HEARTHAWKYour Heart Health Eye in the Sky

2011-11-15T16:06:00.001-05:00

The "Spooky Science" of Heart Rate Variability (HRV)

Over at Track Your Plaque we are always pushing the envelope on heart disease prevention and reversal. I have been in the program so long that (barring another ground breaking find of which there have been many over the years) I am near the end of what I can do physically. However, I have always been intrigued by how the mind might be used to alter the body.

Throughout history there have been many wild claims of yogis and mystics doing incredible things with their minds and living to ripe old ages disease free so I have always kept on the look-out for some hard science to back it up. But I am a skeptic and, like Houdini, skeptical of whether there was any scientific truth to the wild claims - until recently.

I started to read about findings that the heart and other organs have clusters of neuronal cells (rudimentary "brains") and independent nervous systems that interact with the brain. In fact, the heart has been reclassified in some precincts as an endocrine organ because of research that indicates it produces hormones. Sound a little spooky? Hang on, it gets even spookier. I have begun to uncover literature that suggests these "brains" in conjunction with the "master brain" in our heads can even alter the transcription of certain genes. It does not change your DNA but the suggestion is that these "brains" can "order" the body to either up-regulate or down-regulate the production of specific proteins created by DNA, proteins that literally govern how our body behaves.

So where does HRV come in? Recent research has revealed that the beat to beat variation in heart rate (the time between "T to T" peaks in the QRST waveform of a typical EKG) is an exquisitively sensitive measure of the functioning of the Sympathetic Nervous System (SNS) and Parasympathetic Nervous System (PNS), the two major components of our body-wide Central Nervous System (CNS). In a nutshell, when all the body's "brains" are communicating coherently they exert minute variations in the heart rate. However, in situations of stress or disease the heart essentially runs on auto-pilot with little beat to beat variation.

We were so intrigued at Track Your Plaque over the possibilities we approached the HeartMath people, the leaders in HRV monitoring, to provide us with their HRV product so we could put it to the test - and it did not disappoint. Once again, I was the guinea pig. The next few posts will chronicle my personal experience with the basic PC Desktop version of the HeartMath emWave HRV monitor and training device.

The graphic below illustrates my baseline HRV waveform and it is very instructive of what most people will experience.

Notice how choppy and irregular it is which is exactly how the HeartMath people said it would be for a "noob" like myself. A "coherent" nervous system, with the brain in your head in coherence with the rest of the body's "mini-brains" produces a smooth, sinusoidal trace. The HeartMath "emWave" device is essentially a training tool with a built-in "coherence coach" to help you practice reaching a coherent state )with multiple challenge levels (kind of like resistance training for the body.

After several sessions and a little frustration at not be able to instantly master it (what can I say, I'm impatient) I did indeed improve coherence - but that will be the subject of my next blog!

Looking out for your heart health,

HeartHawk

Miracle Pancakes: No Wheat, No Rise in Blood Sugar (as in zero, nada, bupkus)!

2011-09-20T12:52:00.005-04:00

The real challenge in going wheat free is to find suitable food alternatives. I've had little problem with lunch or dinner. I love sub sandwiches and Jimmy Johns make the UnWich (lettuce wrap instead of bread) and a good Cobb salad always works for me. Dinner is even less problematic with lean red meats, chicken, fish, and any number of vegetables which I love anyway.

But breakfast? What to do about toast and pancakes and hashbrowns. And let's face it, bacon and sausage ain't exactly health food despite being low carb. Doc Davis convinced me (I was a doubter and an affirmed Ornish low-fat guy at the time) to go low-carb long before his Wheat Belly book burst onto the scene (the numbers don't lie - see this post). In the process we both began working on recipes just for ourselves (many ended up in his new book and also the Track Your Plaque program cookbook).

But, the low-carb Holy Grail for me was a "miracle batter" that could replace wheat and allow me to eat things like muffins and pancakes. Well, after months of testing and tasting, back and forth between Doc Davis' and my kitchen I think we may have it. Doc D's Miracle Batter as I like to call it (although I tweaked it plenty it was still Doc D's basic recipe - and really - Doc D's Miracle Batter is much catchier name, don't ya think?).

So, where am I going with all this, seeing as how the "recipe" is not quite ready for prime time just yet? Now that it passes my basic taste test it is ready for the real test. What would it do to my exqusitely sensitive blood sugar. Sound the horn please, as I have just completed the first test and the results blew my mind.

Fasting Blood Sugar at 10AM: 87mg/dL (not too bad for a pre-diabetic)

Prepared one serving of pancakes consisting of

1/2 cup of "miracle batter"
1/4 cup almond milk
1 Grade A Jumbo egg
1/4 cup artifically sweetened maple syrup (sweetened with sucralose)

I added the syrup just to "push the envelope" and, well, that's the way I used to eat pancakes as do many others.

Post-prandial Blood Sugar 11:15AM (one hour after consumption): 86mg/dL

WHAT?! I couldn't believe it so I tested again. The retest results: 87 mg/dL !!!

ABSOLUTELY ZERO GLYCEMIC EFFECT!

Now, one test on one person does not a miracle make. But it looks awfully good so far!

Looking out for your health,

HeartHawk

P.S. Did I mention they taste fantastic? Pictured above is one test recipe made with blueberries. Man, like a long cool drink of water to man thirsting in a low-carb desert!

Bride of Franken-Wheat: New Wheat Protein Kills Aphids, Attracts Parasites

2011-09-17T10:41:00.001-04:00

This just in! A new strain of genetically modified wheat ("GM Wheat" as they euphemistically call it in the industry) is about to hit the fields for testing. You can read more here. But, let me synopsize the report for you.

I kid you not, a new genetic modification is being introduced to wheat that will allow it to "release a chemical which will deter aphids, and attract the insects' predators and parasites."

Now, I gotta tell ya, I've had this small personal problem with aphids for a while now. Little critters don't really eat that much but they are kinda itchy. So my first thought was, "Heck, why not give this new wheat a try? Switch to Frosted Mini-Wheats for breakfast, ham sandwich on whole wheat for lunch, kick back with a pizza, a few pretzels, maybe a honey-wheat lager or two for dinner and, BAM, say good-bye to my "aphid dandruff!" But, wait a minute! Attract predators and, gulp, parasites? No thanks, I already have too many lawyers, politicians, and aluminum siding salesman chasing me.

But seriously, is it just me or does anyone really think it's a good idea to eat a plant that exudes a chemical that will "deter aphids, and attract the insects' predators and parasites?" Keep in mind that this is not the first genetic modification to be made to wheat. It already has 3 times as many chromosomes as what good old mother nature intended (42 versus 14). With every bite we consume a plant with special genes designed to kill fungus and other bugs. I mean, c'mon, where does it end? Frankly, I wouldn't spray myself with bug killer let alone eat it!

Looking out for your health,

HeartHawk

Franken-Wheat: My Own Mad Genetic Experiment!

2011-09-17T00:13:00.001-04:00

The numbers don't lie. Nature's own original wheat has 14 chromosomes. Modern wheat has 42! Those extra 28 chromosomes are all genetic codes cross-bred and genetically engineered to produce proteins to kill fungus, bugs, bacteria, make wheat shorter, faster growing etc. We all know abouts the devasting effects of the wheat protein gluten on celiacs - but what the heck are all those bug-killing proteins doing to you when you eat wheat?

Dr. William Davis presents some provocative theories about what disease conditions wheat may provoke in his new book "Wheat Belly." However, the ones that caught my are are the the effects about things like blood sugar and lipoproteins - the things that affect the heart profoundly and cause heart disease. So I did my own test. Here are some numbers from a test I did on myself - personal numbers before and after wheat - that blew my mind!

I see myself as the perfect test subject because, up until then I had been on a low-fat “Ornish” diet and was taking 3g of prescription niacin daily to lower my LDL Cholesterol and raise my very low HDL Cholesterol (the “good” cholesterol). Here are my lipids before doing my own wheat-free test.

LDL Cholesterol: 84 mg/dL
HDL Cholesterol: 55 mg/dL
Triglycerides: 24 mg/dL
Total LDL Particles: 598 nmol/L
Small LDL Particles: 290 nmol/L

Here are my numbers after six months on the low-carb, no-wheat diet where I added back a significant amount of fat (including a fair amount of saturated fat) to replace the carbs. Note that I also STOPPED talking the prescription niacin during those six months.

LDL Cholesterol: 76 mg/dL
HDL Cholesterol: 55 mg/dL
Triglycerides: 26 mg/dL
Total LDL Particles: 550 nmol/L
Small LDL Particles: 92 nmol/L

Just look at those eye-popping numbers. My LDL Cholesterol went down while my HDL Cholesterol and Triglycerides stayed virtually the same. Most importantly, not only did my total number of LDL Particles drop, my dangerous Small LDL Particles dropped a whopping 68%! That was all accomplished with nothing but dietary changes that also allowed me to eliminate one of my prescription meds to boot! Not a bad day’s work for doing little more than giving up bread, noodles, and pretzels (although I must admit I still miss the pretzels)!

The numbers don't lie. When Franken-Wheat's stalking, dont waste your time talking, just keep walking, or better yet, run!

Looking out for your health,

HeartHawk

Wheat-Zilla Conquers the World! Rampaging Monster Kills Every 7 Seconds!

