Why are heart attacks still happening?

I'm a cardiologist. I see patients with heart disease in the form of coronary artery disease every day.

These are people who have undergone bypass surgery, received one or more stents or undergone other forms of angioplasty, have survived heart attacks or sudden cardiac death, or have high heart scan scores. In short, I see patients every day who are at high-risk for heart attack and death from heart disease.

But I see virtually no heart attacks. And nobody is dying from heart disease. (I'm referring to the people who follow the strategies I advocate, not the guy who thinks that smoking a pack of cigarettes a day is still okay, or the woman who thinks the diet is unnecessary because she's slender.)

Two high-profile deaths from heart attacks occurred this week:

Davy Jones--The iconic singer from the 1960s pop group, the Monkees, suffered sudden cardiac death after a large heart attack, just hours after experiencing chest pain.

Andrew Breitbart--The conservative blogger and controversy-generating media personality suffered what was believed to be sudden cardiac death while walking.

It's a darn shame and it shouldn't happen. The tools to identify the potential for heart attack are available, inexpensive, and simple. The strategies to reduce, even eliminate, risk are likewise available, inexpensive, and cultivate overall health.

The followers of the Track Your Plaque program who

1) get a heart scan that yields a coronary calcium score (for long-term tracking purposes)
2) identify the causes such as small LDL particles, lipoprotein(a), vitamin D deficiency, and thyroid dysfunction
3) correct the causes

enjoy virtual elimination of risk.

Comments (10) -

  • Alexandra

    3/4/2012 1:02:04 PM |

    Just read this about Davy Jones:

  • nina

    3/4/2012 9:30:09 PM |

    I saw some recent photos of Davy Jones and thought ''wheat belly''.  Sad, but avoidable.

  • PeteKl

    3/4/2012 11:00:30 PM |

    I don''t claim to entirely know the answer to this question, but I am willing to venture a guess to what might be part of the answer.  My suspicion is that in the end, for better or worse, most people value the opinions of their social group more than they value their health.  Currently Doctor, your recommendations are just too far from mainstream opinion and sadly will be ignored by all but the most thoughtful people.

    As anyone who has tried to modify their diet has probably discovered, the greatest challenge often isn''t dealing with cravings for a missing food.  Instead it is dealing with the social backlash to your lifestyle change from friends and family.  

    At first everyone is interested in knowing why you have made the change and they attempt to accommodate your choice.  However eventually they become annoyed as they realize the change you made is permanent.  I can''t tell you how many times I have heard some variation on the following when deciding where to eat with friends (usually given with a thinly veiled snide tone of voice):

    “I would really like to check out that new Italian restaurant, but Pete won''t eat pasta, so I guess we have to go back to the usual place.”

    It doesn''t matter how many times I tell people that I can always find something to eat no matter where we go.  Someone will still insist on making an issue of my dietary choices.  Things aren''t always this blatant, but it is frequent enough that I eventually start wondering whether I should change my eating habits or stop eating with friends.

    While dietary modifications elicit the most direct response, these types of responses seems to occur with almost any health related change.  If your friends and family aren''t themselves doing something or think the change is a dumb idea (no matter how flimsy the reasoning), most people will avoid making a change.  

    Even my own partner, whose father died suddenly of a heart attack last month and whose relatively young mother has been diagnosed with chronic heart failure ignores my suggestions (which are based on your recommendations).  He has asked me several times for advice that might help his mother and the response to my suggestions is always that it won''t work.

    I finally realized that he simply doesn''t want to challenge the rest of the family.  His older brother, a pharmaceutical representative, is viewed as the “expert” on family health issues and my partner refuses to butt heads with him despite what is at stake.  So I keep quiet and wish his mother the best.

    Much of this is understandable.  Humans are social animals and we have evolved to depend on our social group for survival.  On a savannah in Africa 50,000 years ago this made perfect sense.  But in a modern world of science and technology these natural social instincts are increasingly an obstacle to our health and many of us know it.

