Coronary-Artery Calcium (CAC) imaging

CAC screening improves CAD risk factors without increasing downstream costs: EISNER

March 24, 2011 |                                 Michael O'Riordan

Los Angeles, CA - New data from the Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research (EISNER) study show that noninvasive imaging may actually lead to clinically meaningful improvements in coronary artery disease (CAD) risk factors in healthy individuals. Compared with individuals who did not undergo coronary-artery calcium (CAC) imaging, screening of subclinical atherosclerosis with CAC screening led to an improvement in systolic blood pressure, LDL-cholesterol levels, and a reduction in waist circumference as well as a trend toward greater weight loss among overweight individuals.

The improvements occurred without a significant increase in downstream medical costs, suggesting that CAC screening can play a "gatekeeper" role in determining a need for further noninvasive testing, say investigators.

"We wanted to find out how much impact the scan had on the way that patients take care of themselves, the way they think about changing their lifestyle and doing something about preventing heart disease," senior investigator Dr Daniel Berman (Cedars Sinai Medical Center, Los Angeles, CA) told heartwire. "There have been other studies suggesting an impact on how patients behave after seeing their scan, that as the amount of calcium on the scan went up, patients began to do more about changing their behavior. We noticed the same thing: patients who had a lot of calcium were more likely to do all the things that would prevent heart disease than patients who had less amounts of calcium. Also, the calcium-scoring group did more to change their lifestyle than the patients who did not undergo coronary scanning."

Published online March 23, 2011 in the Journal of the American College of Cardiology with first author Dr Alan Rozanski (St Luke's Roosevelt Hospital, New York), the study included 2137 healthy volunteers randomized to undergo CAC scanning or no coronary-calcium screening. Individuals in the trial were middle-aged and had CAD risk factors but did not have a history of cardiovascular disease.

Change in blood pressure and LDL cholesterol

Of the seven measured risk factors, investigators observed improvements in systolic blood pressure, LDL cholesterol, and a reduction in waist circumference among those who underwent CAC screening.  There was no difference in serum glucose levels, exercise levels, or smoking status between the two treatment arms at four years. CAD risk, as assessed by the Framingham Risk Score (FRS), increased in the no-scan volunteers but remained stable among those who received the CAC scan.

Individuals with higher amounts of calcium were patients who made the larger amount of change.

"Individuals with higher amounts of calcium were patients who made the larger amount of change," said Berman.

The incurred medical costs did not significantly differ between the two treatment arms, with procedure and medication costs totaling $3649 among those who did not undergo CAC screening and $4063 among those who did. The total incurred costs did differ by the amount of coronary calcium observed on the scan, however, with patients having a CAC score >400 significantly more likely to incur more procedural and medication costs than those with less coronary calcium. 

"Overall, in the scanned group vs the no-scan group, the downstream testing costs were similar," Berman told heartwire. "Interestingly, when you look at patients without any coronary calcium, their downstream testing costs were low. Patients who had a lot of calcium, it would be more common for them to go on to additional testing."

Change in clinical risk factors and all incurred medical costs

Parameter	No CAC scan	CAC scan	p
Systolic blood pressure (mm Hg)
Baseline	130	131	0.03
Change from baseline	-5	-7	0.02
LDL cholesterol (mg/dL)
Baseline	130	133	0.15
Change from baseline	-11	-17	0.04
Waist circumference (in)
Baseline	41.0	41.3	0.19
Change from baseline	1	0	0.01
All costs ($)	3649	4063	0.09

Incurred costs according to CAC score

Medical costs	CAC score 0	CAC score 1-99	CAC score 100-399	CAC score >400	p (trend)
All costs ($)	2623	4394	4900	9309	<0.001

Overall, there was no significant difference in the number of performed procedures among patients who underwent CAC screening. There was a trend toward more lipid-lowering medications being prescribed among those randomized to CAC screening and a significant difference in the number of new blood-pressure-lowering medications prescribed.

In a comparison between volunteers with no observable calcification on the CAC scan with those who did not undergo CAC screening, those with a CAC score of zero were significantly less likely to undergo any stress testing at four years as well as less likely to undergo cardiac catheterization and coronary revascularization. The low-CAC-score patients also incurred significantly less medical costs ($2623 among those with a CAC score of zero vs $3649 for those who did not undergo screening; p<0.001).

The results of the EISNER analysis contrast with the results of a meta-analysis published online March 14, 2011 in the Archives of Internal Medicine. As reported by heartwire, Dr Daniel G Hackam (University of Western Ontario, London) and colleagues assessed seven relevant studies and found no significant changes in the use of drug therapies, exercise, dietary therapy, smoking cessation, or diagnostic coronary catheterization or revascularization based on the results of carotid ultrasound, CAC scans, or other noninvasive imaging techniques.

