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Common Heart Treatments Increase Heart Disease??

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You follow your cardiologist’s advice, thinking it will protect you in the long run.  But what if this is not the case?

It will come to no surprise for regular readers of my blog that I think that lifestyle changes are the ONLY answer for heart disease.  Unfortunately, many patients opt not to make the right changes, or worse–these changes are not even discussed with patients because of a lack of knowledge on the part of the provider.

This particular study looks at outcomes of medical treatment (i.e. drugs), coronary angioplasty (PCI) or open heart surgery (CABG) ten years later.  Here’s the disturbing findings after following 611 patients who had CABG, PCI or standard medical therapy (MT=drugs):

  • 10-year rates of needing additional invasive procedures (revascularizations) were 7.4% with CABG, 41.9% with PCI, and 39.4% with MT.
  • Those in the drug only group had a 235% higher risk of future cardiac events (including deaths) than in the CABG group.
  • Those in the PCI group had a 185% higher risk of future cardiac events than in the CABG group.
  • 10-year rates of freedom from angina were 64% with CABG, 59% with PCI, and 43% with MT (P<0.001).

The bottom line?  Medical treatment or PCI actually INCREASED the risk of the need for more stents, heart attacks and / or cardiac death.

Wow.  I know that it SOUNDS like doing procedures is a good thing and it all seems well and dandy on paper, but when translated to the patient the outcomes just don’t work out.  So it boils down to having your sternum cracked open and some blood vessels taken from another area of your body to replace the disease ones that are needed to get nutrients and oxygen to your heart.

Or…

Eat better / stress less / exercise.  Hmmm…tough decision…

Statins Versus Fast Food; Really an Even Battle?

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JUST HOW OFF BASE IS MEDICINE?

Keep in mind that this particular article is an editorial.  The author is writing for the British Heart Foundation.  He believes that the use of a statin can zero out the negative health effects of a Quarter Pounder with cheese and a small milkshake.

Have we really come so far down the dark path of unhealth that we have to accept that patients can’t change and we need to rely on medications instead of lifestyle?  That is truly a sad state of affairs if doctors collectively do not have faith in their patients.

Maybe this is because they themselves are not exactly free of hypocrisy?

Regardless, the faulty reasoning here is that the beneficial effects of statins have been overblown while the negative effects of fast food have been under emphasized.  Or maybe this is just representative of the tightening relationship between medicine and big business as epitomized by the endorsement of Coca Cola by the American Association of Family Physicians…

Statins and Your First Heart Attack

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IS THIS THE BEGINNING OF THE END OF STATINS (LIPITOR, CRESTOR, ZOCOR, VYTORIN, etc…)?

It should come as no surprise to regular readers of my posts that the research just does not support the use of statins to prevent a first heart attack.  The data is very, very weak.  Which would be fine if it didn’t cost the US alone some $20 BILLION per year.  Talk about money wasted.  And not a shred of evidence to suggest that they help prevent a heart attack, and plenty to suggest they harm.  But, despite the evidence, our country and medical system is absolutely convinced that statins are the savior for heart disease.

This meta analysis, reviewing over 65,000 patients over 11 studies with patients at a HIGH RISK of heart disease (forget those with only elevated cholesterol…), found NO EVIDENCE FOR THEIR USE IN PREVENTING THAT FIRST HEART ATTACK!!!  Seriously.  What more information do we need?  Any why do I have to spend hours educating patients that the drug they are taking is worthless to them?  Help!!

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Surprising Fact on Users of Statin Drugs to Lower Cholesterol–

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drugs to lower cholesterol and weight gain
Photo courtesy of http://www.freeimages.com/profile/julosstock

Society has been brainwashed into thinking that drugs to lower cholesterol are required to prevent heart disease if you have high cholesterol. Money thrown at a consistent marketing message can do that.

It is not uncommon for me to hear a patient speak defiantly in a phrase like, “I do NOT want to go on those cholesterol drugs.” It is stated in the same tone as someone saying he or she does not want to have a leg amputated due to a severed artery bleeding like an Uma Thurman opponent or gangrene you can smell from down the hall. This is how serious much of the American public thinks the issue of taking or not taking a statin is. They are under the mistaken belief that statin drugs will actually do a lot to protect him or her from a heart attack.