    Yet it still takes a strong, independent personality to ignore these impulses.  While I have been able to make a number of changes in my life based on your recommendations, it has still been difficult to consistently follow through.  

    Just a few days ago I was invited over to someone''s house to celebrate a birthday.  So what was on the menu?  Several wheat pizza''s, of course.  So did I tell the host that because of my heart problems I no longer eat wheat?  Sorry Doctor, I didn''t.  Instead I shut up, ate the pizza and  proceeded to raise my small LDL particle level for the next week (http://www.trackyourplaque.com/blog/2011/11/friday-is-my-bad-day.html).

  • Robert

    3/5/2012 7:42:48 PM |

    Since adopting a paleo/low carb diet in the last year, I am looking into getting an NMR lipoprofile test to get a baseline of how my particle count looks.  Under the section of treatment options on this particular site, the first line of start with eating right reads "Eat more whole grains, fruits and vegetables."  The very first thing listed is whole grains.  This is so frustrating to see on a site promoting a very useful tool in CVD risk evaluation.  I have read "wheat belly" and "track your plaque", both very good books.  I am also reading primal body, primal mind.  Heart disease runs heavily in my family and I''m pretty much going against what most people in my famliy do by following low carb/paleo eating habits.  I just dont understand why these larger blood test companies, even with all the evidence continuing to pile up, still suggest foods that will worsen the problem the tests are evaluating in the first place.  I guess you have to have confidence in the test they provide (NMR), but just ignore what they say are the best options for treating abnormalities of that test?

  • Dr. William Davis

    3/6/2012 3:47:32 AM |

    It is unbelievable, isn''t it, with all their insights?

    Give them time and they''ll catch on. In the meantime, ignore this nonsense, Robert.

  • Julie

    3/6/2012 6:40:58 AM |

    Dr. Davis,
    What would you recommend for someone who had recently one stent put in and is currently on a statin and plavix post -op?
    Is it necessary to take statins in this case? Any additional supplements etc.?

    Thank you in advance for your help!
    P.S. Loved your book!

  • Catherine

    3/7/2012 12:41:32 AM |

    Dr. Davis,
    Could you please consider changing your "categories" back to the old way you had them organized--single file, alphabetical and one type size? Although it may give a more creative look to the website, it is harder to find the material being sought. I send many new people to your site and they often complain about it.

  • Dr. William Davis

    3/10/2012 3:51:20 PM |

    Hi, Julie--

    This is precisely what the Track Your Plaque program is about.

    In a nutshell:

    1) Identify the causes specific to you, including lipoprotein abnormalties/lipoprotein(a)
    2) Supplement and normalize vitamin D and iodine/thyroid status
    3) Supplement omega-3 fatty acids
    4) Do the diet

  • [...] patients so that they avoid having a cardiac.   "Why are heart attacks still happening?"  Why are heart attacks still happening? | Track Your Plaque Blog     I’m a cardiologist. I see patients with heart disease in the form of coronary artery [...]

  • margaret

    5/25/2013 6:05:53 AM |

    Dr Davis
    Just found your interesting website.  I am trying to get my partner to cut out wheat (overweight, high chol and high BP).  Unfortunately, I can't find a doctor who conducts the tests you recommend.  Do you know of such in Australia (particularly Western Australia)?  

    Many thanks and I'll continue reading till we catch up down here!!

Cheers to flavonoids

Cheers to flavonoids

The case in favor of healthful flavonoids seems to grow bit by bit.

Flavonoids such as procyanadins in wine and chocolate, catechins in tea, and those in walnuts, pomegranates, and pycnogenol (pine bark extract) are suspected to block oxidation of LDL (preventing its entry into plaque), normalize abnormal endothelial constriction, and yield platelet-blocking effects (preventing blood clots).