To heartwire, Berman said that the EISNER data provide support for the recent American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) class IIa recommendation for the use of computed tomography (CT) to measure coronary calcium. According to the ACCF/AHA, the use of CAC "is reasonable for cardiovascular risk assessment in asymptomatic adults at intermediate risk (10% to 20% 10-year risk)."

Berman has research grants from Siemens and GE/Amersham and has both research grants from and is on the speaker's bureau of Astelles and Lantheus.

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Sources

1. Rozanski A, Gransar H, Shaw LJ, et al. Impact of coronary artery calcium scanning on coronary risk factors and downstream testing. J Am Coll Cardiol 2011; DOI:10.1016/j.jacc.2011.01.019. Available at: http://content.onlinejacc.org.
2. Hackam DG, Shojania KG, Spence JD, et al. Influence of noninvasive cardiovascular imaging in primary prevention: Systematic review and meta-analysis of randomized trials. Arch Intern Med 2011; DOI:10.1001/archinternmed.2011.69. Available at: http://archinte.ama-assn.org.

5 Steps You Can Take To Reduce Your Heart Scan Score

By William Davis,MD

CT heart scans are booming in popularity. With over 300 scanners nationwide,
over one million Americans have now been scanned since the introduction of this
technology 10 years ago.

In some cases, lives have been saved. People with high scores (e.g., over
1000) can end up with lifesaving procedures like bypass surgery or stents.

But what about the majority of people who don't have a life-threatening
score?

Too often, people in this very large group are prescribed a cholesterol drug
and patted on the back with advice to cut the fat in their diet. According to
several recent studies, that's a recipe for failure. Do nothing, and you can
expect your score to increase 30% per year. Take a cholesterol drug and cut your
fat, and you can still expect your score to grow 30% per year!

Surely there's a lot more you could do to gain control over your score.

Here's our list of 5 easy yet crucial steps you can take that tip the odds in
your favor that you will not just stop your score from increasing, but perhaps
even reduce it.

1. Take fish oil

Fish oil is among the few breakthrough discoveries of the past 20 years that
has altered the course of cardiovascular illness, slashing risk of death, heart
attack, and stroke. The mis-guided advice of the 1980s that polyunsaturated oils
were healthy has left us appallingly overloaded with omega-6 fatty acids, and
omega-3 supplementation from fish oil has become increasingly important.

The 11,000-participant GISSI-Prevenzione trial brought any remaining
naysayers to their knees. Participants taking fish oil experienced 30% reduction
in cardiovascular death and an astounding 45% reduction in sudden death.

Fish oil provides anti-inflammatory benefits, plaque-stabilizing effects, and
corrects many genetic and acquired causes for heart attack. Fish oil helps
correct the triglyceride and small LDL abnormalities triggered by metabolic
syndrome, the collection of pre-diabetic abnormalities now afflicting 59 million
Americans. Fish oil also accelerates clearance of abnormal fat particles in the
blood that persist after eating. All of this adds up to a dramatic reduction in
cardiovascular "events" and greater control over coronary plaque. In our heart
disease reversal program, we start with 4000 mg of standard fish oil capsules
per day provide 1200 mg of omega-3 fatty acids, EPA + DHA.

2. Take vitamin D

Imagine over half the adults in the U.S. were toothless and had open skin
sores covering their bodies from vitamin C deficiency, or "scurvy. Well, that's
the situation, though less graphic, with vitamin D. Deficiency is rampant in the
U.S., particularly in northern climates where sun exposure is in short supply
for long periods. It's not uncommon even in southern climates, given indoor
workplaces and lifestyles. Vitamin D deficiency has been implicated in
osteoporosis, prostate and colon cancer, hypertension, multiple sclerosis, and
heart disease.

The higher your heart scan score, the more likely you are deficient in
vitamin D. Consider taking a minimum of vitamin D 1000 units per day. Even
better, have your doctor check a blood level (25-OH-vitamin D3) and the dose can
be adjusted accordingly. In our heart disease reversal program, most women
require 2000 units per day, most men 3000 units per day to achieve the desirable
blood level of >50 ng/ml.

3) Boost your HDL cholesterol to 60 mg/dl

Raise this simple value to 60 mg/dl or greater, and you will have
accomplished a huge improvement in a whole constellation of health effects.

This is because HDL is a gauge of many things: body weight, your body's
ability to respond to insulin, potential for hypertension, and the presence of
hidden causes of heart disease, especially the dreaded small LDL. The higher
your HDL, the less likely other undesirable phenomena are present. HDL is the
blood particle that is responsible for regression, or shrinkage, of plaque. The
more, the better.

Boost HDL by losing excess weight, reducing processed carbohydrates like
breads and breakfast cereals, exercise, 4-8 oz of red wine per day, and fish
oil. Raise it even further by considering niacin (vitamin B3), 500-1000 mg.
(Discuss niacin use with your doctor.)

4) Have a colorful lifestyle

Deeply colored foods are rich in flavonoids, naturally-occurring substances
that pack broad, powerful health effects and include blood pressure-reducing and
anti-inflammatory benefits.

