The Emory Symposium on Coronary Atherosclerosis Prevention & Education

Here’s a shoutout to my friend and colleague, Dr. Larry Sperling.

The renowned Emory Heart Center of the Emory University School of Medicine will be holding its 13th annual Emory Symposium on Coronary Atherosclerosis Prevention & Education June 4-8, 2014. This year’s event, which is titled “Emory Escape 2014“, will be held at the OMNI Amelia Plantation on lovely Amelia Island, Florida..

The challenge
Cardiovascular disease remains the number one cause of death of men and women in the United States, and is a major cause of disability. The American Heart Association has a stated goal to reduce deaths from cardiovascular disease and stroke by 20% by 2020. In order to achieve this goal, physicians and clinicians must gain the knowledge, skill and resources to integrate the latest research and clinical guidelines in the context of their own practice.

The event
At ESCAPE attendees will hear nationally renowned speakers discuss the recently released, 2013 ACC/AHA guidelines on hypertension, blood cholesterol, obesity, healthy living and risk assessment. In addition, there will be one day dedicated to lectures on CV prevention in “special population” patients, including patients with HIV, PCOS, breast cancer, connective tissue disease and post renal transplant. There will also be lectures on electrophysiology, interventional cardiology, heart failure, tobacco cessation, and women’s heart health. This conference will close the knowledge gaps between national guideline goals, practice, and research. Physicians and clinicians will have the opportunity to discuss with the speakers and other attendees how these principles can be applied to patient care in the context of their own practice in order to decrease cardiovascular disease risk.

In addition to the extensive educational curriculum, events will include pre-meeting workshops,  an attendee and spouse session and a family social and cookout.

Who should attend
Cardiologists, internists, family practitioners, emergency medical personnel, primary care physicians and nurses can all benefit from this conference.

Register online at www.eccri.emory.edu/escape – registration deadline May 4th

Call 1-800-THE-OMNI to make room reservations.

Hosted by: Emory University School of Medicine Department of Medicine Division of Cardiology.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

Learn more about essential vitamins and supplements at www.vitalremedymd.com.

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The Great FH Debate: Reinforcing the fact that “Time is Plaque”

Currently a debate rages in the world of Familial Hypercholesterolemia (FH).  Old school thinking is that this lipid disorder – typically caused by a mutation in one of three genes – is exceedingly rare. The initial teaching stated that the homozygous form (two mutations – one from mother and one from father, HoFH) occurs at a rate of one in a million, while the heterozygous form (one mutation from just one parent, HeFH) occurs at a rate of one in 500. Recent explosions in not only genetics, but also the acquisition of large volumes of patient data have put this prior supposition in question. Now, a recent study published in the European Heart Journal by Sjouke et al truly proves that we have grossly underestimated the prevalence of FH. Examining over 100,000 patients who were referred for genetic analysis, the authors found 74 patients with clinically significant mutations consistent with the homozygous form of FH (HoFH). Being abundantly cautious in their interpretation of data, the authors pared the number down to just 45, from which they conducted a mathematical calculation of the prevalence of FH. (Their minimalist rationale is beyond the scope of this blog, but suffice it to say that had they included all patients, the disease prevalence would be far greater). Their restrained assessment revealed the prevalence of HoFH in an unselected population to be 1 in about 300,000 while the prevalence of HeFH, 1 in 244.

Perhaps more striking and even earthshattering is what the authors discovered about the wide range of HoFH LDL-C levels. Older belief systems had maintained that the LDL-C in untreated HoFH should always exceed about 450 mg/dL. In their comprehensive and novel analysis however, the authors discovered untreated HoFH patients with LDL-C levels as low as 170 mg/dL. 170 mg/dL overlaps not only the HeFH population, but the non-FH population as well. The bottom line here once again is that as in diagnosing all other diseases, clinicians must maintain open minds when diagnosing FH. When considering FH, we must always look for a family history of premature vascular disease, very high LDL-C levels, signs of the disorder on physical examination, and the presence of aggressive coronary artery or cerebro-vascular disease in the patient we are evaluating. Most important is for all clinicians to keep FH on the tips of our tongues. Without considering the diagnosis, we will never make it. And without making the diagnosis, we will never treat it. Early treatment can be life saving so early diagnosis is of course paramount. In no other lipid disorder is the concept that “Time is Plaque” more apparent. FH patients bathe in their own LDL-C in utero and beyond. The longer they remain untreated the worse they do. So let’s think of FH and treat it when we see it. By doing so we can hope to prolong the lives of more than a million people right here in the USA.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

Learn more about essential vitamins and supplements at www.vitalremedymd.com.

