What role cholesterol medication?

A frequent conversation point among my patients, as well as participants in the www.cureality.com program, is "Are cholesterol medications really necessary?"

No, they are not. What IS necessary is to correct all manifest and hidden causes of coronary plaque. Among these causes, in my view, is LDL cholesterol of 60 mg/dl or greater. There are many other causes of coronary plaque--e.g., small LDL particles, unrecognized hypertension, Lp(a), hidden diabetic patterns, etc.--but reducing LDL to 60 mg is still an important part of a plaque-reversing effort.

Insofar as we wish to get LDL to this goal, the statin cholesterol drugs like Lipitor, Zocor, Crestor, etc. may play a role. However, they should only be considered after a full effort dietary program is pursued. Don't follow the American Heart Association's diet unless you want to fail. It's nonsense.

For a more detailed discussion of how to use nutrition and nutritional supplements to reduce LDL cholesterol, go to www.lef.org, the website for the Life Extension Foundation. I wrote an article for their magazine called "Cholesterol and Statin Drugs: Separating Hype from Reality". You'll find the article at http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=1295&query=davis%20cholesterol%20natural&hiword=CHOLESTEROLA%20CHOLESTEROLS%20DAVI%20DAVID%20DAVIE%20DAVIES%20DAVIN%20DAVIO%20DAVISON%20DAVISS%20DAVIT%20NATURALBASED%20NATURALES%20NATURALIZED%20NATURALLY%20NATURALS%20NATURE%20NATURES%20cholesterol%20davis%20natural%20.)

Can your plaque-reversal efforts succeed without statin drugs? It depends on your causes. For instance, someone with small LDL and Lp(a) only may do great on our basic program and then add niacin. Unfortunately, another person with a starting LDL cholesterol of 240 mg/dl--sky high--will have more success with these drugs.

Believe me, I am no blind supporter of drug companies and their flagrantly profit-seeking practices which, in my view, are cut-throat, shoving anyone and anything out of their way to increase profits and market share. I share many of Dr. Dave Warnarowski's views on how vicious their tactics can be; see his recent Blog post at http://www.drdavesbest.com/blog/ called "I smell a rat".

Nonetheless, the deep and well-funded research of the pharmaceutical industry does yield some useful tools. You don't have to love the insect exterminator, but if your house is being eaten by termites, his services can be useful. Same thing with these drugs. Useful--not the complete answer, not even close, but nonetheless useful in the right situations. Sometimes antibiotics are necessary, even life saving. That's how cholesterol drugs are, too.

Take it all in the proper perspective. Your goal is not cholesterol reduction, per se, but plaque control, preferably reversal.

Supplement Mania!

Ever hear of "polypharmacy"? That's when someone takes too many medicines. People will have lists of 15-20 prescription medicines, for instance, with crazy interactions and oodles of side-effects.

Well, how about "poly-supplments"? That's when someone takes a large number of nutritional supplements.

Let me tell you about a 45 year old man I met.

In an effort to rid himself of risk for heart disease that he felt was likely shared with his family (brother and father diagnosed with heart attacks in their late 40s), Steve followed a program of nutritional supplementation. You name it, he took it: hawthorne, anti-oxidant mixtures, vitamins C, E, B-complex, saw palmetto, 7-keto DHEA, velvet deer antler, gingko biloba, policosanol, chronium picolinate, green tea, pine bark extract, St. John's Wort, CoEnzyme Q10, papain and other digestive enzymes...He became a distributor for a nutritional supplement company to allow him to afford his own extraordinary program.

To satisfy himself that he had indeed "cured" himself of heart disease, he got himself a CT heart scan. His score: 470, in th 99th percentile. Steve's heart attack risk based on this score was around 10% per year. High risk, no question.

For weeks after his scan, Steve admitted walking around in a daze, not knowing what to do. Years of telling himself that he had effectively dealt with his heart disease risk, now all down the drain.

When we met, I persuaded him that to think that this collection of supplements would reverse heart disease was magical thinking. We trimmed his list down to the essentials and got him on the right track.

Heart disease is controllable and reversible, but not this way. Don't fool yourself into thinking that some collection of supplements will be enough to stamp out your heart disease risk. Just like taking an antibiotic when you don't have an infection achieves nothing, so does taking the wrong supplements.

What does heart scanning mean to you?

CT heart scans can mean different things to different people.


What does a heart scan mean to you? There are several possibilities:

1) A way of reducing uncertainty in your future.

2) A tool to crystallize your commitment to health.

3) A device to help you track how successful your heart disease prevention program is.

4) A trick to get you in the hospital.