2011-09-15T11:36:00.003-04:00

Just yesterday, the Associated Press reported that, "An estimated 366 million people world-wide now suffer from diabetes, and the global epidemic is getting worse ..." This is according to the International Diabetes Federation which described the situation as "staggering" with one person dying from diabetes every seven seconds.

It is widely acknowledged that obesity rates and the chronic ingestion of high-glycemic index carbohydrates are a major factor in the development of diabetes. It is the amylopectins in plants that carry the bulk of the carbohydrates of which their are three, amylopectin A, B, and C. Amylopectin A, the form found in wheat, is the most easily digestible and therefore raises blood sugar more than the other forms. In fact, two slices of whole wheat bread can spike blood sugar higher than two tablespoons of sugar. It is also believed that these high surges in blood sugar coupled with the high insulin response they provoke are involved in the epidemic in obesity, especially the creation of visceral "belly fat" that is considered the most dangerous kind.

Other chilling data and statistics regarding Wheat-zilla were revealed in the groundbreaking book "Wheat Belly" recently released by author and cardiologist Dr. William R. Davis.

Looking out for your health,

HeartHawk

The "Big-Wheat" Empire Strikes Back: Attack Begins on Dr. Davis and Wheat Belly

2011-09-14T13:41:00.008-04:00

The Grain Foods Foundation, Wheat Foods Council, Go with the Grain, GrainPower, SixServings, you know them by many names but they all have one goal. To fatten you you up with wheat before the slaughter - by your own bagel-laden hand - while making a buck in the process.

This collection of dubious organizations has recently gone after Dr. William R. Davis and his new book "Wheat Belly" in what I believe will be a vain attempt to discredit him before the truth gets out. A truth that could cost them billions of dollars. Judging by the overwhelming online response and support of Doc Davis they may have bitten off more than they can chew. Here is the link.

http://www.sixservings.org/2011/08/500/

After reading it I thought I would do a quick investigation into their so-called "Scientific Advisory Board." It ain't pretty. This is what passes for independent scientific advice? Yikes!

Glenn Gaesser, PhD: Author of "Big Fat Lies" a book that promotes the concept that actual weight (how fat you are) is not as important as (surprise) dietary fat. Not surprisingly, the book recommends a diet of complex carbohydrates. Most humorously, it rails against the so-called "experts" who produce healthy weight/height charts. Gee, isn't it the Grain Foods Council who admonishes us to believe the "experts?"

James R. Gavin III, MD, PhD: This disclosure gem is precious. "Served as an advisor or consultant for: sanofi-aventis; LifeScan, Inc.; Eli Lilly and Company; Daiichi Sankyo, Inc.; Abbott Diabetes Care; AstraZeneca Pharmaceuticals LP; Served as a speaker or a member of a speakers bureau for: Novo Nordisk; Bristol-Myers Squibb Company; AstraZeneca Pharmaceuticals LP; sanofi-aventis: Owns stock, stock options, or bonds from: Amylin Pharmaceuticals, Inc.; Served as member of the Board of Directors for: Amylin Pharmaceuticals, Inc." Care to guess on what ALL the above drug companies have in common? Surprise, surprise, surprise, they make diabetes drugs! LifeScan, Inc. makes blood glucose monitors. Hmmm, does it seem that ANY of these companies is particularly interested in reducing the number of diabetics?

Ronald Kleinman, MD: Yeah, it gets better! Kleinman, who is known to accept compensation for his opinion, "serves on scientific advisory boards for General Mills, the Grain Foods Foundation and Burger King. He is a member of the Board of Directors for Project Bread in Boston; a member of the Board of Directors Global Child Health Foundation; and a consultant for Mead Johnson Nutritionals." Hey, guess who owned Mead Johnson for 42 years? Bristol-Myers Squibb! Guess what the first item is in the Mead Johnson Food Pyramid For Pregnant Women. If guessed "grains" give yourself a gold star! And whats with: General Mills? Burger King? Project Bread? LMAO! You're kidding, right?

Robert S. Rosenson, MD: The beat goes on. He "Served as an advisor or consultant for: Abbott Laboratories; Amarin Corporation plc; Amgen Inc.; Genentech, Inc.; LipoScience Inc.; Roche; sanofi-aventis; Received grants for clinical research from: Amgen Inc.; Genentech, Inc.; Roche. We covered some of the other drug makers. Amarin is finalizing development of drug to treat high triglycerides. Guess what one of the leading causes of high-TGs is. Roche make anti-diabetes drugs and the famous Accu-Check blood glucose monitor.

Shelley Case, RD: Can't say much about Ms. Case. Her financials are clean but her laser-like focus and expertise is restricted to the gluten protein and celiac disease. What about all those other proteins manufactured by the extra 28 chromosomes in the cross-bred and genetically engineered "Franken-food" we call wheat. To quote Ms. Case, "Patients should be thoroughly tested for Celiac if they present with conditions such as anemia, bone issues, thyroid and liver dysfunction, and arthritis." Hmmm, any chance those conditions - as mentioned in Wheat Belly - could be due to one of the other proteins in wheat?

Julie Miller Jones, PhD, LN, CNS: This quote from Ms. Jones and a group of her cronies enlisted by grain growers in response to the USDA altering the food pyramid logo says it all. " ... we will provide input on the science behind the new icon and ways to achieve the key goal of getting consumers to eat more healthfully, ensuring they are getting their six servings of grains daily, making at least half their grains whole and the rest enriched grains." Does that include celiacs? Do you suppose Ms. Case and Ms. Jones ever talk?

Sylvia Melendez-Klinger, MS, RD, LD: From Ms. Klingers corporate website, "Ms. Klinger is also culinary consultant to food and beverage companies such as The Coca-Cola Company, Kellogg’s, Hormel Foods, Ross Laboratories, GlaxoSmithKline, Dannon, AztraZeneca, Uniliver, Mc Neil Nutritionals, and Weight Watchers International were she completed numerous administrative and communications projects." I think that just about covers Ms. Melendez-Klinger's credentials as an "independent" expert!

Bruce Young, MD: Dr.Young is an obstetrician and gynecologist with credentials in programs for mid-wifery and fetal medicine but I have no idea what his standing is as a grain expert. Best I can tell "Big-Wheat" wants so-called experts to push wheat from conception to our untimely and miserable deaths.

Yeah, if this is an "independent" board then I'm Batman (I'd settle for Bruce Wayne, hell, I'd settle for Adam West). But what did you expect? Let the battle begin. If this is the best the competition can offer I'm betting on Doc Davis!

Looking out for your health,

HeartHawk

The 89 Cent Heart Attack?

2011-05-07T18:58:00.002-04:00

While I was driving down the highway this billboard happened to catch my eye and gave me a chuckle (the added text and arrows are mine, of course).

This burrito looks exactly like the cross-section of an artery in the midst of a heart attack. The similarity is absolutely uncanny!

Remember, you are what you eat, lol!

HeartHawk

Healthcare Industry is Hopelessly Behind the Customer Service Technology Curve

2011-05-05T22:29:00.002-04:00

One of the great things about technology is that it has vastly improved customer service. I can order products, pay, track shipments, get support, do just about everything from my laptop to smart-phone. So, why is it that some medical facilities are still hopelessly behind the technology curve?

Mind you, not all are. For example, I can get all my test results online which is far faster and more convenient than it used to be. But this post is about simple, run of the mill, customer service - the sweet spot if you will - of this blog. Although it has been awhile, alas, I come with yet another story of healthcare customer service gone awry!

I practice Informed, Self-directed Healthcare (ISH). I take responsibility for my health! I consider doctors as specialized consultants I pay to keep me informed and help me make decisions - not dictators who tell me what I MUST do. This is not unlike the way I characterize lawyers. I see a lot of doctors, take their advice, do a great deal of independent research, and render my own opinion.

Recently, I saw a functional medicine doc. He did a fecal analysis test to delve into my stomach problems (after my GI doc threw up his hands and could not provide a diagnosis) which came back with suspicious results for heavy metals. We followed up with a Urine Toxic Metals test that revealed high levels of mercury and lead and an elevated level of arsenic. I thought, in the interest of continuum of care, that I should share these results with my hematologist (I have macrocytotic anemia), gastroenterologist (for my stomach problems of unknown etiology), and my GP. This is where the "fun" starts.

I contacted my hematologist's nurse who asked if I could fax the results. "Fax?," I said, "Who uses a fax anymore? How about if I scan the results and sent it to you as a PDF via e-mail?" She promptly provided an e-mail address and said she would print out a copy and enter the file into the electronic system (they have a completely digital records system but some docs STILL like paper). Then I contacted my GP's nurse who is at the same facility. She would not even consider an e-mail and refused to provide an e-mail address (which I could have guessed since they use the first initial and last name "at" the center name ".com." She had to have a fax. Keep in mind that this is the same medical center with all the same systems. Seems to me that she would have to scan the paper fax to create the electronic record I was willing to send her. What, is she trying to protect, someone's scanning job? My GI's nurse did not even have external e-mail! How in God's name can you run ANY business without the ability to accept external e-mail? Yikes!

Now, you may be thinking this is a HIPAA issue so I checked with a lawyer. Since I am sending the info willingly by e-mail it is a de facto waiver of any expectation of privacy. I explained that e-mail is actually more secure! The e-mail goes ONLY to the person I send it to when a fax just sits on a machine for ANYONE to see.

