Why Is It That Nothing Is Ever Easy?

Thanks go to Michael for asking an interesting question about why I stopped an antibiotic regimen. It points to difficult decisions we all make, some esoteric questions about using statistical analysis, and how heart disease can make your head spin.

I stopped the doxycyline because the effect (MMP suppression) is supposedly durable (its effect is permanent according to the initial studies but we have no long term data yet). I don't yet understand the durability aspect and am researching it (this all new stuff). The azithromycin was stopped because all the studies said it was worthless. So what remains is my anomaly. Here is the problem.

In a statistical sense we are all sample populations (the variable "n" in a statistical analysis) of one. As we all intuitively know, an "n" of one is not large enough to make an inference about a larger population in any analysis. However, that does not mean that "nothing" happened. It just means we cannot infer the same outcome will occur in another population (i.e. someone else). Also in statistical Design of Experiments (DOE) there is the problem of "confounding factors." In layman's terms, it means we all take so many damn medications, supplements, eat different, live different, etc. that it is often statistically impossible to determine with any confidence that a particularly factor (taking an antibiotic) was the primary or even contributing factor in any outcome (disease reversal).

So here I sit. After six scans, the ONLY time I either stopped progression or significantly limited it (below 10%) is in years when I took a course of antibiotics. Now every cardiologist I know who is up on the latest studies will tell me I'm nuts if I think the antibiotics had anything to do with limiting plaque growth. Remember, the doxycycline is to reduce MMP which inhibits plaque rupture, not plaque growth and large scale studies show azithromycin (one-time thought to be a magic bullet) to be worthless. Taking long-term antibiotics without hard proof of some beneficial effect is pretty stupid for obvious reasons. So what the hell do I do?

Now don't get me wrong. There is another possible explanation here and that is this newly postulated effect where niacin loses its effect against lipoprotein(a) which is my real problem. As I mentioned earlier, I am about to take a baseline blood test before withdrawing niacin and then restarting it later (yeah, yeah, HeartHawk, the human test lab). The bottom line here is that even I have doubts, suspicions, and anxieties even though I study this stuff almost everyday and can dice up the statistical data like a Japanese teppanyaki chef. Yup, heart disease can make you a real head-case. And I bet you thought you were the only one going crazy!

Hey, misery loves company.


HeartHawk

Cholesterol: How Low is Too Low?

In my last post I talked about how cholesterol is measured (often erroneously) and mentioned a test where mine was down to 25. Well, you can imagine how my eye-brows and ears shot up when I saw that number (think Mr. Spock). So, like any good consumer advocate I dug in to answer today's question, "How Low is Too Low?" I did not know whether to laugh or cry when I discovered what currently has the traditional medical community's collective undies in a bundle over this issue.

First, let's give the short answer. Nobody knows what is too low but most cutting-edge cardiologists "guestimate" about 40-50 mmol/L just to be safe. Now, on to the fun. An obscure study published in the technical journal Laboratory Investigation shows that cholesterol blocks the damaging effects of alcohol on the Sonic hedgehog protein of zebrafish embryos. I SWEAR AM I NOT MAKING THIS UP! Here is the link if you need a laugh or are suffering from insomnia. http://www.nature.com/labinvest/journal/vaop/ncurrent/full/3700516a.html

Apparently, some nut-job alarmists in the medical community (and probably the anti-drug zealots) are waving this all over the press as evidence that we should rethink the use of statins and lowering cholesterol. Are these people FREAKIN NUTS?! Sonic hedgehog protein? Zebrafish embryos? For Christ-sake this was a study investigating Fetal Alcohol Syndrome Defects. Talk about a leap. I'd have a better chance of making a leap over the Grand Canyon. Lord knows I am the first to begin speculation over arcane research but this . . . this is just over the top even for me! Let me explain it this way.

1. The head bone is connected to the neck bone
2. The neck bone is connected to the back bone
3. The back bone is connected to the butt bone.
4. Ergo, these guys have their heads up their butts!

I am ALWAYS looking for an interesting theory, titilating speculation, or a good conspiracy. But when I am looking for nuts, I'll stick to pistachios (well, almonds and walnuts are actually better for you, but, as I always say, that's the subject of another blog). Well, I did learn something. Sonic Hedgehogs are not just for video-games anymore!

