~ New Blood Test Better Predicts Heart Attack Risk - Lessons President Clinton's Doctors Should Learn
LESSONS BILL CLINTON’S DOCTORS SHOULD LEARN
Shortly after the release of his autobiography, former President Bill Clinton developed unstable symptoms that warned of impending heart attack. Extensive blockages of all three coronary arteries (greater than 90%) were diagnosed through heart catheterization, and Mr. Clinton underwent a quadruple coronary bypass operation.
According to a USA Today report, “Dr. Allan Schwartz, chief of cardiology at the hospital, said that given the extent of Clinton’s blockage, there was a ‘substantial likelihood that he would have suffered a substantial heart attack in the near future.’ Doctors stopped Clinton’s heart for 73 minutes and put him on a heart/lung machine, a common practice in bypass surgery. [Surgeon Craig] Smith said that it was ‘obvious relatively quickly that what he needed was an operation.’”
After the procedure, the doctors addressing the media corps at New York-Presbyterian Hospital/Columbia boasted of their success, calling the procedure lifesaving. Media reports glowed with descriptions of the high-tech hospital care Mr. Clinton received. Senator Hillary Rodham Clinton publicly expressed her and daughter Chelsea’s gratitude for the high-quality care the former President received in the hospital.
QUESTIONS THE MEDIA OVERLOOKED
Before congratulating our medical system, several important questions need to be answered. Mr. Clinton had passed an annual thallium stress test for the preceding five years. His cholesterol was reported in the press as excellent at 179 mg/dL, and doctors monitored his cholesterol values frequently. Mr. Clinton jogged and complained of no symptoms with vigorous exercise.
If coronary disease takes years to develop, why was it not it recognized earlier, before it became life threatening? How could stress test after stress test be normal when extensive coronary disease was present? How could doctors be satisfied with cholesterol values that permit life-threatening disease to develop? The answers to these questions are already available to us.
Had Mr. Clinton and his doctors been better informed, it is highly likely that his procedure would not have been necessary.
WHAT SHOULD HAVE HAPPENED
Mr. Clinton’s doctors might have suggested that he undergo lipoprotein testing. Through no more effort than administering a conventional cholesterol test, they would have obtained insight into several previously unrecognized and potent causes of heart disease. These hidden causes could have been easily corrected, potentially reducing Mr. Clinton’s coronary plaque.
Alternatively, had Mr. Clinton’s doctors simply advised him in, say, 1996 (on assuming the presidency for his second term) to take a 30-second heart scan, they would have been shocked to learn that his “score” was very high — probably over 400 (desirable is 0), signifying extensive hidden coronary plaque. Once Mr. Clinton’s high heart scan score was identified, a search for the causes should have ensued, followed by corrective measures.
Had his doctors been really smart, they would have had Mr. Clinton undergo a heart scan and lipoprotein testing. With five minutes of Mr. Clinton’s time, a powerful prevention program could have been devised. This kind of information would likely have eliminated Mr. Clinton’s need for bypass surgery.
HOW NOT TO MAKE THE SAME MISTAKES
Learn from the mismanagement of Mr. Clinton’s health and do not wait for the appearance of symptoms before you take action to prevent heart disease. If you have no symptoms, a stress test, even with blood-flow images, like the thallium stress test, is virtually useless and does not accurately predict the potential for heart attack in the vast majority of cases. Do not rely on cholesterol to predict your potential for heart attack. Look at the complete picture: do you have high blood pressure, a history of heart disease or stroke in your family, diabetes, or smoking now or in the past? Consider monitoring your lipoproteins to better assess your sources of risk.
Other Measures of Heart Disease Risk
Several other measures are important components of a comprehensive assessment of heart disease risk. Although not lipoproteins, these measures are often included in cardiovascular health panels.
Homocysteine was first suspected to be a cause of heart disease when children with a rare metabolic disorder called “homocystinuria” were observed to develop coronary disease. High levels of homocysteine — often greater than 200 micromoles per liter (mmol/L)—were recorded in the blood of these children.
Since these preliminary observations, it has become clear that elevated homocysteine levels are associated with coronary disease risk in adults, and that this risk occurs at levels far below 200 mmol/L. In adults, homocysteine levels in the 15-50 mmol/L range are associated with a significantly increased risk of heart disease, while some evidence suggests that levels as low as 8-10 mmol/L may elevate risk.
