Sunday, June 29, 2008

AHA Builds Another Shrine to Heart Disease Promotion

I like to visit the American Heart Association (AHA) website from time to time as it is always a good source of bad advice to blog about. I mean, if the AHA practiced heart disease prevention instead of heart disease promotion I would have little to blog about. You might retort, "What do you mean 'Hawk, the AHA is trying to fight heart disease, you know, prevent it, not promote it." To which I would reply, "Read their screed!" The AHA appears to be most interested in giving you the best REPAIR medicine after you have crashed and burned rather than giving you the best crash prevention medicine so you won't need any repair.

Their latest shrine to heart disease promotion is their new web tool "Heart Profilers." It is an extensive and exhaustive piece of programmed "cyber-medicine" that purports to ". . . help you understand different treatments that may be appropriate for you based on your diagnosis, symptoms, and test results. Using this tool will help you better evaluate your options and make informed decisions with your doctor and health care team." Hardly, read on!

I decided to enroll, gave them all my personal info (so they can market to me) and answered an extensive questionnaire about my health, what drugs I take, etc. To say it was slanted toward doing invasive procedures is an understatement. When the entire process starts with the statement, "The chest pain known as angina is usually one of the first symptoms of CAD." you know you are dealing with neanderthal medicine. Yeah, I suppose if you have never had a heart scan it might come to that but by then it is too late - you're hooked into the "cut and drug" assembly line. See what I mean about their repair versus prevent mindset?

The questionnaire tacitly assumes that heart disease is first diagnosed by chest pain. Apparently, unable to take "No" for an answer as to whether I have chest pain, they go on to ask numerous questions about my non-existent angina, heart attacks, angiograms, stents, stress tests and other interrogatives that have little to do with prevention and presuppose extensive heart disease. I mean, how do you answer questions like (and there are many), "Has your doctor said you are a candidate for coronary artery surgery?" when it has not and hopefully never will be an issue? Catch the drift here? Think they are pushing invasive procedures?

Now comes the best part, the recommendations! Here are mine. "Your answers to the questions about risk factors indicate that you have no risk factors for coronary artery disease that need to be managed. " WHAT?! ARE YOU KIDDING ME?! What about the need to raise my HDL above 40mg/dl and further reduce my LDL below their 100mg/dl cut-offs. They never even asked about my sky-high Lp(a) or what my LDL particle size and particle count was (fortunately mine is fine). The fact is I have a high calcium score for my age and it is growing (thankfully not as fast as it would under AHA care). I am a heart attack waiting to happen and the AHA, after taking an exhaustive heart health history says I, "have no risk factors for coronary artery disease that need to be managed." Are they nuts?! Heck, they even HAD a question regarding thyroid disease but the results remained the same no matter if I answered I had no thyroid disease, hyperthyroidism, or hypothyroidism (which I have). Perhaps they need to read the upcoming Track Your Plaque report on hypothyroidism and heart disease! It is a HUGE factor.

It seems the bottom-line here is that the AHA is only interested in heart disease if it is so advanced that you need a procedure or drugs (no mention of supplements like fish oil or Vitamin D at this AHA shrine). I have heart disease that requires aggressive treatment yet the AHA thinks I have "no risk factors for coronary artery disease that need to be managed." What they really seem to mean is I do not need an invasive repair procedure yet. That is what I mean when I say the AHA is a heart disease promotion organization and not a heart disease prevention organization. Sign up, select the "Coronary Artery Disease" option and take the test yourself. It is the best way to experience their stunning ignorance.



Wednesday, June 25, 2008

Your Doctor Just Might Be a Gol-Darn Fool If . . .

With apologies to Jeff Foxworthy . . . your doctor just might be a gol-darn fool if he or she still does not believe in the predictive power of heart scans. The latest piece of evidence, found in the Archives of Internal Medicine, is based on data from the Multi-Ethnic Study of Atherosclerosis (MESA). Researcher Dr. Aaron Folsom remarks "our data suggest that in asymptomatic 45- to 84-year-old US adults, CAC score may be the better choice over IMT." This is a powerful statement as IMT or CIMT (Carotid Intima Media Thickness) as it is sometimes known, has long been an acknowledged "gold standard" for judging global heart attack risk by the American Heart Association (AHA), National Cholesterol Education Program (NCEP), and in the widely heralded ATP-III report.

So, if you are a 45 to 85 year old US adult and your doc gives you any heat about using heart scans to quantify your heart attack risk, look them in the eye and say, "SEE YOU LATER FOOL," and calmly walk out the door - then find a doc who is not just another gol-darn fool.

Oh and by the way if they should ask for more proof than just this study, smack 'em with these studies as well

Raggi P, Gongora MC, Gopal A, et al. Coronary artery calcium to predict all-cause mortality in elderly men and women. J Am Coll Cardiol 2008; 52:17-23.

Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008; 358:1336-1345.

