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

Dr. Cook Weighs in on WACS Antioxidant Study

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!


HeartHawk

More on Antioxidants and the WACS Controversey

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!

Regards,


HeartHawk

Another Nail in the Antioxidant Coffin?

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).

Regards,


HeartHawk

Glycemic Index Versus Load - Another Diet Myth

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.

Simply said,


HeartHawk

Diet Coke Dilemma: Junk Food Junk Science

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.



HeartHawk

OK - Time to Stop Holding Back - TYP is King

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!


HeartHawk

Looky What I Found!

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.

Enjoy!


HeartHawk

So, Where Ya Been HeartHawk?

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!

Still Kicking,


HeartHawk

Yet Another Idiot Doctor with a BUTCHER SHOP Mentality

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?

Unbelieveable,


HeartHawk

Co-Q10: Are these docs out of their minds?

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,


HeartHawk

Another Gene-Based Heart Disease Discovery

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!

Optimistically Yours,


HeatHawk