My personal advice, keep taking your cholesterol medication until your doctor tells you not to.

Sheesh,


HeartHawk

The Great Cholesterol Testing Scam

We have probably all been to see our doctors on multiple occasions to have blood drawn for a "lipid panel" particularly those with diagnosed heart disease. Few probably suspected that their LDL Cholesterol was off by as much as 100%. You might think, "How can that be, this test has been adminstered for decades and seems to be accepted everywhere." Unbelieveable as it may seem, here is the sordid truth!

The standard test for cholesterol, the one in use in the overwhelming majority of clinical medical practices was developed in the 60's by a lipid researcher named Dr. Friedewald. It measured Total Cholesterol, HDL and Triglycerides and then LDL was ESTIMATED (your doctor will say "calculated" but this suggests accuracy that just isn't there) by this formula:

LDL = Totol Cholesterol - HDL - Triglycerides/5

It was already acknowledged that this estimate would be off if the subject had high triclycerides (above 400) or failed to fast before the test (which many patients lie about - come on, admit it).

This was great in the 60's before the advent of newer technologies but, as you will hear me repeat early and often, medical practice typically lags technology by a decade or more. Just add up the numbers: 4 years of medical school plus 3 years of internship and residency, plus the time it takes for modern technology to reach the text books means your doctor is already years behind modern technology the day he starts his practice.

Let's look at a real life example. I recently had a lipoprotein analysis done via one of the latest technologies, Nuclear Magnetic Resonance Spectroscopy. It showed my LDL to be 55 (and subdivided it into 3 more components by size and gave an exact particle count). I then repeated the test using the old method which reported my LDL to be 25, off by more than 100% (depending on how you stack the comparison). For me, you might say, "Damn, 55 0r 25 what's the difference, they are both low." and you would be close to the truth. But let's say my real LDL was 200 but the test said 100. That is the difference between a diagnosis of "no treatment needed" and "let's get you on a statin ASAP!" Get the picture? Yes, the older way is cheaper. But tell me, suppose you go skydiving. You want a cheap parachute that works "most of the time" or an expensive one that works all the time? Hey, it's your life!

Which leaves me where I often end a rant. Most doctors (and hospitals and insurance companies) are hopelessly behind the curve. If you want to do everything you can to ensure you get the most modern treatment, you have to get involved, do your homework, and question everything.

Remember, only you can prevent blissful ignorance,


HeartHawk (with apologies to Smokey the Bear)

Now That Torcetrapib is History, What Next? A "Must Read" on the Future of Heart Disease Drugs

By now I am certain most of you have heard that Pfizer's new investigational HDL raising drug "torcetrapib" has gone bust (tests show it kills more people than it saves). I, for one, was greatly disappointed because low HDL is one of my problems and this new CETP inhibitor was the most promising drug in the pipeline with any chance of being available anytime soon.

For those interested in what is still "in the pipeline" and the future of reverse cholesterol transport drugs (yup, actually sucking cholesterol out of arteries rather than putting it in) this update from "TheHeart.org" is a must read. Go to http://www.theheart.org/viewArticle.do?primaryKey=764787&nl_id=tho23jan07 You will need to sign up as a member to view the article but membership is free. It is the most complete review I have yet to come across (and I see a lot). Remember, this site is funded by drug companies so take the info with a grain of salt but it is comprehensive nonetheless.

Be sure to read about the results of ETC-216 which reversed heart disease in just 5 weeks in 36 test subjects. I had been following the research of Esperion (the company developing ETC-216) and even ordered and received an investment prospectus. Dammit, I missed pulling the trigger on buying the stock literally the week before Pfizer bought them then cried as the stock rose 700% - boo hoo!

Enjoy,


HeartHawk

Unleash the Hounds!

The HeartHawk Blog is now open for anonymous comments (i.e. you do not have to register with Google). My feeling is, "the more the merrier." Let me know if this becomes a problem!

HeartHawk

Pills, Pills, and More Pills! Some Answers

Wow! I guess people like to talk about pills. Here are some answers and comments about your comments.

