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