Body by Track Your Plaque?!

Although there are several exercise guidelines there really is no "Track Your Plaque" exercise program, but if there was one it would probably be a lot like the one that produced the picture at left. Yup, that is skinny, old (and getting older every day) HeartHawk after just 90 days (one with my head chopped off and one with my trademark sunglasses, to remain incognito). No "P90X" discs, no personal trainer, no high tech equipment, just some basic Track Your Plaque principles and a scare followed by a commitment. Read on!

I recently saw my endocrinologist who looked at my OGTT and HbA1c and proclaimed, "You're insulin resistant and prediabetic!" Looking for him to prescribe some new wonder drug, supplement, or spartan diet recommendations I asked, "So what can I do about it?" "Exercise!" was his one word reply which he repeated often. What? As a Track Your Plaque devotee I am used to heart scans, advanced lipoprotein testing, exotic supplements and all the bleeding-edge science that comes along with it. The more I objected and insisted there must be more we can do beyond "exercise" the more he insisted, "Exercise!" Finally, as the frustration grew in both of us he loudly blurted, "Look, you GOTTA exercise!"

Now, I had always gotten SOME exercise. Heck, at 55 years old I still kept up with guys on the basketball court one-third my age - once a week - and there was the problem. How much exercise was needed? A lot more: 30 minutes, 5 times per week, at 70% of my maximum heart rate. Well, like everything else I thought I might as well go "whole hog" and see what I could do. I was going to do 45 minutes per day, a minimum of 5 days per week (averaging closer to 6 days) and I was going to throw in some resistance training every other day.

Guess what, my blood sugar is lower and I even got a little muscle definition after a life of being a "bean-pole." I may actually take my shirt off this summer! The point I am trying to make is that exercise is an ESSENTIAL part of Track Your Plaque or any health program for that matter - and you don't need expensive DVDs or equipment, just a commitment to developing a daily habit to just do it!

Now, I won't kid you. It is often boring and tiring (but not a lot after a few weeks), and it is definitely not as much fun or easy as other things you might do instead (like eating and sleeping). But, if an underweight, old enough to join AARP, sit on my butt behind a computer all day kind of guy like me can do it, so can you! Vigorous exercise lowers your cholesterol, your blood pressure, your blood sugar (to name only a few benefits), and damn, just plain makes ya look better (oh yeah, I can rebound better too - though it didn't help my shot much unfortunately)! What else can do all that?!

Looking out for your heart health,



HeartHawk

American Heart Association Exposed "Selling" Endorsements

I have been critical of the AHA in the past for their stodgy, politically correct perspective on heart disease but this takes the cake. No longer satisfied to endorse sugary, diabetes-inducing foods as heart healthy, they have expanded their coveted "Heart Check" endorsement to the Wii video game console on the premise that several of its games promote fitness. As one of my contemporaries titled it in his post on the Track Your Plaque Forum, "AHA whores for Nintendo." I could not have said it better myself!

What is stunning is that AHA has made selling their endorsement big business. Get a load of this brochure on the AHA website. Here is the AHA pitch . . .

"Shoppers want clear, simple purchase guidance from a trusted source. The American Heart Association heart-check mark increases product sales because seeing the mark on a package assures shoppers they are making a smart choice."

SMART CHOICE?!! OH REALLY?!! The AHA has figured out that they have created a trust factor among consumers (misplaced trust in my humble opinion) and want to cash in on it - big time.

• Nevermind that they are hopelessly behind the the cutting-edge of heart health science (they continue to push dietary cholesterol and saturated fat as the keys to heart health - NOT!).
  
  
• Nevermind they endorse foods like "Berry Burst Cheerios-Triple Berry" (22 grams of wheat and sugar, the top two ingredients). There is an epidemic of childhood obesity and diabetes and the AHA pushes sugar and highly-processed carbs into the veins of children as sure as if it were drugs through a needle.
  
  
• Nevermind that regardless of whether your product is heart healthy or not THE ONLY WAY YOU CAN GET THE AHA ENDORSEMENT IS TO PAY FOR IT!

The AHA now seeks to expand their misuse of this misplaced trust to other dubious product groups and are putting the hard sell out on the streets. They charged Nintendo a whopping $1.5 million for their "endorsement." Think about it, the AHA and Nintendo are teaming up to put the outrageous notion in the minds of consumers that buying a video game is heart healthy because in certain, non-representative situations, you could get some aerobic exercise.

I do not doubt that you can work up a real sweat playing several different video games - but is that the norm? Will Nintendo put a label on "Super Mario Brothers" that states "Nevermind?" This is the same sort of outrageous claim the FDA has recently outlawed for other products. If your claim is not representative of typical results you can be sued! Any hungry lawyers out there?

I am sad to have come to now hold the opinion the once proud AHA has indeed become a "whore" to the almighty dollar. They have lowered themselves to the level of "used car salesmen" and "snake oil peddlers." There is a lot of talk about boycotts these days. How about we start with the AHA and the disreputable companies that buy into their hucksterism to push their products on unsuspecting consumers!