Add more deeply colored foods to your day, especially blueberries,
pomegranates, plums, black grapes, spinach, green peppers, and red wine. Drink
green tea whenever possible. Use cocoa powder (unsweetened) in your protein
shakes or add a daily two-inch square of dark chocolate. Add capers, fresh basil
and other herbs to your salads and dinner dishes. All are rich in
naturally-occurring flavonoids, destined to become health champions of the 21st
century. Among their myriad benefits, flavonoids are natural artery relaxing
agents and add another healthy dimension to your heart scan control program.

5) Substitute raw nuts for unhealthy snacks

Dump the chips, pretzels, and crackers. Replace them with raw almonds,
walnuts, and pecans. (Not "party mix", "honey-roasted", mixed nuts, etc., all no
better than other unhealthy snacks.) Raw and whole (unshelled) are the keys,
bought bulk in most supermarkets or health food stores. This simple substitution
reduces LDL cholesterol 20 points, reduces blood sugar, reduces small LDL,
raises HDL, and boosts your energy level. Don't sweat the fats--the
monounsaturated fat in raw nuts are the source of much of the benefit.
One-quarter to one-half cup per day provides maximum benefit.

Stopping your heart scan score from increasing may be among the most powerful
ways to sharply reduce, perhaps even eliminate, risk for heart disease in your
lifetime. There's no single strategy that guarantees you stop your heart scan
score from increasing―it's all your efforts combined, followed consistently over
time.

Dr. William Davis is a cardiologist and expert in reversal of heart disease. He is author of “Track Your Plaque: The only heart disease prevention program that shows you how to detect, track, and control coronary plaque.” Dr. Davis also makes his book, “What Does My Heart Scan Show?” available for free at www.trackyourplaque.com. Article Source: http://EzineArticles.com/?expert=William_Davis,MD

Article Source:
http://EzineArticles.com/297354

Statin Drugs linked to rise in Diabetes

from Mercola.com

By Suzy Cohen, R.Ph.

Coronary heart disease is a leading cause of death in the United States, killing one in five adults, and doctors are very quick to prescribe statins. In fact, statin drug sales rank in the billions each year globally.

These drugs are so pervasive that they are no longer just indicated for hypercholesterolemia, they are also being prescribed for elevations in C reactive protein, and are promoted for kids as young as eight years old.

Heart disease is so pervasive that some have boldly suggested that we should put statins in our water supply as some kind of protection.

This is very disturbing.

Do You Really Need a Statin Drug?

By far, statin drugs are the most popular cholesterol-lowering drugs available today. They work in your liver by preventing your body from making cholesterol. The drugs block an enzyme called HMG-CoA Reductase. This can be helpful, but only if you are one of those people who happen to produce too much cholesterol.
It doesn’t do a good job at removing it from your clogged arteries, contrary to what most people think.
Physicians and health experts now agree that statins seem to offer more benefit through their ability to reduce dangerous inflammatory chemicals in your body, rather than by reducing production of cholesterol, which usually leads to uncomfortable, unwanted and dangerous side effects. One study found that lowering cholesterol too much actually backfires.
Cholesterol is good for you; it’s one of your body’s most powerful antioxidants, it makes important neurotransmitters and sex hormones so this madness to lower it as much as possible really concerns me. Plus, I believe the indiscriminate use of statins has contributed to the staggering rise in diabetes…

The Statin—Diabetes Connection Few People Know About

I watched this happen to my mom who was given a statin, and then told months later she suddenly had diabetes. All of a sudden? This happened many years ago, and it began my search to understand the connection. It also prompted me to write a book on the subject entitled “Diabetes Without Drugs” (Rodale, 2010).
It typically happens like this:
Many statin users come back to see their physician for a routine visit and after the blood work is drawn, they find their cholesterol ratios may be improved, but now they have high blood glucose.
It’s entirely possible that some physicians then mistakenly diagnose their patients with “Type 2 diabetes” when in fact they just have hyperglycemia—a side effect, and the result of a medication that was prescribed to them months earlier.
Do you think you have type 2 diabetes?
I will provide more information so you can see for yourself that so-called “diabetes” diagnosis might not really be genuine diabetes. It may just be hyperglycemia (high blood sugar)—the result of your cholesterol medication, and for some people, it may be reversible with drug discontinuation. Whether or not you are able to discontinue your medication is between you and your physician.

