December 30, 2019
The new year is upon us and as I promised here is the new and updated cardiovascular disease story. This article series may be the most important series that I will and have tackled as it is the leading cause of death in this country and is entirely preventable with smart prevention oriented choices that begin at birth! Our children are the future.
After three decades of research and a 15-hour deep dive into the world of lipids and cholesterol with Dr. Peter Attia via his excellent podcast "Drive", it is time to update the cholesterol cardiovascular disease story as it exists in 2019/20.
For full disclosure, I have run this coming series of articles by my favorite cardiology and immunology colleagues for accuracy as it is a very complicated topic full of pitfalls. Simply put, I am providing an alternative hypothesis that is partly against the current grain, but worthy of exploration as the current abnormal cholesterol induced cardiovascular disease model is inadequate to explain all outcomes.
I make this point because it is imperative that all readers know that any time you go against conventional wisdom, you run the risk of negative reactions from providers of care that disagree or do not know. This is the way of things in life. This set of cholesterol/lipid and cardiology articles is meant to stimulate the reader to think beyond the simple answer that reductionist medicine provides that "statin medications" and cholesterol lowering in general are the primary or only answers to coronary artery heart disease prevention or treatment at this time. For most of us, we will do better with a combination of lifestyle modification and medication as needed based on risk. The medical dogma is exactly that as is written below.
Let us look at a quote from the Lancet from December 2019: "The indication for lipid-lowering therapy to prevent cardiovascular disease events in high-risk individuals or for secondary prevention is unequivocal. However, the decision on implementing a lipid-lowering intervention in the primary prevention setting is a major challenge in clinical practice for several reasons. Data on the association between the concentrations of the entire range of bloodstream lipids and very long-term cardiovascular outcomes in the general population are rather sparse. In addition, conventional primary prevention guidelines recommend lipid-lowering intervention on the basis of lipid concentration thresholds and the person's individual 10-year cardiovascular risk. This risk assessment might underestimate or fail to take proper account of the cumulative lifetime risk of cardiovascular disease and lipid-related cardiovascular disease risk, particularly in young adults. Furthermore, increased non-HDL cholesterol blood concentrations early in life seem to be stable over the life course and are predictive for incident cardiovascular disease." (Brunner F. et. al. 2019)
What this quote says is that the current guidelines to treat a patient that has had a heart attack or myocardial infarction with lipid lowering drugs is warranted based on the litany of studies to date. There currently is little debate regarding this fact. However, for primary prevention in a patient with or without known risk for cardiovascular disease, this answer is as clear as mud. I am living in this category making the thought experiment very useful.
The statin class of medications may or may not be a part of the solution for an at risk primary prevention heart disease patient. Every patient needs to weigh the risks and benefits of cholesterol lowering medications in the context of a broader picture of disease. I firmly believe that a large part of the population could avoid drugs by following the prescription to be laid out later in this article series. I have been practicing these principles for years and have seen my risk for disease stabilize based on blood lipid parameters, markers of inflammation and general well-being.
As a pediatrician, I see the world through a child's eyes which changes my viewpoint. Working to get children to understand these principles at a very young age in order to prevent heart disease is my goal. Kids are strong, resilient and rapidly repairing themselves. Therefore, if every child followed a heart healthy protocol, I think that our disease risk nationwide would fall like a lead balloon. Unfortunately, this is not happening nor is it likely to any time soon with societal pressures stacked solidly against healthy eating, judicious movement and reduced stress. You only need to visit any public school in this United Stated and see the poisonous food providing 66% of a students calories on any given day.
People, we are failing. It is a simple as that. The alarm bells have been ringing for the better part of four decades. Most major disease parameters seem to be on a rapid upswing. The biggest concern is that we are witnessing all of the chronic diseases of human aging including cardiovascular disease increasing in rates in young Americans with ever reduced time courses.
When we look at the reductions in death rates that are occurring we see: "Yet for both stroke and heart disease, no single breakthrough can be credited for the progress made", Dr. Rosamond from UNC Chapel Hill said. "Rather, it has been the cumulative effect of better prevention, diagnosis and treatment". Some of those efforts have included:
• fewer people smoking and being exposed to secondhand smoke;
• better emergency response to heart disease;
• improved heart medications and procedures;
• scientific research advances;
• legislation to build healthier environments; and
• increased public awareness about healthy living.
Despite the falling death rates, the number of people suffering from cardiovascular diseases is rising. Risk factors such as obesity, high blood pressure and unhealthy diets remain high, experts say."
We are reducing death through effective medical management in a crisis but losing the battle to morbidity, disease frequency and poor quality of life. This cannot be overstated. We are losing the battle. Unfortunately, as I see in clinic daily, the average American child is living in ways opposite of preventative cardiology protocols. I believe that this is the reason that the disease rates will continue to climb unless we take action now. These activities bring about all of the risk factors for heart disease including diabetes, obesity, high blood pressure and systemic inflammation.
My positive nature leads me to believe that there is always hope with enough time. Every week in clinic I spend time with a teenager who buys into the program 100%. I watch over the ensuing months to years as risk fades and health quality soars.