An Update From the 2014 American Society for Preventive Cardiology (ASPC) Annual Meetings

Two weeks ago was the ASPC’s Annual meeting in Boca Raton, FL. The event was superb. Internationally recognized experts in a variety of disciplines convened in Boca Raton for the three–day-event. Nearly 200 healthcare practitioners from around the country came to listen to Professors from Northwestern, Harvard, NYU, The Mayo, Columbia University, The Miami Miller School of Medicine, Emory, Ohio State, UCLA…  Topics such as the somewhat controversial 2013 ACC/AHA Cholesterol and Obesity Guidelines, the enormously under-recognized disorder Familial Hypercholesterolemia, and the vast sex differences in CVD presentation and treatment were discussed.

My lecture was entitled, “The Omega-3 Fatty Acids DHA and EPA: Caution when interpreting the Trials. It’s time to get back to the basics.”  The talk highlighted enormous limitations inherent in recent omega-3 studies. It is not only clinicians and laypeople who must understand such issues, but the press as well. Too many reporters – and even physicians in the news – misinterpret clinical studies, oftentimes sending not just misleading messages to the pubic, but potentially damaging ones as well.

DHA and EPA are the essential fatty acids found in fish, NOT flax, Chia, or olive/canola oil. These fatty acids have been studied in a variety of disorders ranging from heart attacks to dementias, ADHD, eye disease, inflammatory bowel disorders, and Rheumatologic ailments. The list is actually even more extensive than this. Their benefits are legion – anti-inflammatory, anti-oxidant, anti-arrhythmic, and anti-thrombotic to name a few. Scientists across the globe are spending their entire careers evaluating the myriad biological effects of these fatty acids. Although we still do not know precisely how DHA and EPA will fit into our medicinal armamentarium, we do know that they have an important role to play. More studies and clinical trials are needed. One thing is clear however. DHA and EPA are here to stay. They represent a component in our diets that should be emphasized, not neglected. Nearly daily fatty fish or fish oils should be a part of most people’s dietary habits.

Beyond the value of DHA and EPA is an even more important message though. The media, in their unbridled attempt to produce quick and enticing stories, often critically misses the mark. Consequently we all must be very careful about how we interpret what we read or hear. We must always be vigilant when drawing conclusions about our health as well as other consequential matters.

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

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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The Glory of Gum – A Smoker’s Tale

Recently, on a medical sojourn, I was met at the airport by a garrulous woman driver. She was a young-appearing fifty year old who as it turns out had recently sustained a TIA, or “mini-stroke.” Although my first thought was atrial fibrillation, she actually had developed a near occlusion of her left carotid artery. Her right carotid artery, she informed me, had a mere 40% stenosis. Our discussion continued and I gleaned that she had a very strong family history of early onset vascular disease, several close relatives even dying quite young from their events. So my next thought was Familial Hypercholesterolemia. But no, her LDL was apparently normal. Then she fessed up. She had been – and continued to be – a smoker. Just like everyone else in her family! Shocking.

To smoke cigarettes nowadays is something I simply cannot wrap my head around. Cancer, stroke, heart disease, lung disease, wrinkles… Tobacco is devoid of any redeeming quality. It’s just plain bad. So why would anyone smoke in the first place? But, once an individual has experienced a near death event that is a direct consequence of tobacco, how in the world could she continue to smoke. My 40-minute drive took on a mission. I was going to get her to quit. I asked about her children and even grandchildren. We spoke about loss of limbs, dependence upon an oxygen tank, facial cancers and their attendant disfigurement, another stroke – the next one of course placing her in a wheel chair, unable to speak or care for herself. Then she dropped me at my destination. She was to pick me up several hours later. Before stepping out of the car I told her with stern authority that a cigarette should never again cross her lips. Chew gum I said. Gain weight if you must, but please don’t ever come near another cigarette. (I must confess; my tone was intentionally severe and perhaps even paternal. The impact I hoped would justify my behavior.)

