Sunday, December 30, 2012

Preventing Heart Disease: What We Thought We Knew Is Wrong

The word is out.  I first learned about it in a “Sound Medicine” interview last July with science writer Sharon Begley, a follow-up to an article she had written in April. In it she discussed research showing that giving statins to healthy people to lower their cholesterol does not help to prevent a first heart attack.  It turns out that cholesterol numbers are not a good predictor of heart attack risk and that lowering your cholesterol is unlikely to improve your odds.  (See my post, “Statins – Whoops!”)

More recently, Drs. Stephen Sinatra and Jonny Bowden were on “Dr. Oz” discussing the new approach and promoting their new book, The Great Cholesterol Myth:  Why Lowering Cholesterol Won’t Prevent Heart Disease and the Statin-Free Plan That Will.  Here is a synopsis by Dr. Joseph Raffaele:

“Dr. Sinatra explains that cholesterol is a vital substance, necessary for the proper functioning of our bodies. To name just a few: it keeps our cells flexible, is essential for hormone production, and is turned into vitamin D in the skin.  He believes it has been vilified as the cause of heart disease because of a longstanding misinterpretation of the studies often cited to support its role.  He rightly states that about half the people who have high cholesterol never get a heart attack and half who do have a heart attack have normal cholesterol.  The message is clear:  total cholesterol, the number we’ve all been obsessing about for the past few decades, is meaningless.  It’s not the cause of heart disease.”

If cholesterol numbers don’t matter, what does? Cholesterol is still in the picture but the issue is the particle size of your LDL cholesterol.  Small LDL particles are more likely to get into arterial walls and cause inflammation.  Inflammation is now thought to be a contributing factor in many illnesses, not just heart disease.  Obesity, insulin resistance, and a diet high in sugar and processed carbohydrates are factors that contribute to this condition.  Sinatra and Bowden recommend an anti-inflammatory diet with plenty of fruits and vegetables.  They note that only one group of patients has been shown to be helped by statins: middle-aged men who have already had one heart attack. 

“New Thinking on Heart Disease Prevention,” a blog post by Dr. Ryan Sweeney, provides a clear and concise summary of the new approach.  In addition to particle size and inflammation, Dr. Sweeney names oxidative stress as a factor contributing to heart disease.  The summary at the end includes the names of the tests that are needed to monitor the three factors:  CRP-hs, Homocysteine, Oxidized HDL and LDL, and LDL subtractions (for particle size).

In his blog post about the Dr. Oz show mentioned above, Dr. Joseph Raffaele takes all three doctors to task for not mentioning the benefits of hormone therapy in reducing the risk of heart disease for women who take it.  

“What if I told you there is natural therapy that reduces your risk of having a cardiovascular event by 41% and your chance of dying of any cause by 27%, while also being free of any of the side effects commonly seen with statins?   Would you take it?  In addition to heart disease prevention, this therapy’s common “side effects” include a reduction in hot flashes, vaginal dryness, depression, brain fog, insomnia, and vaginal dryness.  Serious “side effects” include a 23% reduction in breast cancer (yes, reduction) and improved bone density. If you are a menopausal woman between 50 and 60 years old, you can expect all these benefits from estrogen replacement.”

So here’s the situation:  millions of patients are currently taking statins with no benefit to their health and some potential hazards.  Statins can cause muscle weakness and memory loss,  as well as other physical and cognitive problems.  For a more extensive list of possible side effects take a look at “How Statins Really Work Explains Why They Don’t Really Work” by MIT scientist Stephanie Seneff.  All of us are paying for this useless and possibly harmful treatment through our insurance premiums and our taxes.  We will also be paying to treat whatever damage is done to patients who take statins.  At the same time, the use of hormone therapy, which has repeatedly been shown to reduce the risk of heart disease and to be safe for most women, is being discouraged by Medicare and insurance companies.  I have been on hormone therapy for thirty-three years, half my life, and I consider myself amazingly lucky.

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