The bottom-line is that I am e-mailing to the hematologist's nurse who offered to make a paper copy for my GP's nurse who will turn around and scan it into their digital system. Ya, that's REAL efficient. Since my GI's office is just down the road from my cardiologist's office (Doc Davis of Track Your Plaque fame) I will drop it off the next time I am at his office (which is thankfully frequent as we talk often).

And people wonder why healthcare is so expensive! Sheesh!

Looking out for your health,

HearHawk

JUPITER to Earth: It's the Calcium Score Stupid!

2010-11-23T13:20:00.001-05:00

Well, well, well! A funny thing happened on the way to the "statin forum." Astra-Zeneca, in a bald-faced attempt to broaden the narket for its statin product Crestor, ended up proving beyond a shadow of a doubt that heart scans and calcium scoring is the most powerful predictor of heart attacks in asymptomatic people.

A post hoc analysis of the MESA study population using JUPITER criteria revealed at 25-fold increase in risk for persons having a positive calcium score. These two studies were fairly large so it was adequately powered to deliver results with a high degree of confidence.

For years docs like Bill Davis and Bill Blanchet have been screaming this from the hilltops and it something every Track Your Plaque practitioner knows. If you have a positive calcium score you have coronary artery disease and your risk of a heart attack skyrockets. Fortunately, it also gives you often decades of warning so you can actually DO something about it. Coupled with technologies like advanced lipoprotein you can find the root causes and correct them.

So, "thank you" Atra-Zeneca. I know you did it for the money - but what the heck - you might end up having helped save some lives in spite of it!

Now darn it, go out talk to your doc about getting that heart scan if you have any doubts about having the seeds of heart disease in your arteries.

Looking out for your health,

HeartHawk

Diabetes? You Gotta Exercise! It Works - Big Time!!!

2010-11-10T21:25:00.000-05:00

Ever since I was diagnosed as prediabetic I have been looking for ways to stave off the inexorable march to full-blown diabetes and its many heart related complications. As I wrote earlier, the words of one of many endocrinologists I went to keeps wringing in my ears. "You gotta exercise. I has been shown to work better than any else."

Well, as a numbers geek I have been tracking things in different situations. Like many prediabetics my fasting blood sugar is pretty stable - about 83mg/dL in my case. My problem is after eating - postprandial blood sugar.

To do yet another test I went out last Sunday and ate a large meal on an empty stomach. This included some nasty stuff like an abundance of french fried eggplant, a rack of ribs (which I'm had plenty of sugar in the sauce), three massive french fried shrimp (oh but were they good) with tartar sauce, a few veggies, and a small side salad (with a dressing which also likely had HFCS). Like I said, not a praticularly healthy meal but, then again, my intention was to cheat and see what the consequences were.

One and one-half hours after the meal my blood sugar was a still a nasty 135mg/dL so I fired up the old recumbent stationary bike and did my typical ride - about 44 minutes, 600 calories, and 7 miles (yeah, I know the calorie counter is reading high but it is just a reference number to help me track and compare rides).

So, 45 minutes later I take another reading - BADDA-BING! 77mg/dL, I dropped 58 points in 45 minutes. WOW! Like the doc says, "You gotta exercise!" Take it from me, it seems like magic and it works. I guess all those old-timers who take their evening "cosntitutional walk" after dinner knew what they were doing.

The bottomline here simple - after you eat - move. Walk stairs, walk around he block, heck do jumping jacks. It all adds up. You don't have to drop your blood sugar a whopping 58 points to have a dramatic effect. Every point you shave makes you a little healthier!

Looking out for your health,

HeartHawk

Kidney Stones and Lithotripsy: More Lessons Learned about Healthcare

2010-08-29T15:35:00.001-04:00

Yes, there will be blood!

You know, the older I get the more I am inclined to believe that heart disease is just another symptom of a more systemic problem - getting old! Since I became consumed by heart disease I have gone down the rabitt-hole of thyroid function (Hashimoto's in my case) and diabetes (currently prediabetic with Impaired Glucose Tolerance and an HbA1c of 5.9).

So now what? KIDNEY STONES!

Ole, HeartHawk finally went in for Extracorporeal Shock Wave Lithotripsy (ESWL) for a collection of stones in my right kidney that I have known about for over two years. A visit to the emergency room with nasty renal pain several weeks earlier prompted me to visit my urologist to reschedule the lithotripsy I postponed the previous year.

I want to take this opporunity provide a series of bullet-point observations about my personal experience with kidney stones and ESWL and use them to further illustrate even bigger observations about the shortcomings of traditional healthcare (just do what the doctor says) and the need for everyone to practice what I call "Informed Self-directed Healthcare" (ask many questions, do your research, get many opinions, don't blindly trust any single doctor) no matter what condition you are treating!

1. I discovered my kidney stones quite by accident during an ultrasound for a still undiagnosed (despite repeated scans and tubes shoved up and down both "ends") bouts with episodic and debilitating stomach pain. The test showed a 16mm stone.

2. After an ER visit for another bout with whatever was ailing my stomach, a CAT scan confirmed the stone but put it at 8mm. By the way the gastroenterologists finally decided that what I had was Cyclic Vomiting Syndrome which is thought to be a "migraine" of the stomach. The pattern of attacks, symptoms (no vomiting actually) and fact that I had a history of migraines all contributed to the diagnosis - although they don't REALLY know but I haven't had an attack in over a year.

3. I saw a urologist who wanted to perform a KUB (Kidney, Ureter, Bladder x-ray) of the stones. When I asked why - noting I have a CAT scan of the damn thing he suggested the KUB was a "better modality" for "seeing" the stones. After the KUB this doc wanted to do a percutanous nephrolithotomy (PCNL) where they cut into you and extract the stone(s) with a scope. This is an invasive 1-2 day surgical procedure which requires a stent in your incision to drain the kidney for 24 hours - hence the hospital stay. This same doc then wanted to do a CAT scan before the procedure. When I asked why he said because it provided better information about the stones than a KUB - ahhh, wait a minute - I thought you said ...! I dropped this doc like a hot rock!

4. I saw another urologist who suggested ESWL so I decided to research lithotriptors. I chose the Storz Modulith SLX based on a combination of treatment efficiency and ability to pulverize stones. Here is a link to one of the studies I reviewed. You CAN dictate which machine will be used by your doc. I actually had it written into the waiver I signed at the hospital. Now, it does complicate scheduling because the machine needs to be available (more on that later).

5. After procrastinating for a year I ended up at the ER with renal colic (pain) that is typical of the stones I KNEW I had. Right lower back pain that was bad but not the "child birth like" torment I had heard - but still bad enough to take the morphine they offered! At the ER a nurse showed up to take me for a CAT scan. I refused. Wouldn't a much lower radiation dose KUB confirm things? Hell, one urologist told me (at one point) it was superior - and certainly cheaper (another example of why healthcare is so expensive)! I actually sat in the imaging room until the attending physician came in. After a brief discussion she agreed with me!

6. I scheduled a followup with my new urologist who says the stone "cluster" now looks much smaller (possibly to small for lithoptripsy - or GONE) and wants to do a repeat KUB. Right now I feel like an x-ray pin-cushion. I suggest we first verify it with ultrasound (no radiation) and if we find something then do a KUB. He agrees. See a pattern here? Seems like docs are handing out radiation like candy. Why?

7. The first ultrasound tech (who was a trainee) had equivocal findings so the test was repeated on the spot by a more experienced tech who found the stones so I had the pre-procedure KUB (this would be the fourth).

8. The doc says the stone "cluster" is now only 4-5mm and is marginal but suggests going ahead with the ESWL to avoid future problems and I agree. I go several rounds with the schedulers to get a Storz SLX-F2 lithotripter in a hospital setting as the procedure is done under general anethesia (I won't settle for receiving general anesthesia anywhere but in a full hospital).

9. I get to the hospital and everything goes smoothly until a nurse shows up to take me for - ANOTHER KUB! Of course, I refuse (I always like the look of bewilderment on the faces of medical staffs when I do this - they are practically speechless). I just had one a week ago! So they call the urologist who agrees to bring the last one to the hospital. After a little prodding of the staff it became clear the final KUB was ordered simply for the convenience of the urologist! Let's see, I get another blast of x-rays so the doc can squeeze in another latte? Bite me!

10. Did I mention an ESWL is done under flouroscopy (x-ray) so they can aim the lithotripter? I was not amused when the lithotripter tech could not tell me what my radation exposure would be (mSV) but noted that my doc put on a lead flak jacket as I was dozing off.

11. The rest of the procedure went well with little pain but I am starting to get concerned about "peeing cherry Kool-Aid" (blood in the urine) for two and one-half days post procedure. I heard it can last a week but usually subsides in two days. The doc called and said I'd received the the max number of shocks (about 3000) so I am certain my guts got a little "tumbled!" Still, somehow I doubt I will ever get used to red urine!

12. Of course, I also have to strain my bloody urine for three days. What fun! No rocks yet which may mean the stones got completely pulverized but it could also mean they're stuck!