I went through my day, completed my tasks, and eagerly awaited her return. Upon her arrival she stepped from the car and proudly and loudly through a mouthful of gum intoned that she had done it. She quit smoking. I am not certain whether her resolution will last an hour or a lifetime. For that moment though she was no longer a smoker. A gum chewer yes, but not a smoker.

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

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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Diet Tip: Please Read the Label

A good deal of my time with patients is spent teaching. I teach about theories regarding plaque formation, consequences of a ruptured plaque – heart attack being the most feared – and the spectrum of cardiac risk factors. In discussing risk factors I then delve deeper. I discuss LDL particles and why counting them is so important. I discuss the role of inflammation in heart disease. We talk about eating a balanced and healthful diet, and of course we always discuss achieving and maintaining an optimal weight.

For the last few years I have been working with a gentleman in his forties who suffers from premature coronary artery disease. He’s already had one stent and our mission is to prevent a second event. And so we have systematically and effectively mitigated each of his risk factors. Except for his weight. As hard as we’ve tried, we have failed. His stubborn 15 to 20 pounds of excess overweight has been a thorn in both of our sides.  He really has tried quite hard. He’s trimmed portions, eliminated all simple carbohydrates, stopped drinking excess alcohol, and religiously exercised an hour a day. Yet, no weight loss… Until his last visit.

The other week my young patient entered the room with draping pants and a flouncy shirt. His clothes were not those of an older, larger brother. They were his. Somehow he had done it. He had lost 19 pounds. And his smile betrayed his brimming desire to let me know his secret.  So here it is. He started reading labels. Though we had previously discussed the importance of label reading, I apparently had failed to adequately emphasize the point. Now here he stood, proving the power of the label. What he had discovered is quite fascinating. My patient, a lover of coffee, had been consuming over 3,600 calories each week in the form of coffee creamers. Although the creamer labels revealed a mere 20 calories per serving, he had failed to recognize just how many servings he used per cup of coffee. It wasn’t until he had counted the bottles of creamer he used on a weekly basis, along with the total number of calories per bottle, did he recognize just how caloric and fattening was his coffee creamer habit. He responded to his newfound knowledge with discipline and resolve, and in three short months without doing anything other than eliminating excess coffee creamer he achieved his desired weight.

The lesson here is simple: Know exactly what you’re consuming. Be careful about portions. And don’t be misled. Do the math if you’re having trouble losing weight. Count the calories you consume and eliminate those you don’t need. This basic approach worked magic for my patient; I’m confident it can do the same for you.

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

For more information more about essential vitamins and supplements 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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Look Beyond The Affordable Care Act… It’s Time to Become Proactive About Your Personal Health!

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Many of us have misgivings about the Affordable Care Act. Although voicing one’s opinion is always a good thing, in this case it should not be a distraction from that which is most important, your own personal health. So, while the politicians continue to battle this out, be sure not to neglect yourself. Instead of ruminating over who’s paying for what, be proactive and do what you can to maximize your health. Here are a few strategies to employ.

First, as hackneyed as this may sound, it is essential to eat a healthful diet and maintain (or achieve and then maintain) an optimal weight. You may believe this to be inconsequential, but having looked at patients’ blood biomarkers for many years I can unequivocally state that losing weight when necessary dramatically improves one’s signs of metabolic disease. In fact, the changes I have seen are nothing short of remarkable. Inflammatory tests, tests demonstrating oxidation of fats, and blood sugar analyses ALL improve with proper eating and appropriate weight.

Then there’s the other commonplace admonition – exercise frequently, optimally on a daily basis. As with diet and weight management, exercise is an essential element in maintaining health and combating disease. Exercise can also take one’s abnormal blood tests and convert them to normal. The good news is that exercise does not demand visits to the gym. Gardening, walking, biking, hiking, and swimming all represent excellent forms of exercise.