Yeah, that means you General Mills and Nintendo. Consumers have lots of options for breakfast foods and entertainment. What do you think their reaction will be when they find out you and the AHA have been distorting the truth?!

Looking out for your heart health,


HeartHawk

Nattokinase Revisited

I had one of my regular meetings with Doc Davis of Track Your Plaque book and website fame today where he remarked about a patient he encountered that nearly died of a pulmonary embolism after going off prescription anti-thrombotic medicine in favor of nattokinase.

Doc Davis has been a critic of nattokinase and endured the slings and arrows of its promoters and those statistical "n of one" users who swear by it. (Interesting to note that Doc Davis is part Japanese and is not without experience with natto as a food his mother made him eat - childhood trauma perhaps? LOL!).

I was curious enough to take a look at the debate on his blog and do a little of my own research. As most readers of my blog know I am a "numbers" guy. Normally, the ridiculous bloviating and hyperbole I found on some sites pushing nattokinase would be enough to turn me off but just because "bad" people say "good" things about a product does not preclude it from actually being good! On the other hand, there is some pretty damning science against the concept that nattokinase works (the small problem of any protein surviving the gut) as well as common sense that suggests if it did work it may be a dangereous way to self-medicate (at least with a prescription drug like Coumadin you are under supervision by a doctor).

For better or worse I decided to go to my trusted sources at PubMed and look at some of the more recent studies to see if there is anything new that supported casual and chronic oral adminstration of nattokinase to prevent heart disease. Here is what I found in a highly summarized (and editorialized) form so as not to induce boredom (use the links for more info).

Bioproperties of potent nattokinase from Bacillus subtilis YJ1.
http://www.ncbi.nlm.nih.gov/pubmed/20334345
Yup, nattokinase is still fibrinolytic - if it gets into the blood stream.

Purification and Characterization of Nattokinase from Bacillus subtilis Natto B-12
http://www.ncbi.nlm.nih.gov/pubmed/19788184
Now if we could only get this stuff to work orally as a functional food!

Combined nattokinase with red yeast rice but not nattokinase alone has potent effects on blood lipids in human subjects with hyperlipidemia
http://www.ncbi.nlm.nih.gov/pubmed/19786378
Nattokinase does not appear to exert its effects (if any) via lipids.

Enhancement of oxidative stability of the subtilisin nattokinase by site-directed mutagenesis expressed in Escherichia coli
http://www.ncbi.nlm.nih.gov/pubmed/19631297
Hey, we are getting closer to at least limiting oxidative degradation - still no panacea.

Purification, immobilization, and characterization of nattokinase on PHB nanoparticles
http://www.ncbi.nlm.nih.gov/pubmed/19608412
Nanoparticles are all the rage these days and may have some utility with stabilizing nattokinase but still no oral in vivo data.

Nattokinase decreases plasma levels of fibrinogen, factor VII, and factor VIII in human subjects
http://www.ncbi.nlm.nih.gov/pubmed/19358933
Now we're talking - hard data with oral nattokinase in humans! Unfortunately, this was an open-label, self-controlled sudy with 45 people (15 in each arm). Can you imagine trying to get a prescription drug past the FDA with a study like this? Still, at least SOMETHING for proponents to hang their hats on.

Effects of nattokinase on blood pressure: a randomized, controlled trial
http://www.ncbi.nlm.nih.gov/pubmed/18971533
Hey, hey! More human data and this time randomized, controlled, and with almost twice as many participants as the previous study. Too bad the end point was blood pressure data - but it did show improvement.

Effect of nattokinase on restenosis after percutaneous transluminal angioplasty of the abdominal artery in rabbits
http://www.ncbi.nlm.nih.gov/pubmed/18819862
Reminds me of Judah Folkman's comment when the media overhyped his results and declared he had cured cancer, "If you are a mouse and you have cancer we can take good care of you!" Lucky rabbits!

Cerebellar hemorrhage provoked by combined use of nattokinase and aspirin in a patient with cerebral microbleeds
http://www.ncbi.nlm.nih.gov/pubmed/18310985
Oh yeah, just when you thought everything was rosy this booger shows up. Just because something is not classified as a drug by the FDA does not mean it is safe for general use. First Doc Davis relates a story about nattokinase putting a patient at risk because id did not bust a clot and now here is someone who "over-busted!"

Nattokinase-promoted tissue plasminogen activator release from human cells
http://www.ncbi.nlm.nih.gov/pubmed/19996631
More geek science. Yeah, if you get it in the blood nattokinase has numerous effects. So do a lot of chemicals!

The fibrinolytic activity of a novel protease derived from a tempeh producing fungus, Fusarium sp. BLB
http://www.ncbi.nlm.nih.gov/pubmed/17827689
Here is an even more powerful natural product. Should everyone abandon nattokinase and rush out to buy tempeh - the next wonder supplement?

