Tuesday, March 8, 2011

is heart disease reversable?

Is heart disease reversible?

Now there is a question that will elicit strong opinions in the medical community especially among cardiologists whose specialty is to care for people with heart disease.
The textbook definition of heart disease or more specifically coronary artery atherosclerosis describes it as a progressive disease be treated but not cured.
Some authors have described a steady progression of the disease, however more careful analysis reveals that while coronary atherosclerosis starts when we are young its progression is a not steadily progressive but goes through active and quiescent phases.

Most cardiologists and other Physicians will insist that heart disease cannot be reversed. Some will focus totally on cholesterol levels and insist that taking a cholesterol lowering drug is all that is needed and won’t discuss it further.
Surely the goal of treating coronary disease would be to reduce and eliminate the plaque and indeed a huge amount of money has been spent attempting to demonstrate that cholesterol lowering drugs would cause the plaques to shrink.
Pfizer who makes the cholesterol lowering drug lipitor spent over one billion dollars developing and testing a drug that would raise the levels of the so called “good cholesterol”, HDL only to find that not only did they not reduce the amount of plaque but the patients had significant side effects and the drug was withdrawn from further research, in fact this and other events has led Pfizer to completely abandon further development of any heart related drugs.
A large multi center trial called REVERSAL, REVERSing Atherosclerosis with Aggressive Lipid lowering (the drug marketing department loves these acronyms) showed that while one dosage of one particular medication did seem to stop the growth of the plaque the other medication did not, so there was no reversal in spite of the considerable amount of media coverage and marketing that followed promoting the medication (Lipitor) which supposedly had a better result.
All of this data has been discouraging in stopping the largest single cause of death in the developed world.
On the other hand one can find easily on the Internet advertisements for a variety of books and products claiming to reverse heart disease.
Dr. Dean of Ornish has made a career of claiming that following his very strict no fat diet. The joke about the Ornish diet because if it is so strict is that “it won’t make you live longer it just seems like it”. My older brother many years ago went to in Ornish seminar in came back with a very simple interpretation of the diet, he said” if you put something in your mouth and it tastes good spit it out” Other authors have also insisted that eliminating all fat will stop and reverse heart disease. A large group of people believe that chelation therapy works however there has never been any data demonstrating its effectiveness at reducing plaque.

If all this seems discouraging do not give up hope there are a small group of us who believe and have some evidence that heart disease actually can be reversed to some extent.

We must remember that fundamentally coronary artery disease is not a cholesterol problem and the focus on cholesterol will not lead us to a solution. The fundamental cause of coronary artery disease is inflammation.
The idea that inflammation is the cause of coronary disease begin to emerge in the medical literature in the mid nineties. Interestingly enough the renewed attention on the cause of coronary disease came about because of the problem of re-stenosis after an angioplasty or a stent.

This research caused a fundamental reevaluation of our whole idea of coronary disease, once described is a bland lipid storage disorder. The new research by many scientists has now fully described the role of inflammation from the inception of the plaque when it is called a fatty streak, to its growth and eventual rupture with disastrous consequences such as heart attack or stroke.

We will discuss inflammation more fully in week four and help you understand this very complicated subject.
But for now let’s just talk about inflammation in its simplest forms, we have all experienced acute inflammation for example if we experience a cut or abrasion on our skin we will see that classic signs of inflammation that have been described for centuries.
Warmth (calor)
Pain (dolor)
Redness (rubor)
Swelling (tumor)

We now know if that this is exactly what’s going on inside of our coronary arteries and the rest of our arteries for that matter. We can’t see it we can’t feel it but we know that this is what is going on.
I have seen it thousands of times in the operating room and came to the conclusion that inflammation was involved even though the experimental work was just beginning. I certainly will not take credit because I did not have the skills or the facility to accomplish the work that ultimately proved the clinical observation.

Lets it go back to your skin abrasion and remember that over a short period of time the signs of inflammation including the swelling and redness go away, the body is built to heal itself. However if you continue to injure that same spot every day it will never heal.

Dr. Peter Libby from Harvard University has a written eloquently both in the medical literature and in such publications as Nature and Scientific American explaining the change in our fundamental knowledge of heart disease and explaining the mechanisms by which inflammation causes the plaque to form grow and eventually rupture. Although he is certainly brilliant and very influential I am always disappointed to see that his only solution for inflammation is to prescribe a statin medication.


The answer is yes, but not if we continue the same approach of trying to find a spot in the inflammatory pathway to block the inflammatory response.
But this is the typical approach; we don’t really ask what the fundamental cause is? We only ask how can we produce a drug that blocks the inflammatory process and make monstrous amounts of money using this medication.

