~ Sep 2010 Coronary Artery Disease Can Be Reversed
By William Faloon, Life Extension
In response to the failure of quadruple-bypass surgery to keep blood flowing to Bill Clinton's heart, the Associated Press proclaimed that there is no cure for coronary artery disease.1
As we predicted in November 2004, a lot more than statin drugs would be needed to prevent atherosclerotic plaque from re-occluding the former President's coronary blood flow.
According to his cardiologist, Bill Clinton did everything right since his 2004 bypass, including eating well, exercising, and keeping his blood pressure and cholesterol in check. Despite this, the bypass graft re-occluded at the beginning of this year, necessitating the insertion of two stents to prop the vessel open.
Mainstream cardiologists were quoted in the media stating that those undergoing coronary artery procedures often have to return every four to five years for tune-ups, i.e., to reopen newly blocked coronary arteries. One cardiac surgeon bragged that he had performed 10 or 15 different stent procedures on the same patient over a period of time.
Bill Clinton's cardiologist stated that we don't have a cure for this condition, but we have excellent treatments.
These blatant admissions document the inability of conventional doctors to prevent and reverse atherosclerosis.
In response to Bill Clinton's heart attack and subsequent need for bypass surgery in 2004, Life Extension reminded its members that atherosclerosis arises from a chronic condition known as endothelial dysfunction.
We listed the risk factors that cause endothelial dysfunction and described how members could protect against each and every one of them.
The fact that mainstream cardiologists have 'thrown in the towel' when it comes to eradicating coronary artery disease reveals how little they pay attention to the published scientific literature.
Coronary Artery Disease Can Be Reversed
Contrary to what mainstream cardiologists say, it is possible to reverse the blockage of blood flow through the coronary arteries. One way is to follow the aggressive lifestyle modification program Dean Ornish, MD has prescribed for decades.
Dr. Ornish and colleagues showed that a regimen that emphasized a very low fat diet, regular exercise, meditation, and avoidance of certain risk factors not only stopped the progression of coronary artery disease, but could reverse it.
This result was demonstrated in a randomized controlled trial, known as the Lifestyle Heart Trial, with data published in The Lancet in 1990. In this study, test subjects were recruited with pre-existing coronary artery disease.2 The patients assigned to Dr. Ornish's regimen had fewer cardiac events than those who followed standard medical advice.3 What's more, their coronary atherosclerosis was somewhat reversed, as evidenced by decreased narrowing of the coronary arteries after only one year of treatment. Most patients in the control group, on the other hand, had worsening of their coronary artery blockage at the end of the trial compared to when they started. These favorable results have been replicated by doctors using similar methods (for example, Caldwell B Esselstyn, Jr., MD4 and K. Lance Gould, MD).5
The drawback to Dean Ornish's program is that it is very restrictive. Participants must avoid all meat and dairy products except egg whites, nonfat milk, and nonfat yogurt; as well as all vegetable oils, nuts, seeds, and avocados. Participants following the Ornish program must supplement with calcium, iron, vitamin B12, and essential fatty acids or deficiencies will develop.
As you'll read soon, there are other documented ways to maintain healthy coronary artery blood flow that are ignored by most practicing cardiologists.
Dick Cheney Does Opposite of What Dr. Ornish Recommends
Perhaps no living political figure exemplifies poor lifestyle choices and ensuing chronic heart disease better than former Vice President Dick Cheney.
Cheney was known for eating outrageous quantities of artery-clogging foods and smoked heavily for 20 years. He almost certainly suffers today from cardiac risk factors that extend beyond his early-life unhealthy habits.
Shortly after Bill Clinton's coronary stents were inserted this year, Dick Cheney suffered his fifth heart attack. The first occurred in 1978, when he was only 37. He suffered his second in 1984 and a third in 1988 before undergoing quadruple bypass surgery to unblock his arteries. His fourth heart attack occurred in 2000. At that time, doctors inserted a stent to open a re-occluded coronary artery.