5) A moneymaking tool for unscrupulous physicians hoping to profit from "downstream" testing, particularly heart catheterizations.


Like anything, heart scans can be used for both good and evil. How can you be sure that your heart scan is put to proper use--for your benefit and not someone else's profit?

Simple: Get educated. Understand the issues, be armed with informed questions.

If, for instance, you're a 55-year old female with a heart scan score of 90, active without symptoms, and you're told to have a heart catheterization right off the bat---run the other way. This is bad advice. A heart procedure like catheterization at this score in an asymptomatic woman is very rarely necessary. That decision can only be made after a step-by-step series of decisions are made by a truly interested, unbiased party. (A stress test is almost always required in this situation before the decision can be made to proceed with a catheterization.)

Unfortunately, in 2006, getting unbiased advice from your doctor is still a struggle. That's why we started Track Your Plaque---unbiased information, uncolored by drug or device company support, with an interest in the truth.

Coronary disease is drying up!

I had an interesting conversation with a device representative this morning. He was a sales representative for a major medical manufacturer of stents, defibrillators, and other such devices for heart disease.

Since I'm still involved with hospital heart care and cardiac catheterization laboratories, this representative asked me if I was interested in getting involved with some of the new cardiac devices making it to market over the next year or two. "The coronary market is drying up, what with coated stents and such. We've got to find new profit sources."

Well, doesn't that sum it up? If you haven't already had this epiphany, here it is:

HEART DISEASE IS A PROFITABLE BUSINESS!

Why else can hospitals afford billboards, $10 million dollar annual ad campaigns, etc.? They do it for PROFIT. Likewise, device and drug manufacturers see the tremendous profit in heart disease.

The representative's comments about the market "drying up" simply means that the use of coated stents has cut back on the need for repeat procedures. It does NOT mean that coronary disease is on the way out. On the contrary, for the people and institutions who stand to profit from heart care, there's lots of opportunity.

Track Your Plaque is trying to battle this trend. Heart disease should NOT be profitable. For the vast majority of us, it is a preventable process, much like house fires and dental cavities.

Mammogram for your heart

With the booming popularity of "64-slice CT scans", there's a lot of mis-information about what these tests provide.

These tests are essentially heart scans with added x-ray dye injected to see the insides of the arteries. However, to accomplish this, a large quantity of radiation is required. In addition, the test is not quantitative, that is, it is not a precise measure that can be repeated year after year.

It is okay to have a 64-slice CT coronary angiogram. It is NOT okay to have one every year. That's too much radiation. However, a heart scan can be repeated every year, if necessary, to track progression or regression. Once stabilization (zero change) or reduction is achieved, then you're done (unless your life takes a major change, like a 20 lb weight gain).

The tried-and-true CT heart scan is the gold standard--easy, inexpensive, precise, and repeatable. Not true for 64-slice angiograms.

Is your doctor using "leeches"?

What if you went to your doctor for a problem and he/she promptly placed leeches on your body?

Yeccchhhh! Would you go back? I'd bet that you'd run the other way as fast as your bleeding legs could take you. Outdated health practices like "bleeding" are outdated for good reason.

Then why would you allow your doctor to approach your heart disease prevention program by checking cholesterol and then waiting for symptoms to appear? That miserable approach leads to tragedy and death all too often--ask Bill Clinton! He might as well have had leeches!

Don't allow your doctor's ignorance or disinterest impede your prevention program. Get your coronary plaque measured, then attack it from all sides by knowing all causes, hidden and obvious. That's why Track Your Plaque is such an effective program.

I often wonder why more doctors aren't using this unbelievably powerful approach to deal with heart disease. But when I see colleagues implanting stents, defibrillators, and the like for many thousands of dollars per patient, the answers are obvious. Given a choice of a rational, effective program of prevention that pays the doctor a few hundred dollars for his time, versus $2000 to $10,000 for a procedure, you can see that the temptation is irresistible for many physicians.

All in the family--What to do if there's heart disease in your family

What should you do if a close relative of yours is diagnosed with coronary disease?
This question came up recently with a patient of mine. The patient--a strapping, 47 year old businessman who looked the absolute picture of health--was undergoing bypass surgery. Although I'd met him for the purposes of plaque reversal, he was already having symptoms and his stress test was flagrantly abnormal, all discovered after a heart scan score of 765. On the day after the patient's bypass, the patient's brother came to me. Understandably concerned about his own health, he asked what he should do. The answer: get a heart scan.
Measure the disease with the easiest test available. If his heart scan score is zero, great--he's at exceptionally low (near zero) risk for heart attack. A modest program of long-term prevention is all that's necessary. What if his score is like his brother, should he get in line for his bypass? No, absolutely not! But he will need two things: 1) a stress test to ascertain whether or not he's safe (60% likelihood a stress test would be normal), and 2) an effort to determine how the heck he got so much plaque. (We favor lipoprotein testing, of course, for greatest diagnostic certainty.)
Message: Learn from the lessons your own family provides. Don't let this valuable information go to waste.
Beware the "false positive" stress test