Research Suggesting Raised Blood Sugar is a Side Effect of Statin Use

Several studies have indicated that statins can cause high blood sugar, which can be mistaken for “diabetes.” For example, researchers in Glasgow, Scotland conducted a meta analysis, known as the JUPITER trial, which took into account 13 statin trials that each included 1,000 patients or more. The participants were followed for over than a year. The conclusion was there was indeed an increase, albeit small, in the development of Type 2 diabetes.
It should be considered that some of the patients in this meta analysis already had symptoms of insulin resistance or metabolic syndrome, so it could be said that they were on their way to diabetes anyway.
Now consider another meta-analysis published in the Lancet Here, the researchers reviewed randomized controlled trials beginning in 1994 and ending in 2009, for a total of 91,140 participants who took either a statin or a placebo.
They found that people treated with statin drugs showed a nine percent increase for diabetes. They did not evaluate other factors however, which would be considered pre-diabetes, so I suspect their nine percent number to be on the low side.
Insulin is a pancreatic hormone that reduces blood sugar. You want some insulin to maintain blood glucose levels, but too much of it is bad—it’s an inflammatory compound in your body when it is elevated. And guess what? The use of statin drugs appears to INCREASE your insulin levels! High insulin is extremely harmful to your health.
For starters, elevated insulin levels lead to heart disease, and isn’t that the reason cholesterol drugs are prescribed in the first place?
The ratio of glucose to insulin should be less than 10:1, this ratio is far more important than the levels of glucose or insulin alone. Keep that in mind if you seek a complete recovery. For more information about the harmful effects of elevated insulin levels, see my article on dearpharmacist.com, or my book Diabetes Without Drugs.
You want to keep insulin normal, to protect yourself from heart disease and high blood pressure. Chronically elevated insulin causes a cascade of inflammatory chemicals and high cortisol which lead to belly fat, high blood pressure, heart attacks, chronic fatigue, thyroid disruption, plus major diseases like Parkinson’s, Alzheimer’s and cancer.
Unfortunately, the most popular cholesterol drugs in the world seem to increase insulin levels. However, that’s just one mechanism by which these drugs can raise your risk for diabetes.

How Statins Raise Your Insulin

Keeping things simple, you might imagine it like this: When you eat a meal that contains starches and sugar, some of the excess sugar goes to your liver, which then stores it away as cholesterol and triglycerides. Now stay with me — when you have a statin on board, it’s like a message to your liver saying, “No! Don’t make any more cholesterol, please stop.”
So your liver sends the sugar back OUT to your bloodstream. As a result, your blood sugar goes up.
In 2009, it was proven that statins could directly raise blood sugar, whether or not you have diabetes. Over 340,000 people were included before this conclusion was made. The people who did not have diabetes but took statins experienced a rise in blood glucose from 98 mg/dl to 105 mg/dl. Those who already had diabetes and also took statins experienced a rise from 102 mg/dl to 141 mg/dl.
After adjustments for age and medication use were considered, researchers concluded that both diabetic and non-diabetic statin users showed a statistically significant rise in blood sugar.
Why take all these risks, just to get the convenience of taking a pill instead of eating a better diet and exercising?
It’s been scientifically discussed and even published in JAMA that eating a better diet could lower cholesterol as well as the statin drug lovastatin.
And of course, there are so many other benefits to eating a healthier diet that consists of fruits, vegetables, nuts, seeds, and lean meats. Besides feeling better and increasing lifespan, you can squeeze into those skinny jeans you’re hiding in your closet.
Another way statins can affect your blood sugar is via their “drug mugging” effect. A drug mugger is my term, and the title of my newest book, which describes how a drug can rob your body’s warehouse of a valuable nutrient. In the case of statins, they rob your body of two different nutrients, both of which are needed to maintain ideal blood sugar.

Two Important Nutrients Decimated by Statins

The first nutrient that is mugged is vitamin D. There have been mixed studies regarding the D-depletion effect of statins, but statins reduce your body’s natural ability to create active vitamin D called 1,25-dihydroxycholecalciferol, shortened to “calcitriol” when it is eventually converted to its active hormone form.
This happens because statins reduce cholesterol, and you need cholesterol to make vitamin D! It is the raw material that exposure to UVB from sunlight will convert to vitamin D.
It is well documented that D improves insulin resistance, so needless to say, when you take a drug mugger of vitamin D (like statins), then you increase your risk for diabetes.
More specifically, a 2004 study published in the American Journal of Clinical Nutrition determined that raising a person’s serum vitamin D levels (from 25 to 75 nmol/l) could improve insulin sensitivity by a whopping 60 percent.
Compare that to the blockbuster diabetes drug metformin, one of our pharmaceutical gold-standards, which can dispose of blood sugar by a meager 13 percent according to the New England Journal of Medicine.
Now, statins also suppresses your natural coenzyme Q10— also called “ubiquinol” in its active form; it makes energy for every cell in your body, and it’s produced mainly in your liver.
This powerful antioxidant just so happens to also play a role in maintaining blood glucose. When you deplete levels of CoQ10 by taking a drug mugger of it, like a statin drug, then you lose that benefit. You also raise your risk for heart failure, high blood pressure and heart disease as CoQ10 deficiencies can contribute to those conditions. A study by Hodgson et al, published in 2002 found that 200mg CoQ10 taken daily caused a 0.4 percent reduction in hemoglobin A1c.
Moreover, CoQ10 protects your body from oxidative stress, a strong contributing factor in the development of diabetes, metabolic syndrome and heart attacks. You want to make sure you have enough CoQ10 (or ubiquinol) on board to protect every cell in your body. The take home point is that statins annihilate this compound and you need it for good health.
In summary, if you take a statin medication and you’ve been told that you have diabetes, it may be drug-induced, and it’s possible that it can be reversed over the course of time. However, you will have to eat right, exercise, and take supplements that help to lower your risk for heart disease naturally.
About the Author
Suzy Cohen, R.Ph., has been a licensed pharmacist for 22 years, and has had a weekly syndicated health column for the past 13 years which you can get for free by signing up at her website Widely recognized as “America’s most trusted pharmacist,” she has appeared on The Dr OZ Show, The View, Good Morning America Health and The 700 Club.
Cohen is also the author of three books: The 24-Hour Pharmacist, Diabetes Without Drugs, and Drug Muggers: Keep Your Medicine from Stealing the Life Out of You.
For more information, see www.SuzyCohen.com.