In 2001, doctors implanted a device to track and control Cheney's heart rhythm. In 2008, he underwent a procedure to restore his heart to a normal rhythm after doctors found that he was experiencing a recurrence of atrial fibrillation. Despite all this, Cheney suffered his fifth heart attack in February 2010.
Dick Cheney has reportedly taken statin drugs for nearly two decades. In June 2001, his LDL was an excellent 72 mg/dL, indicating he was taking a high-dose statin drug. This did not, however, prevent him from suffering another heart attack.
The former Vice President has had access to the best that conventional cardiology can offer, yet his chronic heart ailments have not abated.6 Cheney's multi-decade case history presented the media with another opportunity to declare there is no cure for coronary heart disease, something that Dr. Dean Ornish and many others involved in natural healing vehemently disagree with.
Crestor® Approved by FDA to Reduce C-Reactive Protein
The FDA has given pharmaceutical giant AstraZeneca a gift worth tens of billions of dollars by allowing their statin drug Crestor® to be the only medication approved to reduce the risk of heart attack in aging men and women with LDL-cholesterol less than or equal to 130 mg/dL, elevated C-reactive protein greater than or equal to 2 mg/L, and at least one other traditional cardiac risk factor (e.g. hypertension, smoking, or family history).
Life Extension members were warned long ago about the dangers of excess C-reactive protein in the blood. C-reactive protein is a marker of inflammation. Chronic inflammation, as evidenced by high C-reactive protein blood levels, is one cause of atherosclerosis.7-9 Published studies indicate that elevated C-reactive protein may be a greater risk factor than high cholesterol in predicting heart attack and especially stroke risk.10-14
While generic statin drugs and natural therapies have also been shown to reduce C-reactive protein, the FDA has anointed Crestor® as the only approved drug to treat patients with elevated C-reactive protein who also fit certain age and traditional risk factor criteria. This means that Medicare, Medicaid, and private insurance companies have to pay over $125 for 30 20-mg tablets of Crestor® as opposed to as little as $7.30 for 30 40-mg tablets of generic simvastatin (brand name Zocor®).
Crestor® is the most potent statin drug, so some people may require 40 mg of simvastatin to achieve the same results as 20 mg of Crestor®. Both of these doses are higher than what is usually needed to lower LDL (low-density lipoprotein). Statin drug side effects are amplified as the dose escalates, so one can expect that those prescribed high-dose Crestor® (to reduce C-reactive protein) will suffer more liver-muscle damage.
An increased risk of type 2 diabetes was recently suggested in statin drug users, which further emphasizes the need to use the lowest effective dose if one chooses to use this class of drug.15 There are other options.
The Phony Health Care Cost Crisis
The FDA's gift to AstraZeneca means that only high-cost Crestor® can be advertised and health insurance-reimbursed for the purpose of reducing cardiac risk in patients with a combination of elevated C-reactive protein, "normal" LDL cholesterol, advancing age, and at least one traditional cardiac risk factor like high blood pressure, smoking, and family history. While AstraZeneca enjoys gargantuan profits, taxpayers will be forking over 17 times more than what a generic of probable equal efficacy would cost.
Remember, there is no real health care cost crisis. It is governmental over-regulation of our disease-care system that causes medical prices to be hyper-inflated.
Life Extension has long advocated that those who need statin drugs should use the lowest possible dose. For many people with excess C-reactive protein, the lifestyle modifications you will soon read about (and/or low dose 5-10 mg/day simvastatin) can bring elevated C-reactive protein down to safer ranges.
Too Many Statin Drug Users Suffer Heart Attacks
Pharmaceutical companies have promoted statin drugs as a virtual universal remedy to prevent heart attack. According to conventional guidelines, statin drugs are to be prescribed when LDL blood levels exceed 130 mg/dL and lifestyle modifications like stopping smoking and losing weight fail to bring LDL cholesterol to an optimal level.
