a "Dream Big" page where you can sign-up to be a sales rep if you're willing to pay a monthly fee for the right to sell into one or more selected zip codes (that's right, you pay a seperate monthly fee for each zip code you select and they bill your credit card directly). You can quit anytime but OF COURSE they will bill you for one extra month. Talk about having big cajones! These money-grubbers are off the hook!
At the end of the day, what we have here are a bunch of chelation therapy charlatans looking to make a quick buck off desperate heart disease patients. I mean c'mon, how low can you get? Next stop, my local consumer fraud agency. Seems some of their reps are right here in Wisconsin. How convenient! HeartHawk's a comin' boys. I'd call a lawyer if I wuz you!
Gosh, I get ornery when I'm sick!
Posted by HeartHawk at 9:38 PM
Monday, March 26, 2007
Well folks, I'm back on my feet (well on my butt and at my desk anyway) after a NASTY case of the flu to report that maybe, just maybe, the traditional medical establishment will one day "get it."
A March 19, 2007 study released in the American Heart Association journal Circulation showed that multi-slice CT heart scanning can predict with 100% sensitivity (people who test negative and are not having a heart attack) and 92% specificity (people who test positive and are having a heart attack) whether a person who enters an emergency room with chest pain is actually having a heart attack. It's negative predictive value was 100% over the course of a 15 month follow-up. Not one study participant who tested negative and was released had a heart attack.
"Although not all emergency-department patients with chest pain require CT imaging for risk stratification, the present study demonstrates applicability of the technique to selected patients in the population with intermediate risk in whom the incremental value of noninvasive imaging may have a significant impact on patient management," the authors concluded.
Sometimes (not often) it just makes me laugh the way some of these rocket scientists think. Let's see, we can do a bunch of expensive blood tests that tell us that you MIGHT or MIGHT NOT be having a heart attack, we can cut you open and shove a catheter into your heart (a surgicially invasive procedure that exposes you to as much raditation as a scan), or we can have you lay down and, in 10 minutes, non-invasively take a picture that tells us if there are any actual blockages with near 100% accuracy. Uh, I vote for number 3!
It is amazing how long it has taken "modern" medicine to make it this far. Oh well, they'll probably come around sometime in the next decade or so. Until then, it is still up to you to stay alert, stay informed, and stay alive!
(Cough, Cough, Sneeze, %*&#$@!) Regards,
Posted by HeartHawk at 4:46 PM
Wednesday, March 14, 2007
For about a decade now the American Heart Association in conjunction with interventional cardiologists belonging to the American College of Cardiology have successfully waged a war against heart scan screening as a tool for identifying asymptomatic or "hidden" heart disease. Given the enormous profits generated by stents and by-pass surgery I think everyone can understand why they fear any move towards prevention over invasive procedures.
I mentioned back on March 5th that, eventually, this will change and suggested it will take a major medical malpractice suit to shake the foundations of traditional medicine. Now it appears the Texas State Legislature may deliver the first seldgehammer blow to the wall. Citing the new SHAPE guidelines (Track Your Plaque members can read about it in THIS ARTICLE) issued by the Association for the Eradication of Heart Attacks (AEHA) and his own personal experience with heart disease and heart scanning, Texas Representative René Oliveira (D-Brownsville) formally filed his Texas Heart Attack Prevention Bill his first full day back in office after by-pass surgery, a procedure he underwent after a CT scan indicated severe coronary blockages. The bill would mandate insurance coverage for heart scanning to a maximum amount of $200. See the full story (along with goofy rebuttals - Where the hell does Nissen get off calling ANYONE a shameless self-promoter) at HeartWire.
One the major impediments to obtaining a heart scan is cost especially for lower income individuals. Representative Oliveira correctly notes that the added insurance cost of the scans is dwarfed by the cost savings generated by reducing heart attacks through early detection and treatment of asymptomatic heart disease. YA THINK?! This situation is the same one faced by early proponents of mammography to detect breast cancer in its most treatable stages. They too were held back by the medical establishment and short-sighted insurers only to be proven right years - and many painful deaths - later.