Beware the "false positive" stress test

There's a widely-known (among cardiologists) problem with nuclear stress tests. It's called the "false positive." (Nuclear stress tests are known as stress Cardiolites, stress thalliums, stress Myoviews, persantine stress tests, adenosine stress tests)

Stress tests, nuclear and otherwise, are helpful for identifying areas of poor blood flow. If an area of poor blood flow is detected and the area is substantial, then there may be greater risk of heart attack and other undesirable events in the relatively near future.

What "false positive" means is a stress test that shows an abnormality but it's not true--it is falsely abnormal. There are a number of reasons why this can happen. The problem is that this phenomenon is very common. Up to 20% of nuclear stress tests are false positives.

There are indeed situations where there may an abnormality and it is not clear whether it is true or false. This may lead to a justifiable heart catheterization or CT coronary angiogram. But, given the extraordinary number of false positives, there's a lot of gray in interpreting these tests. Hospital staff, in fact, call nuclear medicine "unclear" medicine. It's common knowledge that you can often see just about anything you want to see on a nuclear image of the heart. Abnormalities in the bottom of the heart, the "inferior" wall, are especially common due to the overlap of the diaphragm with the heart muscle, yielding the appearance of reduced blood flow. Defects in the front of the heart heart are common in females with large breasts for the same reasons.

The problem: The uncertainty inherent in nuclear stress tests opens the door to the unscrupulous or lazy practitioner. Any blip, tick, or imperfection on the nuclear images serve as carte blanche to drag you into the hospital for procedures.

This abusive practice is, in my experience, shockingly common for two reasons: 1) It pays better to do heart catheterizations, and 2) Defensive medicine.

What's the disincentive? Only doing the right thing and maintaining a clear conscience. Slim reasons for many of my colleagues--and a lot less money.

If you are without symptoms and feel fine, and a nuclear stress test is advised by your doctor, followed by a discussion of an abnormality, insist on a discussion of exactly what is abnormal, just how abnormal, and what the alternatives might be. If you receive unsatisfactory or incomplete answers despite your best effort, it's time for another opinion.

Comments (11) -

  • Michelle C

    10/25/2007 4:23:00 PM |

    I was very interested to see this article.  My father had a cardiolyte test.  The results said that his arteries were clear, but that he'd had a heart attack in the anterior infraseptal wall.  He was shocked because he's never had any symptoms.  His doctor wanted to refer him for a possible angiogram, but my dad declined.  Now I wonder if this was a misdiagnosis.  It's made getting health insurance next to impossible for him, and he regrets the day he ever agreed to the test in the first place.

  • Jerry Lewis

    10/16/2008 12:04:00 PM |

    Stress management is a very important factor to improve short term memory loss. Stress causes the body to release a hormone called cortisole which blocks the memories from being registered. Since it is a known fact that all women going through early menopause have stress, it is essential to stay positive and stay stress free. http://www.xanax-effects.com/

  • Anonymous

    7/24/2009 1:02:26 AM |

    What is the incidence of false positive nuclear stress test results in women who have had previous (non-cosmetic) breast surgery for cancer and benign lesions?  I would appreciate reference to studies if any.

  • R.G.

    9/2/2009 8:40:08 PM |

    I am so glad to find this site.  I recently had the Thallium test which came back positive, yet I'm not overweight, don't smoke, have normal to low blood pressure and a resting heart rate of 60.  My risk factors are being post-Menopausal and having a family history.  I asked my MD if he would be willing to re-test and he refused, so I'm going to a different doctor, not telling him anything about my previous results and get a second, unbiased opinion.  Then if that one comes back positive, I'll know for sure what steps to take next.

  • Michelle

    10/30/2009 8:28:16 PM |

    I had an abnormal stress test and just had an angiogram today. It showed no blockages and that I have large arteries. My cardiologist says my heart is an great shape. It does put my mind at ease knowing I don't have CAD. Since my mom had her first 95% blockage at 36.


    Michelle

  • Anonymous

    11/9/2009 11:16:14 PM |

    I had a false positive stress test.  The stress test came out markedly positive, which prompted my doctor to send me to heart catheterization immediately the next day.  But the heard cath showed that my heart was completely fine.  Of course, you can imagine the stress that I went through.  Even though it is good to know that my heart is fine, I am feeling like short of breath once in a while, probably  due to lack of enough exercise as well as possible anxiety.  I wish that noone had to go through this.