Life Extension has long argued that LDL levels should be kept below 100 mg/dL in healthy people to optimally protect against atherosclerosis. In certain high-risk cardiac patients, LDL levels need to be suppressed below 70 mg/dL.
The high dose used in the Crestor® study pushed median LDL level down 50% to a low of 55 mg/dL from a median of 108 mg/dL at baseline and it reduced C-reactive protein by 37%. Despite these impressive reductions in two proven cardiac risk factors, a significant number of subjects taking Crestor® still suffered "major cardiovascular events."17 This further exposes the fallacy of relying only on statin drugs to maintain healthy arterial blood flow. Remember Bill Clinton and Dick Cheney took statin drugs for years, but their coronary arteries re-occluded anyway.
Crestor® will soon be promoted as a panacea for heart attack prevention. What will not be disclosed in drug advertising, however, is that more than half of the major cardiovascular events in the Crestor® study would occur despite the high-dose use of this drug. In statistical terms, while Crestor® reduced the relative risk of the combined endpoint of heart attack, stroke, or death from cardiovascular causes by 47%, the majority (53%) of these cardiovascular endpoints in this high-risk study group would still take place! What this means is that if you have cardiac risk factors and rely solely on a high-dose statin drug, you are still at significant risk of suffering a heart attack.
Why Crestor® Failed to Protect All the Study Subjects
There are at least 17 independent risk factors involved in the development of atherosclerosis and subsequent heart attack and stroke. Statin drugs do not come close to correcting all of these risk factors. Based on the findings from the Crestor® study, it is obvious that even when LDL (and total cholesterol) is reduced to extremely low levels, too many people still suffer a major cardiovascular event.
This study will nonetheless be the basis of a national advertising campaign to tout Crestor®. An analysis of the study findings, however, documents the critical need to correct all known cardiovascular risk factors (including elevated LDL, total cholesterol, and C-reactive protein).
We are not vilifying the proper use of statin drugs. For many people with stubbornly high LDL and C-reactive protein levels, they represent an important weapon against arterial disease. Our emphasis is that statin drugs are not the only way to lower LDL and C-reactive protein, and they should not be relied on as the only approach to protect against atherosclerosis.
Reducing C-Reactive Protein Requires a Multimodal Approach
Life Extension has reviewed thousands of C-reactive protein blood test results over the years. Our consistent observation is that overweight and obese individuals have stubbornly elevated C-reactive protein levels.18 Our findings were confirmed in a recent study that showed overweight and obese individuals are far more likely to have elevated C-reactive protein. In fact, obese people are three times more likely to have elevated C-reactive protein levels than normal-weight individuals.19,20
C-reactive protein is a marker of chronic inflammation. A large body of evidence correlates chronic inflammatory reactions with the increased risks of cancer,21-23 stroke,24 heart attack,25-27 and dementia.28 People who accumulate excess body fat suffer sharply higher incidences of all these diseases, further validating the importance of maintaining C-reactive protein at optimal ranges.
In the Crestor® study, median C-reactive protein levels were 4.2 mg/L in the Crestor® group, and 4.3 mg/L in the placebo group at baseline.17 Obese individuals can have C-reactive protein levels that are easily double this.29 The biological challenge in overweight people is to combat the excess C-reactive protein made directly by fat cells (adipocytes) and the C-reactive protein made in the liver in response to excess amounts of interleukin-6 expressed in abdominal fat that is dumped directly into the liver.
Since obese and overweight individuals spew out C-reactive protein from their liver and fat cells, it is often challenging to bring this lethal inflammatory compound (C-reactive protein) into safe ranges.
We are impressed with the data from the Crestor® study showing the reduction in C-reactive protein and major cardiovascular events. Our decade-long evaluation of C-reactive protein blood results, however, prompts us to warn that it will require more than statin drugs to suppress dangerously high C-reactive protein levels prevalent in so many individuals.
The good news is that low-cost nutrients and hormones, along with dietary changes, can work as well as statins in reducing deadly C-reactive protein.