If nothing else, this "shot across the bow" by the Texas Legislature may open some eyes and begin the inevitable process toward enlightment and a big "I TOLD YOU SO" by none other than li'l ole HeartHawk.
And the walls came tumblin' down!
Posted by HeartHawk at 10:54 PM
Wednesday, March 7, 2007
The Bern-Rotterdam analysis, one of three major studies looking at the phenomena of stent thrombosis in Drug Eluting Stents (DES) has been published in the February 24 issue of The Lancet. The study looked at late-stent thrombosis rates (>30 days after stenting) from 2002 to 2005 for Sirolimus-Eluting Stents (SES) and Paclitaxel-Eluting Stents (PES).
8146 patients underwent stenting at hospitals that adopted policies of 100% DES use with SES ( 3823 patients) and PES (4323 patients). A total of 152 angiographically documented stent thromboses occurred, of which 61 were late-stent thromboses. The rate of stent thrombosis was 1.3 per 100 person-years with a cumulative incidence of 2.9%.
Rates of early-stent thrombosis were similar for the SES and PES but were more common in PES-treated patients (1.8% vs 1.4%). The authors cautioned that the rates for the 2 stents cannot accurately be compared since PES tended to be used in more complex lesions and follow-up in these patients was not as long as it was for the SES patients.
Of note was the fact that 87% taking dual antiplatelet therapy (aspirin and Plavix) experienced early stent thrombosis (<30>
Two unanswered questions remain.
1. Is the higher risk of DES stent thrombosis offset by the reduced risk of stent restenosis as compared to bare metal stents (BMS)?
2. What critieria could more effectively conclude which patients would be better off using DES versus BMS.
If nothing else, two conclusions can also be drawn.
1. We have begun to quantify DES risks so we will soon have metrics to compare different DES technologies versus BMS and under what circumstances each provides the best outcome.
2. It is still better to prevent heart disease using a proactive approach such as heart scans, lipoprotein analysis, and proper preventive measures than to wait until a stent is the only option.
Posted by HeartHawk at 12:16 AM
Monday, March 5, 2007
Every Monday, my local "big-city" newspaper publishes a special health section which I, of course, always read. The first thing I noticed was a lead article about garlic. The headline read, "Crushing garlic may cut loss of healthful compounds." Although over half the article discussed the recent study showing garlic had no LDL reducing effects (something I blogged about last week) the newspaper felt that "crushing garlic" was the story.
But, what really caught my eye was a small, inset feature beneath the garlic story titled "Know-It-All Facts." In this week's edition they published a brief on modifiable and unmodifiable risk factors for heart disease. One of the "unmodifiable" risk factors listed was "age" followed by this statement, "About 83% of coronary disease occurs in people 65 and older." The statement was attributed to the American Heart Association. TALK ABOUT GETTING IT COMPLETELY WRONG! Perhaps 83% of of heart attacks, strokes, angioplasties, by-passes, and other catastophic coronary events occur in people over 65 but, make no mistake, those person's coronary disease started LONG BEFORE they were 65!
The above incident is further proof that the general public, with the aid of the traditional medical establishment, continues to be misinformed and misled. What the hell are they trying to say, that I should not be begin to worry about heart disease until I am 65, when it is too late to do anything but go under the knife? Thanks, AHA, for nothing! Heart disease is NOT a plumbing problem, it is a prevention problem. It starts early (well before age 65), is chronic, and only catastophic if you fail to take early steps to head it off.
DAMMIT, this is pure malfeasance and malpractice! What else can you call it when the tools and technology are there to prevent catastophic disease but doctors continue to let it go so they can carve you up? But the day is coming when the medical establishment, insurance companies, and the rest will pay. CLICK HERE to read about how it is going to happen!
Monday and grumpy!
