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.
Will the real LDL please stand up?

Will the real LDL please stand up?

The results of the latest Heart Scan Blog poll are in.

The question: How has your LDL been measured? The 187 responses broke down as:


I have only had a conventional calculated value
108 (57%)

NMR LDL particle number
35 (18%)

Apoprotein B
21 (11%)

Direct LDL cholesterol
21 (11%)

Non-HDL cholesterol
8 (4%)

I don't know what you're talking about
23 (12%)


Remember the TV game show, To Tell the Truth? Celebrities would have to guess which of three guests represented the real person, such as the notorious con man, Frank Abagnale, Jr., or Mad Magazine publisher, William M. Gaines (who stumped celebrity Kitty Carlisle, heard to exclaim, "I never figured it was him. I mean look at the way he's dressed. I was looking for someone who ran a very successful magazine, so I thought it couldn't be him!")

The celebrities playing the game were permitted to ask the three guests a series of questions, hoping to discern who was the real person vs. the two impostors. At the end, each celebrity had to guess who was truly the person of interest. "Will the real Frank Abagnale, Jr. please stand up!"

If we were to act as the celebrities in our LDL game, we quickly discover some telling facts:

--Conventional LDL cholesterol (the only value 57% of our poll respondents have had) is calculated, not measured. LDL is calculated using the 40-year old Friedewald calculation.

--Directly measured LDL cholesterol (the value 11% of respondents had) is just that: directly measured. It eliminates some of the uncertainties of calculated LDL.

--Apoprotein B-Every LDL and VLDL particle produced by the liver contains one apoprotein B molecule. ApoB therefore provides a crude particle count measure of LDL and VLDL particles. Of course, it includes VLDL and is not completely the same as just an LDL measure. Some lipid authorities Like Dr. Peter Kwiterovich have advocated that apoB replace calculated LDL, and that calculated LDL essentially be discarded.

--Non-HDL cholesterol--I mention this more for completeness. Hardly anybody uses this crude value in practice--Indeed, only 4% of our poll respondents had this measure/calculation. Non-HDL is simply total cholesterol minus HDL cholesterol = Non-HDL cholesterol. It is thus a combination of cholesterol in LDL and VLDL (triglycerides), similar to apoprotein B. While, like apoB, it is a bit different in that it includes VLDL, it has proven a superior measure of risk.

--LDL particle number--In my view, this is the gold standard for LDL and risk measurement, obtained by only 18% of our poll respondents. LDL particle number is proving superior for discriminating who is truly at risk for a cardiovascular event, particularly when metabolic syndrome or diabetes is part of the picture, i.e., when HDL and triglycerides are considerably distorted, leading to substantial corruption of calculated LDL.


While 18% is a minority, it still represents growth in recognition that conventional calculated LDL cholesterol is an unreliable, inaccurate, and outdated value. If the real LDL were to stand up, I believe that it is LDL particle number that would spring to its feet.

Comments (13) -

  • Jan Jones, M.A.in Education, B.S. in Education

    4/28/2009 3:48:00 PM |

    This post comes with great timing for me, in a way...
    I just went to my dr last week to have my cholesterol checked since I have been on Dr. Davis' recommended protocol for 3 months and wanted to get accurate results to determine my current progress. In January my dr was recommending statins for me due to a slightly elevated LDL with an HDL of 65
    /trig-80/tot-235.

    At my appt. I asked her to do the test to get specific results for my LDL naming the best tests mentioned here. She looked at me as if I was from Mars and told me she never heard of such tests and those type of results would be of no benefit to any course of treatment and my insurance probably wouldn't pay for them because they may be experimental...got the picture.  Lots of resistance.  She then asked me where I got all of these ideas and so I told her about this "blog" well you can imagine her little grin as the dreaded internet doctoring reared its ugly head.  So, she said let's go to my office and look up this "blog" so I can see exactly what this LDL test is.  Low and behold as she put in the heartscan blog address, it came back ACCESS DENIED.  She tried several times and could not get in because the Scripps Medical Group system has it blocked.  

    So, I ended up getting a regular lipid panel and she added a Lp(a) test and kept saying something about fluffy particles. I don't have results yet but I am definitely feeling a lack of confidence in this physician who seems very together in a busy practice, yet isn't up on things to manage preventative care in a knowledgeable way.  How do we find primary care drs who know what they are doing?  For those of us in our 50's it is crucial to get these things under control to lead healthy lives and avoid many common problems that plague people as they get older.

    My husband and I don't want to wait until we need a cardiologist to get the type of information we are getting here.  

    Jan

  • Kiwi

    4/28/2009 11:58:00 PM |

    Jan,
    Even my cardiologist is ignorant about LDL particle sizes so what hope for the poor local Dr.