13. Now, here is the kicker that REALLY pisses me off. I am doing some post-op research about how long to expect blood in the urine and come across another study that suggests ESWL greatly increases the risks of diabetes and high blood pressure. WHY IN GOD'S NAME WAS THIS NOT DISCUSSED WITH ME PRIOR TO THE PROCEDURE? This is unconscionable! I am prediabetic with heart disease! Ya think this might be pertinent to my decision? To be fair there are competing studies that found no such association but that is beside the point. It should still be disclosed!

14. So here I sit, three days later, peeing red into a bucket, and wondering whether the "benign" procedure I just had is going to raise my blood pressure and accelerate my diabetes years down the road. Sometimes I wonder - maybe ignorance is bliss - NAAAHHH!

Looking out for your health (and mine),

HeartHawk

Body by Track Your Plaque?!

2010-05-23T17:22:00.023-04:00

Although there are several exercise guidelines there really is no "Track Your Plaque" exercise program, but if there was one it would probably be a lot like the one that produced the picture at left. Yup, that is skinny, old (and getting older every day) HeartHawk after just 90 days (one with my head chopped off and one with my trademark sunglasses, to remain incognito). No "P90X" discs, no personal trainer, no high tech equipment, just some basic Track Your Plaque principles and a scare followed by a commitment. Read on!

I recently saw my endocrinologist who looked at my OGTT and HbA1c and proclaimed, "You're insulin resistant and prediabetic!" Looking for him to prescribe some new wonder drug, supplement, or spartan diet recommendations I asked, "So what can I do about it?" "Exercise!" was his one word reply which he repeated often. What? As a Track Your Plaque devotee I am used to heart scans, advanced lipoprotein testing, exotic supplements and all the bleeding-edge science that comes along with it. The more I objected and insisted there must be more we can do beyond "exercise" the more he insisted, "Exercise!" Finally, as the frustration grew in both of us he loudly blurted, "Look, you GOTTA exercise!"

Now, I had always gotten SOME exercise. Heck, at 55 years old I still kept up with guys on the basketball court one-third my age - once a week - and there was the problem. How much exercise was needed? A lot more: 30 minutes, 5 times per week, at 70% of my maximum heart rate. Well, like everything else I thought I might as well go "whole hog" and see what I could do. I was going to do 45 minutes per day, a minimum of 5 days per week (averaging closer to 6 days) and I was going to throw in some resistance training every other day.

Guess what, my blood sugar is lower and I even got a little muscle definition after a life of being a "bean-pole." I may actually take my shirt off this summer! The point I am trying to make is that exercise is an ESSENTIAL part of Track Your Plaque or any health program for that matter - and you don't need expensive DVDs or equipment, just a commitment to developing a daily habit to just do it!

Now, I won't kid you. It is often boring and tiring (but not a lot after a few weeks), and it is definitely not as much fun or easy as other things you might do instead (like eating and sleeping). But, if an underweight, old enough to join AARP, sit on my butt behind a computer all day kind of guy like me can do it, so can you! Vigorous exercise lowers your cholesterol, your blood pressure, your blood sugar (to name only a few benefits), and damn, just plain makes ya look better (oh yeah, I can rebound better too - though it didn't help my shot much unfortunately)! What else can do all that?!

Looking out for your heart health,

HeartHawk

American Heart Association Exposed "Selling" Endorsements

2010-05-21T10:11:00.008-04:00

I have been critical of the AHA in the past for their stodgy, politically correct perspective on heart disease but this takes the cake. No longer satisfied to endorse sugary, diabetes-inducing foods as heart healthy, they have expanded their coveted "Heart Check" endorsement to the Wii video game console on the premise that several of its games promote fitness. As one of my contemporaries titled it in his post on the Track Your Plaque Forum, "AHA whores for Nintendo." I could not have said it better myself!

What is stunning is that AHA has made selling their endorsement big business. Get a load of this brochure on the AHA website. Here is the AHA pitch . . .

"Shoppers want clear, simple purchase guidance from a trusted source. The American Heart Association heart-check mark increases product sales because seeing the mark on a package assures shoppers they are making a smart choice."

SMART CHOICE?!! OH REALLY?!! The AHA has figured out that they have created a trust factor among consumers (misplaced trust in my humble opinion) and want to cash in on it - big time.

Nevermind that they are hopelessly behind the the cutting-edge of heart health science (they continue to push dietary cholesterol and saturated fat as the keys to heart health - NOT!).
Nevermind they endorse foods like "Berry Burst Cheerios-Triple Berry" (22 grams of wheat and sugar, the top two ingredients). There is an epidemic of childhood obesity and diabetes and the AHA pushes sugar and highly-processed carbs into the veins of children as sure as if it were drugs through a needle.
Nevermind that regardless of whether your product is heart healthy or not THE ONLY WAY YOU CAN GET THE AHA ENDORSEMENT IS TO PAY FOR IT!

The AHA now seeks to expand their misuse of this misplaced trust to other dubious product groups and are putting the hard sell out on the streets. They charged Nintendo a whopping $1.5 million for their "endorsement." Think about it, the AHA and Nintendo are teaming up to put the outrageous notion in the minds of consumers that buying a video game is heart healthy because in certain, non-representative situations, you could get some aerobic exercise.

I do not doubt that you can work up a real sweat playing several different video games - but is that the norm? Will Nintendo put a label on "Super Mario Brothers" that states "Nevermind?" This is the same sort of outrageous claim the FDA has recently outlawed for other products. If your claim is not representative of typical results you can be sued! Any hungry lawyers out there?

I am sad to have come to now hold the opinion the once proud AHA has indeed become a "whore" to the almighty dollar. They have lowered themselves to the level of "used car salesmen" and "snake oil peddlers." There is a lot of talk about boycotts these days. How about we start with the AHA and the disreputable companies that buy into their hucksterism to push their products on unsuspecting consumers!

Yeah, that means you General Mills and Nintendo. Consumers have lots of options for breakfast foods and entertainment. What do you think their reaction will be when they find out you and the AHA have been distorting the truth?!

Looking out for your heart health,

HeartHawk

Nattokinase Revisited

2010-05-15T15:37:00.009-04:00

I had one of my regular meetings with Doc Davis of Track Your Plaque book and website fame today where he remarked about a patient he encountered that nearly died of a pulmonary embolism after going off prescription anti-thrombotic medicine in favor of nattokinase.

Doc Davis has been a critic of nattokinase and endured the slings and arrows of its promoters and those statistical "n of one" users who swear by it. (Interesting to note that Doc Davis is part Japanese and is not without experience with natto as a food his mother made him eat - childhood trauma perhaps? LOL!).

I was curious enough to take a look at the debate on his blog and do a little of my own research. As most readers of my blog know I am a "numbers" guy. Normally, the ridiculous bloviating and hyperbole I found on some sites pushing nattokinase would be enough to turn me off but just because "bad" people say "good" things about a product does not preclude it from actually being good! On the other hand, there is some pretty damning science against the concept that nattokinase works (the small problem of any protein surviving the gut) as well as common sense that suggests if it did work it may be a dangereous way to self-medicate (at least with a prescription drug like Coumadin you are under supervision by a doctor).

For better or worse I decided to go to my trusted sources at PubMed and look at some of the more recent studies to see if there is anything new that supported casual and chronic oral adminstration of nattokinase to prevent heart disease. Here is what I found in a highly summarized (and editorialized) form so as not to induce boredom (use the links for more info).

Bioproperties of potent nattokinase from Bacillus subtilis YJ1.
http://www.ncbi.nlm.nih.gov/pubmed/20334345
Yup, nattokinase is still fibrinolytic - if it gets into the blood stream.

Purification and Characterization of Nattokinase from Bacillus subtilis Natto B-12
http://www.ncbi.nlm.nih.gov/pubmed/19788184
Now if we could only get this stuff to work orally as a functional food!

Combined nattokinase with red yeast rice but not nattokinase alone has potent effects on blood lipids in human subjects with hyperlipidemia
http://www.ncbi.nlm.nih.gov/pubmed/19786378
Nattokinase does not appear to exert its effects (if any) via lipids.

Enhancement of oxidative stability of the subtilisin nattokinase by site-directed mutagenesis expressed in Escherichia coli
http://www.ncbi.nlm.nih.gov/pubmed/19631297
Hey, we are getting closer to at least limiting oxidative degradation - still no panacea.

Purification, immobilization, and characterization of nattokinase on PHB nanoparticles
http://www.ncbi.nlm.nih.gov/pubmed/19608412
Nanoparticles are all the rage these days and may have some utility with stabilizing nattokinase but still no oral in vivo data.

Nattokinase decreases plasma levels of fibrinogen, factor VII, and factor VIII in human subjects
http://www.ncbi.nlm.nih.gov/pubmed/19358933
Now we're talking - hard data with oral nattokinase in humans! Unfortunately, this was an open-label, self-controlled sudy with 45 people (15 in each arm). Can you imagine trying to get a prescription drug past the FDA with a study like this? Still, at least SOMETHING for proponents to hang their hats on.

Effects of nattokinase on blood pressure: a randomized, controlled trial
http://www.ncbi.nlm.nih.gov/pubmed/18971533
Hey, hey! More human data and this time randomized, controlled, and with almost twice as many participants as the previous study. Too bad the end point was blood pressure data - but it did show improvement.

