The New Hub-Bub Over Metabolic Syndrome

Metabolic Syndrome has long been identified as a risk factor for heart disease. However, idientifying exactly what it is and what its cause or causes are has been a subject of much debate. Now, a new study published in Cell Metabolism has thrown the issue into a full-fledged brouhaha over whether Metabolic Syndrome is a multi-cause condition or more simply a single cause condition with multiple symptoms. For example, is small-LDL a contributor to a diagnosis of Metabolic Syndrome or is some other single root cause driving a host of symptoms such as small-LDL to appear.

The Multi-Cause camp has labored long and hard at defining what group of causes is sufficient to render a diagnosis of Metabolic Syndrome. Different organizations have different standards but all require having some combination of common symptoms such as:

• Presence of diabetes
• Microalbuminuria
• High blood pressure
• High triglycerides
• Low HDL
• Overabundnace of small-LDL
• Insulin resistance
• High fasting blood glucose
• High waist to hip ratio

Here are links to the various guidelines NCEP ATP III (what most U.S. doctors use), American Heart Association, World Health Organization (pages 32 and 33), European Group on Insulin Resistance (EGIR).

This latest study by the Joslin Diabetes Center focuses on insulin resistance in the liver as the key factor in the cause of metabolic syndrome and its association with heart disease. It advances the theory that metabolic syndrome is not simply a collection of abnormalities that should be treated independently but a group of closely linked disturbances in glucose and cholesterol metabolism that stem from a defect in insulin signaling in the liver. This thinking suggests the cure for Metabolic Syndrome is not to treat a variety of symptoms but rather to find and treat the underlying cause perhaps with a single "magic bullet." This is tantatmount to treating and eliminating a cold virus rather than treating the associated symptoms aches, sore thoat, congestions, and sniffles associated with the cold.

OK, great! Now let's find that magic bullet!

HeartHawk

Do YOU Worship at the Alter of LDL Cholesterol?

Many years ago, doctors would simply measure total cholesterol and call it a day. As the snail-slow medical community progressed it identified LDL Cholesterol as the "bad" guy and basically did little else for decades but beat up on LDL and develop LDL lowering drugs like statins and, more recently, ezetimibe. But a funny thing happened on the way to the temple.

Much like the COURAGE trial delivered a much different than expected result on stenting (it's not much better than drug therapy for non-acute heart disease) , the ENHANCE trial found that lowering LDL with ezetimibe provided little improvement in outcomes. Track Your Plaque proponent Dr. William Davis often opines, "The average LDL Cholesterol of a heart attack victim is 134mg/dl, the average LDL Cholesterol for someone who does not have a heart attack is 131mg/dl." It is a statistical dead heat!

The latest theory is that what matters most is not merely how low you drive LDL Cholesterol but how you go about lowering it (statins deliver pleiotropic effects beyond simply lowering LDL). Ezetimibe can dramatically lower LDL when taken in combination with a statin. You have probably seen the commercials for Vytorin (simvastatin plus ezetimibe) that proclaim it treats the "two sources of cholesterol" (genetic and dietary). The ENHANCE studiers naturally expected to prove ezetimibe was a blockbuster drug that whose LDL lowering effects would earn billions. But it didn't happen. Moreover, the researchers were accused of delaying publication of the bad news.

Dr. Eric Topol has an interesting Video Blog on the subject that is worth the 4-1/2 minutes of your time to see and hear. He suggests that the true cuplrit is oxidized LDL. It makes a lot of sense as we begin to "peel back the onion" on LDL Cholesterol. Stay tuned! You know my next move. Find a test for it so I can hang on number on it!

Regards,


HeartHawk

Is Your Aspirin Resisting You?

Like most of you I take aspirin daily, 325mg. Even traditional cardiologists recommend aspirin for heart disease sufferers. Aspirin works by interfering with the generation of thromboxane A2 (TXA2) which is needed for platelet aggregation (clotting). The COX-1 enzyme acts on arachidonic acid (AA) to produce endoperoxides that in turn produce TXA2 . Aspirin interferes with the generation of TXA2 by irreversably acetylating the platelet COX-1 enzyme thereby blocking its access to AA. Because platelets are anucleate, they cannot generate additional COX-1. In the absence of TXA2, platelet aggregation does not occur. Got all that?!

Most practitioners prescribe anywhere from 81mg to 325mg. Studies such as CURE suggest 81mg is optimal. The ISIS-2 study puts the dose at 162mg (for recent heart attack sufferers) and, frankly, since aspirin is so cheap, many (like me) simply make the leap to "more must be better." Ahh, but there are downsides to higher dose aspirin, among them bleeding and stomach problems (me again). But there is another dosing consideration, aspirin resistance, a reduced response to aspirin that one study suggests affects 27% of the general population.