I think these patients fear that the doctor will recommend (key word here is “recommend,” not “force”) statins when the misguided lifestyle advice doesn’t work. If the lifestyle changes didn’t work, then taking a drug to lower cholesterol is now a requirement, not an option. If only the general public really knew (If that statement does not mean anything to you, it might be a good time to spend some time with my Cholesterol eBook that can be found on Amazon by clicking here).

But this article is not about beating up on how ineffective the statins are at actually preventing a heart attack or the long list of side effects associated with their use. Rather, this article is about a much, much bigger issue.

It is about the public’s view of medicine and the subsequent responsibility we have for our own health. Just yesterday I had a conversation with a patient whose wife is an obese diabetic with a desire for sweets that she just won’t kick. Her, and many other diabetics just like her, are under the delusion that everything is ok because they are on drugs to “control” the condition.

But what would’ve happened if we didn’t have drugs that we give to diabetics? We would have to sit this patient down, have a direct face-to-face conversation about what is going to happen to her if she doesn’t make changes. Not MIGHT, but WILL happen. Replay this scenario with pretty much every other chronic disease, especially in the early stages of the disease. In this scenario, the responsibility is smack dab in the patient’s lap where it should be.

Medications, however, remove the responsibility from the patient. There is no worse ideology than one that eliminates a lack of personal responsibility when it comes to the prevention and management of chronic disease. None.

This particular study says it all and makes it more real that patients who are given drugs to “control” their chronic disease or, even worse, drugs to control merely the RISK FACTOR for a chronic disease, (like cholesterol) have let go of personal responsibility.

In it, researchers compared two groups of 27,886 US adults, from 1999 through 2010; one group who took statins and the other group that did not use statins to lower cholesterol. Here’s what they found:

  • Over the time frames measured, the calorie intake of statins users climbed (2009-2010 was 9.6% higher than that in the 1999-2000 period).
  • The non-statin group calorie intake, however, was unchanged during the same study period.
  • Over the time frames, the fat intake of statin users jumped 14.4%.
  • Non-statin users’ fat intake? Unchanged.
  • BMI increased more among statin users (+1.3) than among nonusers (+0.4).

In a group who had an obvious concern over cardiac health, enough so to take a medication designed to lower cholesterol to lower the risk of a heart attack, the concern extended no further than a number on a lab test. If that number got better using a drug to lower cholesterol, there was no need to control anything else in the lifestyle.

Unless we return the true responsibility for health back where it belongs (with the patient) the health of our culture will continue to decline, with the doctors frustrated and their time bled dry and the drug companies raking in massive profits.

Could Statins Actually Help Prevent Heart Disease?

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Ok, so maybe I’ve been too hard on statins.  Just because they suck at preventing a first heart attack is no reason to throw the baby out with the bath water.

The list of side effects continues to grow, with diabetes being the most concerning (unless of course, it is you personally who happens to die from a fatal rhabdomyolosis, in which case you’re probably less worried about diabetes….), because for every 11 heart attacks avoided 8 new cases of diabetes will be created.

I have argued less against the use of statins in secondary prevention (those who have already had a heart attack and are now trying to prevent a second heart attack) because the data is a little stronger.  In general, though, statins will do very little to protect against a first heart attack.  The only real benefit is seen in those who have a greater risk.  In other words, the otherwise healthy, lean body weight, low blood pressure 45-year-old male with an isolated, elevated cholesterol will have ZERO benefit from taking a statin.  This doesn’t stop him from getting prescribed a statin by some overzealous primary care doctor who just got back from a conference sponsored by Pfizer, however.

As I have mentioned before, only 1 out of every 100 people will see a benefit from taking a statin.  My point has always been that lifestyle changes will blow the effectiveness of statins out of the water every single time with lower cost and no side effects.

But what if we could identify a (very) small subset of patients who have not had a heart attack and yet would most likely be that ONE person out of 100 that benefits from taking a statin?  Turns out we may be closer to this answer with this particular study.