Vitamin C Reduces C-Reactive Protein
Soon after the media put the Crestor® clinical trial on the front pages, a study was published showing that 1,000 mg a day of vitamin C reduces C-reactive protein as effectively as some statin drugs.19
In this University of California Berkeley study, participants who received vitamin C and started out with C-reactive protein levels greater than 2 mg/L had 34% lower levels compared with the placebo group after only two months.19,20
This study was done based on previous findings that vitamin C supplements reduce elevated C-reactive protein. This study received scant media coverage.
A Healthy Diet Significantly Reduces C-Reactive Protein
Eating too much saturated fat or high-glycemic carbohydrates increases C-reactive protein.30,31 One study showed a 39% decrease in C-reactive protein levels after only eight weeks of consuming a diet low in saturated fat and cholesterol.32 The study participants also saw reductions in their LDL, total cholesterol, body weight, and arterial stiffness.
So while you may soon see ads promoting the 37% C-reactive protein reduction in response to high dose Crestor®, you should be aware that the same benefit has already been shown in response to healthier eating--with no drugs used.
For those who cannot adequately control their food intake, the lipase-inhibitor drug orlistat reduces absorption of dietary fat by 30%.33 A drug called acarbose reduces the number of absorbed carbohydrate calories by inhibiting the glucosidase enzyme.34,35 Both of these drugs lower LDL, triglycerides, glucose, cholesterol and other cardiac risk factors when taken before each meal.34-41 There are over-the-counter dietary supplements that exhibit some of these same effects.
Another study shows that eating cholesterol-lowering food works about as well as consuming a very low-fat diet plus statin drug therapy. One study showed a 33.3% reduction in C-reactive protein and 30.9% reduction in LDL in subjects eating a very low-fat diet and taking a statin drug. Those who ate the cholesterol-lowering foods showed a 28.2% reduction in C-reactive protein and a 28.6% reduction in LDL.42 This study showed that eating cholesterol-lowering foods achieved almost the same benefit as those who followed a very low-fat diet and took a statin drug.
The cholesterol-lowering foods used in this study include almonds, soy protein, fiber, and plant sterols.42 Few people can follow a rigorous low-fat diet and some people want to avoid statin drugs. Based on this study, those who need to reduce LDL and/or C-reactive protein blood levels can accomplish this by eating cholesterol-lowering foods or taking supplements such as soluble fiber powder before heavy meals.
In a study of 3,920 people, subjects who ingested the most dietary fiber were found to have a 41% lower risk of elevated C-reactive protein levels, compared with those who ate the least fiber. The doctors who conducted this study concluded: "Our findings indicate that fiber intake is independently associated with serum CRP concentration and support the recommendation of a diet with a high fiber content."43
There is an important take-home lesson here for those with high C-reactive protein levels that persist even after initiating statin drug therapy. You may be able to achieve significant additive benefits by making dietary modifications, taking at least 1,000 mg of vitamin C each day, and following other proven ways to quell chronic inflammatory reactions.
Sex Hormones and Inflammation in Men
Aging men are plagued with declining testosterone levels while their estrogen remains the same or even increases. This imbalance often sets the stage for a host of chronic inflammatory disorders, while increasing the amount of abdominal adiposity.
For years, we at Life Extension have advised maturing men to restore their free testosterone to youthful ranges (between 20 and 25 pg/mL of blood) and keep their estrogen from getting too high. Ideal estrogen (estradiol) levels in men have been shown to be between 20 and 30 pg/mL of blood.
Dietary Supplements That Suppress Inflammation
Chronic inflammation is the result of a host of underlying pathologic processes. While statin drugs help suppress these inflammatory events, dietary supplements function via additional mechanisms to suppress the production of pro-inflammatory cytokines and C-reactive protein. Here is a partial list of nutrients that have demonstrated effects in suppressing chronic inflammatory reactions:
We have seen countless cases of men with chronic inflammation experience a reversal of their elevated C-reactive protein (and painful symptoms) when a youthful sex hormone profile is properly restored. Independent published studies corroborate our findings that low testosterone and high estradiol predisposes aging men to chronic inflammatory status and higher C-reactive protein.90-92
- Vitamin K52-54
- Fish oil58-64
- Borage oil (source of gamma-linolenic acid)65,66
- Vitamin C72-76
- Soluble fiber83-86
- Coenzyme Q1087,88
Pomegranate Restores Coronary Artery Blood Flow
In stating that there is "no cure for heart disease," the media never bothered to look at the scientific literature, where there is a host of documented natural approaches to reverse clinical markers of atherosclerosis.