Sources:
Journal of the Federation of American Societies for Experimental Biology May 1, 2004; 18(7): 805-815
Journal of Investigative Medicine March 2009; 57(3): 495-499
About.com February 20, 2010
The Lancet February 2010; 375(9716): 735 – 742
The Lancet February 27, 2010; 375(9716): 700 – 701
Reuters March 10, 2011
International Journal of Obesity February 8, 2011 [Epub ahed of print]
American Heart Journal (ENHANCE trial) February 2005; 149(2): 234-239
Lancet February 27, 2010; 375(9716): 735-42
Journal of Investigative Medicine March 2009; 57(3): 495-499
JAMA 2003;290(4):502-510
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Read article with comments here  http://articles.mercola.com/sites/articles/archive/2011/03/28/the-stealth-drug-cause-of-diabetes.aspx

Seniors, Statins, and Side Effects

by Thomas D. Meade, M.D.
How many seniors with heart disease are told that statins may cause shortness of breath or worsen their heart failure? Probably very few.

Most would be astonished to think their cardiologist would prescribe a drug that could worsen their condition, but that is exactly what was reported at the November 2009 CHEST - the national meeting of chest physicians.Ref: www.medscape.com/viewarticle/712329

In addition to this information, what if your physician told you there are other possible side effects including memory loss, muscle and joint pain, liver damage death from muscle necrosis, decreased libido and testosterone inhibition, and many of these drugs have not been proven to decrease your chance of death from fatal heart attacks or strokes?

What if they told your chance of worsening nerve pain (peripheral neuropathy from diabetes or other causes), fibromyalgia pain, spinal stenosis and possibly lymphedema exists from taking statins?
How about if you were told that after 30 years of taking these powerful medications your lifespan may not increase one day or in a best case scenario a few months. How about if they told you the data on statins in women or men without heart disease is extremely weak or nonexistent? How many patients would still pay for these expensive drugs?

How many patients are on Crestor® or Zetia® that are not told what the package insert states? Let me help you..... On the CRESTOR® package safety information, it states, ‘CRESTOR® has not been approved to prevent heart, disease, heart attacks, or strokes'. One might ask why am I taking this? Ask your prescribing physician.

On the Zetia® patient product information it states, ‘ ....ZETIA® has not been shown to prevent heart disease or heart attacks.' Chances are CRESTOR® and ZETIA® patients are hearing this information for the first time, yet it is dispensed with the package insert, but rarely emphasized by the prescribing physician.

This is not to say there isn't a role for statins, but certainly it is far less and at a much lower dose than is being recommended today. It is now being recognized that the major benefit of statins lies in a recently discovered anti-inflammatory effect and not so much, if at all from the cholesterol lowering effect.

However, since inflammation is much harder to quantify and track, the quantity of statins sold and the profitability would not nearly approach that of recommending them for their cholesterol blocking effect.

Additionally, there are many other less expensive ways to get anti-inflammatory benefits both naturally with anti inflammatory foods such as berries, omega-3 fatty acids, olive oil, fresh fish, certain spices including ginger, curcumin, and even the lowest dose of aspirin.

I always believed there should be something in medicine similar to the financial world's ‘Truth in
Lending', well-known to any homeowner who has finalized a mortgage and finds out that their 5% or 6% rate quote is really significantly higher due to add on closing expenses and fees. This information is not provided up front but usually after walking down the buyer's pathway a bit.

In medicine, this would be analogous to a patient being convinced by his physician he or she should be on statins and given a prescription in the exam room, and while checking out the ‘Truth in Medicine' clerk stopped the patient and handed them a document stating

"..the prescription just provided to you has not been approved to prevent heart attacks, heart disease, or strokes. If you take this drug for everal decades you might live a few weeks or months longer, but you could die from rhabdomyolysis sooner. It may cause liver disorders, it may cause you to completely lose your memory, and it will stop cholesterol production in your liver, which is the building block of testosterone, which controls your sex drive. It also has been shown to cause genetic mutations of your vital cell components  (i.e. the mitochondrion - also know as the powerhouse of the cell). It can zap your energy and cause weakness and predispose you to tendon and ligament ruptures. It will deplete your CoQ-10 by 50% so you should go to the health food store and buy some,....'