1. Neil - I have used both l-arginine (to improve endothelial function) and l-carnitine (to reduce lipoprotein(a)) in the past. There is plenty of evidence for l-arginine on carotid plaque and improving endothelial function so theoretically it should be good for the heart. L-carnitine shows mild reductions in lipoprotein(a). Unfortunately, neither did much for me and they are both expensive as hell. I will probably start taking l-arginine again as I catch up on the new studies (it also has a mild effect similar to Viagra - heh heh!). About that magnesium citrate. It's often used as a big time laxative! However, magnesium supplements are good for improving heart rhythm. What's the dose?

2. Michael - let's talk about that calcium score. Have you had a full lipoprotein analysis? Your other numbers are great (mine are "kick-ass" as well except for lipoprotein(a) which is my scourge). There could be other problems such as particle size, particle number, or HDL2b subfraction percentage. Plus, there are some other things I will blog about in the future such as taking doxycycline to inhibit Matrix Metalloproteinase (MMP) (stuff that make stable plaques rupture). I took a six month course of it. What is really cool is what my dentist told me it did for my teeth (remember that gum disease heart disease link - more later in a future blog). It really got me thinking! E-Mail me if you what to discuss your situation privately. Either way and I'll try to run it past Dr. Davis next time I talk with him.

3. To all regarding Vitamin D. Look up Dr. Cannell on the web for his groundbreaking work with Vitamin D. Track Your Plaque did an interview article sometime back (which is unfortunately part of the closed member content - but I'll work on that). Damn, I'm good! It's now available, open to the public for free at this link http://www.trackyourplaque.com/library/fl_03-006cannell-d.asp This round is on HeartHawk!

I meant to blog about "the great cholesterol testing scam" but since we got so many comments on the pills I held off. That will be next!

Regards,


HeartHawk

Hey! I feel smarter already!

In my last blog, I mentioned I still take a B-Complex vitamin largely for the ability of folic acid (Vitamin B-9) to reduce homocysteine even though the latest medical trials (WAFACS, HOPE-2, NORVIT, and VISP) all question whether this results in reduced cardiac events.

However, the Lancet (a respected British medical journal) reports in its January 20, 2007 edition, that a secondary conclusion of the FACIT trial shows folic acid does improve cognitive function. Also, the November 25, 2006 issue of the British Medical Journal reports that combined evidence from cohort, genetic, and randomized controlled studies is indeed strong enough to support a modest protective effect of this nutrient.

I guess I'm smarter (at least cognitively speaking) than I thought!

Still flying high,


HeartHawk

Just for fun, let's brag about the pills we take

Talk about getting old! Each and every day I take 11 different drugs and supplements for a total of 19 pills to fight my heart disease. Anybody else who wants bragging rights feel free to comment and claim your throne as the king of pill takers. If nothing else it will make the rest of us feel better. So, just what is old HeartHawk taking? Well, here is the list with a little descriptive commentary on why. As always, consult your physician before taking any new drug or supplement

Niacin: Perhaps the most underappreciated supplement niacin lowers bad cholestrol (LDL), raises good cholestrol (HDL - probably better than any prescription agent), lowers triglycerides, and is about the only good agent for lowering lipoprotein(a) (lp(a) is what's trying to kill me) and it is cheap. It also shifts LDL particle size toward the less deadly large size. I choke down 3, 1 gram horse pills every day. I take a prescription brand called Niaspan because I take so much and it has a lower incidence of side effects.

Rosuvastatin: Sold under the brand name Crestor, it is one of the newest and most effective statin drugs available for lowering LDL. It also modestly raises HDL. I buy it in 10mg form but split the pills and take 5mg per day (it's that effective and cheaper)

Ezetimibe: Sold under the brand name Zetia, it works differently from statins (which work in the liver) by blocking cholesterol in the intestines. When used in combination with statins it is especially effective in lowering LDL (mine was down to 25 at my last blood test but that is the subject of a future rant). 20mg is the standard dose.