Here is what (I think) we know.

1. Nattokinase exhibits lytic effects in vitro.
2. It MAY have some effect taken orally in vivo.
3. If it does work no one knows the mechanism of action for certain. Consider this, maybe it is some component or action OTHER than the lytic effect seen in vitro. Why take the risky components to enjoy the effective components?
4. There is a tiny amount of evidence for nattokinase taken orally but certainly nothing conclusive.
5. There is absolutely NO safety data on it other than small study and anecdotal experience. Remember torcetrapib the wonder HDL drug? I couldn't wait for it to hit the market so I could take it! It did everything Pfizer said it would - then downstream the data showed it killed more people than it saved. No way would nattokinase be FDA approved based on existing HARD data.

It seems what we have in nattokinase is an interesting agent - but nothing more. Since it is unregulated we are all free to experiment (and I experiment plenty). But don't kid yourself - it is nothing more than an experiment with an unknown outcome! "Natural supplement" does not equal "safe" any more than "drug" equals "effective!"

As always, I remain a fan of Informed, Self-directed, Healthcare (ISH). But, stay informed, remain a skeptic, and play safe!

Looking out for your heart health,


HeartHawk

Advanced Lipoprotein Testing and the Fallacy of "Average"

I use http://www.nutritiondata.com/ quite a bit to determined carb content of various foods now that I am tracking my blood sugar. I am prediabetic and like all good TYP'ers this is one more thing I am tracking to reduce my heart disease risk.

While at the site today I stumbled across a blog written by their so-called heart disease expert, Dr. Steve Parker, titled, "Advanced Lipoprotein Testing: Not Quite Ready for Prime Time" In it, Parker essentially said that advanced lipoprotein testing (ALT) such as that offered by NMR has, "never been shown that such testing offers any additional benefit over traditional risk factor assesement and management."

Now, I am certain that Dr. Parker is a very nice man who means well but for people like me and many others he is wrong - possibly dead wrong. It all has to do with applying common sense and the statistical fallacy of assuming what is good for the average person is good for all persons, more importantly, what is good for teh many is necessarily good for the one -YOU!

Dr. Parker starts with an argument that is perhaps the most powerful reason for using using ALT, "The Centers for Disease Control reports that half of all heart attacks occur in people with 'normal' cholesterol levels." If this is true (it is) one must come to the conclusion there must be some other factor besides standard lipid values (i.e. LDL, HDL, and Triglycerides) that can ferret out which person is likely to have a heart attack and which is not. Unfortunately, this is where Dr. Parker's deductive reasoning and intuition shut down. In fact, he contradicts himself based on an earlier blog he wrote praising ALT!

Here is the "killer" paragraph where Parker forgets all reasoning and statistical training he may have ever had.

"It's never been shown that such testing offers any additional benefit over traditional risk factor assesement and management. And all of the established clinical management guidelines utilize LDL cholesterol rather than LDL subfractions. Physicians know what to do with LDL cholesterol. We don't have evidence-based protocols that tell us what to do with these subfractions."

Let's dissect this statement to get to the truth.

1. It has never been shown that if I shoot myself out of a cannon wearing a parachute over Lake Michigan in February that I will die of exposure. What I do know is that a typical cannon with enough power to propel me from Wisconsin to Michigan (so I do not land over water) will kill me instantly and that even if shot from a lesser cannon with a parachute I will land far enough offshore that I will be unable to swim back in 36 degree water to safety. Sometimes one has to apply deductive reasoning. If I employ ALT and discover I have a dangerous lipoprotein subfraction such as Small LDL or Lipoprotein(a) (which I do) I am now in a better position to do something about it! I don't need a study to deduce this.

2. Just because "all of the established clinical management guidelines" use LDL and "Physicians know what to do with LDL cholesterol" does not mean I MUST be limited to antiquated methods applied by ignorant and behind-the-times physicians. I could go further and suggest Dr. Parker himself is ignorant. Many physicians DO know what to do with ALT and use it effectively to treat their patients using the most advanced technologies available.

3. The term "We don't have evidence-based protocols" is often shorthand for "I am too stupid or too lazy too engage in critical thinking so someone please tell me what to do." I do not need someone to do a study on taking common sense actions. I have high Lipoprotein (a) with an otherwise world-class lipid panel. My own physician (whom I fired) told me I was fine! If I had not done ALT I would not have discovered I had this independent risk factor for heart disease and would not be in a position to do something about it. I mean, c'mon, this is not rocket science!