Inflammation is the normal response our body makes to injury.

So to reverse heart disease a two pronged approach that; 1) avoids injury, to do this we must understand what it is that injures our arteries on a daily basis so that we can avoid the injury. 2) Understand the inflammatory process and the natural, normal things that modulate the responses so that we can maximize this affect without any side effects as are common with most medications.

It seems to me and to some others that if we stopped the injury that was causing the inflammation we would stop the growth of the plaque and facilitate healing.

I do not have any hard data but I do have several observations of patients who had dramatic reduction in the amount of plaque in their arteries by following a program to reduce inflammation.
(We may want to insert a couple of testimonials here from the inflammation awareness site)
One in particular is a man in his early fifties who was treated by a cardiologist friend of mine for chest pains, he underwent a cardiac catheterization demonstrating 60 to 70 percent narrowing in all three coronary arteries, and he was prescribed the usual statin medications but was not satisfied and sought my advice. My advice to him was to begin taking an omega three supplement, vitamin D and to restrict the amount of sugar and simple carbohydrates in his diet; he was also instructed to begin walking 30 minutes daily. At his six month follow-up his cardiologist scheduled another cardiac catheterization and warned am to be ready to have several stents placed in the arteries. Much to the cardiologist surprise the narrowing were now reduced to 40%.
I know anecdotes are not data and do not prove anything, but the observation has objective measurement of reduction in plaque which has been impossible with our current medications to reduce cholesterol.
The approach here was to have this gentleman stop injuries to his arteries by consuming a diet which he was genetically adapted to eat, avoiding those things that we know cause inflammation in the arteries. This diet and the exercise he began to do caused his weight dropped almost 20 pounds significantly reducing the inflammatory cytokines produced by that fat. We then took a look at those things lacking in his diet that are known to modulate the inflammatory response namely omega 3 fatty acids from fish oil and adequate amounts of vitamin D both of which are well documented to modulate the inflammatory spots in blood vessels.

Dr. William Davis has collected data using CT scans of the heart to obtain what is called a calcium score. Calcium in the coronary arteries proves that there is plaque there.
Dr. Davis published a paper which I was privileged to review before its publication showing that in 63 patients using a program to reduce inflammation a significant number had a reduction in calcium score. He actually had trouble getting it published in some journals because this was the first time such a thing had been reported.

Clinical observations and a small number of patients demonstrating reversal of coronary disease can never get the attention that a huge randomized trial, but we will continue to make the observations and publicize the fact that coronary artery disease is reversible by controlling inflammation.

The fundamentals of reversing heart disease then are;
Reducing the number of injuries to our blood vessels
Naturally modulating the inflammatory response.

inflammed by medical marketing


The Jupiter study made numerous headlines in November of 2008; most saying that taking a statin drug (Crestor) could lower their risk of a heart attack by 50%.

I know marketers do what marketers do but the facts are far different than the headlines.
The study was of 17,802 people with normal cholesterol levels but with elevated CRP, a blood test indication inflammation. Half were given a placebo and half were given Crestor 20 mg daily, after two years there were 157 cardiac events in the placebo group (1.8%) and 83 events in the treated group (0.9%), a real and actual reduction of 0.9% or less than ½ percent per year.
That would mean that 180 people would have to be treated for two years at a cost of $3.95 per day to prevent one cardiac event.
Since both LDL cholesterol and CRP went down no one can say that it was not the lowering of inflammation that was responsible for the small benefit.
When your Doctor started you on cholesterol lowering medications they did not tell you that there was only a 1 in 180 chance that you would benefit from the drug.
Marketing has trumped medicine, unduly influencing your Doctor, the FDA and NCEP (National Cholesterol Education Program) ignoring better solutions.
Since the last few years has produced massive amounts of evidence that inflammation is the root cause on Heart disease as well as many other chronic diseases let’s focus on ways to eliminate and correct the inflammation that is reducing the quality and quantity of our lives.

Weight Control
Overloaded fat cells produce chemicals that directly cause inflammation in our arteries. As little as 10% reduction in weight can correct the problem.

Baby aspirin
The original anti inflammatory has been proven to be more effective than drugs to prevent heart attack.

Avoid Soybean and corn oil

These oils, which are in every prepared food, and which we have been told to consume instead of animal oils, contain Omega 6 fatty acids which in excess amounts cause inflammation and heart disease.

Take a fish oil supplement

Omega 3 from fish oil is nature’s most effective anti inflammatory. Demonstrated in large studies to drastically reduce heart attack and death. Most of us do not eat enough fatty fish and need to supplement.