Fenofibrate: I take the Tricor brand. This is the latest in a new class of drugs called fibrates that are PPAR-alpha (peroxisome proliferator-activated receptor - say that 10 times real fast) activators. Fenofibrate seems to have a lower incidence of side effects than other fibrate drugs. It lowers LDL, raises HDL, lowers triglycerides, lowers lp(a) and shifts cholesterol particles toward the better large size. I take 145mg daily as I prepare to take a "niacin vacation." I seem to be exhibiting an interesting and anecdotally noted effect where the niacin fails to be effective against lipoprotein(a) after extended use. Stopping then restarting niacin seems to restore the anti-lp(a) effect (theoretically). I have completely stopped the progression of heart disease during periods when my lp(a) is reduced to about 30mg/dl.

Esomeprazole: You know, the little purple pill -Nexium. Here is what sucks! I take 40mg of Nexium daily because all that other crap upsets my stomach. Great, I take pills to counteract the other pills. Wait, it gets better! Read the next entry.

Co-Q10: Good old Co-enzyme Q10. I take 120mg per day to counteract the muscle pain and weakness induced by statins. Hey, it works and is generally good for you anyway.

Fish Oil (Omega-3 Fatty Acids): This is the motherlode of all supplements and I take four honking 1200mg pills per day. It does everything - reduces inflammation, clotting, lowers triglycerides and small LDL particles. If you take only one supplement, make sure it's this one. In one study it lowered risk of heart attack death by 45%.

Aspirin: Need I say more. Unless your doctor advises against it - take it.

Vitamin B Complex: I take this mostly as a hedge against homocysteine. The link here is growing tenuous but heck, I've been taking it for 6 six years. It's a habit.

Vitamin C: The same goes for Vitamin C. Despite the shaky claims of Drs. Linus Pauling and Mathias Rath (kinda kooky in my opinion) the evidence for Vitamin C is just not that strong. But, it is a cheap anti-oxidant and at least I know I won't get scurvy! I take 1000mg per day.

Vitamin D: There is growing evidence that Vitamin D may be the newest "must have" supplement for heart disease sufferers (especially if you live in a region without a lot of sun). I know Dr. Davis of Track Your Plaque swears he is seeing more and more clinical evidence of plaque reduction in his practice among Vitamin D takers. I am a little more skeptical but his success is hard to argue with. I take 4000IU per day. 'Nuff said!

So there is my laundry list. Any challengers?

HeartHawk

The best stent is still no stent - reloaded

I recently wrote an article for Track Your Plaque warning of the problems with stents and that heart disease sufferers should not consider them a quick fix for a lifetime of heart health indiscretions. While a stent still beats open heart surgery, bypasses, and death it is also still a sign of failure to beat the disease. Unless you intervene and prevent or reverse your disease, you will likely need additional procedures and the stents themselves carry new risks. Let's review them.

1. Inserting a stent, though minimally invasive, is still a surgical procedure that carries risks. You also get a boatload of radiation (remember, they are basically x-raying you during the entire procedure).

2. Bare metal stents are notorious for rapid "restenosis" (re-narrowing) requiring repeat procedures.

3. Drug Eluting Stents (DES) were hailed as a "cure" for restenosis but exhibit their own problem - clotting. Remember, it is a clot that causes most heart attacks. Even the best and brightest docs do not yet know why. Worse, they state that patients receiving DES may have to adhere to a dual anti-platelet regimen (usually Plavix and aspirin) for years, maybe forever! This carries increased bleeding risk (think bleeding ulcers and hemorraghic stroke). They even advise temporary discontinuance for dental procedures.

4. Unbelievably, stents are often used "off-label." Yeah, that means docs use them in ways that are not in compliance with manufacturer and FDA recommendations. That's right, it means they are experimenting on you and it's legal! Scary thought, hey?!

For the real heart health geeks like me who want more here are some of my sources. Warning, be prepared for cutting edge docs using medical geek-speak! But, the frank behind the scenes discussion will open your eyes to how modern medicine works. It ain't as pretty as they lead us to believe!

TheHeart.org Continuing Medical Education Program on Stents: Cutting edge medical techno-geeks get into it on video. You must sign-up as a TheHeart.org member but it's free.

Drs Eric Topol and Rob Califf discuss the recent FDA meeting on drug-eluting stents: Another TheHeart.org presentation.

Remember, heart procedures mean you are losing the battle and need to work harder. So unless you have admitted defeat - get moving. We can beat this thing!