4. The final and most crushing indictment of Dr. Parker's logic is the fallacy of extending information about statistical averages to an entire population. On average, a person with my traditional lipids (LDL, HDL, Triglycerides) would be in a low risk group - except I am among a few in this group who have high Lp(a). Yes, it might not be cost-effective to test EVERYONE for Lp(a). The cost of the test for everyone might not save enough lives to be cost-effective (this is the danger of national healthcare rules that rely on "evidence-based" medicine for the masses). BUT LET ME MAKE THIS CLEAR! I do not give a DAMN about the average guy - I care about ME! If I had followed "evidence-based" medicine and good old Dr. Parker's advice I might be dead. Instead I am proactively fighting my extraordinarily high Lp(a) - but only because I got the test and fought my insurance company to test my son (I won the battle and now my son knows 30 years before I did so he can take action even sooner).

So there it is. If you are a "good little soldier" willing to sacrifice your life for the "good of the many" and save a few bucks then great - more power to you. But, if you want to "pull out all the stops" to make certain you stay alive and your children live long lives then you will do everything possible to know your risks and take appropriate action.

No thanks Dr. Parker. I think I'll continue to track my lipoprotein sub-fractions using ALT. Just because most docs are stupid or lazy does not me I have to be. And, just because many people may not benefit from ALT does not mean ALL - specifically ME - won't benefit IMMENSELY. So, take your pick. Go with the flow or get aggressive. Practice Informed, Self-Directed Healthcare (ISH). Heck, it's your life. YOU decide!

Looking out for your heart health,


HeartHawk

Fish Oil and Omega-3 Index: A Feather in the Telomere Cap

And just when you thought it couldn't get any better another compelling reason for knowing your Omega-3 Blood Index and optimizing your fish oil dose is uncovered. A new study among patients with coronary artery disease (CAD) has discovered an association between fish oil and the rate at which telomeres shorten (January 20, 2010 issue of the Journal of the American Medical Association, Dr. Ramin Farzaneh-Far et al).

We all recall from high school biology (yeah, right) that the rate of telomere shortening is thought to determine the number of times a cell can replicate thus limiting the life of a cell. This shortening of telomeres has been shown to independently predict morbidity and mortality in patients with CAD.

According to lead researcher Dr. Farzaneh-Far, "This suggests the existence of a novel mechanism for why omega-3 fatty acids are effective in this patient population—an area that has not been well worked out previously; it suggests they could be acting through telomeres . . . It's also the first study that shows that a dietary factor may be able to slow down telomere shortening . . . This is yet another reason for cardiologists to try to convince their patients to take either a fish-oil supplement or eat regular fatty-fish meals."

The bottomline of this observational study (which, again, showed association not causation) is that participants (608) with the lowest levels of Omega-3s had the fastest rate of telomere shortening. What is also interesting is that Dr. Farzaneh-Far and his team used what he termed "a relatively new blood test" called the Omega-3 Index test. The test cut-offs were 2.3% for those with the fastest (worst) telomere shortening and 7.3% for the slowest (best) shortening.

TIME-OUT! TIME TO BLOW THE TRACK YOUR PLAQUE HORN - AGAIN!!!

I hate to be a total shill (not really) but, come on. Dr. Davis and Track Your Plaque are once again ahead of the curve in bringing the Omega-3 Index test to its Members for some months now. It seems to me TYP also did an extensive treatise on Omega-3 Index testing in its October 2009 newsletter, and, what was the optimal blood level discussed - oh yeah - 7.3%!

Now for the REAL bottom-line! Just like Vitamin D, it doesn't matter how much you take, it matters how much get's into your blood. In fact, you don't even know, in most cases, whether the preparation you may be taking even contains its stated dose! If you do not test your blood level you have no idea if you are receiving optimal treatment - period! It took me three blood tests just to get my Vitamin D level "zeroed in."

In summation, I guess I wholeheartedly agree with Dr, Farzaneh-Far's statements, "from the telomere point of view, this is the first study to show an effect of a dietary factor, that this may be able to slow down telomere shortening" and "The idea is that the omega-3 index, the percentage of fatty acids in the blood, could be measured and that low levels would predict worse outcomes. So the omega-3 index might be useful for risk stratification in the future."

Call your doctor, get the test. If your doc says, "No!" then test yourself to get a baseline reading and decide whether it might be a good idea to get OPTIMAL treatment. I am getting my blood draw today! I'll let you how how it turns out.

Looking out for your heart health,


HeartHawk

The Pizza Paradox

It seems to me that it has been a while since I waxed rhetoric about the roller coaster we all ride while fighting heart disease. One of my favorite rants amidst the rapid changes I encounter particularly with regard to diet and heart disease is what I call "The Pizza Paradox."

I love a good pizza but gave them up early on in my personal battle with heart disease because, let's face it, cheese, Italian sausage, and pepperoni are not high on the list of heart-healthy foods.

Well, with the flood of low-carb indications coming out for fighting heart disease my favorite lament is that I still can't eat pizza but now it is the crust that is going to kill me not the toppings!

Life just isn't fair!