Weintraub WS and Diamond GA. Predicting cardiovascular events with coronary calcium scoring. N Engl J Med 2008; 358:1394-1396. (Note this is a comment that shows how even traditionalists are starting to face the truth)

As Bugs Bunny might say, "What's up doc!"


Friday, June 20, 2008

Calling Dr. Wikipedia! Stat!

You just knew this had to be coming but I never would have believed it had I not seen it with my own two eyes! As many readers of my blog know, I have been diagnosed with Hashimoto's Thyroiditis and subclinical hypothyroidism (elevated TPO and TG antibodies, low normal T4/T3 and high normal - depending on who you ask - TSH).

Yesterday, I submitted to an ACTH Stimulation Test to examine if I have adrenal insufficiency as a cofactor in my hypothyroidism. In this test, an initial blood draw is taken to establish a baseline serum cortisol. Then, you are injected with synthetic ACTH, the pituitary hormone that signals your adrenal glands to produce cortisol, and your levels are rechecked every 15-30 minutes for a period of time (usually an hour). I guess I had my first reservations when making an advanced reservation to have the test done. I was actually at the testing hospital for another blood test (free testosterone) but, unbelieveably, they had no method for taking a reservation in person. I called the number they gave me and it was clear the nurses and techs I spoke with were unfamiliar with the test. Finally, I convince someone to meet me in their lobby and after 15-20 minutes of private consultation, paging through 3-ring binders, and calls to other staff I had my appointment.

I show up for my test and they take me to a nice room where they have numerous vials and solutions, IV's, etc. ready for me but they are still not certain about how to do the test. I suggest they simply call the doc who ordered the test for me as he has an office right in the hospital. He faxes some additional info and we are off to the races. About 45 minutes into the process I get bored. So, I saunter outside the testing room with an IV dangling from my left arm to retrieve my chart which I know will invariable be sitting in a chart holder on the wall outside the door. I always love the " how dare you" look I get from the docs and nurses who happen to see me grab my chart but there is really nothing they can do to stop me. As I begin paging through the notes I come upon the "magic" set of faxed instructions that got things moving. My eyes roll and I can barely contain my astonishment - it is a printout of the Wikipedia entry on - you guessed it - the protocol for the ACTH Stim Test. The doc had simply crossed out the optional 45 minute interval draw and accentuated the need to heparinize the blood sample.

So, the moral of the story is, the next time you feel guilty or inadequate about doing battle against an arrogant doctor armed with nothing but web research - DON'T! You may both be practicing Wikipedia medicine!



Saturday, June 14, 2008

Give Me a Freakin' Break: Need I say More?

You know, you work so hard to inform people about dealing with issues like plaque and calcium and then you stumble across this crap.

I found this on Have these people no shame? This is pure, unadulterated BS! Perhaps they should change the name of the site to just plain

I wish there was a nutrient that was 100% effective in flushing rogue con artists away!



Wednesday, June 4, 2008

What Next, Down is Up? An HDL Conundrum

Man, and I thought quantum physics was wacky stuff! Study after study has shown that higher HDL is strongly associated with cardiovascular health. HDL Cholesterol efflux mechanisms and the entire mechanics of reverse cholestrol transport have been proposed, studied, and experimentally observed. Now this!

In what could be a landmark study recently published in the Journal of the American Medical Association, researchers conducted a meta-analysis of the data from the Copenhagen City Heart Study (over 9000 persons with two decades of followup), the Copenhagen General Population Study (an ongoing study of over 30,000 persons), and the Copenhagen Ischemic Heart Disease Study (2500 persons referred for angiography). The conclusion, "Lower plasma levels of HDL cholesterol due to heterozygosity for loss-of-function mutations in ABCA1 were not associated with an increased risk of IHD." The lead investigator added, "The principal finding of this study is that heterozygosity for loss-of-function mutations in ABCA1 associated with substantial, lifelong lowering of plasma levels of HDL cholesterol, but not with corresponding higher levels of plasma triglycerides or atherogenic remnant lipoproteins, did not predict an increased risk of ischemic heart disease."

Now, let's review their findings - this time in English! The researchers looked for mutations in a key gene (ABCA1) that lowers HDL Cholesterol (HDL) and reduces cholesterol efflux from the artery wall but does not affect triglycerides. As expected, the group with the mutations had an HDL that averaged 17mg/dl lower than the general population and that 17mg/dl reduction should have translated to a 70% risk increase based on the results of the Copenhagen City Heart Study. However, this low HDL group did not appear to have any more risk than average. It was only in the presence of low HDL and high triglycerides that they found higher heart disease risk.

The findings suggest that, although low HDL is consistently associated with higher heart disease risk, it is not, by itself, a cause. The practical implication is not to dismiss low HDL as a marker for heart disease but to question its true role. It further suggests that simply raising HDL (as is the target of many new drugs such as CETP antagonists) is not enough and it must be considered in relation to other factors that often appear in conjunction with low HDL such as high triglycerides. Of course, this provides additional validation for the 60/60/60 Track Your Plaque principle. Keep that HDL high and those TGs low!

Wacky stuff!


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