Don't neglect the basics in your heart disease reversal program

Carl loved new ideas and novel approaches. You could tell by the sheer number of nutritional supplements he took. His list had grown to 18 different supplements over the past two years.

Carl came to me for coronary plaque regression. Lipoprotein analysis did uncover several previously unsuspected abnormalties, most notably small LDL particles and lipoprotein(a). In addition, Carl's LDL cholesterol ranged between 111 mg-156 mg and he was clearly hypertensive, with systolic blood pressures consistently around 150-160. (Recall that people with Lp(a) are more prone to hypertension.)

Carl was more than willing to have his lipoprotein(a) reduced. We did so with niacin and testosterone and the level dropped to near zero. Likewise, we corrected his small LDL pattern with niacin, fish oil, and a reduction in processed carbohydrates.

But Carl really resisted doing much about his LDL cholesterol and high blood pressure. I got the sense that these "boring" issues simply didn't interest him. After all, LDL cholesterol and blood pressure were the stuff of TV commercials and the popular conversation propagated by drug companies.

Carl's follow-up heart scan, however, finally persuaded him: a 24% increase in one year, likely due to the neglect of the basic issues.

I liken Carl's case to being like the teenager with a new car who polishes the paint to a bright finish, puts new wheels and tires on it, spruces up the interior with various doodads--but then fails to change the oil. Sometimes it's the most basic issues that can diminish your success.

Issues like LDL cholesterol and high blood pressure aren't the most glamorous, but they do count in your coronary plaque control program.
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Do stents prevent reversal?

Do stents prevent reversal?

I've seen this phenomenon several times now: A highly-motivated Track Your Plaque participant with a stent in one artery will do all the right things--lose weight, achieve 60:60:60 in basic lipids, identify and correct hidden lipoprotein disorders, take fish oil, correct vitamin D, etc.

Follow-up heart scan shows dramatic reduction in scoring in the two arteries without stents--30% per artery. But the artery with the stent will show marked increase in scoring above and/or below the stent. (It's impossible to tell what happens in or around the stent itself from a calcium scoring standpoint, since steel looks just like calcium on a CT heart scan.) In other words, there is marked plaque growth in the vicinity of the stent, despite the fact that dramatic reversal of atherosclerosis has occurred in other arteries without stents.

Should we take this to mean that a stent destroys the opportunity for atherosclerotic plaque reversal in the stented artery? I don't know, but I fear this may be true. What dangers does this different sort of plaque pose? Is it the result of the injury imposed at time of stent implantation, some modification of flow or biologic responses as a result of the presence of the stent?

These are all unanswered questions. But I believe that it is yet another suggestive piece of evidence that the best stent is no stent at all.

Comments (3) -

  • neil

    1/29/2007 4:38:00 AM |

    While I certainly enjoyed your book and am extremely grateful for your generous sharing in your daily blog, I am very troubled by this blog entry. Over the last day I have been thinking quite a lot about it off and on, and that would be because I have three stents implanted; two Cypher and one Taxus.

    Since my dates in the hospital cath lab in early 2004 I have been following along with TYP principles carefully with the hope of being additional plaque neutral or even a bit of regression, but I see from this entry my hopes might be dashed.

    Your statement in the blog entry "I've seen this phenomenon several times now", does this mean it happens most always, or sometimes, or occasionally? What is the game plan now for these patients? Do they (or did) have any similarities that might be contributing to their plaque growth (LPa, diabetes, vit. D, BMI, gender, etc), or are their lipoproteins and assays corrected to perfection?

    Thanks again for all that you do, your program and willingness to share is unique and very special to many of us. If you could follow up sometime on this situation with a future blog entry or observations, I would be most appreciative.

    With concern,

    Neil

  • Dr. Davis

    1/29/2007 1:29:00 PM |

    Neil--
    All this means is that the presence of a stent may modify the potential for reversal ONLY IN THE VICINITY OF THE STENT. Other areas, meaning the majority of your other arteries' lengths, are still subject to your control and the benefits of your prevention program.

    Keep in mind that this is an experience involving just a handful of patients. To my knowledge, there are no formal published experiences like this to compare to. All patients had their patterns corrected to perfection by Track Your Plaque standards and don't seem to be distinguished by any one single lipoprotein pattern.

    My "gut sense" is that the sort of plaque growth that we see around stents and tracked by heart scanning does not carry the same implications that non-stent associated plaque does.

  • Anonymous

    2/27/2008 12:43:00 AM |

    I just found your site recently and have been reading through the posts.  I find it very educational.  Thanks!  

    I'm curious.  Were the stents medicated stents (since it is my understanding that they prevent this kind of thing)?

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