Looking out for your heart heart health,


HeartHawk

Jumpin' Jupiter: How About a Little Statin Common Sense

Well, by now I am certain most of you have heard that the FDA, based on the results of the JUPITER Study, has approved rosuvastatin (Crestor) for men over 50 and women over 60 with normal LDL-cholesterol levels (LDL <130>2.0 mg/dL), elevated high-sensitivity C-reactive protein (hs-CRP >2.0mg/dL) and triglycerides under 500 mg/dL.

I have had a chance to review both the glowing recommendations and scathing condemnations of this FDA action and find them to be as frustrating as they are amusing. I THINK A LOT OF FOLKS NEED TO GET A GRIP! I advise EVERYONE to read Dr. Davis' well-reasoned, common-sense analysis of the JUPITER results on his latest HealthCentral blog post. He brilliantly dissects the issue for us and calmly separates the useful health info from the useless hysteria on both sides of the aisle.

Here is my take/synopsis and some important things to remember.

1. Always bear in mind the difference between cause and association. Nobody said CRP "causes" heart disease. In fact, it is more likely than CRP is simply an indicator that you have something else that does cause heart disease (i.e. CRP is just "associated" with heart disease). Find that root cause and treat it. A statin may not be the best treatment for the specific root cause of your elevated CRP (but maybe it is).

2. Virtually all drugs have good effects and unwanted side-effects. But, the effects are different for everyone. Statins reduce LDL cholesterol and CRP - no question. They are neither magic nor poison. My advice is to study, analyze, ask questions then make an informed decision. I take Crestor (5mg) - but as little as I think is prudent based on my unique circumstances!

3. It is worth mentioning that researchers found a signficant increase in diabetes among participants. Factor this into your personal equation.

In short, it is nuts to both crucify statins or propose they be put in the water supply. I mean, really, does it a take a rocket scientist to figure this much out?

Looking out for your heart health,


HeartHawk

New Genetic Link for Vitamin D and Heart Health

And now comes more genetic proof that Vitamin D is an important heart health player. Once it became established that a "Vitamin D receptor" existed in the heart it was only a matter of time before researchers began teasing out why nature put it there.

New research shows that a gene variant of CYP27B1, which blocked production of an enzyme responsible for Vitamin D activation, accounted for a greater than two-fold risk for congestive heart failure (odds ratio 2.14, 95% CI 1.05-4.39). For a quick stats lesson on all that numeric gobbledygook it means that the researchers were "confident" that if they repeated their research 20 times they would get a result showing a increased risk of anywhere from 1.05 to 4.39 in 19 of the trials (95% of 20). The 95% figure is considered the minimum confidence threshhold for accepting a statistical result as valid. You can also look at the "confidence interval" (CI). If the interval does not include "1" (no risk difference) you are fairly certain your experiment determined a greater risk (a range above 1) or a lower risk (a range below 1). We can decipher "odds ratio" another day!

Of note was that a single SNP (the C allele of SNP rs4646536 for all you gene freaks out there like me) was the culprit. The large NIH VITAL Trial will provide more definitive data on both Vitamin D and Omega-3 links to heart disease when it is completed sometime in 2014. Until at least then, I will be taking my 8000IU of Vitamin D (what I need to hit a blood level of 60ng/dL - everyone is different).

Looking out for your heart health,


HeartHawk

To Nap, Siesta, Perchance to Sleep?

Time for a "Seinfeld" blog about next to nothing. Which is about how much sleep I got last night. Along with a bottle of 2007 Malbec I just bought, it got me daydreaming about the 2007 EPIC study that drew an association between napping and heart disease. I say association because nothing in the study proved napping causes a reduction in heart disease. The EPIC people (mostly cancer researchers) simply noted that people who napped had fewer coronary deaths. It could be they are just a more laid-back bunch!

Fortunately, the CARDIA study provides some hard data on sleep and calcium scores that supports a good night's sleep. For those who are Track Your Plaque Members the TYP Library provides the best heart disease reversal "Cliff Notes" on the issue (as it almost always does). Here is the link.

Sleep and the Track Your Plaque program:Does sleep quantity or quality cause plaque to grow?

That's all for today. Time for that nap!

Looking out for your heart health,


HeartHawk

CETP Redux: Lower is Better . . . No, Wait, Higher is Better?

Higher HDL inhibits heart disease, right? CETP inhibits HDL production, right? Ergo, find an agent that inhibits CETP, raises HDL, and you will reduce heart disease right? Well, maybe! Then again, maybe not.

The torcetrapib debacle showed that CETP can be inhibited thereby generating spectacular increases in HDL but you actually increase risk due to side effects like raising blood pressure (side effects that are not produced by newer agents like anacetrapib and dalcetrapib). There is also some question that the HDL produced by CETP inhibition may be defective. Now comes a new study that shows CETP inhibition in and of itself my be atherogenic.

Given that one of my problems is low HDL, I was so damn hopeful that CETP agents would be part of my personal cure. I think it is time to bet my family farm on something else while we wait another decade for the evidence. Yes, I think it will take that long to figure it all out. I suggest we start dreaming about some other miracle advance (sigh)!