Now most patients would crumple up the prescription and leave the office, deciding the risks are not worth the benefits. Some may not, but the ‘Truth in Medicine' approach would at least level the playing field and not shower the patients with one sided information from direct to consumer TV advertisements and little information on the side effects from hurried and overworked but well meaning physicians.

Thomas D. Meade, M.D.March 2010

Dr. Tom Meade serves as The Senior Partner of OAA Orthopaedic Specialists. He co-developed the 300,000 sq. ft. Integrated Health Campus, a landmark national showcase medical facility. He also hosts two educational cable TV programs, "Real Life in the OR" and "Inside Medicine." (www.ssptv.com)

How Statins Really Work Explains Why They Don't Really Work

Read Stephanie's Page. Its not just an article but a series. Very credible

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How Statins Really Work Explains Why They Don't Really Work

Introduction

The statin industry has enjoyed a thirty year run of steadily increasing profits, as they find ever more ways to justify expanding the definition of the segment of the population that qualify for statin therapy. Large, placebo-controlled studies have provided evidence that statins can substantially reduce the incidence of heart attack. High serum cholesterol is indeed correlated with heart disease, and statins, by interfering with the body's ability to synthesize cholesterol, are extremely effective in lowering the numbers. Heart disease is the number one cause of death in the U.S. and, increasingly, worldwide. What's not to like about statin drugs?

I predict that the statin drug run is about to end, and it will be a hard landing. The thalidomide disaster of the 1950's and the hormone replacement therapy fiasco of the 1990's will pale by comparison to the
dramatic rise and fall of the statin industry. I can see the tide slowly turning, and I believe it will eventually crescendo into a tidal wave, but misinformation is remarkably persistent, so it may take years.

I have spent much of my time in the last few years combing the research literature on metabolism, diabetes, heart disease, Alzheimer's, and statin drugs. Thus far, in addition to posting essays on the web, I have, together with collaborators, published two journal articles related to metabolism, diabetes, and heart disease (Seneff1 et al., 2011), and Alzheimer's disease (Seneff2 et al., 2011).
Two more articles, concerning a crucial role for cholesterol sulfate in metabolism, are currently under review (Seneff3 et al., Seneff4 et al.). I have been driven by the need to understand how a drug that interferes with the synthesis of cholesterol, a nutrient that is essential to human life, could possibly have a positive impact on health. I have finally been rewarded with an explanation for an apparent positive benefit of statins that I can believe, but one that soundly refutes the idea that statins are protective. I will, in fact, make the bold claim that nobody qualifies for statin therapy, and that statin
drugs can best be described as toxins.

 http://stephanie-on-health.blogspot.com/2011/03/how-statins-really-work-explains-why.html

Happy 80th Birthday to Dr Duane Graveline

For the current update to his story be sure to scroll down on his page.

"March 2011 Update
Time for another update and this time I am somewhat confused because I am improving. Last week was my 80th birthday and after four years of a progressive downhill course, I am getting stronger. Once again my muscles feel like muscles instead of soft dough. "

My Statin Story - Duane Graveline, M.D.
http://www.spacedoc.net/rest_of_my_story.html

The Track Your Plaque Program, by William Davis

The following was exerpted from "How to Reverse Heart Disease with the Coronary Calcium
Score by Jeffrey Dach MD at http://jeffreydach.com/2008/03/27/cat-coronary-calcium-scoring-reversing-heart-disease-by-jeffrey-dach-md.aspx
==================================================================

The Track Your Plaque Program, by William Davis MD

1) Quantify plaque with Coronary Calcium Score with CAT scan (or with Electron Beam CT). Obtain your CAT Scan serially, every 12 months to assess response to treatment and lifestyle modification (track your plaque).

2) Use Sophisticated Lipoprotein Panel (Quest-VAP , LabCorp-NMR) to uncover hidden causes of plaque progression. LDL particle size and number, Lipoprotein (a). Repeat every 6 months.

3) The Main Treatment Goal is the reduction in Coronary Artery Calcium Score, and by inference, reduction in plaque volume and reduction in cardiovascular mortality. The cardiology community still awaits the hard data on these results (CHD mortality and CHD events, treatment arm vs no treatment arm).  These numbers have not been published as far as I know.

How to Measure Success in Halting or Reversing Heart Disease Plaque
According to Dr. Davis, calcium score typically increases at an astonishing rate of 30-35% per
year without treatment. Therefore, Dr. Davis considers treatment success to be reduction in this rate from 30 to perhaps only a 5-10 per cent increase in calcium score per year.  An absolute reduction in calcium score on follow up scanning is the optimal outcome, which is difficult to achieve even with strict adherance to the Track Your Plaque program, in Dr Davis's experience.