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LDL Cholesterol: Sometimes the Simple Questions are the Most Revealing

Recently, after participating in a meeting attended by a few high-powered CVD researchers I returned home plagued by a most simplistic question: What is the purpose of LDL cholesterol? Please refrain from bursting into uncontrollable spasms of laughter; I am well aware that as a clinical lipidologist I never imagined such a question would have the capacity to keep me up at night. And yet it did. And so I called my faithful counsel, upon whom I can always rely to extricate me from any lipid conundrum. Tom Dayspring responded to my query unflustered, promptly sending me articles to help me find my way. I read them and this is what I realized. LDL cholesterol is essentially garbage. The story goes something like this.

Our livers manufacture triglyceride – (TG) and cholesterol – containing lipoprotein particles called VLDLs. This is old news. VLDL contains about 80% TG and 20% cholesterol. Its purpose is to nourish our organs. As these particles pass through the tiny capillaries of our various organs, enzymes called Lipoprotein Lipase (LPL) snip the fatty acids from their TG backbone, Glycerol. This too is old news. These released fatty acids are either used for energy or stored by our organs for future needs. The shrunken down VLDL particles, devoid of most of their TG energy content, are now re-dubbed. They have become LDL particles. They are cholesterol-rich. Their content represents what most people speak about after visiting their doctors – LDL-C or LDL cholesterol. Here’s where it gets intriguing. Although any lipid specialist can tell you that every single cell in our body has the capacity to make cholesterol, most believe that the cholesterol contained in LDL particles has some greater purpose. Our cells however do not need the cholesterol contained in LDL particles; nonetheless, most of us believe they use it. This belief is untrue. LDL-C is actually not utilized to any significant degree by any organ systems in human beings. Other animals may use some of it here and there, but not us. We just don’t need it. In fact, the goal of LDL particles is to get to the liver ASAP for disposal. Otherwise, these particles tend to land in places where we do not want or need them, our blood vessel walls to be more specific. You know how that story goes – plaque forms; plaque ruptures; heart attacks or strokes ensue…

So when people tell you not to worry about your high LDL-C levels, please reconsider abandoning your doctor’s LDL-C-lowering advice. And definitely don’t worry that low LDL-C levels will deprive your cells of their much-needed cholesterol. It won’t. Your cells are quite capable of making their own supply of cholesterol. On a somewhat esoteric note, it is true that the surface of LDL particles transports some vital nutrients around the body (vitamin E for one). This fact however does not imply that more LDL is better than less. We need just a tiny bit for non-cholesterol purposes. Excess does us no good, and in truth it does us a good deal of harm.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information about the supplements and vitamins critical to your everyday health visit www.vitalremedymd.com.

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Two Recent Supplement Studies Merit Mentioning – Vitamin D and Glucosamine Sulfate

Two recent trials addressing commonly used supplements are worth noting as they exemplify pertinent and prevalent issues facing physicians and patients every day. One deals with vitamin D, the other with Glucosamine Sulfate.

The vitamin D study, published out of the University of California San Diego in Anticancer Research, is entitled “Meta-analysis of Vitamin D Sufficiency for Improving Survival of Patients with Breast Cancer.” In the trial, patients with the highest vitamin D levels had the best outcomes. This group had an average 25, OH-Vitamin D level of 30 ng/ml. The initiated should instantly recognize that this number lies on the lowest edge of a normal range for vitamin D. Yet, the press reported the following, “High vitamin D levels may increase breast cancer survival.” So what might an uninformed reader assume? Take large quantities of vitamin D to shield you from breast cancer, of course. This clearly is not at all what the study concluded. A more appropriate title for the press might have been, “Very low vitamin D levels associated with worse breast cancer outcomes.” Our takeaway message is probably to avoid very low levels of D. But, we should in no way infer that very high D levels protect us from cancer (or anything else for that matter). Some trials even suggest that very high D levels might be dangerous. Once again the ideal reaction to this single piece of evidence is simply to speak with your doctor. Have your vitamin D tested. If your level is very low, supplementation is likely in order. If your level is normal, probably no further action need be taken. The key though is not to act alone. This type of discussion is another opportunity to engage your physician and help develop your own brand of personalized medicine.