Dr. Roger Corder is a prolific author of many scientific papers detailing his research into the flavonoids of foods, but wine in particular. He summarizes his findings in a recent book, The Red Wine Diet. Contrary to the obvious vying-for-prime-time title, Dr. Corder's compilation is probably the best discussion of flavonoids in foods and wines that I've come across. Although it would have been more entertaining if peppered with more wit and humans interest, given the topic, its straightfoward, semi-academic telling of the story makes his points effectively.

Among the important observations Corder makes is that regions of the world with the greatest longevity also correspond to regions with the highest procyanidin flavonoids in their wines.

Regading the variable flavonoid content of various wines, he states:

Although differences in the amount of procyanidins in red wine clearly occur because of the grape variety and the vineyard environment, the winemaker holds the key to what ends up in the bottle. The most important aspect of the winemaking process for ensuring high procyanidins in red wines is the contact time between the liquid and the grape seeds during fermentation when the alcohol concentration reaches about 6 percent. Depending on the fermentation temperature, it may be two to three days or more before this extraction process starts. Grape skins float and seeds sink, so the number of times they are pushed down and stirred into the fermenting wine also increases extraction of procyanidins. Even so, extraction is a slow process and, after fermentation is complete, many red wines are left to macerate with their seeds and skins for days or even weeks in order to extract all the color, flavor, and tannins. Wines that have a contact time of less than seven days will have a relatively low level of procyanidins. Wines with a contact time of ten to fourteen days have decent levels, and those with contact times of three weeks or more have the highest.

He points out that deeply-colored reds are more likely to be richer in procyanidins; mass-produced wines that are usually "house-grade" served at bars and restaurants tend to be low. Some are close to zero.

Wines rich in procyanidins provide several-fold more, such that a single glass can provide the same purported health benefit as several glasses of a procyanidin-poor wine.

So how do various wines stack up in procyanidin content? Here's an abbreviated list from his book:

Australian--tend to be low, except for Australian Cabernet Sauvignon which is moderate.

Chile--only Cabernet Sauvignon stands out, then only moderate in content.

France--Where to start? The French, of course, are the perennial masters of wine, and prolonged contact with skins and seeds is usually taken for granted in many varieties of wine. Each wine region (French wines are generally designated by region, not by variety of grape) can also vary widely in flavonoid content. Nonetheless, Bordeaux rate moderately; Burgundy low to moderate (except the village of Pommard); Languedoc-Roussillon moderate to high (and many great bargains in my experience, since these producers live in the shadow of its norther Bordeaux neighbors); Rhone (Cote du Rhone) moderate to high, though beware of their powerful "barnyard" character upon opening; decanting is wise.

Italy--Much red Italian wine is made from the Sangiovese grape and called variously Chianti, Valpolicella, and "super-Tuscan" when blended with other varietals. Corder rates the southern Italian wines from Sicily, Sardinia, and the mainland as high in procyanidins; most northern varieties are moderate.

Spain--Moderate in general.

United States--Though his comments are disappointingly scanty on the U.S., he points out that Cabernet Sauvignon is the standout for procyanidin content. He mentions only the Napa/Sonoma regions, unfortunately. (I'd like to know how the San Diego-Temecula and Virginian wines fare, for instance.)

The winner in procyanidin content is a variety grown in the Gers region of southwest France, a region with superior longevity of its residents. The wines here are made with the tannat grape within the Madiran appellation; wines labeled "Madiran" must contain 40% or more tannat to be so labeled (such is a quirk of French wine regulation). However, among the producers Dr. Corder lists are Chateau de Sabazan, CHateau Saint-Go, Chateau du Bascou, Domaine Labranche Laffont, and Chateau d'Aydie. (A more complete can be found in his book.)

How does this all figure into the Track Your Plaque program? Can you succeed without red wine? Of course you can. I doubt you could do it, however, without some attention to flavonoid-rich food sources, whether they come from spinach, tea, chocolate, beets, pomegranates, or red wine.

Though my wife and I love wine, I confess that I've never personally drank or even seen a French Madiran wine. Any wine afficionados with some advice?