Track Your Plaque Program Details - Attain the Following Targets:
a) Reduction of LDL to 60 mg/dl (LDL should be measured directly, not calculated)

b) Reduction of triglycerides to 60 mg/dl.

c) Raising HDL to 60 mg/dl.

d) Correction of hidden causes of plaque on Lipoprotein profile such as total number of small LDL particles, IDL, and Lp(a).

e) Achieving normal blood pressure (<130/80)  Even a small elevation of blood pressure in diseased
arteries can cause increased mortality.  Diseased arteries are fragile and plaque rupture can occur easily.

f) Achieving normal blood sugar (≤100 mg/dl). Diabetes is a high risk factor for heart disease.

g) Reduction of C-reactive protein to <1 mg/l

Dietary
Modification and Supplements to Attain Above Targets:
Niacin

a) Niacin vitamin B3 (Slo-Niacin Upsher-Smith or Niaspan Kos Pharmaceuticals preferred) 500-1500mg. per day (avoid the no-flush niacin which contains inositol).

Omega 3 Fish Oil
b) Fish oil (Omega 3 oils) 4000 mg per day (providing 1200 mg omega-3 fatty acids). (molecular distilled pharmaceutical grade).

Vitamin D
Vitamin D level restored to above 50 ng/ml (Vitamin D3 2000-5,000 u/day), Vitamin K2 also used. 
Low vitamin D is associated with increasing arterial calcification and increased heart disease risk. Consumption of calcium tablets by women increases arterial calcification and heart attack risk. Read my previous article on vitamin D which can be found here.

d) Low Glycemic Diet (avoid Fructose Corn Syrup, avoid wheat products), and eliminate wheat products like Shredded Wheat cereal, Raisin Bran, and whole wheat bagels.

e) Consume foods such as raw almonds, walnuts, pecans; olive oil and canola oil. Beneficial for lipoprotein profile.

f) Increasing protein intake, our major building block for body tissues.  Added benefit of protein intake is that it doesn't increase blood sugar.  This is low glycemic nutrition.

g) Wine—Red wines contain resveratrol, (don’t exceed two glasses/ day). Bioflavonoids and anti-oxidants have a strong anti-inflammatory effect.

h) Fiber - Gound flaxseed (2 tbsp/day)-Extra fiber aids in detoxifying liver and the entire body  by
interrupting the enterohepatic circulation. Psyllium (metamucil). Regulates bowel movements and has favorable effect on lipoprotein profile.

Vitamin C

Vitamin C (1000–3000 mg/day), is a key player, as it is the vitamin for strong collagen formation,
strengthening the arterial wall.  See Linus Pauling's patented protocol which includes Vitamin C and amino acids Proline and Lysine, the two amino acids that act as receptors for Lp(a).  By consuming additional Lysine and Proline, the receptor sites on the Lp(a) and other lipoproteins are covered up and made less sticky, resulting in less deposition in the artery wall.  The vitamin C is important not only for strong collagen formation, a major component of the arterial wall, but also for all other structural elements of the body, for that matter.

Humans have a genetic deficiency in Gulano-Lactone-Oxidase (GLO), the final enzyme step in the manufacture of Vitamin C, and therefore unlike all the other animals who make their own Vitamin
C, we cannot make this necessary vitamin.  We share with all other primates this genetic disease, the inability to manufacture vitamin C, producing a vitamin C deficiency state in all humans.

Also see Thomas Levy's two books on Vitamin C.

j) Exercise and weight loss- improves insulin sensitivity, reduces inflammatory markers, reduces blood pressure, improves lipoprotein profile.

Magnesium
k) Magnesium supplementation is inexpensive and safe. Magnesium deficiency due to dietary
deficiency or thiazide diuretics for hypertension is common, and is associated increased heart disease risk.  Magnesium reduces blood pressure, relaxes smooth muscle in arteries, and is needed for normal endothelial function.

L-Arginine
L-arginine is converted to nitric oxide, an important substance for arterial health. Research by Furchgott and other showed that nitric oxide (NO) relaxes arterial smooth muscle, dilating coronary arteries by up to 50%.  However, Nitric Oxide (NO) is gone after a few seconds, so it must be replenished at a constant rate to keep the arteries relaxed and open. Lack of NO is associated with constricted arteries, damage to the arterial lining, and accelerated plaque growth. L-arginine shrinks coronary plaque, corrects "endothelial dysfunction", improves insulin sensitivity, is anti-inflammatory and shrinks plaque.  Dosage: l-arginine 6000 mg twice a day, best taken on an empty stomach.