I have, for a long time, been a vocal advocate for the “heart test,” or calcium artery scoring (CAC) using an ultra fast CT scan.  Overall, the studies and subsequent data on the use of the EBCT (electron-beam CT) continues to improve and radiation doses have continued to drop to the point where the radiation exposure can be less than a dental X-ray (as opposed to standard CT scans, which we hand out like candy in the ER, which have a much higher radiation dose and have been linked to some 29,000 cancers per YEAR).

In the study, researchers looked at the benefits of statins through the lens of those having high calcium scores, indicating a higher likelihood of having a blockage in the coronary arteries.  Specifically, they looked at the relationship between the CAC, statin use and outcomes (heart attack, chest pain leading to stents being put in, resuscitated cardiac arrest, stroke, cardiovascular death).  Here’s the specifics:

  • Researchers looked for those with Ultra fast CT scores over 100 (21% of participants with CAC 100 or higher).
  • They then looked at those with abnormal cholesterol levels:  LDL > 130 mg/dL, HDL < 40 mg/dL for men (50 mg/dL for women) and triglycerides > 150 mg/dL.

With these two factors in mind, here’s how the study data played out:

  • More than half of events (55%) occurred in the 21% of participants with CAC ≥100 (the CT scan group bore the brunt of the heart events).
  • Conversely, 65% of events occurred in participants with 0 or 1 lipid abnormality (in other words, heart events are happening to those with normal cholesterol)
  • In those with CAC ≥100, event rates were as high as 29.5 per 1000 person-years, regardless of lipid / cholesterol numbers.
  • On the other hand, when the CAC was a big fat zero, cardiac event rates were 5 times lower at 5.9 per 1000 person-years regardless of lipid / cholesterol numbers.

To summarize, those with higher CAC scores were at a much greater risk of a cardiac event, regardless of where his or her lipid numbers were at.  Medicine has been locked into using the blinders of cholesterol (sounds like some D & D special armor…) despite the fact that it just wasn’t making sense when we looked at current research.  While there has been some move away from cholesterol, it hasn’t been with a logical head.  The most recent guidelines on statin use have indeed thrown cholesterol levels out the window, but instead of replacing them with something smarter like the CAC, the blanket recommendation was just to give everyone a statin.

The smarter approach, based on this study, would be to use treatment for those at the highest risk based on CAC scores, NOT on cholesterol levels.  Let me point out though, that nothing in this study actually looked at whether or not statins could lower cardiac events in those with higher CAC scores, although this is an excellent question to ask.

Maybe, just maybe, one of these decades medicine will actually catch up to the research.

The NEW Statin Guidelines: This is the Best We Got?

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I keep thinking that I’m missing something here.  Some magical number that makes these drugs to lower cholesterol worth the hype.

I’ve read all the studies and I’ve seen the numbers, but I don’t read ALL of the medical literature that gets published on statins.   So maybe I missed the one that showed that statins are worth all the hype and the new recommendations.

There has been much pushback on the newly released 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on reducing atherosclerotic cardiovascular disease risk.  The arguments include conflict of interest (8/15 panelists had financial ties) and overzealous interpretation of the data.  Here are the scenarios when moderate to high dose statins should be used:

  • Anyone with low-density lipoprotein (LDL) cholesterol levels >190 mg/dL.
  • Anyone from 40 to 75 years or age with type 1 or 2 diabetes.
  • Anyone aged 40 to 75 years with LDL cholesterol levels between 70 and 189 mg/dL and 7.5% or higher estimated 10-year risk of atherosclerotic cardiovascular disease.
  • Moderate-dose statin treatment in anyone with an estimated 10-year risk between 5% and 7.5%.

This pretty much covers everyone.

But this  aren’t the problem.  Or rather, the problems.

First, the queen of all twisting of the data has to do with cholesterol.  If you remember how this all started years ago, it was all about total cholesterol.  Everyone needed their total cholesterol checked so that we could see whether or not they needed drugs.  The entire, laser-like focus on preventing heart disease kept total cholesterol in the crosshairs.  We did this, spending mass amounts of money on “educating” doctors and patients that total cholesterol = heart disease = statins.

It got embedded deep.  Really deep.

It was not until 10 years later that anyone asked whether lower total cholesterol with drugs was preventing heart attacks and deaths.  Turns out they didn’t work really well.  Actually, they sucked.  So much that these new guidelines do not even take total cholesterol into account.  Basically, the suggestions were that we don’t need to look at markers anymore, but we just treat for the sake of treating because the research shows that these drugs help to reduce deaths.