Effect of nattokinase on restenosis after percutaneous transluminal angioplasty of the abdominal artery in rabbits
http://www.ncbi.nlm.nih.gov/pubmed/18819862
Reminds me of Judah Folkman's comment when the media overhyped his results and declared he had cured cancer, "If you are a mouse and you have cancer we can take good care of you!" Lucky rabbits!

Cerebellar hemorrhage provoked by combined use of nattokinase and aspirin in a patient with cerebral microbleeds
http://www.ncbi.nlm.nih.gov/pubmed/18310985
Oh yeah, just when you thought everything was rosy this booger shows up. Just because something is not classified as a drug by the FDA does not mean it is safe for general use. First Doc Davis relates a story about nattokinase putting a patient at risk because id did not bust a clot and now here is someone who "over-busted!"

Nattokinase-promoted tissue plasminogen activator release from human cells
http://www.ncbi.nlm.nih.gov/pubmed/19996631
More geek science. Yeah, if you get it in the blood nattokinase has numerous effects. So do a lot of chemicals!

The fibrinolytic activity of a novel protease derived from a tempeh producing fungus, Fusarium sp. BLB
http://www.ncbi.nlm.nih.gov/pubmed/17827689
Here is an even more powerful natural product. Should everyone abandon nattokinase and rush out to buy tempeh - the next wonder supplement?

Here is what (I think) we know.

1. Nattokinase exhibits lytic effects in vitro.
2. It MAY have some effect taken orally in vivo.
3. If it does work no one knows the mechanism of action for certain. Consider this, maybe it is some component or action OTHER than the lytic effect seen in vitro. Why take the risky components to enjoy the effective components?
4. There is a tiny amount of evidence for nattokinase taken orally but certainly nothing conclusive.
5. There is absolutely NO safety data on it other than small study and anecdotal experience. Remember torcetrapib the wonder HDL drug? I couldn't wait for it to hit the market so I could take it! It did everything Pfizer said it would - then downstream the data showed it killed more people than it saved. No way would nattokinase be FDA approved based on existing HARD data.

It seems what we have in nattokinase is an interesting agent - but nothing more. Since it is unregulated we are all free to experiment (and I experiment plenty). But don't kid yourself - it is nothing more than an experiment with an unknown outcome! "Natural supplement" does not equal "safe" any more than "drug" equals "effective!"

As always, I remain a fan of Informed, Self-directed, Healthcare (ISH). But, stay informed, remain a skeptic, and play safe!

Looking out for your heart health,

HeartHawk

Advanced Lipoprotein Testing and the Fallacy of "Average"

2010-02-07T23:03:00.004-05:00

I use http://www.nutritiondata.com/ quite a bit to determined carb content of various foods now that I am tracking my blood sugar. I am prediabetic and like all good TYP'ers this is one more thing I am tracking to reduce my heart disease risk.

While at the site today I stumbled across a blog written by their so-called heart disease expert, Dr. Steve Parker, titled, "Advanced Lipoprotein Testing: Not Quite Ready for Prime Time" In it, Parker essentially said that advanced lipoprotein testing (ALT) such as that offered by NMR has, "never been shown that such testing offers any additional benefit over traditional risk factor assesement and management."

Now, I am certain that Dr. Parker is a very nice man who means well but for people like me and many others he is wrong - possibly dead wrong. It all has to do with applying common sense and the statistical fallacy of assuming what is good for the average person is good for all persons, more importantly, what is good for teh many is necessarily good for the one -YOU!

Dr. Parker starts with an argument that is perhaps the most powerful reason for using using ALT, "The Centers for Disease Control reports that half of all heart attacks occur in people with 'normal' cholesterol levels." If this is true (it is) one must come to the conclusion there must be some other factor besides standard lipid values (i.e. LDL, HDL, and Triglycerides) that can ferret out which person is likely to have a heart attack and which is not. Unfortunately, this is where Dr. Parker's deductive reasoning and intuition shut down. In fact, he contradicts himself based on an earlier blog he wrote praising ALT!

Here is the "killer" paragraph where Parker forgets all reasoning and statistical training he may have ever had.

"It's never been shown that such testing offers any additional benefit over traditional risk factor assesement and management. And all of the established clinical management guidelines utilize LDL cholesterol rather than LDL subfractions. Physicians know what to do with LDL cholesterol. We don't have evidence-based protocols that tell us what to do with these subfractions."

Let's dissect this statement to get to the truth.

1. It has never been shown that if I shoot myself out of a cannon wearing a parachute over Lake Michigan in February that I will die of exposure. What I do know is that a typical cannon with enough power to propel me from Wisconsin to Michigan (so I do not land over water) will kill me instantly and that even if shot from a lesser cannon with a parachute I will land far enough offshore that I will be unable to swim back in 36 degree water to safety. Sometimes one has to apply deductive reasoning. If I employ ALT and discover I have a dangerous lipoprotein subfraction such as Small LDL or Lipoprotein(a) (which I do) I am now in a better position to do something about it! I don't need a study to deduce this.

2. Just because "all of the established clinical management guidelines" use LDL and "Physicians know what to do with LDL cholesterol" does not mean I MUST be limited to antiquated methods applied by ignorant and behind-the-times physicians. I could go further and suggest Dr. Parker himself is ignorant. Many physicians DO know what to do with ALT and use it effectively to treat their patients using the most advanced technologies available.

3. The term "We don't have evidence-based protocols" is often shorthand for "I am too stupid or too lazy too engage in critical thinking so someone please tell me what to do." I do not need someone to do a study on taking common sense actions. I have high Lipoprotein (a) with an otherwise world-class lipid panel. My own physician (whom I fired) told me I was fine! If I had not done ALT I would not have discovered I had this independent risk factor for heart disease and would not be in a position to do something about it. I mean, c'mon, this is not rocket science!

4. The final and most crushing indictment of Dr. Parker's logic is the fallacy of extending information about statistical averages to an entire population. On average, a person with my traditional lipids (LDL, HDL, Triglycerides) would be in a low risk group - except I am among a few in this group who have high Lp(a). Yes, it might not be cost-effective to test EVERYONE for Lp(a). The cost of the test for everyone might not save enough lives to be cost-effective (this is the danger of national healthcare rules that rely on "evidence-based" medicine for the masses). BUT LET ME MAKE THIS CLEAR! I do not give a DAMN about the average guy - I care about ME! If I had followed "evidence-based" medicine and good old Dr. Parker's advice I might be dead. Instead I am proactively fighting my extraordinarily high Lp(a) - but only because I got the test and fought my insurance company to test my son (I won the battle and now my son knows 30 years before I did so he can take action even sooner).

So there it is. If you are a "good little soldier" willing to sacrifice your life for the "good of the many" and save a few bucks then great - more power to you. But, if you want to "pull out all the stops" to make certain you stay alive and your children live long lives then you will do everything possible to know your risks and take appropriate action.

No thanks Dr. Parker. I think I'll continue to track my lipoprotein sub-fractions using ALT. Just because most docs are stupid or lazy does not me I have to be. And, just because many people may not benefit from ALT does not mean ALL - specifically ME - won't benefit IMMENSELY. So, take your pick. Go with the flow or get aggressive. Practice Informed, Self-Directed Healthcare (ISH). Heck, it's your life. YOU decide!

Looking out for your heart health,

HeartHawk

Fish Oil and Omega-3 Index: A Feather in the Telomere Cap

2010-01-20T10:00:00.007-05:00

And just when you thought it couldn't get any better another compelling reason for knowing your Omega-3 Blood Index and optimizing your fish oil dose is uncovered. A new study among patients with coronary artery disease (CAD) has discovered an association between fish oil and the rate at which telomeres shorten (January 20, 2010 issue of the Journal of the American Medical Association, Dr. Ramin Farzaneh-Far et al).

We all recall from high school biology (yeah, right) that the rate of telomere shortening is thought to determine the number of times a cell can replicate thus limiting the life of a cell. This shortening of telomeres has been shown to independently predict morbidity and mortality in patients with CAD.

According to lead researcher Dr. Farzaneh-Far, "This suggests the existence of a novel mechanism for why omega-3 fatty acids are effective in this patient population—an area that has not been well worked out previously; it suggests they could be acting through telomeres . . . It's also the first study that shows that a dietary factor may be able to slow down telomere shortening . . . This is yet another reason for cardiologists to try to convince their patients to take either a fish-oil supplement or eat regular fatty-fish meals."

The bottomline of this observational study (which, again, showed association not causation) is that participants (608) with the lowest levels of Omega-3s had the fastest rate of telomere shortening. What is also interesting is that Dr. Farzaneh-Far and his team used what he termed "a relatively new blood test" called the Omega-3 Index test. The test cut-offs were 2.3% for those with the fastest (worst) telomere shortening and 7.3% for the slowest (best) shortening.

TIME-OUT! TIME TO BLOW THE TRACK YOUR PLAQUE HORN - AGAIN!!!

I hate to be a total shill (not really) but, come on. Dr. Davis and Track Your Plaque are once again ahead of the curve in bringing the Omega-3 Index test to its Members for some months now. It seems to me TYP also did an extensive treatise on Omega-3 Index testing in its October 2009 newsletter, and, what was the optimal blood level discussed - oh yeah - 7.3%!

Now for the REAL bottom-line! Just like Vitamin D, it doesn't matter how much you take, it matters how much get's into your blood. In fact, you don't even know, in most cases, whether the preparation you may be taking even contains its stated dose! If you do not test your blood level you have no idea if you are receiving optimal treatment - period! It took me three blood tests just to get my Vitamin D level "zeroed in."