Reverse Cholesterol Transport and Essential Phospholipid - Phosphatidyl Choline (PC)

James C. Roberts MD FACC, a practicing invasive cardiologist, lectures extensively on his clinical success with Phosphatidylcholine (IV or in Liposomal Oral Format with EDTA):  Reverse Cholesterol Transport and Metal Detoxification.  A DVD of his lectures is available which describes considerable clinical success with oral EDTA and phosphytidylcholine.  This page contains his DVD lecture material complete with clinical case histories.

Essential Phospholipid is available under trade name Phoschol which increases Lecithin Cholesterol Acyl Transferase activity (LCAT) (Dobiasova M 1988).  Activating LCAT is beneficial because LCAT is the crucial substance which transports cholesterol from the arterial plaque back to
the liver for metabolic breakdown into bile.  This process reverses atherosclerotic plaque formation.  Dosage: 3 softgels Phoschol a day each containing 900 mg PC.

Thyroid Function

Normalize thyroid function. Broda Barnes MD showed that low thyroid function was a significant risk factor for heart disease. This conclusion was based on autopsy data from Graz Austria and detailed in his book, Hypothyroidism the Unsuspected Illness, and his other book, Solved the Riddle of Heart Attacks. Barnes felt that the thyroid lab tests were frequently unreliable, and he used clinical judgement instead.

LipoProtein (a)

All About Reducing Lipoprotein (a)

Lipoprotein little A, also written as Lp(a) is a genetic variant lipoprotein which is associated with a high risk of heart disease, and therefore identification and reduction is essential.  The problem is that the conventional Lipid panels done in your doctor's office do not include Lp(a).  Only the more sophisticated lipoprotein panels such as the VAP (Atherotech) or NMR (Liposcience) panels provide Lp(a) data.

Lp(a) and Lipoproteins:
1) Lp(a) is best to measured in (nmol/l), and target  below 75 nmol/l .
2) Lp(a) measured in mg/dl (weight may not be accurate), then target below 30 mg/dl .
3) Measured (not calculated) LDL target 50–60 mg/dl.
4) LDL particle number target (NMR) of 600–700 nmol/l or apoprotein B of 50–60 mg/dl. Reduce small LDL to <10% of total LDL.

Treating Lp(a) with Niacin
Use Niaspan® (Kos Pharmaceuticals) or over-the-counter Slo-Niacin® (Upsher-Smith).

Both are better tolerated than OTC plain niacin, which may cause the hot flushes. Reduce hot flushed by drinking a full glass of water with each gelcap, and some find adding an aspirin tablet to the routine helps to reduce flushing.

Lp(a) and BioIdentical Hormones
Bio-Identical hormones are beneficial for reducing heart disease.  In menopausal females, estrogen preparations such as Bi-Est are used. Estrogens have been shown to reduce coronary artery calcium score.

In males over 50, bio-identical testosterone cream may lowers Lp(a) by as much as 25% (William Davis MD).  Medical studies show that optimizing Testosterone levels in aging males can reduce risk of coronary artery disease by 60%.

DHEA can promote weight loss, and improve insulin sensitivity.

Lp(a) and L-Carnitine

The supplement L-carnitine can be a useful adjunct; 2000–4000 mg per day (1000 mg twice a day) can reduce Lp(a) 7–8%, and occasionally will reduce it up to 20%.

Remember, reduction in calcium score on follow up calcium scan is the goal.

What about Statin-Cholesterol Lowering drugs?
Dr Davis admits that the total cholesterol and the LDL cholesterol numbers are of little value in predicting heart disease risk. And he says that the statin drug side effects, ie. muscle pain and weakness, are more common in actual practice than the drug advertising would suggest, making statin
drugs difficult to take for the long term.

In my opinion, statin drugs are not recommended for women as explained in my previous article on Statin Drugs for Women, which can be found here .  My other article on Statins, Lipitor and the Dracula of Medical Technology can be found here.

What about Calcium Supplements for women to prevent osteoporosis?
Dr Davis points out that women who take calcium tablets have double the risk of heart attacks than those on placebo.

Check out my earlier Heart Disease Reversal Page here.
Credit and Thanks is given to William Davis MD at the Track Your Plaque Web Site and Blog
for the above information. http://jeffreydach.com/2008/03/27/cat-coronary-calcium-scoring-reversing-heart-disease-by-jeffrey-dach-md.aspx

Getting Off Statin Drug Stories by Jeffrey Dach MD

Dr Dach's article, "Getting Off Statin Drug Stories" concludes with this:
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Are You Still a Believer in Anti-Cholesterol Drugs?
If you are still a believer in Statin Drugs, take a look at this study published July 2010 in the Archives of Internal Medicine by Dr. Ray.  He reviewed 11 statin drug clinical trials with 65,229
participants followed for approximately 244,000 person-years.  The astounding results showed the statin drug group all-cause mortality was THE SAME as the placebo group!  There was no benefit from the statin drugs !!!  This article was published in the mainstream medical literature !!

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Read the full article here http://jeffreydach.com/2011/03/04/getting-off-statin-drug-stories-jeffrey-dach.aspx?ref=rss