Which brings us to the second problem.  They suck at preventing death.

And they did not hide this in the recommendations, as you can see in this review article on the subject.  The numbers are given as “NNT,” or number needed to treat over 5 years to see a benefit.  This number helps us to understand how many patients need to be treated to benefit a single patient.  As an example, using steroids in an acute asthma attack will save 1 person from going to the hospital for every 8 treated, so a NNT of 8.  This is considered pretty darn good.  Acid blocking drugs in a bleeding stomach ulcer to prevent another episode of bleeding?  15.  Probiotics for preventing C. diff infections?  25.

You get the idea.

So what about the use of statins?  Here’s the numbers:

  1. Dying from all causes NNT 138
  2. Having a cardiac event NNT 49
  3. Dying from cardiac causes NNT 88
  4. Having a stroke NNT 155
  5. Developing diabetes NNT 98

The saddest part about all of this is that society and medicine has degenerated to the point where we are willing to accept a treatment that is so poor that we have to treat 88 people for 5 years to prevent a single death.  And the costs to prevent that single heart attack are staggering (think about the costs of 5,280 months of statin drugs).

With these recommendations, we have given up on the hope that the American public can and will make the necessary lifestyle changes to protect their hearts and have instead leaned more heavily on the use of drugs for “prevention” of heart disease.

That is the saddest part of all of these recommendations.

 

How Compliant are You with Your Heart Meds?

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Let’s face it.  The general public sucks at taking their meds the way they are supposed to.  But it’s still going to help, right?

Studies have shown that upwards of 75% of patients taking medications are not fully compliant.  In other words, the vast majority of medicated patients do not take drugs as prescribed.

With this in mind, understand that trials on medications are done under Ivory Tower-like conditions.  And the results on trials for a large chunk of available medications show a paltry benefit at best (anti-depressants, high blood medications and cholesterol medications are just a few examples).  We can extrapolate that, if the benefits of drugs like those mentioned above are a  hair above non-existent with high compliance, that with low compliance the chance that benefits of the drug will outshine side effects becomes akin to finding the winning Powerball ticket walking through a parking lot.

Just in case you think I’m being dramatic (ok…so maybe the Powerball comment was a wee bit dramatic–but not by much), I present this particular study.  In it, researchers looked at several different drugs, the statins or blood pressure medications (beta-blocker, ACE inhibitor or ARB), to see what the benefits of the drugs looked like if someone was compliant versus non-complaint.   High compliance was considered to be someone taking his or her drug at least 80% of the time they were supposed to be.  Here’s what they found:

  1. Highly compliant patients were 19-36% less likely to have a heart attack or need a heart stent procedure.
  2. Everyone else who did not take the meds as prescribed basically had no benefit.
  3. Even those who were partially adherent had no reduction in heart attacks or cardiac procedures.

This means that, with statins (my favorite class of drugs) or the most commonly used blood pressure medications, only a small percentage of those patients taking them will ever see a benefit.  Even if they do see a benefit, many times that benefit is small.  None of this takes into account the long list of side effects from these classes of drugs.

THIS is what we call “medicine” today.

 

Statins and risk of polyneuropathy – (05-23-02)

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Statins and risk of polyneuropathy

This article adds more weight to the clinical observation of statin drugs having polyneuropathy as a side effect. A few important things to consider here…the statins lower activity of HMG CoA reductase (one of the enzymes responsible for cholesterol synthesis). They also lower synthesis of CoQ10 at the same time. This is well documented. I’ve always been stumped at this one–CoQ10 is vital for high respiratory tissues such as the heart and skeletal muscle. Hence some of the side effects of the statins are muscle aches. I would guess that the polyneuropathy is also related to reduced CoQ10, which could easily be fixed with supplementation (which any patient on the statins should be put on). The other scary part is recent recommendations that are designed to increase the number of patients that should be on cholesterol lowering meds (three guesses as to who funded THAT study!!). This would increase the side effects we see in this class of drugs.

Neurology — Abstracts: Gaist et al. 58 (9): 1333

Read entire article here