Posted by HeartHawk at 9:44 AM
Tuesday, February 27, 2007
Alas and alack, another supposed cholesterol reducing supplement bites the dust! This time, a double-blind, placebo-controlled study revealed that GARLIC has absolutely no effect on LDL or HDL cholesterol nor triglycerides. See the full text at Archives of Internal Medicine 2007; 167:346-353 or view the abstract by CLICKING HERE (these may require free member registration)
On the lighter-side, I gotta say this had to be one of the most enjoyable studies to participate in. In order to keep the study blind, volunteers all ate daily gourmet sandwiches in addition to taking supplements in order to mask who was receiving natural garlic (via the sandwich) and who was receiving the active ingredients in pill form. Which brings me to the question of the week, "What the heck did they use as a placebo in place of raw garlic in the sandwiches?!"
The researchers were quick to point out that while garlic is useless for lowering LDL cholesterol (as originally thought), it does not mean it does not have some other unknown effect on atherosclerosis. That is scientific CYA-speak for "it's about as effective as eating dirt." Garlic is a healthy food to be sure, it just won't lower your cholesterol.
Dr. Gardner, the head researcher put it best, "You just can't go out and have an Egg McMuffin for breakfast, a Big Mac for lunch, and a clove of garlic later and think you're okay. That's not the way it works. I really hope the take-home message from this is, if you're going to use garlic, use it in humus on whole-wheat bread, or in an Asian stir-fry full of vegetables, all power to you. That's where garlic is really good for you: do that."
Posted by HeartHawk at 4:56 PM
Wednesday, February 21, 2007
Sunday, February 18, 2007
I was recently reminded of the the outrageous actions of one Dr. Chae Hyun Moon. Dr. Moon was the former Director of Cardiology at Redding Medical Center where he was the subject of an FBI investigation in 2002 for performing hundreds of unnecessary heart procedures including open heart bypass surgery. Redding is owned by what once was the second largest for profit hospital chain, Tenet Healthcare Corporation.
Moon often lied to patients after routine tests telling them that they needed immediate surgery or face a quick and certain death. Had it not been for one lucky priest who was intercepted on his way to heart surgery by an honest doctor that read his charts, Moon might still be practicing today. Moon once bragged he did 1900 procedures in ONE YEAR! Do the math, that's over 5 per day! It is no wonder that among the less serious charges against him were failure to provide adequate post-surgical care and patient medical records.
The most chilling aspect of this case is that Moon's butchery dated back well over a decade. Local doctors were afraid to fight this respected "quack" and the profit-driven monster behind Tenet Healthcare. A rival hospital finally required that all their patients sent to Moon must be monitored by their own Cath Lab Director in 1996. They knew what was going on and opted to cover their own asses while allowing Moon to continue to malpractice on other hospital's patients! Unbelieveably, these restrictions were eased after Moon sued the hospital - and I kid you not - for restraint of trade!!! The Medical Board of California did not get around to suspending Moon for nine months after the FBI raid on Redding Medical Center.
In the end, Moon faced no criminal prosecutions and finally had to give up practicing only because he was unable to secure medical malpractice insurance. It is a sad day when our last and only line of defense is the INSURANCE COMPANIES! If you or I started cutting into people for no good reason we would be labeled perverts, sadists, even murderers and would would be spending our retirement behind bars. Can I possibly impress upon everyone how imperative it is to take responsibility for your own health and to seek multiple opinions?
Maddeningly, this "healthcare holocaust" was no wake-up call to the field of interventional cardiology. When did a medical degree become a license to destroy lives for profit? Even as I write this blog there are young cardiologists out there exclaiming, "I have to find a way to do more procedures!" That, my friends, is an actual quote and it makes my skin crawl. BEWARE: The butchers are still lurking. Don't be led like a sheep to slaughter. You need not be the next victim.
Sleep well (if you can),
Posted by HeartHawk at 6:04 PM
Tuesday, February 13, 2007
Sometimes the report from the heart health front lines just makes ya just want to grin from ear to ear. EPIC, a major multi-center study (519,978 participants in 23 centers located in 10 European countries) was the first major study to establish the value of a Mediterranean diet (including wine) in reducing overall mortality. A recent EPIC cohort study (a sub-group with no previous history of heart disease) followed 23,681 individuals for over 6 years and found that working men who take a mid-day "siesta" had a 37% reduction in fatal coronary events compared to those who did not take naps. Sorry ladies, but too few women died under ANY circumstances to make as strong of a statistical correlation between nap-taking and heart health (but there was a little)!
