Headlines today announce that the new President of the American Heart Association (AHA), cardiologist Dr. John Warner, has suffered a heart attack, aborted by an emergency stent placement. Typical of the ridiculous attitudes that prevail at the industry-friendly AHA, they Tweeted:
“Sending all our love and support to @American_Heart president Dr. Warner as he recovers from a mild heart attack. Heart disease can strike anyone, at any time. That’s why we keep fighting.”
If you ignore the nonsense that AHA policy dictates, you can absolutely gain control over cardiovascular risk. But you will NOT find the answers in any AHA policy. I learned these lessons practicing as an interventional cardiologist, then abandoning this ridiculous way of managing coronary disease to devote my efforts to early detection and prevention.
So I thought I would articulate some of these thoughts in an open letter to Dr Warner as he recovers from his procedure.
Imagine you read these headlines:
“Campaign in Afghanistan a success: 10,000 Americans dead.”
You would be confused, perhaps outraged. How can the death of American soldiers be regarded as success when it is clearly an outright failure?
Well, for the same reasons, why do our colleagues, hospital executives, and people in Big Pharma and the medical device industry make claims such as “We’ve had a banner year, our most successful year ever: 800 coronary bypasses and 18,000 heart catheterizations performed.” These are not measures of success; they are measures of failure–failure to identify the people at risk, failure to correct the factors that lead to heart attack, angina, and atherosclerotic coronary disease, failures that you have now survived.
There are a number of reasons why someone like you—deeply-entrenched in the conventional world of heart disease management and what passes for prevention—highlights the miserable failure that the modern coronary care paradigm represents:
1) We are trapped by the outdated but profitable Lipid Hypothesis–We’ve been misled and stalled on this absurd and outdated notion that “cholesterol”—meant to represent nothing more than a crude and indirect marker for atherogenic lipoproteins, even back in the 1950s when Drs. Friedewald and Fredericksen at the NIH recognized that quantifying the true etiology of coronary atherosclerosis, bloodborne lipoproteins, caused atherosclerotic plaque accumulation. Cholesterol was meant to be nothing more than a crude marker for such lipoproteins but IS NOT A DISEASE IN ITSELF. But Big Pharma entered the picture, muddying the water and persuading our colleagues that cholesterol was a causative factor and deserves “treatment.” Hundreds of billions of dollars later and many coronary events that were NOT prevented by the absurd notion of statin cholesterol treatment later, we still have plenty of coronary events that pay Big Pharma, cardiologists, hospitals, and the medical device industry quite richly.
2) We know from abundant data that small oxidation- and glycation-prone LDL particles are highly atherogenic (atherosclerotic plaque-causing), as they endure for 5-7 days in the bloodstream, compared to 24 hours for large LDL particles provoked by fat consumption; are adherent to the glycosaminoglycans of the arterial intima; are potent triggers of the inflammation cascade, e.g., intimal matrix metalloproteinase; and are triggered to abundant degrees in some genotypes upon consumption of the amylopectin A of grains—yes, the food that the American Heart Association advises to fill the diet with—and sugars.
3) I have advocated CT heart scans to generate a coronary calcium score for over 20 years, the only means we have to measure, then track, progression or regression of coronary plaque burden. And your coronary calcium score is wonderfully manipulable and reversible—I’ve done it countless times and published the data. People who stop progression of their coronary calcium score (compared to the 25% per year progression typical of people taking statin drugs) or reduce their score have virtually no cardiovascular events–NO EVENTS.
4) As with all complex conditions such as dementia and cancer, coronary disease is multifactorial. Thinking that a statin drug (+ aspirin and a beta blocker) are sufficient to prevent coronary events is absurd and overly-simplistic, like thinking that taking Aricept for dementia will stop the disease—of course, it does no such thing. Our colleagues say that many of the causes cannot be treated because the drugs do not yet exist—that is indeed true: There are no drugs to “treat” many of the contributors to coronary atherogenesis. But there are many non-drug strategies to identify, then correct, such causes: Removal of all dietary factors that provoke formation of small LDL particles, insulin resistance, and glycation; restoration of vitamin D to a 25-hydroxy vitamin D level of 60-70 ng/ml that exerts anti-inflammatory effects such as reduction of abnormal activation of matrix metalloproteinase; a dose of omega-3 fatty acids sufficient to generate an RBC omega-3 index of 10% or greater associated with dramatic reduction in cardiovascular events, reduction in small LDL, and subdued postprandial atherogenic lipoprotein patterns; restoration of ideal thyroid status, given the extravagant increase in risk with TSH values even in the high “normal” range; cultivation of healthy bowel flora to correct the common dysbiosis caused by sugar consumption, chlorinated water, antibiotic exposure, pesticide/herbicide exposure, and common drugs such as H2-blockers and PPIs for acid reflux. Problem: While effective, these strategies are not dispensed by Big Pharma, require no involvement of the medical device industry, don’t even require a doctor in most instances. Thus, there are no sexy sales reps advocating for them, no all-expense-paid trips to Orlando, no direct-to-consumer ads on TV, and few doctors who even want to bother with the effort.
I am hoping that, now that this disease has touched you personally, your eyes will be opened to the corrupt and absurd policies of conventional coronary care and the American Heart Association. Your life, after all, may be at stake in coming years. Contrary to the self-serving Tweet from AHA staff to you, heart attack risk is 1) quantifiable, 2) trackable, 3) stoppable and reversible. Look at what happened to political commentator, Tim Russert, a few years ago: a coronary calcium score of 550 that his doctor dismissed as nonsense, treating his cholesterol with a statin and hypertension with various agents, along with aspirin, advising a low-fat diet and exercise. Five years later, Mr. Russert died suddenly on the set of his Meet the Press TV show. If we calculate his heart scan score at the time of death, it was 1880, a score that is associated with 15-20% per year death or heart attack: Mr. Russert’s heart attack and death was clearly written on the wall 5 years earlier, but an ignorant colleague failed to see it. Mr. Russert should be alive today, healthy, not having submitted to any coronary procedure. You, likewise, should be healthy with no stents and virtually no risk. But that is not what the conventional world of heart disease provides because it makes no money for healthcare insiders.