The second trial evaluated what was described by the press as a “new form of Glucosamine” – Glucosamine Sulfate. First, please understand that Glucosamine Sulfate has been available for decades. Being more costly than its counterpart, Glucosamine HCL, it is typically found in only superior products. For me the interesting aspect of this trial (published in The Annals of Rheumatologic Disease) is that in a double blind placebo controlled fashion (the purported king of clinical trials) Glucosamine Sulfate was shown to statistically significantly decrease joint space narrowing over a two-year follow-up period. Older studies had similar findings, and consequently for the past ten years I’ve recommended a Glucosamine Sulfate-containing joint product that I formulated for VitalRemedyMD called JointFormula (catchy name I know). I’ve received nearly universal patient reports of improvement in joint discomfort. Anecdotally, results have been most dramatic in the hands and knees. Many of those who take JointFormula have written notes of gratitude, thanking us for helping them avoid knee replacement surgery. Yet, some trials other than the above-mentioned have “proved” the worthlessness of Glucosamine. How do we explain this to our grateful patients? Placebo effect is surely a possibility. It is also possible that what works in one person might fail in another. And, we must always acknowledge that clinical trials are not the final word. We see enough discordance of conclusions among the trials; so by this observation alone we should know that trials are hardly ever truly “conclusive.” The lesson from this study is that there will always be conflicting results among clinical trials. The ultimate decisions regarding patient care always reside between patient and doctor. Trial results help guide doctors; they should not shackle them. And, patients should not be made to feel foolish for their beliefs, nor should doctors be made to feel unscientific for theirs. Instead, doctors need to continue “practicing” medicine as best as they can, and patients must remain their own most potent advocates for health and wellness.

Learn more about supplements and vitamins at www.vitalremedymd.com.

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Omega-3 Fish Oils – Misleading and Erroneous Interpretations of Scientific Studies Can Cause Harm

Recent statistics demonstrate a small but pervasive decline in national sales of fish oil supplements. Before I continue, let me make it clear that I have a bias here. In 2007 I formulated VitalOils1000, the first omega-3 fish oil carefully and uncompromisingly concentrated and purified so as to enable the American Heart Association’s recommended 1,000 mg of combined EPA and DHA to be placed in a single enteric coated soft gel.

Now, seven years later, VitalOils1000 still stands alone among a sea of fish oil choices (sorry; I couldn’t resist). Needless to say, I am very proud of that accomplishment. So my conflict is clear; I want people to take VitalOils1000. I believe it’s good for them. In fact – that’s why I designed it. So I am disturbed by the decline in people’s consumption of fish oils. Though the “business” ramification of this decline bothers me, I am far more disturbed by its root cause. Falsely frightened people have crumbled under the illusory conclusions of a few poorly constructed trials and the even-more-poorly constructed conclusions derived by “critics” of these trials.

Consider first the fact that four decades of research spanning bedside to bench and back again have demonstrated the sweeping benefits of the omega-3 fatty acids DHA and EPA – fish oil’s “active ingredients”. That’s forty years of thousands of brilliant minds examining the omega-3 issue from a multitude of vantage points. Forty years of overwhelmingly positive conclusions! Then come a few – and I mean a few – poorly designed studies with at times truly ridiculous conclusions. As with most other aspects of news reporting, the negative draws more readers and listeners than the positive. And so the media ran with the story. Some doctors even jumped on the bandwagon. “Fish oil is not what we thought it was,” they concluded. In response, omega-3 experts from around the world voiced their discontent. But their voices were muted as they failed to resonate with fear. The scientists and doctors spoke with authority and knowledge, devoid of histrionics. And so their side of the story didn’t sell newspapers or airtime. The outcome we now witness is that some people prematurely “drank the media cool aide”. They stopped their fish oils.

The problem is that I and many others in this field are left with the great concern that these individuals have left themselves less well protected against a host of disorders than they had been while taking fish oils. Unless they’ve dramatically increased their fatty fish consumption, they have certainly placed themselves in a relative omega-3 deficient state. Think of this: the average American consumes about 100 mg of combined EPA and DHA daily while the average Japanese consumes eight times this amount. And the Japanese have far lower rates of heart disease and prostate cancer than do Americans. Yet, the scant research behind the omega-3 fear mongering cited concerns about the ineffectiveness of omega-3s in cardiovascular disease as well as the possibility of omega-3s predisposing to prostate cancer.

There are many other plausible explanations for these inconclusive trials (see my blog www.fpim.org). Throwing the fish out with the fish water is however not called for. And so my conclusion here is once again to read the primary research. Do you own homework – though it may be hard – and decide for yourself what you think is best. If you need help evaluating the literature, look for the opinions of those who are true leaders in this field – William Harris, PhD, Bruce Holub, PhD, Tom Brenna, PhD, Susan Carlson, PhD (not the owner of the supplement company), and Kevin Maki, PhD for starters. There are plenty of others but be sure to listen to the experts.

Sadly we can no longer rely upon the media’s “Medical Experts” to be our source of scientific veracity. They are too busy, and often forced to weigh in on disciplines far removed from their particular areas of expertise. They cannot possibly be expected to know everything about every medical field. I am sorry to leave you with the task of “doing your own homework”, but nowadays it is something we must all become accustomed to do.

For more information about the supplements and vitamins critical to your everyday health visit www.vitalremedymd.com.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

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