In summation, I guess I wholeheartedly agree with Dr, Farzaneh-Far's statements, "from the telomere point of view, this is the first study to show an effect of a dietary factor, that this may be able to slow down telomere shortening" and "The idea is that the omega-3 index, the percentage of fatty acids in the blood, could be measured and that low levels would predict worse outcomes. So the omega-3 index might be useful for risk stratification in the future."

Call your doctor, get the test. If your doc says, "No!" then test yourself to get a baseline reading and decide whether it might be a good idea to get OPTIMAL treatment. I am getting my blood draw today! I'll let you how how it turns out.

Looking out for your heart health,

HeartHawk

The Pizza Paradox

2010-01-10T23:54:00.007-05:00

It seems to me that it has been a while since I waxed rhetoric about the roller coaster we all ride while fighting heart disease. One of my favorite rants amidst the rapid changes I encounter particularly with regard to diet and heart disease is what I call "The Pizza Paradox."

I love a good pizza but gave them up early on in my personal battle with heart disease because, let's face it, cheese, Italian sausage, and pepperoni are not high on the list of heart-healthy foods.

Well, with the flood of low-carb indications coming out for fighting heart disease my favorite lament is that I still can't eat pizza but now it is the crust that is going to kill me not the toppings!

Life just isn't fair!

Looking out for your heart heart health,

HeartHawk

Jumpin' Jupiter: How About a Little Statin Common Sense

2009-12-16T12:31:00.009-05:00

Well, by now I am certain most of you have heard that the FDA, based on the results of the JUPITER Study, has approved rosuvastatin (Crestor) for men over 50 and women over 60 with normal LDL-cholesterol levels (LDL <130>2.0 mg/dL), elevated high-sensitivity C-reactive protein (hs-CRP >2.0mg/dL) and triglycerides under 500 mg/dL.

I have had a chance to review both the glowing recommendations and scathing condemnations of this FDA action and find them to be as frustrating as they are amusing. I THINK A LOT OF FOLKS NEED TO GET A GRIP! I advise EVERYONE to read Dr. Davis' well-reasoned, common-sense analysis of the JUPITER results on his latest HealthCentral blog post. He brilliantly dissects the issue for us and calmly separates the useful health info from the useless hysteria on both sides of the aisle.

Here is my take/synopsis and some important things to remember.

1. Always bear in mind the difference between cause and association. Nobody said CRP "causes" heart disease. In fact, it is more likely than CRP is simply an indicator that you have something else that does cause heart disease (i.e. CRP is just "associated" with heart disease). Find that root cause and treat it. A statin may not be the best treatment for the specific root cause of your elevated CRP (but maybe it is).

2. Virtually all drugs have good effects and unwanted side-effects. But, the effects are different for everyone. Statins reduce LDL cholesterol and CRP - no question. They are neither magic nor poison. My advice is to study, analyze, ask questions then make an informed decision. I take Crestor (5mg) - but as little as I think is prudent based on my unique circumstances!

3. It is worth mentioning that researchers found a signficant increase in diabetes among participants. Factor this into your personal equation.

In short, it is nuts to both crucify statins or propose they be put in the water supply. I mean, really, does it a take a rocket scientist to figure this much out?

Looking out for your heart health,

HeartHawk

New Genetic Link for Vitamin D and Heart Health

2009-12-09T09:30:00.004-05:00

And now comes more genetic proof that Vitamin D is an important heart health player. Once it became established that a "Vitamin D receptor" existed in the heart it was only a matter of time before researchers began teasing out why nature put it there.

New research shows that a gene variant of CYP27B1, which blocked production of an enzyme responsible for Vitamin D activation, accounted for a greater than two-fold risk for congestive heart failure (odds ratio 2.14, 95% CI 1.05-4.39). For a quick stats lesson on all that numeric gobbledygook it means that the researchers were "confident" that if they repeated their research 20 times they would get a result showing a increased risk of anywhere from 1.05 to 4.39 in 19 of the trials (95% of 20). The 95% figure is considered the minimum confidence threshhold for accepting a statistical result as valid. You can also look at the "confidence interval" (CI). If the interval does not include "1" (no risk difference) you are fairly certain your experiment determined a greater risk (a range above 1) or a lower risk (a range below 1). We can decipher "odds ratio" another day!

Of note was that a single SNP (the C allele of SNP rs4646536 for all you gene freaks out there like me) was the culprit. The large NIH VITAL Trial will provide more definitive data on both Vitamin D and Omega-3 links to heart disease when it is completed sometime in 2014. Until at least then, I will be taking my 8000IU of Vitamin D (what I need to hit a blood level of 60ng/dL - everyone is different).

Looking out for your heart health,

HeartHawk

To Nap, Siesta, Perchance to Sleep?

2009-12-07T16:10:00.004-05:00

Time for a "Seinfeld" blog about next to nothing. Which is about how much sleep I got last night. Along with a bottle of 2007 Malbec I just bought, it got me daydreaming about the 2007 EPIC study that drew an association between napping and heart disease. I say association because nothing in the study proved napping causes a reduction in heart disease. The EPIC people (mostly cancer researchers) simply noted that people who napped had fewer coronary deaths. It could be they are just a more laid-back bunch!

Fortunately, the CARDIA study provides some hard data on sleep and calcium scores that supports a good night's sleep. For those who are Track Your Plaque Members the TYP Library provides the best heart disease reversal "Cliff Notes" on the issue (as it almost always does). Here is the link.

Sleep and the Track Your Plaque program:Does sleep quantity or quality cause plaque to grow?

That's all for today. Time for that nap!

Looking out for your heart health,

HeartHawk

CETP Redux: Lower is Better . . . No, Wait, Higher is Better?

2009-12-04T20:59:00.003-05:00

Higher HDL inhibits heart disease, right? CETP inhibits HDL production, right? Ergo, find an agent that inhibits CETP, raises HDL, and you will reduce heart disease right? Well, maybe! Then again, maybe not.

The torcetrapib debacle showed that CETP can be inhibited thereby generating spectacular increases in HDL but you actually increase risk due to side effects like raising blood pressure (side effects that are not produced by newer agents like anacetrapib and dalcetrapib). There is also some question that the HDL produced by CETP inhibition may be defective. Now comes a new study that shows CETP inhibition in and of itself my be atherogenic.

Given that one of my problems is low HDL, I was so damn hopeful that CETP agents would be part of my personal cure. I think it is time to bet my family farm on something else while we wait another decade for the evidence. Yes, I think it will take that long to figure it all out. I suggest we start dreaming about some other miracle advance (sigh)!

Looking out for your heart health,

HeartHawk

Cool New Heart Scan Technology

2009-12-02T10:13:00.007-05:00

In another sign that Dr. Davis and Track Your Plaque had it right all along, a small study at Beth Israel Deaconess Medical Center of the RCadia Automated CT Analyzer provided a high negative predictive value and may help move patients quickly through the emergency room.

"the algorithm of ECG, serial enzymes, and perfusion imaging is both expensive as well as time-intensive, so clearly there is a need for a quick noninvasive test, and recent studies have shown that [coronary computed-tomography angiography] CCTA fits the bill very nicely. But there are problems with CCTA—one of them is the off-hours availability of expert coronary CTA readers,"

The automated analyzer could have a role as a second reader in the emergency-department setting as an aid to normal expert CCTA readers. It's available at all hours, it interprets raw data—there's no waiting for 3D reformats—and there are cost savings to be had from rapid triage of this group of patients,"

Dr Girish Tyagi
Radiological Society of North America 2009 Scientific Assembly.

The study pitted the analyzer the consensus interpretation of two expert readers. For 100 analyzable studies, the automated analysis yielded a negative predictive value of 98%. The COR Analyzer's overall sensitivity was 83% and its specificity was 82%. RCadia Analyzer identified five of the six patients with significant stenosis found by the expert readers (five true positives, one false negative) and yielded 16 false positives and 78 true negatives.

Not perfect but the fact that "big money" is starting to invest in the technology and hospitals are beginning to use CCTA as a replacement for the expensive, time-consuming (and wasting) series of ECGs, enzyme tests, and perfusion studies speaks volumes!

Looking out for your heart health,

HeartHawk

About Ads on This Blog

2009-12-02T09:57:00.003-05:00

Yeah, I guess I am a phillistine now that Google Ads run on my blog. As you probably know Track Your Plaque is a non-paying gig and we refuse to run ads on the member site (members voted this down even if it meant reducing the $6.65 per month membership fee that keeps the site out of hock). So, we are experiementing with "monetization" (fancy word for running ads) on the free, non-member stuff like our blogs.

NOTE: These ads are not endorsements by me or Track Your Plaque! They are what they are, links to sites with products and services that the advertisers believe will interest readers of this blog. Caveat emptor!

Regards,

HeartHawk

Whistleblowers Unite! And Get That Second Opinion!

2009-12-01T18:33:00.004-05:00

We can only hope that this whistleblower wins his case! Basically, this doc claims he was fired for objecting to an arrangement where by a manufacturer of medical products was offering advance access to new products (in this case a heart valve) only if a hospital raised their purchases of the company's other products (such as stents).