Comments (14) -

  • Anonymous

    10/28/2007 3:02:00 PM |

    There is a dietary supplement called "Resvinatrol Complete" which labels as the red wine alternative. The product description says "Resveratrol is a natural ingredient found in grapes, red wine, purple grape juice, peanuts and some berries with important anti-inflammatory and antioxidant properties". Is this similar to the effects of Flavonoids?

  • Carl

    10/28/2007 6:09:00 PM |

    The Madiran I drink is imported by Bonny Doon and labeled 'Heart of Darkness'.  This one is easy to find locally, current prices run $12-$18 in my area.  
    I like it a lot, but it may take some getting used to. Tannat grapes as the name implies have Tannins galore, so I decant for half an hour or more and always drink it with food (grilled meats, roasted game).  

    They don't import this every year, but I still find plenty at my local store.  If this book becomes a big hit, expect the price of Tannat wines like Madiran to go up.  Judging from the wines he approves/disapproves you might find that reds with lots of tannins are worth trying.  

    I sometimes find other Madirans locally and I'll usually give them a try but HoD is my 'go to' Tannat.  By the way, the Tannat grape does very well in the South American country of Uruguay, so if you see one of those languishing on the rack give it a try.  

    South America has been kind to some varieties of wine and Tannat has done well in the country of Uruguay. Not easy to find

  • Carl

    10/28/2007 7:10:00 PM |

    Addendum: Esquire magazine ran a series of articles a few years ago about how to live to be 100.  They noted that Sardinian shepherds who ate the local diet of minestrone vegetable soup with local cheese and local red wine had esp. long lives.  The article attributed this to exercise, diet and the benefits of the local red wine.  They also pointed out that these red grapes -and others - grown at high altitudes had more of the beneficial flavonoids.  With that in mind, I started looking for good red wines from high altitude grapes. I found that traditional Argentinian Malbec from Medoza falls into this category.  I particularly recommend the Malbec made by/imported by Patrick Campbell (owner of Laurel Glen, maker of REDS and Za Zin zinfandels).  His Terra Rossa Malbec is everything we're looking for - and costs me $10 or so locally.  Highest recommendation.
    Note that Malbec is often blended with Tannat grapes, in france it's usually considered a 'blending' grape for Bordeaux...but in Mendoza (Argentina) it really shines on it's own.

  • Dr. Davis

    10/28/2007 8:15:00 PM |

    I am skeptical that resveratrol is the active substance in red wine that confers benefit, or at least substantial benefit.

    Corder also expresses skepticism based on the lack of an endothelial-normalizing effect. There is another study that suggests that resveratrol absorption in humans is poor and unlikely to achieve the levels that are required in experimental prepartions to achieve its purported benefits.

  • Dr. Davis

    10/28/2007 8:21:00 PM |

    Thanks, Carl.

    I'm heading to the wine store!

  • Anonymous

    10/29/2007 1:12:00 AM |

    hello- just wondering what you thought of the diet recommendations in Corder's book? I think he does offer up some bread recipes that inlcude wheat. I saw it very quickly at the bookstore- should I go back and buy it for the diet and wine advice?

  • Alan

    10/29/2007 11:31:00 AM |

    Hi Dr Davis.

    More and more as I read your excellent blog I discover that, although I see it from a diabetic patient's viewpoint, we think alike on many aspects of diet.

    I've also written on wine, but directed more to diabetes health here: http://loraldiabetes.blogspot.com/2007/03/red-red-wine.html

    You might find some of the included references interesting. I practise as I preach; right now it's a very nice '03 Coonawarra Cabernet Sauvignon.

    Cheers, Alan, T2, Australia

  • Dr. Davis

    10/29/2007 12:11:00 PM |

    In all honesty, I simply glanced at the recipes, since I was skeptical that he had anything original to say in diet. He does, however, seem to provide some recipes with a focus on high flavonoid content. So I remain uncertain of how wise his diet is. I think his expertise is wine and flavonoids, not foods. I believe he is the sort of "doctor" that does research but does not take care of poeple. I am even more skeptical of health advice from people who do not actually take care of other people.