The details are available in the Archives of Internal Medicine.
Posted by HeartHawk at 5:17 PM
Saturday, February 10, 2007
My latest "Lame Duck" award goes to the "Biophotonic Scanner" marketed by Pharmanex. This high-tech sounding device supposedly tests your antioxidant levels by scanning your hand with a "low level blue laser light." Ostensibly, this device measure the levels of carotenoid antioxidant compounds in your skin and uses the measurement as a "surrogate" for overall body antioxiant levels, oxidative stress, and general health. Oh, really?! Let's ask some difficult questions which Pharmanex conveniently avoids answering in all their literature.
1. What are carotenoids? They are natures pigments and are indeed powerful antioxidants. For example, it is the much hyped carotenoid "lycopene" that makes tomatoes red. They also makes carrots orange (hence the name, etc., etc.). But there is a wide spectrum of carotenoids each with a different color from pale yellow to dark red. Bottomline, there are tons of them and they all emit slightly different spectral signatures. Remember back to your last physics course. Color "happens" because when electromagnetic energy (light) strikes matter it absorbs some frequencies and reflects/scatters others. You know, light energy strikes the electron cloud, momentarily elevates electrons to a higher energy level, they fall back to their normal state and release a photon of a particular energy level (i.e. frequency) that corresponds to the light you "see." Simple, right?! This brief review is background for point #2.
2. By what method does this device make the measurement? If you dig deep enough (they don't really say upfront - for good reason) you will find they claim to use Raman Spectroscopy, a method of determining the presence of certain compounds by detecting scattered laser light of certain frequencies. But, the studies they cite all report how this technique is used to measure carotenoid compounds in the macula of the human EYE (primarily the carotenoid "lutein" which has been shown to slow macular degeneration). For their scanner to work properly it would presuppose the human hand absorbs carotenoids uniformly and that HAND skin is as similar from person to person and as undisturbed by environmental factors as the macula on the retina of your eyes. Let's see, the macula is inside the eyeball surrounded and bathed by an aqueous solution and the hand is - well - God knows where YOUR hand has been! So, I think NOT you bunch of pseudo-science scam artists. Their own data shows that carotenoid concentrations per unit measurement by their device change by as much as 50% based on the population scanned! So much for accuracy!
3. What is the value of the measurement? Well, again supposedly, it is to tell you whether or not you are deficient in antioxidants. But even they admit the the device ONLY measures carotenoids. Recall point #1. Do they purport to measure every last one of the multitude of carotenoids?! There are also literally dozens of other antioxidants in the human body. Even if you were "a quart low" on carotenoids, it does not mean you are completely antioxidant deficient. And, exactly what level is considered deficient? That's a good question too. But, since the device is calibrated in the field, an unscrupulous operator can set it to register ANY level as deficient, which leads us to our final and most damning question.
4. What does Pharmanex REALLY sell? Why, antioxidant supplements, of course. What better way to bump up sales than to come up with some fancy Rube Goldberg contraption that tells you that you need their product to be healthy. They literally brag about the income opportunities for selling supplements and consumables for their "scanner."
Neat trick, huh?! This is not the first nor the last group of sheisters to pull this type of medical hoax. I have no doubt that this device measures SOME level of carotenoids in the hand, but given the variable nature of the tested substance and medium (your freakin' hand!) is it accurate? Is even an accurate measurement of carotenoids a proper assessment of health? Ahhh, probably NOT! So, if your doc, supplement clerk, or nutritionist wants to "biophotonically" test you just tell them to shove a photon torpedo where the sun don't shine!
Quack, Quack, Quack!
HeartDuck . . . oops . . . I mean HeartHawk!
Posted by HeartHawk at 9:30 PM