Looking out for your heart health,


HeartHawk

Cool New Heart Scan Technology

In another sign that Dr. Davis and Track Your Plaque had it right all along, a small study at Beth Israel Deaconess Medical Center of the RCadia Automated CT Analyzer provided a high negative predictive value and may help move patients quickly through the emergency room.

"the algorithm of ECG, serial enzymes, and perfusion imaging is both expensive as well as time-intensive, so clearly there is a need for a quick noninvasive test, and recent studies have shown that [coronary computed-tomography angiography] CCTA fits the bill very nicely. But there are problems with CCTA—one of them is the off-hours availability of expert coronary CTA readers,"

The automated analyzer could have a role as a second reader in the emergency-department setting as an aid to normal expert CCTA readers. It's available at all hours, it interprets raw data—there's no waiting for 3D reformats—and there are cost savings to be had from rapid triage of this group of patients,"

Dr Girish Tyagi
Radiological Society of North America 2009 Scientific Assembly.

The study pitted the analyzer the consensus interpretation of two expert readers. For 100 analyzable studies, the automated analysis yielded a negative predictive value of 98%. The COR Analyzer's overall sensitivity was 83% and its specificity was 82%. RCadia Analyzer identified five of the six patients with significant stenosis found by the expert readers (five true positives, one false negative) and yielded 16 false positives and 78 true negatives.

Not perfect but the fact that "big money" is starting to invest in the technology and hospitals are beginning to use CCTA as a replacement for the expensive, time-consuming (and wasting) series of ECGs, enzyme tests, and perfusion studies speaks volumes!

Looking out for your heart health,


HeartHawk

About Ads on This Blog

Yeah, I guess I am a phillistine now that Google Ads run on my blog. As you probably know Track Your Plaque is a non-paying gig and we refuse to run ads on the member site (members voted this down even if it meant reducing the $6.65 per month membership fee that keeps the site out of hock). So, we are experiementing with "monetization" (fancy word for running ads) on the free, non-member stuff like our blogs.

NOTE: These ads are not endorsements by me or Track Your Plaque! They are what they are, links to sites with products and services that the advertisers believe will interest readers of this blog. Caveat emptor!

Regards,


HeartHawk

Whistleblowers Unite! And Get That Second Opinion!

We can only hope that this whistleblower wins his case! Basically, this doc claims he was fired for objecting to an arrangement where by a manufacturer of medical products was offering advance access to new products (in this case a heart valve) only if a hospital raised their purchases of the company's other products (such as stents).

So, let's be clear about the allegation here. The suggestion is that if a hospital wants the latest and greatest medical technology it would have to commit to purchasing products that it decided it did not need before. LIKE MAYBE A STENT THAT MIGHT OTHERWISE HAVE NOT BEEN RECOMMENDED TO SOME UNSUSPECTING PATIENT?

The moral of the story is that the pressure to do unnecessary procedures is real. Always get a second opinion!

Looking out for your heart health,


HeartHawk

P.S. This is also why I value the posts from Track Your Plaque's "Spy on the Inside" our very own member who works in a cath lab!

Defining a Cure for Heart Disease

When can I be considered "cured" of heart disease or, more accurately, Coronary Artery Disease (CAD)? This is a subject that has plagued me for years and especially since I became involved with Track Your Plaque (TYP).

It seemed so simple at first. If I reversed or halted the progression of coronary calcium then I was "cured" (note that TYP does not make this hard claim of a cure - but you DO dramatically reduce your risk of a heart attack and I need a frame of reference to start the conversation).

The subject becomes even murkier when you consider the independent clinical experience of heart attack prevention pioneers Dr. Davis and Dr. Blanchet. Davis seem to feel that there is considerable risk reduction even if coronary calcium progresses but is held under 10% per year. Blanchet pushes the limit to about 15%. Both doctors rarely see heart attacks in their practices and other leading heart docs like Dr. Arthur Agatston (the doc of South Beach Diet fame and inventor of the gold-standard Agatston coronary calcium scoring system) made this statement.

"I'll let you in on a big secret. Physicians who practice aggressive prevention have seen heart attacks and strokes practically disappear from their practice. It's that simple — this approach [plaque reduction] can literally prevent heart attacks and strokes and save lives."

So when can I consider myself "cured" of heart disease and why is it so important to define a standard for a cure? Let's tackle the second, and easier, question first.

It is no secret I am a numbers guy. I need a target a goal. More selfishly (my competitive neurosis is showing) I need to know when I am winning and when I am losing. Put more simply, I need to know how to "keep score!" What number and unit of measure signals that I am “cured.” Even more importantly, I need a method of comparing and ultimately selecting the different heart disease treatments and programs available in my search for a cure.

To answer the first question, I believe there is a spectrum of possible standards in defining a cure for heart disease. At one end we have a practical definition, "No heart attacks." At the other end of the spectrum we have a far more complex definition, “No detectable coronary plaque.”