  • David

    10/29/2007 10:15:00 PM |

    Red wine is wonderful, to be sure, but apples and cocoa are the champs when it comes to procyanidins. One Red Delicious has over 200 mg. of procyanidins, or about 9 times the amount in a glass of red wine. (J Nutr. 2000 Aug;130(8S Suppl):2086S-92S).

    Procyanidins are amazing antioxidants, and the cardiovascular benefits are only the beginning of their healthy properties. They're also chemopreventative, and have exciting antiaging properties as well. One apple procyanidin (b2) has even been shown to promote hair growth in balding men in several clinical trials. Apple procyanidins are also water soluble and easy to absorb, and have advantages for people who don't drink alcohol (wine) or eat fat and sugar (chocolate).

    So I say, if you drink, switch to red wine. If you eat sweets, choose polyphenol-rich dark chocolate. Bitter is better. Just make sure you eat your apples too!

  • G

    10/31/2007 12:39:00 AM |

    Dr. D -- Salice Salentino (riserva 2003) is excellent! It's imported from the South of Italy and especially dark, bitter and delicious (even better, inexpensive and available at Trader joe's!!)
    Malbec from TJ's is good too (but not as nice as the above)...
    Thank you for the vote for Flavonoids!! congrats on you award from health.com (never heard of them but that's awesome) I wish Oprah would feature TYP on her program... I suspect she's 25-OHD deficient... (my sister mentioned Oprah was recently dx'd with hypothyroidism which of course is autoimmune and therefore related to Vit D deficiency)

  • shreela

    6/12/2008 4:26:00 AM |

    This looks very promising:

    Researchers studied 7,211 nondrinkers, and 3,598 people who drank a glass a day of wine, beer or liquor, testing them for elevated blood levels of alanine aminotransferase, or ALT, a finding that indicates liver damage.

    They found above-normal levels in 3.2 percent of nondrinkers, 3.5 percent of beer drinkers and 2.3 percent of daily hard-liquor drinkers.

    But among those who drank a glass of wine a day, the rate averaged only 0.4 percent.

    Wine May Help Keep Liver Healthy

    I searched alanine aminotransferase along with diabetes, heart disease, and alzheimer's, and each one had patients with eleveated ALTs.

    Another thing that interested me was that it also included white wines, which IIRC, don't have nearly as much resveratrol as red wines.

  • Rick

    1/21/2009 7:44:00 AM |

    For some reason, red wine upsets my stomach, while white wine and purple grape juice are fine. (I have to be careful with dark chocolate, too.) Anyone know why this might be?

    And as an aside, do you think vermouth has similar benefits to wine?

  • mongander

    8/16/2009 1:45:26 AM |

    My doctor has been bugging me to get on statins for years but I refused. I finally agreed to start taking niacin, which is what Dr William Davis recommends. When my doc told me my HDL had shot up to 80 (from under 40), I figured it was due to the niacin, but my doc asked, "Have you started drinking alcohol?"  I explained that while I don't usually drink alcohol, I do consume 1 oz of 190 proof Everclear which I use to help dissolve some fruit and berry powders (pomgranate ellagic acid powder and Muscadine Peel Powder). My doctor thinks the 1 oz of alcohol is what elevated the HDL. When I replied, "Well, that's good, isn't it?", she shrugged her shoulders.....she's Islamic, so she may not be able to admit that alcohol had a positive benefit.

    I also have a good diet, avoiding most processed foods, especially processed carbohydrates, avoid almost all wheat, but am not on a low carb diet.  I get quite a bit of exercise.

  • buy jeans

    11/2/2010 8:38:07 PM |

    Italy--Much red Italian wine is made from the Sangiovese grape and called variously Chianti, Valpolicella, and "super-Tuscan" when blended with other varietals. Corder rates the southern Italian wines from Sicily, Sardinia, and the mainland as high in procyanidins; most northern varieties are moderate.