So, let's be clear about the allegation here. The suggestion is that if a hospital wants the latest and greatest medical technology it would have to commit to purchasing products that it decided it did not need before. LIKE MAYBE A STENT THAT MIGHT OTHERWISE HAVE NOT BEEN RECOMMENDED TO SOME UNSUSPECTING PATIENT?

The moral of the story is that the pressure to do unnecessary procedures is real. Always get a second opinion!

Looking out for your heart health,

HeartHawk

P.S. This is also why I value the posts from Track Your Plaque's "Spy on the Inside" our very own member who works in a cath lab!

Defining a Cure for Heart Disease

2009-11-28T08:44:00.006-05:00

When can I be considered "cured" of heart disease or, more accurately, Coronary Artery Disease (CAD)? This is a subject that has plagued me for years and especially since I became involved with Track Your Plaque (TYP).

It seemed so simple at first. If I reversed or halted the progression of coronary calcium then I was "cured" (note that TYP does not make this hard claim of a cure - but you DO dramatically reduce your risk of a heart attack and I need a frame of reference to start the conversation).

The subject becomes even murkier when you consider the independent clinical experience of heart attack prevention pioneers Dr. Davis and Dr. Blanchet. Davis seem to feel that there is considerable risk reduction even if coronary calcium progresses but is held under 10% per year. Blanchet pushes the limit to about 15%. Both doctors rarely see heart attacks in their practices and other leading heart docs like Dr. Arthur Agatston (the doc of South Beach Diet fame and inventor of the gold-standard Agatston coronary calcium scoring system) made this statement.

"I'll let you in on a big secret. Physicians who practice aggressive prevention have seen heart attacks and strokes practically disappear from their practice. It's that simple — this approach [plaque reduction] can literally prevent heart attacks and strokes and save lives."

So when can I consider myself "cured" of heart disease and why is it so important to define a standard for a cure? Let's tackle the second, and easier, question first.

It is no secret I am a numbers guy. I need a target a goal. More selfishly (my competitive neurosis is showing) I need to know when I am winning and when I am losing. Put more simply, I need to know how to "keep score!" What number and unit of measure signals that I am “cured.” Even more importantly, I need a method of comparing and ultimately selecting the different heart disease treatments and programs available in my search for a cure.

To answer the first question, I believe there is a spectrum of possible standards in defining a cure for heart disease. At one end we have a practical definition, "No heart attacks." At the other end of the spectrum we have a far more complex definition, “No detectable coronary plaque.”

Without tipping my hand I’d like to ask those who read my blog to answer a simple poll question, “Under which condition would I consider myself "cured" of Coronary Artery Disease (CAD)?”

I’ll follow-up later with more thoughts on the subject of what constitutes a cure and we can begin to debate the issue!

Looking out for your heart heath (and a cure),

HeartHawk

More Healthcare Hijinks!

2009-08-17T13:48:00.003-04:00

As a healthcare consumer advocate I always marvel at how little knowledge - even common sense - exists among so-called "health professionals." I think I'll devote series of blogs to some of my most recent "healthcare hijinks" experiences.

I get a great deal of my healthcare at a local clinic which in the past six-months has really taken great strides to improve customer service. They are very friendly, aggressive about getting back to patients about their healthcare (they even have a new online system where you can check test results as they become available), and the improvement is noticeable. But this is more a tale of inability to think on your feet - a skill that I feel is basic to the notion of healthcare.

I had some crazy TSH readings (typical of anyone with early Hashimoto's Thyroiditis) so my endocrinologist was tweaking my meds over a series of weeks. It is common for a doctor to relay information to one of their nurses who, in turn, (keep in mind these are college graduates experienced with medications and patient care) interfaces with the patient on issues such as dosage adjustments.

Let me first preface my diatribe with the fact that the nurse I am about to take to task was friendly, courteous, and worked hard to follow up with me (I am often difficult to reach because of my crazy schedule). Maybe it was just a "bad day." Nonetheless, I was left wondering just how competent the person on the other end of the phone was.

The nurse called to say the doc wanted to up my dose of Armour thyroid from 1/2 grain to 3/4 grains twice per day and the nurse asked if I wanted a new prescription. I said we could proabably still use my current prescription but would have to renew it much earlier as I will be using a 50% bigger dose. This is where the keystone cops episode begins.

The nurse remarked, "But your prescription is for 1 grain." I explained that since my dosage changes so frequently (and because it is far cheaper to do it this way) I use 1 grain pills that I simply split into 1/2 grain doses. At that she remarked, "But the doctor wants you to take 3/4 of grain." My retort was, "Yes, but I can also split the 1/2 grain pieces into 1/4 grain pieces. I could even take three 1/2 doses three times per day (which I believe would be the superior way to take any thyroid preparation containing T3)." At that point she was completely befuddled. After a short course in remedial math (which I am still not certain she comprehended) I convinced her that 1/2 grain plus 1/4 grain equaled 3/4 grains and that three 1/2 grain doses was the same amount of medicine as two 3/4 grain doses.

Afterwards, we laughed it off and she ended with,"Well, I am really not familar Armour Thyroid". What a shame for the doctor's thyroid patients! Now, even in the "far out" world of Armour Thyroid (sarcasm intended) basic math (like 1/4 plus 1/2 equals 3/4) still holds true!

As I mentioned, perhaps it was just a bad day with a little brain fog (I guess that is scary in itself). But it made me both laugh . . . and think! Of course this is not as bad as when I went to the pharmacy with a prescription for therapeutic vitamins and walked away with a prescription for coumadin - but that's another story (i.e. always read your labels)!

Looking out for your health,

HeartHawk

Finally, No More Begging and Conniving for Blood Tests

2009-06-01T11:03:00.007-04:00

If you have heart disease or just about any serious health issue you have probably been in this boat. You don't feel right, there has been a change in you treatment, or, dammit, your just plain curious - you want a blood test. The old way was to call your doctor, wait for an appointment, then beg or connive your way into getting your doc to order the test (I have gotten REALLY good at conniving over the years). And, of course, this is no guarantee you will actually GET the test. You are at the complete mercy of the medical establishment.

BUT NOT ANYMORE!

A new technology called liquid chromatography/tandem mass spectrometry allows accurate blood assays with a single drop of blood and a paper-like carrier medium keeps the sample stable for extended periods of time and can be easily transported via mail.

BREAK YOUR BLOOD TESTING CHAINS AND BEG NO MORE!

Now you can get common blood tests ANYTIME YOU WANT! I was skeptical at first but Doc Davis finally, after his own test (that's TYP Nurse Dawn's hand in the photo - talk about giving blood for the cause), convinced me - so here is my SHAMELESS PLUG for TYP - you can review and order kits by clicking here. Oh, and one more thing, TYP members get a discount!

Regards,

HeartHawk

Common Sense: $1 Million Per Ounce

2009-05-15T15:46:00.007-04:00

Now just how much do you think this little observation cost?

The obesity epidemic in the US is due solely to increased food intake

That's right, this "revelation" is based on reporting at the 2009 European Congress on Obesity and the combined genius and interpretation of no less than:

Deakin University, Melbourne, Australia
World Health Organization Collaborating Centre for Obesity Prevention
US Department of Agriculture
National Health and Nutrition Examination Survey
American Heart Association
American College of Cardiology

But, look at it this way. There was probably no chance McDonald's, KFC, Burger King, and Taco Bell were gonna break the news!

Would you like fries with that? Somtimes, ya just gotta laugh!

HH

Anti-Platelet Ad Nauseam

2009-05-14T10:06:00.003-04:00

Why do I torture myself? Number 1 answer: I am a masochist, of course! I read a fair number of medical journals and reports and lately all I hear about are anti-platelet medications like clopidogrel, prasugrel (see my last post) and now ticagrelor (where the hell do they get these names - sounds like anime' characters - Ticagrelor, ruler of all Mythica!) . As I punned earlier - it's starting to get thin.

Like prasugrel, ticagrelor is not even out of trials, yet they are hyping the hell out of a product you cannot even buy. It's claim to fame (should it be determinined in Phase 3 that it does not kill more people like torcetrapib did) is that its effect is reversible - SO YOU CAN HAVE HEART BYPASS SURGERY FASTER AFTER STOPPING IT! I kid you not. Oh, and while it does not contribute to "major bleeds" to any greater extent than other agents it does show an increase in "minor bleeds." I don't know about you, but whenever I bleed I consider it a major event.

Given that the market for clopidogrel alone is $8 billion we can expect more of the same with everyone scratching for a piece of the action. Here is a clue for the rest of us.

YOU DON'T NEED ANY OF THIS STUFF IF YOU DO NOT HAVE HEART DISEASE!

Let me put it this way. An ounce of heart disease prevention (or a half ounce of heart disease reversal) is worth $8 billion of clopidogrel! Practice informed, self-directed healthcare instead of uninformed drug and surgery healthcare (Time to plug Track Your Plaque).

HH

Clopidogrel vs Prasugrel: The Arguments are Getting Thin

2009-05-12T13:20:00.003-04:00

Watching drug manufacturers duke it out over competing products is like watching a tragic comedy - you don't know whether to laugh or to cry. Witness the latest antics in the fight over the wildly profitable market for anti-platelet drugs currently dominated by clopidogrel.