Get involved and stay alive - and well,


HeartHawk

Information Please

The biggest problem you will have in fighting heart disease is the woeful lack of information about new discoveries concerning why heart disease occurs, how heart attacks happen (it's not what we were led to believe), and successful medical treatments for preventing and even reversing heart disease.

Check out the links section of this blog for useful websites that I use to collect information. But, be wary. There is no such thing as free lunch. Take note of who is paying for the website. If it is a drug company you can bet all the information is slanted - but it is information nonetheless. Just be certain you properly filter it and adjust for the bias.

At the top of the list is the Track Your Plaque website. This is a paid membership site but also has a lot of free information including a free book titled "What Does My Heart Scan Show?" (I wish it had been available when I got my heart scan) and a free newletter. The medical director is cardiologist Dr. William Davis. I found Dr. Davis during my initial research. Suffice to say I have fired all my other doctors. He gets it! If you are looking for cutting-edge and aggressive help, this is where you will find it. DISCLAIMER: I also helped launch and administer the website (yeah, I'm a computer geek too) for which I have been paid the princely sum of zero dollars and zero cents (well, OK, I do get a free membership worth $6.65 a month). But, hey, this is the Internet. You never know where the next Google or YouTube will come from! The first clue will be that I start posting from Tahiti instead of the Midwest!

Some of the other sites such as Medscape are also membership sites and are free to join (they are generally paid for by drug and medical device manufacturers as opposed to consumers so guess whose side they are on). Regardless of the motivation they are still useful sites for information gathering. Part of the beauty of the free market is that whoever is paying for the site will certainly trumpet their own success and cast themselves in the best light but they will also criticize the competition and point out their failures. The trick is to get your information from MANY sources to provide the proper balance.

Then, of course, there are the traditional sites like the American Heart Association. These are a good place to get statistics (i.e. what happened in the past) and, unfortunately, old news. But, they are a good place to go and verify (perhaps 1-5 years later) what you found elsewhere.

This blog is here to help but, remember, the person MOST interested in keeping you alive is YOU!

Get involved and stay alive,


HeartHawk

In the beginning . . . the doctors really pissed me off!

The clock began ticking for me one day when I was 14 years old. My grandfather took me to the beach and bought me TWO ice creams. That night he died of a heart attack at age 65. Twelve years later his son (my uncle), a strapping fireman, had dinner, laid down on the couch, and died of a heart attack. The ticking became louder. Two decades later my mother was at a party in Memphis. That night, in a hotel room with her friends, she said "I feel dizzy." Those were the last words she spoke. That night the ticking became unbearable.

These people were all healthy, vibrant, and symptom free one moment and dead the next. But, heck I was even healthier, exercised vigorously 3-5 times per week (I'm a basketball junky), and ate pretty well. I had just come from the doctor who checked my cholesterol. He told me, "I have seen 50 people today and your cholesterol is lower than ALL of them. You don't need any more tests. Go home and relax." But, just to be safe, I had a heart scan anyway and there it was - heart disease.

That first week was hell. I was afraid to do anything and could not find anyone to explain what the heart scan meant. My doctor told me not to worry, that anything there had been there for a while. I searched for the top cardiologist in the area and prevailed upon him to do a "nuclear stress test" (needles, radioactivity, and lot's of expensive machines). The results were negative but I pressed the cardiologist for more. He finally gave me a prescription for Lipitor.

That's when I got mad. I thought, "these guys are quacks!" The heart scan says I have heart disease but the best docs and technology say I have no problem. To top it off, they hand me a prescription to lower my cholesterol. What the hell!? My cholesterol is already really low. How can that be the source of my problem?

That was six years ago. The real problem, then and now, is that there is cutting edge technology to ferret out hidden heart disease and treatments to halt and even reverse it. But, much of the medical community is either too apathetic or too invested in fixing clogged arteries or selling one-size-fits-all prescriptions to get you the information you need.

Well this blog aims to change that. Get set for reviews, research, rants, and anything and everything that is at the cutting edge of curing heart disease. So sit back while I grind my axe and cut through the crap. After all, if you have heart disease, this IS a life or death situation!

Looking out for your heart health,


HeartHawk