In one study, doctors tested a group of heart disease patients to ascertain pomegranate's effects on inducible angina and the rate of blood flow through the coronary arteries. The entire group was given a baseline stress test to induce angina and an advanced diagnostic technique to measure coronary blood flow.
One group of cardiac patients received their medications plus placebo, while the second group received their medications plus pomegranate juice. After three months, coronary blood flow was again measured using the same tests performed at baseline. In the group receiving the pomegranate juice, stress-induced angina episodes decreased by 50%, whereas stress-induced angina increased by 38% in the placebo group.97
When measuring coronary artery blood flow, the placebo group worsened by 17% after three months, whereas coronary blood flow improved by 18% in the pomegranate group.
This study showed that daily consumption of pomegranate can improve blood flow to the heart in coronary artery disease patients in a relatively short period of time. The doctors noted that the test they used to measure coronary blood flow was shown to be the best predictor of future heart attack risk.
Another study compared one group of patients receiving statin and other drugs to a group who received the same drugs plus pomegranate juice. In the drugs-only group, a measurement of systemic atherosclerosis (carotid intima-media thickness) increased by 9% in a year, whereas the group receiving the drugs plus pomegranate showed a 35% reversal in carotid intima-media thickness.98
One way that pomegranate protects cardiovascular health is by augmenting nitric oxide, which supports the functioning of endothelial cells that line the arterial walls.99 Nitric oxide signals the vascular smooth muscle to relax, thereby increasing blood flow through arteries and veins. In the aforementioned study, pomegranate also protected against atherosclerosis by reducing LDL's basal oxidative status by an astounding 90% and increasing beneficial paraoxonase-1 (PON-1) by 83%.98
Pharmaceutical companies would pay a lot for a patented compound that performs as well as pomegranate. If such a compound were developed, you would see national TV ads promoting it as the "drug" every American should take to protect against heart attack. Fortunately, pomegranate is a low-cost dietary supplement. You won't see it advertised by the mass media, but then again, you don't have to pay inflated prescription drug prices for it.
Avoid Foods Cooked at High Temperatures
What one eats plays a major role in chronic inflammatory processes. Cooking foods at temperatures greater than 250 degrees Fahrenheit results in sugars and certain oxidized fats reacting with proteins to form glycotoxins in the food.93 Consuming foods high in glycotoxins can induce a low-grade, but chronic state of inflammation.94 In addition, the glycotoxins in food cooked at high temperatures also promote the accumulation of advanced glycation end products (AGEs) in our living tissues, which results in an accelerated aging process.95,96
Coronary Artery Occlusion May Be Controlled with Other Nutrients
Kyolic® garlic,100-102 GliSODin™ (oral superoxide dismutase complex),103,104 fish oil,105-108 and cocoa polyphenols109-114 have all been shown to improve clinical markers of arterial blood flow.
An interesting study compared statin drugs side-by-side with fish oil in patients with heart failure. After a median of 3 years of follow-up, fish oil showed more benefit than statin therapy.115 Fish oil helps promote a shift from small, dense LDL particles (more atherogenic) to larger, "fluffier" LDL particles (less atherogenic), and it functions by numerous other mechanisms to protect against heart attack.116,117 Furthermore, the data showing reduction in sudden cardiac death with omega-3 fatty acids (like fish oil) is far more robust and consistent than what has been found in statin drug clinical trials.118,119
Unlike side effect-prone statin drugs, fish oil seems to help protect against virtually every age-related degenerative disease.107,120-124 Those with LDL levels above 100 mg/dL of blood who cannot lower it with dietary changes or supplements should consider a low dose statin drug and fish oil.
