Sunday, April 22, 2012

Heart Disease – Know Your Options

Every year, millions of people are asked to go in for angiograms – some may have no symptoms and others may exhibit discomfort or breathlessness during exertion.

The angiogram will inevitably show blocks in one or more arteries because atherosclerotic plaque begins accumulating before the third decade of life. Many men and women who are symptom-free and healthy have been found to have 75% or more arterial blockage when autopsied after accidental death from causes unrelated to arterial disease.

Based on the angiogram findings, you may be told you must have angioplasty/stents or bypass surgery because your coronary arteries are blocked and you are at risk for a heart attack. You may also be told that angioplasty or bypass surgery is the only option and it must be carried out immediately.

Research shows that surgery is rarely necessary, and even when necessary, doesn’t need to be carried out immediately.

Consider the following...

Limitations of an angiogram
The coronary angiogram is the "gold standard" of cardiovascular diagnosis and cardiologists consider it the final word in determining if bypass surgery is needed.

However, the patient must realize that angiograms cannot pick up the small arteries that make up the heart's microcirculation. An artery may appear to be obstructed, but the heart muscle it feeds often functions normally and is in no danger because its blood supply comes from the microcirculation or from collateral vessels too small to be imaged by the angiographic technique. (Collaterals are small capillary-like branches of an artery that form over time in response to narrowed coronary arteries).

Some facts about bypass surgery

The Coronary Artery Surgery Study (CASS) reported that regardless of whether one, two or more of the major coronary arteries were blocked—patients progressed very well without surgery, having the low fatality rate of 1.6% per year and a corresponding survival rate of 98.4%. During the same time period (over 2 decades), those who received bypass surgery had a fatality rate of slightly over 10%, or about one death for every 10 operations.
The same study showed that the most critical factor in determining whether or not a person will benefit from bypass surgery seems not to be the number or extent of blockages, but rather how well the left ventricular pump is functioning. This is assessed by measuring the total amount of blood pumped with each beat, known as the ejection fraction. A healthy heart generally has an ejection fraction of 50% or greater. Studies have shown that almost 90% of all bypass surgeries are performed on patients whose ejection fraction is over 50%.
Cardiac bypass procedures can lead to long-term cognitive brain impairment. In addition to this, because bypass surgery alters arterial blood flow, that portion of the artery upstream from the bypass graft site accumulates plaque at 10 times the rate of an un-grafted artery. Because of this, bypass patients must also face the possibility that one operation may not be enough. Reports indicate that 15% to 30% of vein grafts become re-blocked within one year of surgery.
Lastly, let’s not overlook the psychological trauma. It would be difficult to find anyone who is not terrorized by the operation.
Because of these facts, rushing patients in for emergency surgery because of a severely narrowed coronary artery is usually unwarranted and needlessly frightens patients and their families.
The good news is that the disease can be treated with non-invasive approaches.

Comparision of Invavsive vs. Non-Invasive Therapies
There are 39 major studies comparing bypass surgery or angioplasty with conservative medical treatment using only drugs. Many of the studies have what is called a selection bias (i.e. the patients were selected in such a way so as to favor a predetermined type of treatment).
In spite of these selection biases heavily favoring surgical intervention, almost every single study clearly and unequivocally demonstrates that invasive treatment, be it bypass surgery or angioplasty, fails to reduce heart attacks and mortality when compared to patients who have been conservatively treated with medication. In addition, there is a clear increase in mortality, heart attack rate, cardiovascular events, repeat angioplasty and bypass surgery in the invasively treated patients.
Still, many doctors scoff at non-interventional approaches because these methods are unable to eliminate or unclog the obstructed coronary artery.
But you don't have to unclog arteries. Proper medication can restore blood flow to that section of the heart by dilating other blood vessels in the same area that are not blocked while other medicines simultaneously reduce the workload of the heart so that the heart muscle requires less blood.
Removing the block becomes IRRELEVANT. Moreover, atherosclerosis is a systemic disease. It occurs throughout all the coronary arteries. If you fix one segment, a year later it may be another segment that leads to a heart attack. So systemic therapy, with medication has the potential to do a lot more.
Once blood flow is adequate for the work load of the heart, chest pains will disappear. So will the risk of a heart attack or death. (A non-interventional cardiologist can be your best bet).
Choose your treatment based on knowledge, not on fear.

Thursday, April 19, 2012

Does Conventional Medical Advice Protect Us From Sudden Heart Attacks?

Late last year, health enthusiasts in Bangalore were stunned by the sudden death of a local doctor. He had no history of heart disease, maintained a healthy lifestyle and was a fitness freak who never missed a workout. Yet he collapsed while jogging on the treadmill and died of a massive heart attack shortly afterwards. He was only 43 years old.
Cardiologists say there is nothing one can do in such cases since the attack comes without warning. They also say angiograms cannot pick up the blocks that cause such sudden attacks. And yet fitness experts insist we should have regular checkups. They also say people over 40 should be “practical” and not go overboard with their workout. This is how the experts explained away the tragedy.
Since the victim was a doctor and extremely health-conscious, we can safely assume that he had regular checkups, stuck to a healthy diet and was “practical” about his “cardio” workout routine.
This raises an important question: How could someone who diligently followed expert advice with checkups, diet and exercise succumb to the very disease he worked so hard to avoid? Is it just bad luck or is there a missing piece to this puzzle?
Here are some possible answers...
The “risk factors” that doctors focus on in standard tests, often miss the real underlying causes of heart disease.
The “one-size-fits-all” low-fat diet that experts recommend does not build a healthy heart.
Long duration exercise such as cardio, creates over-trained, under-fit, immune-compromised “exerholics” with reduced heart and lung reserve capacity.
Note: While the above statements may sound incredible and contrary to everything you’ve been told, they are based on sound science and worth considering if you don’t want to be caught off guard like the unfortunate doctor.
Let’s take each of the above in turn
Standard Health Checkups and Subsequent Treatment Give a False Sense of Security
Undue attention is placed on cholesterol while far more important risk factors are ignored. This is in spite of knowing that...
“Half of all heart attack victims have normal cholesterol levels”
- The Harvard Medical School Family Health Guide