Homocysteine causes arterial injury, increases oxidization of LDL particles (thereby making them more damaging), constricts arteries, and provokes blood clot formation. The net result is a threefold increase in heart attack risk. Many people with heart disease have elevated homocysteine levels.42-43
Once you have recognized that your homocysteine is elevated, management is relatively easy and consists of B vitamin supplementation. Common starting regimens are vitamin B6 (25-50 mg), vitamin B12 (1000 mcg or more), and folic acid (1000-5000 mcg). Folic acid can be obtained over the counter in doses up to 800 mcg. Higher doses are available by prescription. Very rarely, taking folic acid by itself will “mask” hidden vitamin B12 deficiency, causing red tongue, anemia, and neurological effects. Therefore, folic acid is best taken in combination with vitamins B12 and B6. For modestly elevated homocysteine levels, a combination B vitamin complex is a good way to begin.
Inflammation is fuel for the fire that leads to coronary plaque rupture, resulting in heart attack. Inflammation may also contribute to other diseases, such as diabetes, cancer, and arthritis. A number of proteins circulate in the blood, signaling heightened states of inflammation. The most clinically studied of these is C-reactive protein (CRP).
Dr. Paul Ridker of Harvard University is the nation’s foremost authority on CRP. He has demonstrated that high CRP levels increase heart attack risk threefold, even when LDL level is low. When elevated CRP occurs in the company of small LDL particle size, a very high risk for heart attack can develop — a risk that is sixfold greater.17
Scientists have developed a way to measure CRP, called “high-sensitivity” CRP, that can detect low levels of inflammation. While highly elevated levels nearly always represent inflammation outside the heart (e.g., arthritis) and should not be used to prognosticate coronary risk, modestly elevated levels can be used to gauge low-grade inflammation that contributes to coronary plaque rupture.
Healthy lifestyle choices, such as restricting saturated fat, choosing low-glycemic-index foods, and engaging in regular exercise, are the best way to lower CRP. Fish oil can be a useful adjunct in your program for turning off inflammation and lowering CRP.44 Prescription agents like the cholesterol drug ezetimibe (Zetia®) and the diabetes drugs Actos® and Avandia® can lower CRP. Aspirin lowers CRP modestly,45 as does alpha tocopherol (vitamin E).46 Plant-based compounds called flavonoids, including olive oil polyphenols, are emerging as potentially important factors in lowering inflammation and CRP levels, though further investigation is warranted.46,47
Our blood maintains a precarious balance between being able to flow freely into the smallest capillaries and being capable of clotting in response to injury. Clotting proteins circulating in the blood help maintain this balance. Fibrinogen is a principal clotting protein. With the appropriate stimulation (injury or stress), fibrinogen is modified to form a smaller protein called fibrin. Thousands of strands of fibrin accumulate at an injury site to form a blood clot.
When greater blood levels of fibrinogen are present, the balance is tipped in favor of blood clot formation, even when it may not be appropriate. This can happen, for instance, at the site of a ruptured coronary plaque. The injured plaque surface causes fibrinogen to be converted to fibrin, forming a blood clot, which may result in heart attack. Fibrinogen can also promote atherosclerotic plaque growth, even without blood clot formation. Elevated fibrinogen levels are associated with an increased risk of heart attack.48-50
The modern American lifestyle of sedentary occupations and excessive intake of high-fat foods and refined starches increases fibrinogen. Estrogen raises fibrinogen levels, which may account for some of the increased blood-clotting tendency observed with estrogen replacement.
Fish oil at doses of 3000 mg or greater daily does a good job of lowering fibrinogen.51 Combine this with a diet rich in green vegetables and fiber, low in saturated and hydrogenated fat, and physical activity, and fibrinogen levels usually drop into a favorable range. For the occasional person who requires more intensive effort, the fibric acid class of drugs, especially fenofibrate, can lower fibrinogen by 15-40%. Niacin also helps by lowering fibrinogen by 10-30%.52
NUTRITIONAL SUPPLEMENTS THAT LOWER LDL PARTICLE NUMBER
How and When to Get These Tests
- Oat bran, ground flaxseed, or ground psyllium seed: 2 tablespoons/day. Oat bran and flaxseed are the most versatile, great either in hot cereal or added to yogurt or fruit smoothies.53-56
- Raw almonds, walnuts, or pecans: 1/4-1/2 cup/day.39
- Soy protein powder: 3 tablespoons (25 gm)/day of this supplement added to yogurt or fruit smoothies is among the most effective nutritional methods for lowering LDL particle number, by suppressing the liver’s production of cholesterol.54 Other convenient sources of soy protein include soy cheese, low-carbohydrate pasta, and soy milk.
- Stanol/sterol esters: found in some butter substitutes and fortified orange juice products.54
- Beans: lima, Spanish, black, red, etc.: 1/2-1 cup/day.55
- Chitosan: 1200 mg per day lowers LDL level by around 10%.57,58
- Pectin: citrus fruit rinds can be an effective adjunct for lowering cholesterol.59 Pectin can also be taken as a supplement.