Be physically active

Recent studies have shown that the active muscle cell produces anti inflammatory compounds and releases them into the blood stream.

More statin nonsense

All diabetics over 40 should be on statins, says an expert
Stockholm, Sweden - All people over the age of 40 with diabetes—type 1 or type 2—should be taking statins to reduce their risk of stroke or coronary events, one expert stressed to diabetes doctors at the European Association for the Study of Diabetes (EASD) 2010 Meeting last week. Dr John Betteridge (University College London, UK) outlined the evidence base for statins in diabetes and stressed their safety, as long as they are appropriately used and drug interactions are avoided.
Betteridge has received honoraria for lectures and attendance at advisory boards and some research funding from AstraZeneca, Bristol-Myers Squibb, Kowa, Merck Sharp & Dohme and Pfizer. This man clearly is a spokesman for the pharmaceutical industry. To say or infer that what he says is unbiased is terribly naïve yet this man is the expert at medical meetings, a man who dictates medical practice to other doctors, a man regarded by other doctors as particularly knowledgeable in the use of medicines and the treatment of illness. This is a man whose words are purchased by the highest bidder. Truth has no role when he speaks only allegiance to the mantra of his owners.
This is the man who can look at these facts:
1) Of the 137,000 people admitted to 500 U.S. hospitals with evidence of heart attack, 75 percent had LDL cholesterol levels below the recommended level of 130 and 50 percent had LDL cholesterol levels below 100.
2) 50 percent of heart attacks occurred in people with normal cholesterol levels.
And say with conviction that cholesterol elevation is the cause of elevated cardiovascular risk.
This is the man who can look at the ENHANCE study comparing Vytorin (a combination of Zocor and Zetia) and Zocor alone, which showed that even though the combination drug Vytorin lowered the LDL cholesterol 40 percent more than Zocor alone there was no difference in the progression of the atherosclerotic plaque and still say “lower cholesterol is better”, the marketing mantra of the statin maker, his masters.
This is the man who with respect to statin drug side effects can say to his fellow doctors, "you have to reassure your patients that the side effects are most unlikely due to the drug, and you have to look for other causes and counsel them that this is a very important drug for them to take."
Not one word about the ten of thousands of cognitive reactions to statins, manifested by various forms of amnesia, confusion, increased forgetfulness, disorientation and a dementia closely resembling that of Alzheimers. Nor about the adverse reaction of statins in the form of emotional and behavioral reactions such as aggression, sensitivity, paranoia, hostility, depression, suicidal ideation, homicidal ideation, combativeness and a road rage type reaction. Both the statin side effect repository at the San Diego College, directed by Dr. Beatrice Golomb and Dr. Graveline’s at www.spacedoc.net have found that cognitive and emotional reactions appear in patients reports just as often as reports of various neuromuscular problems. Most authorities now agree that myopathy incidence is now much closer to 15 percent than the less that 2 percent figure stated by the drug companies at the time statins first were marketed. Dr. Golomb has recently reported that of those cases reporting myopathy, 68 percent will prove to be permanent. Neuropathy already is considered permanent and particularly unresponsive to treatment of all kinds. Dr. Wolfe’s study following Baycol withdrawal reported that rhabdomyolysis incidence now runs at several hundred rhabdomyolysis hospitalization each year with a 10 percent death rate amounting to some 30deaths annually despite the withdrawal of Baycol from the market.
In view of this information about these well-known adverse reactions from statin drug use, how can Dr John Betteridge sleep at night knowing how widely divergent his words are from the truth? If this in formation is insufficient for you to question this man’s integrity concerning the relevance of cholesterol let me add the results of the JUPITER study that he has ignored so completely. Dr. Ridker took thousands of people of both sexes and over a wide range of ages with cholesterol levels of 130 or lower and no evidence of cardiovascular disease – healthy by all standards. He then gave all of these volunteers a test for inflammation known as the (hs)CRP test. Those testing positive for inflammation by this single test he then divided into two groups. To one group he gave a placebo, to the other he gave a moderate dose of a statin. Then Ridker observed these two groups for heart attacks and strokes (hard evidence of cardiovascular disease) as time passed. By 18 months of observation the placebo group showed so many cases of heart attacks and strokes that to proceed would be to violate medical ethics. This is the study that established for all to see the irrelevance of cholesterol either as a marker for CV risk or as a factor in the disease process – 35 years of brainwashing revealed by this one study. And our expert never mentioned it at the 2010 meeting in Stockholm a few months ago.
By Dwight Lundell MD