  • mark

    4/29/2009 2:04:00 AM |

    I thought the whole basis for cholesterol being bad was centered on lipoproteins and not on cholesterol itself.  It is the Friedewald equation which has been used in arguing for cholesterol being bad.  So even though cholesterol tests are inaccurate, it doesn't matter, becasue the whole basis for the lipid hypothesis was based around lipoproteins and that Friedewald equation.

    Would the same studies implicate cholesterol (in the lipoprotein) if more accurate tests were used?  

    It could explain why in so many studies, HDL and LDL have conflicting correlations.  In one set of individuals, high LDL indicates high LDL cholesterol.  That is to say, for a certain lifestyle and environmental and genetic factors, the individuals with high LDL will also have high LDL cholesterol.  

    Then in other populations, their lifestyle (and other factors) makes it so that high LDL lipoproteins does not coincide with high LDL cholesterol.  

    Or some individuals with low LDL can have high LDL cholesterol.  

    Mark.

  • Drs. Cynthia and David

    4/29/2009 8:37:00 AM |

    Sadly, I suspect much of the reason for sticking with the inaccurate and misleading LDL #s is that much of the research is paid for by drug companies pushing LDL lowering drugs, so of course it is not in their interest to have the truth come out that LDL per se is not really important.  Does taking a statin reduce the number of LDL particles? or just the amount of cholesterol in the particles?

    It's also horrifying (as Jan comments above) that this site is blocked by the medical establishment.  No wonder the doctors don't know anything- they can't even look up information easily!

    Thanks for all your educational posts.  There is still a lot of resistance out there,  but I think you are making progress.

    Cynthia

  • vin

    4/29/2009 11:07:00 AM |

    18% is very unlikely to be true for the total population. I think the actual number is much lower.
    The question should really be put to health care people : which test do they use for their patients?

  • steve k

    4/30/2009 12:36:00 AM |

    can you explain the difference between 25(0h)2 vs. 1.25?  What does it mean if the 1.25 is high and not the 25(oh)2 which you say should be measured.  I have been taking D3 and agree with all the benefits cited.  Thank you

  • Trinkwasser

    4/30/2009 8:19:00 AM |

    In many parts of the UK you can only get TChol. Lipid panels are "too expensive". They need to save money on the tests to afford the statins. My GP is clueful enough to turn a blind eye when I biro in the Full Lipid Panel, and also to interpret the results (LDL is nominally over limit but is trumped by my excellent trigs and HDL) but her cluefulness is very constrained by the accountants. They pay bribes to get a certain % of patients on statins irrespective.

  • homertobias

    4/30/2009 4:51:00 PM |

    Jan
    Was it Scripps Clinic or Scripps La Jolla?  Was it simply that her in house computer was blocked from surfing the internet?  This is very common.  Lab corp or Quest (better) will run your NMR.  Just have your doctor order it and find a draw station.  Blood needs to be spun and needs a YELLOW and BLACK tube.

  • Jan Jones, M.A.in Education, B.S. in Education

    5/1/2009 2:03:00 PM |

    homertobias,

    The dr is with Scripps Clinic and she had access to the internet in her private office without any apparent problems.  When she entered the address of the blog it was blocked and when a google search of dr. davis found the blog that too would not open.  

    I had written down all of the tests that dr davis recommends here and she had no idea what that was about. I asked for NMR  and she didn't know what to order, which was why she wanted to go to the blog to see it for herself.

    I got my lipid panel results yesterday but the Lp(a) test she ordered did not come back.  They're checking on that one.  

    Thanks for the info.

    Jan

  • RyanVM

    5/1/2009 11:20:00 PM |

    I'm betting they just have a generic block on blog sites (blogger, wordpress, etc).

  • Mark K. Sprengel

    6/18/2009 12:19:04 AM |

    I'm pretty sure my insurance uses the calculated LDL value. It's rather irritating as our annual blood test scores are used along with a series of questions about diet/exercise etc. to determine how much of a credit we get on our paychecks. They also use the BMI which I've read is very innacurate for athletic/lean bodies. Our human resources rep had no answer when I pointed out it would probably put me at overweight if I was 210 lbs at 6' tall but 10% bodyfat even though I would be healthier.

  • Trinkwasser

    7/14/2009 1:41:43 PM |

    This is useful. I can't remember who posted it but all credit to them. The Iranian Formula corrects for the low trigs I hope we all have where the Friedewald Equation falls apart

    http://homepages.slingshot.co.nz/~geoff36/LDL_mg.htm

  • Robin

    11/2/2012 3:54:08 AM |

    If they were interested enough, they'd look it up on their own computers when they got home. If they had only a business laptop, which would lock them out of helpful sites, then they'd find a way of doing their own research - just like the rest of us have to when not relying on the medical establishment.

Loading