Without tipping my hand I’d like to ask those who read my blog to answer a simple poll question, “Under which condition would I consider myself "cured" of Coronary Artery Disease (CAD)?”

I’ll follow-up later with more thoughts on the subject of what constitutes a cure and we can begin to debate the issue!

Looking out for your heart heath (and a cure),


HeartHawk

More Healthcare Hijinks!

As a healthcare consumer advocate I always marvel at how little knowledge - even common sense - exists among so-called "health professionals." I think I'll devote series of blogs to some of my most recent "healthcare hijinks" experiences.

I get a great deal of my healthcare at a local clinic which in the past six-months has really taken great strides to improve customer service. They are very friendly, aggressive about getting back to patients about their healthcare (they even have a new online system where you can check test results as they become available), and the improvement is noticeable. But this is more a tale of inability to think on your feet - a skill that I feel is basic to the notion of healthcare.

I had some crazy TSH readings (typical of anyone with early Hashimoto's Thyroiditis) so my endocrinologist was tweaking my meds over a series of weeks. It is common for a doctor to relay information to one of their nurses who, in turn, (keep in mind these are college graduates experienced with medications and patient care) interfaces with the patient on issues such as dosage adjustments.

Let me first preface my diatribe with the fact that the nurse I am about to take to task was friendly, courteous, and worked hard to follow up with me (I am often difficult to reach because of my crazy schedule). Maybe it was just a "bad day." Nonetheless, I was left wondering just how competent the person on the other end of the phone was.

The nurse called to say the doc wanted to up my dose of Armour thyroid from 1/2 grain to 3/4 grains twice per day and the nurse asked if I wanted a new prescription. I said we could proabably still use my current prescription but would have to renew it much earlier as I will be using a 50% bigger dose. This is where the keystone cops episode begins.

The nurse remarked, "But your prescription is for 1 grain." I explained that since my dosage changes so frequently (and because it is far cheaper to do it this way) I use 1 grain pills that I simply split into 1/2 grain doses. At that she remarked, "But the doctor wants you to take 3/4 of grain." My retort was, "Yes, but I can also split the 1/2 grain pieces into 1/4 grain pieces. I could even take three 1/2 doses three times per day (which I believe would be the superior way to take any thyroid preparation containing T3)." At that point she was completely befuddled. After a short course in remedial math (which I am still not certain she comprehended) I convinced her that 1/2 grain plus 1/4 grain equaled 3/4 grains and that three 1/2 grain doses was the same amount of medicine as two 3/4 grain doses.

Afterwards, we laughed it off and she ended with,"Well, I am really not familar Armour Thyroid". What a shame for the doctor's thyroid patients! Now, even in the "far out" world of Armour Thyroid (sarcasm intended) basic math (like 1/4 plus 1/2 equals 3/4) still holds true!

As I mentioned, perhaps it was just a bad day with a little brain fog (I guess that is scary in itself). But it made me both laugh . . . and think! Of course this is not as bad as when I went to the pharmacy with a prescription for therapeutic vitamins and walked away with a prescription for coumadin - but that's another story (i.e. always read your labels)!

Looking out for your health,


HeartHawk

Finally, No More Begging and Conniving for Blood Tests

If you have heart disease or just about any serious health issue you have probably been in this boat. You don't feel right, there has been a change in you treatment, or, dammit, your just plain curious - you want a blood test. The old way was to call your doctor, wait for an appointment, then beg or connive your way into getting your doc to order the test (I have gotten REALLY good at conniving over the years). And, of course, this is no guarantee you will actually GET the test. You are at the complete mercy of the medical establishment.

BUT NOT ANYMORE!

A new technology called liquid chromatography/tandem mass spectrometry allows accurate blood assays with a single drop of blood and a paper-like carrier medium keeps the sample stable for extended periods of time and can be easily transported via mail.

BREAK YOUR BLOOD TESTING CHAINS AND BEG NO MORE!

Now you can get common blood tests ANYTIME YOU WANT! I was skeptical at first but Doc Davis finally, after his own test (that's TYP Nurse Dawn's hand in the photo - talk about giving blood for the cause), convinced me - so here is my SHAMELESS PLUG for TYP - you can review and order kits by clicking here. Oh, and one more thing, TYP members get a discount!

Regards,

HeartHawk

Common Sense: $1 Million Per Ounce

Now just how much do you think this little observation cost?

The obesity epidemic in the US is due solely to increased food intake

That's right, this "revelation" is based on reporting at the 2009 European Congress on Obesity and the combined genius and interpretation of no less than:

Deakin University, Melbourne, Australia
World Health Organization Collaborating Centre for Obesity Prevention
US Department of Agriculture
National Health and Nutrition Examination Survey
American Heart Association
American College of Cardiology

But, look at it this way. There was probably no chance McDonald's, KFC, Burger King, and Taco Bell were gonna break the news!

Would you like fries with that? Somtimes, ya just gotta laugh!

