Tuesday, June 07, 2011

AIM-HIGH? Not so high apparently.

Some things in medicine seem like common sense, but they are not.

Since heart disease and osteoporosis increase after menopause, when estrogen levels drop, it was thought that supplementing estrogen would help.  Then the WISE study demonstrated that there may actually be harm in taking estrogen.

Diets high in fruits and vegetables, which in turn are high in vitamins, nutrients, and phytochemicals, lead to decreased risk of heart disease.  So, it would make sense that vitamin supplements would help, right?  Many studies and meta-analyses have looked at whether supplementing B vitamins, vitamin E, folate, or coenzyme Q10 would reduce the risk of heart disease.  Not a single study has shown that vitamin or mineral supplementation reduces heart disease.  In fact, vitamin E supplementation may increase the risk of stroke.

But niacin was thought to be different.  Niacin raises HDL ("good cholesterol") levels and lowers triglycerides and LDL levels.  Several small studies showed that niacin alone might reduce risk of cardiovascular events.  Therefore, it was thought that if some is good, then more is better.

The AIM-HIGH trial of more than 12,000 patients already on statins with controlled LDL cholesterol sought to determine whether addition of long-acting niacin would further reduce cardiovascular events.  However, the trial was recently stopped early because patients showed no decrease in cardiovascular events, but did experience an increase in risk for stroke.  This increase in stroke was somewhat surprising, and there is no obvious explanation for the small but significant increased risk of stroke.

Another drug, torcetrapib, a CETP-inhibitor, which raises HDL, was studied a few years ago as a hope for patients with heart disease.  However, studies showed increased all-cause mortality amongst patients on a combination of a statin and torcetrapib.

Dr. Neal Barnard of PCRM, the Physicians Committee for Responsible Medicine, has an interesting take on the subject. Artificially raising the HDL with medicine like niacin may not be what helps people live healthier and longer. The key may be healthy diet and exercise, which in turn raise HDL levels.

Better living doesn't necessarily come from better pharmacology.  Healthy diet and lifestyle are still the cornerstone of reducing heart disease risk.

2 comments:

Chad said...

This is so true! So glad that I stumbled across your blog. I only wish I was still living in San Diego so I could drive up and see you as my cardiologist!

Long story short, this time last year I was sick.. just feeling horrible and with a family history of massive heart attacks on both sides of the family, I went in for a Berkley Heart Lab study.

Got the results back and was greeted with sample boxes for Niaspan and Simcor. I was told that I had a genetic disorder, we don't know what really causes it, some folks livers just produce more cholesterol, etc, etc, etc. My cardiologist told me that if I wanted to make it past 45 I had to take them and he scheduled me for a stress test and follow up blood test for 6 weeks later.

I refused to take the meds and started doing research online. I found Dr. Caldwell Esselstyn's lecture on Youtube. I immediately cut out red meats, processed foods and chicken but continued a small amount of fish and a few eggs. I also started running......

I went in for my results and stress test 6 weeks later and was greeted with a smile and "I see these meds are really working for you!". I replied, "Doc, I tossed them in the garbage along with meat, chicken and processed foods". He literally had to sit down. I then told him I was going 100 percent plant based and have no intentions on taking any medications. He just looked at me like I was crazy and told me to call him when I can't stick with it and he'd write me a prescription.

So anyways, I'm now 6 months plant based and follow Dr. Esselstyn's diet to the letter.. Only exception is I do have guacamole from time to time. My total cholesterol went from 210 to 150, triglycerides went from 220 to 53, my vitamin D levels came up significantly, etc, etc, etc.. BP fell to a steady 105/70 and I was running 140'ish / 90ish prior.

So, I guess what I'm trying to say is.. Hats off to you and your mission of teaching people that there are other options other than a pill. "Let thy food be thy medicine". =)

Thanks for posting your blog! I'll be a regular from here on!

-Chad

dreaminitvegan said...

I'm so glad I found your blog! My husband who is 45 and not vegan, only at home because he has no choice because my son and I are vegan.
He just received some info. that his LDL is too low and HDL too high. He is getting the results from his blood work in the mail. He is also 40lbs over weight. Doctor recommended niacin, which I know can cause alot of damage to the body, and my husband would rather not take but just folllow a strict plant based diet instead. Which is great! Do you know of any plant based cardiologists up in Santa Barbara County? Also a good naturopath?
my e-mail is dreaminitvegan@yahoo.com