Simple Guidelines to Protect Yourself Against Heart Attack and Stroke
Fortunately, the proper blood tests can identify risk factors unique to each individual so that corrective action can be taken before one's heart or brain is decimated by a catastrophic vascular event. To view the optimal blood levels of cardiac risk markers you should seek to attain, log on to www.lef.org/heart. A review of this website reveals a wide range of lifestyle, nutrient, hormone, and drug choices available. If you don't want to take drugs, plenty of natural alternatives exist. Some people will need to take drugs, however, to get into optimal ranges.
Multiple studies document that a chronic inflammatory process is directly involved in the degenerative diseases of aging including cancer,125-127 dementia,128-130 stroke,131-133 visual disorders,134,135 arthritis,136-138 liver failure,139,140 and heart attack.141-146
Homocysteine and C-Reactive Protein as Risk Factors For Atherosclerosis
The media attacked the use of B-complex vitamins because they did not reduce the risk of heart attack in a clinical study.188 As Life Extension pointed out long ago, it's not the type of nutrient, hormone, or drug that determines clinical outcomes. What matters are the achieved blood levels that occur in response to taking a compound designed to reduce disease risk.
A different study analyzed blood levels of homocysteine and C-reactive protein in heart attack patients compared with a control group who had no symptoms of heart attack. The groups were matched for serum cholesterol, HDL, triglycerides, age, sex, body mass index, and blood pressure. The results showed that compared with the control patients:
This study demonstrates the importance of keeping homocysteine below 10 Ámol/L (optimal levels are below 7-8 Ámol/L) and C-reactive protein as low as possible (optimal levels are below 0.55 mg/L for men and 1.5 mg/L for women).189
- 32% more heart attack patients had homocysteine levels above 10 Ámol/L
- 500% more heart attack patients had homocysteine levels above 15 Ámol/L
- 572% more heart attack patients had C-reactive protein levels above 3.00 mg/L
Fortunately, a low-cost C-reactive protein blood test can identify whether you suffer a smoldering inflammatory fire within your body that will likely cause you to die prematurely. An abundance of scientific research provides a wide range of proven approaches to suppress chronic inflammatory reactions.147-165
The comprehensive Male and Female Blood Test Panels reveal your C-reactive protein level, along with other factors that could cause your C-reactive protein to be too high. Blood components that can spike C-reactive protein levels include high LDL,166 low HDL,167 low testosterone168 and excess estradiol (in men),169 elevated glucose,170,171 excess homocysteine,172 and DHEA deficit.173
Optimal blood levels of C-reactive protein are below 0.55 mg/L in men and below 1.50 mg/L in women.174-177 Standard reference ranges accept higher levels as normal because so many people fail to take care of themselves and thus suffer chronically high C-reactive protein levels with subsequently increased risk of heart attack,178-180 stroke,181,182 cancer,125,183 senility,184,185 etc.186
Despite the media portraying cardiac stents as the best choice for those with coronary blockage, a 2007 trial published in the New England Journal of Medicine evaluated 2,287 patients over 5 years and found that stents provided no additional benefit over drug cocktails in patients with chronic stable angina (chronic stable coronary artery disease). The study found that stent placement did not affect heart attack risk or coronary mortality.187 Yet these procedures continue to be very popular due to the reimbursement potential ($15,000 per procedure) offered by stent placement to cardiologists.
The fact that conventional drug cocktails, bypass grafting, and stents provide such limited benefits emphasizes the need for a comprehensive program to correct all 17 independent cardiac risk factors.
Dangers of Relying on the Media for Health Information
Today's news media function as a mouthpiece for the conventional medical establishment.
It is in the economic interests of mainstream cardiology to deceive the public into believing the only way of treating heart disease is with bypass surgery, stents, and drugs.
References . . .
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