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  • Anonymous

    4/18/2011 11:29:39 PM |

    I had a false positive Nuc Stress Test last week. After research the reason was due to the following. 18 months ago I had bariatric surgery The Ruin Y, procedure and lost over 100 pounds. My BMI went from 45 to 25. Last week after eating a Beef Stick I developed chest pains radiating down my left arm and was taken to ER Via ambulance. After the stress test, I had a Cath and was found to be normal - 20% blockage in one artery. My Bariatric Surgeon said I suffered from "Dumping" which can mimic an heart attack. The abnormal Nuc Stress test was due to a overlay of tissue on the posterior part of heart from the surgery. Next time I talk with Surgeon before more tests, but they were two different cities and being 55, with a blood AIC over 10 for 10 years, was prime candidate for MI. Better safe than sorry!

  • Charlie

    12/11/2012 1:45:22 PM |

    I am a Nuclear Medicine technologist.  Several factors influence a false positive test:

    1. Motion - heavy breathing or sliding from the original position in the scan can cause a false positive.  This is generally checked by the tech after the scan is finished.  In many cases the scan will be performed again if there is over a certain amount of movement visualized in a graph.

    2. Breast size - patients with large / dense breasts or with breast implants (saline or otherwise) will definitely cause a breast attenuation artifact that looks similar to an infarction or ischemia.  The resting images typically provide a map of the heart tissue to view what possible attenuation might occur, or previous infarctions.  Generally cardiologists are able to determine the factor based on information given from the technologist, as well as location of the defect in the image.

    3. Diaphragm - the diaphragm on some patients can be very dense (patients with a large belly pushing the diaphragm up, or a thin person having an elevated hemidiaphragm that sits too closely to the cardiac emmissions.  This can cause an inferior wall defect.

    4. Coronary abnormalities - certain twists and turns can cause a much higher reduction of blood flow at the time of the test.  Not common, but I've seen it in correlation to a angiogram.  Also if you have several vessels that are equally diseased, the global perfusion will be equal and hard to discern of a specific disruption of blood flow to a particular area.

    5. Cardiologist / Radiologist reading - some cardiologists and radiologist read much different than others.  I've seen some tests that have a tiny defect, most likelly from motion or obesity that is read positive automatically without any further detail.

    -----------
    My advice is this.  I think it is a great test in conjunction with a full work up by a cardiologist you trust.   If it comes back positive, know that it's possible you are fine and need further workup.  90-95% of the tests I perform are negative, with very very rare false negatives (meaning if it's negative, it's very likely you do not have trouble with perfusion to your heart).  Most of my false positive performances come from patients that have a large BMI, large breasts, breath heavily, or cannot raise both arms.

    Keep in mind an angiogram is up to interpretation as well.  Many cardiologists treat different blockages in different areas much differently.  Some treat with medicine and others will stent areas that are borderline treatable.  

    Hope this helped a bit.  Not much in medicine is completely black and white, these tests are tools to help give the best treatments possible and they are becoming better and better everyday.

  • Jolene

    8/9/2013 9:36:49 PM |

    I have a BMI of 66! I am 368 ibs. I had a nuclear stress test done. the activity portion failed with a lower part being gray or "no flow" on the images. I DID move my legs at teh end of the test without thinking. However when i asked for a new test the family nurse Practitioner (who told me the results) refused saying it wouldnt change the facts? What facts!? I am 31, overweight. Thats it. I have NEVER smoked, done drugs, drank, my Cholesterol is a 98, my BP is usually borderline (147/74)  or low (112/72). I have no family history of anything, no one has died from heart disease or had heart disease? So again, what facts? Also she as i said is a FNP! Not the Cardiologist? So why is she even looking at my charts and giving me any kind of advice about procedures or anything? Any help understanding this would be much appreciated. Thanks.

  • KUPPUSAMY

    7/8/2014 2:43:36 AM |

    I have stress test positive in 2006 followed by Angiogram negative. Since then around 6 stress tests positive (equivocal). I am diagnosed for Rosucar ASP 10(Rosuvastatin and Asprin capsules) & Telmisartan 40 mg and amlodipine  5mg.

    I don't have any complaints but for hypo thyroid TSH 7.80.

    Now cardiologist advise to go for stress test again but this time stress test thallium. Will it identify correctly?

    What are the ill facts and side effects about Stress test Thallium

    Please advice me.

    Kuppusamy

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