Heart Health

Heart Health

Warning:  FDA approved drug

“Statin drugs can cause diabetes” warns the new FDA labeling of all statin drugs.  The latest recommendation is based on two recent studies showing as much as 27% increase in diabetes caused by some statin drugs (JUPITER and PROVE-IT studies).  The new labeling also includes warnings of cognitive changes and memory loss.  Interestingly, the FDA removed the recommendation for routine blood testing to monitor for the sporadic and rare side effect of liver failure, but added warnings in regard to interactions with other drugs that can increase the risk of muscle injury.

It seems just a few years ago there was a movement to put every overweight kid on statins - and while we’re at it just put statins in the water supply.  The big pharma induced love affair with statins is fading and for good reason.  These drugs are not the “end all be all” to heart disease prevention and they have significant risks.

Dr Joe Prendergast, acclaimed endocrinologist and a leading researcher in heart disease, sat on the MD advisory board to evaluate the very first statin drugs released to market.  After his review of the risks and benefits he personally told me “he’d never use statin drugs” as the risks were too high and there were better alternatives.  

Remember about half the people dying from heart disease have normal cholesterol.  It ain’t all cholesterol folks!  Cholesterol is our friend, precursor to our steroid hormones, and present in every cell membrane.  It ONLY makes plaque once it starts to oxidize and cause inflammation.  We need to take a broader look at the whole process of artery disease and work to control all levels, including targeted cholesterol management, but also improving the health of the cells that line the arteries, and controlling oxidation, inflammation and blood thickness.

We should start with diet, including plenty of fresh fruits and veggies, healthy oils such as coconut and olive, and lean meat found in fish and wild game or grass-finished livestock or poultry.  Daily exercise and maintaining a healthy weight is still the number one way to reduce heart disease, by far!  Getting good quality sleep and managing stress are also powerful moves that improve heart health.

Exercise, obesity and heart health

Exercise lowers body weight and watching TV increases body weight – no surprise there – but research now shows we can actually influence the genetic expression of obesity related genes by our behavior!  Harvard scientist, Dr Qebin Qi, studied the effects of watching television and exercise on the genetics of obesity.  His team analyzed body mass but also the genes that are associated with obesity, and found that watching TV is associated with up-regulation of genes that are associated with obesity, while walking an hour daily actually down-regulates the obesity genes.  This is good news for those who “inherit” the tendency to put on weight showing that genetic predisposition is not necessarily pre-determined fate and you can exert control over your genes.  This environmental influence on our genetic code is called “epigenetics” and I predict it will be a big player in the future of medicine.

From the “well duh” category, another study showed that physicians who “practice what they preach” are more likely to give health advice.  Lead author Dr Olivia Hung from Emory University surveyed 1000 primary care docs and the ones who did not smoke and exercised regularly were much more likely to pass that advice onto patients.  None of us are saints, but I want my doctor to set an example for healthy living.

On another positive note, more and more studies are showing that the biggest health benefits from exercise are obtained with simply going from getting no exercise to getting some exercise.  Even just a bit of regular walking 30 minutes daily reaps large rewards in preventing high blood pressure, heart attack, stroke, and diabetes.  

Fat, but fit, is also making heart health news.  Regular exercise, such as walking, will lower disease risk even if no weight is lost.  This doesn’t mean ignore being overweight, as losing excess weight also lowers disease risk, but I find it encouraging to note the benefits of modest exercise independent of weight loss.

Heart smart supplements

A study from the Annals of Internal Medicine by Dr Patricia Uber found that cardiologists asked patients about the use of over-the-counter (otc) medications and supplements in only 2% of clinic visits.  The cardiology residents did slightly better asking during 16% of visits.  The patients were later questioned by the researchers who found 70% of the patients were taking otc meds and supplements.  

As the use of complementary and alternative therapies continues to increase doctors have got to at least ask and consider the use of otc supplements by our patients.  Believe me, for your doctor to keep track of the risks, benefits and drug interactions involved with various supplements is a challenge.  So patients, please, please tell you physicians about your otc supplements and when possible provide ingredient lists and information about the supplement.  We appreciate the help!
Taking more than 500mg / day of calcium is associated with a 30% increase in heart attack occurrence, according to a meta-analysis published in the British Medical Journal.  Lead author Dr Ian Reid notes “clinicians should tell their patients that, for most older people, the risks of calcium supplements outweigh the benefits. Changing to calcium-rich foods may be appropriate.”
In what may be a colossal case of “missing the forest for the trees” it seems we’ve been recommending way too much calcium for modest benefits in bone health against the backdrop of a vitamin D deficiency epidemic.  Very recent research on vitamin K, especially the K2 form, is shedding even more light on why calcium may end up in the artery wall instead of our bones.  We need vitamin D to absorb calcium, but it’s vitamin K that turns on the protein in the bone that allows calcium to be deposited into bone, while also turning on signals in the artery wall keep to calcium away.  Stay tuned for new guidelines on calcium dosing.  In the meantime have your serum vitamin D level checked as the odds are you are low.  And research shows taking at least 45 mcg/day of vitamin K2 lowers the risk of artery disease.
Better screening, better treatment
How can we really know if we are doing ok when it comes to heart disease?  What steps can we take to better analyze and promote artery health?  I recommend looking for plaque and looking at markers of artery health.  Consider getting a cardiac CT scan to see if you have any calcium in the coronary arteries.  A simple ultrasound can look for plaque in the bigger arteries.  Newer technology allows us to test for central artery blood pressure, a great marker for measuring artery health, with a simple 15 minute in-office test.  
If we find significant artery plaque, then we do better blood tests to figure out exactly why the plaque if forming.  With more thorough information about the whole blood / artery system I’m able to prescribe more specific and successful treatments.  Using proven treatments that include lifestyle habits, natural supplements and medications, we are getting a better handle on heart disease.
Inset

The next free seminars are “Adrenal Fatigue” Monday, March 26th, and “Supplements:  Why you need them and how to choose them”, Monday, April 9th, both at 6pm, at the IMC.  Seating is limited so RSVP at 245-6911 or online at rsvp@imcwc.com.
 
Bio

Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine.  He specializes in Bioidentical Hormone Replacement for men and women, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com).  Call (970) 245-6911 for an appointment or more information. 

He is also medical director of Integrative Weight Solutions, a holistic, physician supervised HCG weight loss program that incorporates expert evaluation for hormone and digestive health imbalances, exercise physiology, and behavioral support for a powerful and balanced journey to weight loss.  For more information see www.integrativeweightsolutions.com or call 245-0373 to arrange a free consultation.