Perhaps most important of all is the engagement of patients and their doctors. Patients and doctors need to work in concert in order to achieve the goals we all desire. By examining novel blood tests, appropriately utilizing the best of modern medical technology, and prescribing suitable medications when necessary, your doctor can help you achieve your optimal health. After teaching you the basics of physiology your physician can show you how your body responds to healthful adjustments. You can literally see yourself get healthier over time. From personal experience treating thousands of patients I can assure you that watching your own numbers improve will be incomparably motivating. So speak to your doctor; ask for his or her help; learn as much as you can about your own body; and get healthy in 2014!

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

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Interventional Prevention – Taking Cardiovascular Disease Prevention to a New Level

In the November 27, 2013 JAMA issue, my letter, “The Pitfalls of Population-based Prevention was published with a very favorable response from Dr. Harvey Fineberg, the head of the Institute of Medicine (IOM). I was elated to see not only the letter’s publication and my introduction of the term, “Interventional Prevention” – a modern-era approach to risk reduction – but Dr. Fineberg’s forward-thinking reply as well. Interventional Prevention is after all a departure from “standard” prevention practices. We typically think of prevention in two facets, primary and secondary.

Primary prevention entails thwarting events before they have occurred while secondary prevention is the system wherein doctors utilize strategies to stop adverse events from occurring AFTER a first event has taken place. For example, hypertension and tobacco abuse are both well-established risks for heart attack and stroke. Our goal as health care practitioners is to lower blood pressure and help patients stop smoking in order to prevent heart attacks and strokes. In patients who have already had one of these events, this is termed secondary prevention; while it is primary prevention in those who have never suffered such an outcome. This describes the established approach to prevention.

Interventional Prevention is a much more proactive process. In this construct, doctors use cutting-edge predictors of risk such as biological markers in our blood and urine and imaging of different vascular beds (carotid and coronary arteries for example) to diagnose “hidden” disease or biologic perturbations and motivate patients to make significant lifestyle and medication changes in order to reduce their risk. Then we can evaluate these same markers and actually see improvements. We can do this in patients who have never had heart attacks and strokes, ostensibly decreasing their risk of ever experiencing such an adverse outcome. In Interventional Prevention, doctors identify and expose novel risks, make changes in patients’ regimens, and then facilitate improvement in what would otherwise have been “hidden” risk factors. Essentially we illuminate the invisible thereby affording patients and doctors the opportunity to heal aspects of our bodies before these perturbations cause irreparable harm. For example, with appropriate interventions we can demonstrate improvement in inflammatory blood enzymes such as LpPLA2. High levels of LpPLA2 predict both heart attacks and strokes while low levels predict the opposite. Through proper interventions we can witness the normalization of this and many other blood and urine biomarkers, clearly demonstrating on an individual basis the improvement in health and concomitant diminution of risk. This is truly patient-centric medicine. The medicine of the future has already arrived.

Learn more about comprehensive preventive cardiology at preventivecardiologyinc.com

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“Find a Doctor You Trust And Trust Him”

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A patient recently shared advice given him by his close friend (who also happens to be a physician). When my patient questioned his friend about the best way to make medical decisions in the context of today’s information-overload (which can be not only misleading but downright wrong and dangerous) he counseled him to “Find a doctor you trust and trust him.”

This philosophy may appear simplistic, superficial, or even tautological. It is not. Actually, it is brilliant in its simplicity. After all, how is anyone, doctor or layperson, to understand everything about medicine? Advances and discoveries abound. I’ve said this before – but it is certainly worth repeating, – every day hundreds if not thousands of articles are published in the medical space. It is impossible for even the most studious physician to appropriately assimilate such exhaustive data. A judicious doctor will however rigorously read the most pertinent trials and merge them into his well-established and highly-refined approach to health and illness. This approach is founded upon oftentimes decades of combined arduous education as well as invaluable clinical experience. Recognizing everything that goes into a fine physician’s decision-making process how is it remotely possible for even the most voracious reader of internet tomes to come close to the well-considered recommendations of such doctors? It is just not possible. This realty does not imply that patients shouldn’t educate themselves to become their own best advocates. They should; and in fact they must. Knowing more will help patients find those doctors they trust. But at that point patients ought to let their guard down just enough to accept the well-considered advice of their trusted physician. Without doing so, patients leave themselves wide open for not just doubt and concomitant angst, but inferior care as well.