- Glucomannan: this fiber from konjac root decreases LDL level by around 10%, while lowering blood sugar and promoting weight loss by providing a feeling of fullness.58 A dose of 1500 mg before meals works well, and should be consumed with plenty of water, since it is highly water-absorbing.
If you have already been diagnosed with coronary or vascular disease, or have a history of heart attack, coronary stent, angioplasty, or bypass surgery, your doctor may have failed to identify many of the underlying causes of your condition.
Uncovering the hidden causes of your heart disease can make a profound difference to your future. After all, how can an effective prevention program be devised without identifying all causes of your heart disease? It is not unusual for lipoprotein assessment to identify three, four, or five risk factors of heart disease. The good news is that this information can help you and your doctor to implement new treatments to comprehensively reduce your risk.
If you do not have known heart disease but have reason to believe that you are at high risk—due to family history of the disease, diabetes in yourself or your family, being overweight or obese, or having had significant cholesterol or triglyceride abnormalities identified—strongly consider lipoprotein testing to shed more light on the extent of your risk factors. Better information can mean more effective prevention and thus better health. The same advice applies if a computed tomography (CT) heart scan has revealed that you suffer from arterial calcification.
Even if you are simply concerned about heart disease risk, you might consider lipoprotein testing. The blood draw is no different than that for a cholesterol panel and is performed at virtually no risk to you.
Thankfully, more and more physicians are recognizing the deficiencies of conventional lipid assessment and have turned to lipoprotein testing for better answers. Laboratories around the country are now offering advanced lipoprotein testing. Life Extension now offers the Vertical Auto Profile, or VAP™, method of advanced lipoprotein testing.
Advanced lipoprotein testing can help provide great insight into your risks for heart disease, filling the gaping deficiencies of mainstream cholesterol or lipid testing. The superior information provided by lipoprotein testing can help you and your physician to devise an effective program to prevent future heart attacks.
If you have a family history of heart disease, high blood pressure, diabetes, or any measure of coronary plaque, you should strongly consider lipoprotein testing. If you have had coronary disease already diagnosed—that is, if you have had a heart attack, angina, or a heart procedure like coronary angioplasty or bypass surgery—then lipoprotein testing can be a crucial part of your program to prevent future cardiac catastrophes, particularly if conventional lipid testing has failed to pinpoint the cause of your disease.
GLYCEMIC INDEX: AN IMPORTANT FACTOR WHEN LIPOPROTEIN PARTICLE SIZE COUNTS
Being aware of the glycemic-index values of different foods is very important when you have small LDL particles, low total HDL, deficient large HDL, or increased triglycerides or VLDL. This means choosing foods that release sugars slowly, an effect that may help improve all of these risk factors. Abrupt spikes in sugar release help create these abnormalities and lead to both coronary plaque growth and diabetes. By contrast, foods that release sugars slowly or contain little or no sugar can help correct these patterns.60,61
The glycemic index is calculated by comparing a food’s ability to raise blood sugar to that of either white table sugar or white bread, two foods that are processed by the body like pure sugar. The height of the blood sugar peak is then measured. A glycemic index of 100 would be equal in sugar-release properties to sugar or white bread; an index below 100 would mean less sugar release. In general, proteins and fats have lower glycemic index values, while carbohydrates and refined foods have higher values.
Carbohydrates are a potential problem for glycemic index control. Processed foods like breakfast cereals, white bread, other white flour products, and sweets are clearly the worst culprits, causing big spikes in blood sugar after ingestion. Desirable carbohydrate sources with lower glycemic indexes include foods containing oats, whole fruits and vegetables (the pulp and fiber slow sugar release, unlike their juices), and beans.
Healthy oils, like canola, olive, and flaxseed oils, slow the sugar-release effect of other foods. Foods rich in fiber, such as oat bran, whole grains, and raw nuts (almonds, walnuts, pecans), tend to slow sugar release. Supplements containing glucomannan and other fibers are very viscous, which slows sugar release and also promotes satiety, thereby supporting weight loss.
A website managed by the University of Sydney (www.glycemicindex.com) has an excellent searchable database that allows you to enter the food in question and obtain its glycemic index. Dr. Jennie Brand-Miller has published extensively on the glycemic index, and the complete glycemic index tables generated by her research are also available in her book The Glucose Revolution (Marlowe and Company, 1999).
Dr. William Davis is an author, lecturer, and practicing cardiologist focusing on coronary disease regression. He is author of the book, Track Your Plaque: The only heart disease prevention program that shows you how to use the new heart scans to detect, track, and control coronary plaque. He can be contacted through www.trackyourplaque.com.
For Life Extenension Blood Tests, call 1-800-208-3444.
References . . .
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