HH

Anti-Platelet Ad Nauseam

Why do I torture myself? Number 1 answer: I am a masochist, of course! I read a fair number of medical journals and reports and lately all I hear about are anti-platelet medications like clopidogrel, prasugrel (see my last post) and now ticagrelor (where the hell do they get these names - sounds like anime' characters - Ticagrelor, ruler of all Mythica!) . As I punned earlier - it's starting to get thin.

Like prasugrel, ticagrelor is not even out of trials, yet they are hyping the hell out of a product you cannot even buy. It's claim to fame (should it be determinined in Phase 3 that it does not kill more people like torcetrapib did) is that its effect is reversible - SO YOU CAN HAVE HEART BYPASS SURGERY FASTER AFTER STOPPING IT! I kid you not. Oh, and while it does not contribute to "major bleeds" to any greater extent than other agents it does show an increase in "minor bleeds." I don't know about you, but whenever I bleed I consider it a major event.

Given that the market for clopidogrel alone is $8 billion we can expect more of the same with everyone scratching for a piece of the action. Here is a clue for the rest of us.

YOU DON'T NEED ANY OF THIS STUFF IF YOU DO NOT HAVE HEART DISEASE!

Let me put it this way. An ounce of heart disease prevention (or a half ounce of heart disease reversal) is worth $8 billion of clopidogrel! Practice informed, self-directed healthcare instead of uninformed drug and surgery healthcare (Time to plug Track Your Plaque).

HH

Clopidogrel vs Prasugrel: The Arguments are Getting Thin

Watching drug manufacturers duke it out over competing products is like watching a tragic comedy - you don't know whether to laugh or to cry. Witness the latest antics in the fight over the wildly profitable market for anti-platelet drugs currently dominated by clopidogrel.

Clopidogrel (Plavix most notably) has been around for years as a first line anti-thrombotic with indications for use in numerous cardiovascular conditions including post-surgically after stent implantation. Given its age it has also been studied extensively and all its warts are well-known.

Most comic is the fight for dominance between clopidogrel and prasugrel. I say comic for one major reason - prasugrel is still under investigation - you can't even get it in the US at this point. But this hasn't stopped the marketers from attempting to pit it against clopidogrel which goes off-patent in 2011.

The latest "hit job" on clopidogrel comes from analysis based on the TRITON-TIMI 38 trial. Researchers dicovered that there are several common gene variants among patients receiving clopidogrel that may reduce its effectiveness thereby increasing the risk of subsequent heart attack, stroke, and mortality. What was conveniently NOT CONCLUDED was whether simply taking more clopidogrel could overcome this reduced response.

Now guess who is a major sponsor of the TRITON-TIMI 38 trial? If you guessed Daiichi Sankyo and Lilly, the two co-developers of prasugrel, you win today's Sherlock Holmes award! Now, do you suppose anybody has studied whether certain gene variants affect the efficaciousness of prasugrel - not yet - but you have to wonder what the folks at Bristol-Meyers (the holder of the Plavix patent) are working on.

Now, don't get me wrong, I love a good fight. Let the druggies battle it out. But as consumers we need to cast a watchful eye over the message. Prasugrel is not even FDA approved yet and there are no long-term studies on it. Who know what warts may pop up. Your genetics may indeed sway you away from clopidogrel one day but don't think it is without its own, at present, hidden warts.

The devil you know may be better than the devil you do not. Of course, here is where I plug informed, self-directed health care programs like Track Your Plaque which offer tangible results in preventing and reversing heart disease. The ONLY real solution is to never need clopidogrel OR prasugrel in the first place!

Looking out for your heart health,


HeartHawk

I'm Baaaa ... aaack!

Yes, the reports of my demise are greatly exaggerated. I'd like to say something artsy like, "I was taking a sabbatical to 'rediscover my voice'." - but that would be a load of crap. The truth is more akin to being really busy and not sure what to write. But, "being busy" is nothing but an excuse. People MAKE TIME to do what they like! And how can an arrogant and opinionated guy like me not know what to write? Here's my answer.

I write a lot. But every forum has it's boundaries and rules of decorum. Also, it is a little dishonest to post the same material on multiple blogs (not to mention that sites that have you under contract get a wee bit upset if you repost paid for material on free sites). So, where am I going with this - back to my roots!

On other blogs I have to be the "good cop." This blog is my outlet to be the "bad cop!" Expect my prose to be biting, opinionated, edgy, and designed to draw both complements and criticism. It is done from my heart (pun intended) and without apology. I may go after third parties but am ALWAYS respectful of commenters - so let's debate. If you are one of those third parties then comment back and watch my tone change. My opening shots are intended to get your attention - not wound! We may not always like it but we are in this together.

When I started this blog it was to be a no holds barred comment on the state of heart health care. I promised, "a hell of a ride" so hold on tight - be mad, be glad, be anything but but bored!

Regards,


HeartHawk