Please read more about preventive cardiology at www.preventivecardiologyinc.com.

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Cholesterol and Vascular Disease Part 5: Non-Statin Cholesterol Medications

September is National Cholesterol Education Month. In support of this important educational initiative we are republishing our six part series on cholesterol and the role it plays in cardiovascular disease.

Note: Seventy-one million American adults have high cholesterol, but it is estimated that only one-third of them have the condition under control.

Previously, in Part 4 of this blog series on cholesterol we spoke about the statins. This week we will look at other cholesterol medications. Another very effective method for decreasing LDL is by combining a statin with other drugs.

Medications

  • One of the most effective add-on medications is Ezetimibe. This medicine works by blocking cholesterol absorption in our small intestine. It’s not just the cholesterol we eat that is blocked; more importantly it’s the enormous amount of cholesterol that is recycled daily between our liver and intestine. At this point, clinical trials have failed to demonstrate a reduction in heart attack and stroke by using Ezetimibe. Still, many lipid specialists (me included) believe that future trials will demonstrate its importance in particular patient populations.
  • Another important class of cholesterol-lowering drug is called the bile acid sequestrants. Welchol is the most commonly utilized of these medications. By blocking the reabsorption of bile acids in our intestine our liver is forced to produce more bile acids from their precursor, cholesterol. Interestingly, WelChol also has the added benefit of lowering blood sugar and increasing HDL. Patients with very high triglycerides should be careful of this medication because it can increase triglycerides further. Like Ezetimibe, WelChol is best used in combination with a statin. Read More…

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Cholesterol and Vascular Disease Part 4: The Great Statin Debate

September is National Cholesterol Education Month. In support of this important educational initiative we are republishing our six part series on cholesterol and the role it plays in cardiovascular disease.

Note: Seventy-one million American adults have high cholesterol, but it is estimated that only one-third of them have the condition under control.

It has been unequivocally established that high levels of LDL can lead to heart attacks and strokes. Parts 1- 3 of this blog described the history of cholesterol, the superiority of LDL particles over LDL cholesterol, and the pathophysiology associated with an overabundance of LDL particles. In addition to our understanding of the biological process whereby LDL particles cause vascular disease, we also have a plethora of clinical trials demonstrating the efficacy of lowering LDL.

Everyone–lay people, physicians, and scientists–is plagued by the overabundance of clinical trials involving all aspects of health and medicine, many of which clearly contradict one another. In order to practice medicine in a fashion that appropriately considers the outcomes of these clinical trials, one must find a way to make sense of them. My approach has been to evaluate the clinical trials not just individually, but as a whole. I look for trends. When studies repeatedly reach the same conclusions (especially when they pathophysiologically “make sense”) I feel much more comfortable concluding that they are correct. In the case of LDL we find a commonality that is indisputable. The studies repeatedly demonstrate that statins–a class of cholesterol lowering medications I will momentarily describe–uniformly decrease the risk of cardiovascular events by about 30%. This event reduction is consistent among patients in the setting of both primary and secondary prevention. And so we must listen to the studies and lower our patients’ LDLs accordingly.

Statins are the class of medication for cholesterol management that unequivocally possess the greatest amount of science supporting their use. These medications work by blocking a critical enzyme in our body’s production of cholesterol. In response to lower levels of cholesterol within our cells, the cells increase surface receptors to bring in more LDL particles. The result is a diminution in the number of LDL particles – as well as the LDL cholesterol – in our bloodstream. Read More…

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Preventive Health News

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This week’s roundup of important preventive health and health-related news.

 Visit vitalremedymd.com for preventive health solutions.

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