A study reported on August 22, 2011 in the journal ‘Atherosclerosis’ where 82,000 adults in the UK were followed for an average of 8 years concluded that:
  • Higher total cholesterol levels were NOT associated with an increased risk of death due to heart disease.
  • Higher total cholesterol levels were actually associated with a REDUCED risk of death due to stroke.
Researchers in The Fukui Study, Japan, classified 22,971 participants into groups according to their cholesterol levels. They concluded that:
Those in the 160-169 mg/dl group (both sexes), suffered significantly HIGHER all-cause mortality than those in the 240-259 mg/dl category.
High Blood Pressure Is Not Caused By A Blood Pressure Drug Deficiency
Doctors consider 95% of high blood pressure cases to be of unknown cause. Yet there are real reasons for high blood pressure. Here are some root causes:
When scientists need lab animals with high blood pressure for experimentation purposes, they inject healthy animals with sugar because glycosylation leads to high blood pressure. Hormonal imbalances, infections, mineral deficiencies, repressed emotions and exposure to chemicals or heavy metals can also do the trick.
Because blood pressure readings reflect body mineral and electrolyte balances and toxicity levels, as well as kidney and cardiovascular function, discovering the root causes for malfunction can be a complex and challenging endeavor. It is rare to find a practitioner who properly monitors blood pressure (taking comparative readings in both arms, calf and ankle areas and measures central arterial pressure). Rarer still is the practitioner who will properly test for, and treat underlying causes, as opposed to masking symptoms with drugs.
One thing is for sure: this epidemic was not created by a shortage of blood pressure medication. In fact, most drugs prescribed for the condition merely exacerbate its underlying causes while creating additional serious problems that should alarm any patient.
Warning: Relying exclusively on standard health checkups to protect you from heart disease is like crossing a two-way street while looking in only one direction. You are bound to get run over.
Time for doctors to order better predictive tests
Cardiologists must look at other risk factors for coronary artery disease that may have more significance than the usual cholesterol, hypertension and family history.

Here are some important indicators to look for:

High Fibrinogen
High Insulin (whether the patient is diabetic or not)
Low Testosterone
High C-reactive protein
High Homocysteine
High Ferritin
Low Magnesium
High (or Low) Cortisol
Low Coenzyme Q10 (especially for those on Statins)
Low 25-Hydroxy Vitamin D3
Other predictive tests worth looking at are: N3/N6 Ratio and Blood Viscosity.
Optimizing each of these risk factors can dramatically reduce heart attack and stroke. This approach goes far beyond just taking pills to suppress cholesterol and blood pressure.

Low-Fat Diets Do Not Protect Against Heart Disease

Last September, the American Journal of Clinical Nutrition carried a remarkable overview of studies that have examined saturated fat intake. Here are some of the results found by researchers with the Department of Food Science and Technology, University of California, Davis (UC):
  • One analysis of 50 years of research on the link between saturated fat intake and heart health found no evidence that a low-fat diet prolongs life
  • Results of studies on the association of saturated fat intake with atherosclerosis and cardiovascular disease were found to be "inconclusive or even contradictory"
  • To state flatly that saturated fat causes heart disease is to ignore the many common factors that have been shown CONCLUSIVELY to contribute to heart disease, such as an intake of carbohydrates with high glycemic index, smoking, obesity, diabetes, high homocysteine, high C-reactive protein, lack of exercise and oxidative stress
  • Abstaining from saturated fats has not been shown to lower the incidence of coronary disease or total mortality
And finally, it is worth noting that fatty acids are essential to all the tissues of the body.

Cardio Does Not Strengthen Heart and May Expose You to Sudden Attacks

The Harvard Health Professionals Study followed over 7,000 people and found that the key to exercise is NOT length or endurance but intensity: The more intense the exertion, the lower the risk of heart disease. Contrary to popular belief, high intensity exercise is also safer.
The Harvard Alumni Health Study published in the Journal of the American Medical Association came to the following conclusions:
Those who performed more vigorous exercise had a lower risk of death than those who performed less vigorous exercise.
Aerobics, jogging and marathon running are low-intensity, long-duration exercises. The Harvard study clearly shows that this kind of exercise increases your risk of heart disease and death.
Here’s why: When you exercise for long periods at a low to medium intensity, since there is no demand for high energy output, you train your heart and lungs to get smaller in order to conserve energy and increase efficiency at low intensity.
Action Steps for Better Heart Protection
As you can see, one needs to go way beyond conventional medical advice in order to achieve optimal wellness.
Ask your doctor to focus on better predictive tests as described above in addition to the usual tests.
Once you isolate true risk factors, work to correct underlying causes rather than to go on medication to suppress symptoms.
Don’t be afraid of fat. Learn to distinguish between good, bad and ugly fats. Eat a diet rich in good fats and notice the dramatic difference.
Focus on short bursts of high intensity exercise followed by periods of recovery to build a strong heart and powerful lungs.