Once again, like many of you, I am also a Track Your Plaque convert (see my early posts and disclaimers). As a numbers geek it appeals to me to have hard data to track and make intelligent decisions about controlling my heart disease. So the question those like me have is, "Is there any way to determine if I am aspirin resistant and if so, how resistant am I and how much aspirin do I need to take?" The biggest problem is that there is currently NO clinically valid definition or measurement of "aspirin resistance". However, here is the latest on available tests to provide some answers.

The PFA-100 is US Food and Drug Administration (FDA)-approved to detect platelet dysfunction, von Willebrand disease, and aspirin-induced platelet inhibition. The instrument measures collagen-induced platelet plug formation as time in seconds to occlude an aperture. Its sensitivity as a screen for platelet dysfunction is approximately 95%.

The VerifyNow Aspirin Assay is FDA-approved for detection of aspirin-dependent platelet aggregation. Its sensitivity as a screen for aspirin-induced platelet dysfunction is approximately 91%.

PlateletWorks is FDA-approved to detect platelet dysfunction due to inhibition secondary to diet, aspirin, and/or other drugs. PlateletWorks has limitations. There is a very short time allowed -- 10 minutes -- between sample collection and assay. Also, there may be unacceptably high false-positive rate because of interference by dietary substances such as chocolate and red wine.

AspirinWorks is FDA-approved to provide a quantitative measurement of aspirin-induced inhibition of TXA2 generation from a urine sample. Results are ranged in quartiles with different quartiles represent differing degrees of risk for heart attack. A patient whose results are in the first quartile has a relative risk 1 (average). A patient whose results are in the second quartile has a 1.3 times greater risk of heart attack than a patient in the first quartile. A patient whose results are in the third quartile has a 1.5 times greater risk, and a patient in the fourth quartile has twice the risk. As with many lipid tests, there are still problems to work out in comparing results based on different assay methods.

The bottom-line is there is no perfect way to determine to what degree you are aspirin resistant but the technology is improving. However, if you are looking for some way to put a hard number on where you stand there are several interesting tests available. For now, I simply take the high-end of the dose range until my tummy starts to hurt then take a break or reduce my dose.

Regards,


HeartHawk

New Year's Eve: A Cure for Lp(a) Sufferers?

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!


HeartHawk

The Revolution Moves Forward: It's About(.com) Time

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!


HeartHawk

Great Resource for Understanding Clinical Trials

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.
http://www.medpagetoday.com/Medpage-Guide-to-Biostatistics.pdf

Enjoy,


HeartHawk

Cypher Stent Commercial: Not Very COURAGE-OUS

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.

Cypher Video

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!

Yuck,

HeartHawk

Over the Edge. Cypher Stent Commercial Goes Too Far

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!

HeartHawk

OK, This is Too Cool To Miss!

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!


HeartHawk

Diet: This is getting spooky real FAST!

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.

Regards,


HeartHawk

And Now, Even the Stent Mongers are Starting to GET It!

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.

Stay tuned,


HeartHawk

FINALLY! A Few Docs that GET it!

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!

Regards,


HearHawk

Breaking Medical News - The Pope is Catholic!

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!

Regards,


HeartHawk

Blessed with Brilliant Commenters

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!

Regards,


HeartHawk

It's STILL About the Plaque, Stupid!

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!


HeartHawk

The Davis/Walton-Shirley Dilemma - What's the Answer?

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?


HeartHawk

Dr. Melissa Walton-Shirley States Her Case

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.

Regards,


HeartHawk

I told you so ... you Yahoos!

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!


HeartHawk

You Just Might be a Yahoo if . . .

. . . if you get all your heart health info from Yahoo!

Now, don't get me wrong, Yahoo is a fine search engine. Heck, how could I have made the above obervation if I never used it? But, it is yet another example of how hopelessly confused and inadequate traditional, mainstream medicine is.

The latest example can be found at Yahoo Health in a Heart Health nutrition quiz authored by Simeon Margolis, M.D., Ph.D. (although I also must admit that as a basketball junkie I am thoroughly impressed that Dr. Margolis still holds the record for most points scored in a game at his prestigious alma mater, Johns Hopkins). However, in question #5 of the quiz, the good doctor dismisses the heart health value of a long list of supplements - including Vitamin D! There have been numerous reports and studies published in the last year that support the use of Vitamin D supplementation as a preventive measure for heart disease. I am sworn to secrecy but I know of a small clinical study (which won't be available for at least six months) that will validate the latest research about the ability of Vitamin D to actually reverse heart disease. That study is too small to provide conclusive proof but the data is astounding.

The point is that many, if not most, physicians today are hopelessly out of date and out of touch with the fast pace of heart disease detection and prevention. So, at the risk of endless repetition, get your information from as many sources as possible. Relying on the advice of your local physician, or even the celebrity docs on Yahoo!, could be a fatal mistake!

Yippity Yahoo,

HeartHawk

It's the Plaque - Stupid!

I remember when I first met Dr. William Davis and we discussed the book he was writing titled "Track Your Plaque." My first thought was, "What a goofy name!" In retrospect, focusing on plaque and methods to track and reverse it was brilliant.

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!


HeartHawk