Clopidogrel (Plavix most notably) has been around for years as a first line anti-thrombotic with indications for use in numerous cardiovascular conditions including post-surgically after stent implantation. Given its age it has also been studied extensively and all its warts are well-known.

Most comic is the fight for dominance between clopidogrel and prasugrel. I say comic for one major reason - prasugrel is still under investigation - you can't even get it in the US at this point. But this hasn't stopped the marketers from attempting to pit it against clopidogrel which goes off-patent in 2011.

The latest "hit job" on clopidogrel comes from analysis based on the TRITON-TIMI 38 trial. Researchers dicovered that there are several common gene variants among patients receiving clopidogrel that may reduce its effectiveness thereby increasing the risk of subsequent heart attack, stroke, and mortality. What was conveniently NOT CONCLUDED was whether simply taking more clopidogrel could overcome this reduced response.

Now guess who is a major sponsor of the TRITON-TIMI 38 trial? If you guessed Daiichi Sankyo and Lilly, the two co-developers of prasugrel, you win today's Sherlock Holmes award! Now, do you suppose anybody has studied whether certain gene variants affect the efficaciousness of prasugrel - not yet - but you have to wonder what the folks at Bristol-Meyers (the holder of the Plavix patent) are working on.

Now, don't get me wrong, I love a good fight. Let the druggies battle it out. But as consumers we need to cast a watchful eye over the message. Prasugrel is not even FDA approved yet and there are no long-term studies on it. Who know what warts may pop up. Your genetics may indeed sway you away from clopidogrel one day but don't think it is without its own, at present, hidden warts.

The devil you know may be better than the devil you do not. Of course, here is where I plug informed, self-directed health care programs like Track Your Plaque which offer tangible results in preventing and reversing heart disease. The ONLY real solution is to never need clopidogrel OR prasugrel in the first place!

Looking out for your heart health,

HeartHawk

I'm Baaaa ... aaack!

2009-05-12T11:10:00.003-04:00

Yes, the reports of my demise are greatly exaggerated. I'd like to say something artsy like, "I was taking a sabbatical to 'rediscover my voice'." - but that would be a load of crap. The truth is more akin to being really busy and not sure what to write. But, "being busy" is nothing but an excuse. People MAKE TIME to do what they like! And how can an arrogant and opinionated guy like me not know what to write? Here's my answer.

I write a lot. But every forum has it's boundaries and rules of decorum. Also, it is a little dishonest to post the same material on multiple blogs (not to mention that sites that have you under contract get a wee bit upset if you repost paid for material on free sites). So, where am I going with this - back to my roots!

On other blogs I have to be the "good cop." This blog is my outlet to be the "bad cop!" Expect my prose to be biting, opinionated, edgy, and designed to draw both complements and criticism. It is done from my heart (pun intended) and without apology. I may go after third parties but am ALWAYS respectful of commenters - so let's debate. If you are one of those third parties then comment back and watch my tone change. My opening shots are intended to get your attention - not wound! We may not always like it but we are in this together.

When I started this blog it was to be a no holds barred comment on the state of heart health care. I promised, "a hell of a ride" so hold on tight - be mad, be glad, be anything but but bored!

Regards,

HeartHawk

More Customer No-Service

2009-02-19T12:09:00.008-05:00

There was recent post on the Track Your Plaque Member Forum about hand-held body-fat analyzers that piqued my interest. I wondered if they really work. So, I attempted to contact the company in question. Their on-site customer service e-mail form did not work so I went "under the hood" of their website (it's great to know these tricks) to get the internal e-mail address (which they do not publish) used by the form so I could send it myself. Here is what I sent.

Your website contact form did not work – it kept asking to supply a “referrer” for which I saw no field to enter. Here is my question

What is the difference in technology and accuracy of your products that offer "two point" versus 'full body" sensing. I’d like to understand the technical difference before I select which of your fat analyzer products to buy.

Thanks

I got this curious reponse.

Dear Mr. Hearthawk:

Thank you for the email this morning and the opportunity to address this issue with you. I am happy to assist you in getting this situation resolved.

I certainly apologize for the issue you describe in your email. Unfortunately, there are some issues that need more intervention than email provides and I believe this is one of them, simply in the interest of time for you. In order to best serve you, please call our Consumer Support team, toll-free at 800-634-4350. Our trained representatives are available Monday through Friday, 830a to 430p CST to assist you over the phone and try to resolve your issue without sending your unit in for repair. If repair is necessary, we can set up your file to start the process or provide valuable options to your particular situation.

Please have the following information available in order to expedite your call:

1. Model number (from the sticker on the back/bottom of the unit)
2. Serial number (from the sticker on the back/bottom of the unit)
3. Proof of purchase
4. Your case number of 1205305

We appreciate your interest in our products, thank you for contacting Omron Healthcare and look forward to hearing from you soon.

Jennifer Kelly Customer
Service Representative
Consumer Support
Omron Healthcare, Inc.

Ahhhh, this e-mail is so obtuse in so many ways.

1. I did not send the e-mail "this morning." I sent it weeks earlier.
2. I did not have any complaint. I asked a simple question. What are they apologizing for?
3. I do not own any Omron products. I trying to determine whether the hand-held model would serve my purposes.
4. Aren't they even a tiny bit interested in why their customer support form doesn't work?

I did call the representative who agreed that neither the hand-held or foot-scale models would be accurate given they only measure half your body. They suggested that for accuracy you buy their more expensive model with both foot and hand sensors.

Brilliant! They were late, clearly never read my e-mail, droned on in a non-repsonsive way, never bothered to inquire about their non-functional web-form. All the hallmarks of a company who pretty much doesn't give a damn about their customers.

HH

A CETP Phoenix Rising from the Ashes of Torcetrapib?

2009-02-01T19:52:00.005-05:00

Gene investigation and pharmaceutical research may be working together to revive cholesterol ester transfer protein (CETP) inhibition as a means of combating heart disease. The failure (both therapeutic and financial) of Pfizer's novel CETP inhibition agent "torcetrapib" literally pushed Pfizer off the heart drug development cliff and with it perhaps the finest heart drug research team in existence.

But recently, the Women's Genome Health Study led by Dr. Paul M Ridker has discovered variants in the gene for CETP that impact heart attack risk. They note that the risk is partially but not completely reduced by a rise in HDL. Torcetrapib was found to raise blood pressure (BP) along with other adverse effects such as effects on aldosterone. It was thought that these effects overwhelmed the postive effect of raising HDL. This new study raises the hope that the negative effects were only peculiar to torcetrapib but not other similar agents.

Merck's anacetrapib and Roche's dalcetrapib are two potentional CETP inhibitors in Phase 2 and Phase 3 trials repectiviely that do not exhibit the toxic effects found with torcetrapib. Dr. John Kastelein, who is involved with both trials added, "When you have a number of patients in different clinical studies and there is still doubt about whether the mechanism works at all, research such as this by Ridker et al is good . . . torcetrapib was about the worst choice Pfizer could have made. They thought a few millimeters of mercury were nothing compared with the immense power of a 70% increase in HDL-C. But everyone was lulled to sleep—no one understood at the time that the elevation of blood pressure was only the tip of the iceberg and below that was a whole metabolic derangement that was extremely harmful."

The Women's Genome Health study was divided into two parts. First, they looked for common genetic variants associatied with HDL. Baseline HDL was measured among the 18,245 particpants (caucasion females at or above 45 years of age) who were followed for ten years. They discovered nine locations in the genome with at least one genetic variant or SNP (single nucleotide polymorphism) that were associated with HDL. Eight of these locations were already known to influence HDL, but one was new.

The second and most important part of the work found that among all the SNPs associated with raising HDL, all those linked to lowering heart attack risk were found on the CETP gene sequence. Whenever a CETP SNP raised HDL it also reduced heart attack risk. One such CETP SNP (rs708272) was associated with a 3.2 mg/dL increase in HDL and a 24% lower risk of heart attack. Such as small HDL increase should not produce such a profiund reduction in risk. Something else is clearly going on!

Perhaps this is not the end of the line for CETP agents that some had predicted. The Phoenix may be rising!

Looking out for your heart health,

HeartHawk

A Fabulous, Fascinating, Fortuitious Forum: The 2008 Top Ten

2008-12-31T12:00:00.001-05:00

As I sit back and think about all the things that have happened on the Track Your Plaque Forum in the last year I am truly amazed. So much so I have come up with a Top Ten list (in no particular order) of all the things we have done together on the Forum this year. Here are several interesting or important (IMHO) posts that started or were further developed by Members over the past year (they can be accessed by clicking the links).

Dr. Davis was right: Framingham Researchers say Lack Of Vitamin D May Increase Heart Disease Risk
We were saving many lives through the early recognition, adoption, and use of Vitamin D. The rest of the world is just now catching up to where we all were over one year ago. Happy New Year and please pass another bottle of sunshine!

Hypothyroidism as a driver of artherosclerosis?
Soon after Vitamin D we embarked on a discussion of the role of thyroid disease a powerful co-factor in heart disease. Once again we were well-ahead of the curve (and still are) on thyroid issues and heart disease and are pushing the envelope ever further. Until now, who knew thyroid was an issue for so many of us?

Lp(a) studies for discussion
Lipoprotein(a) is the scourge of many TYP Members. Everything from new drugs under study to treatments such as niacin, nuts, and NAC has been covered in the TYP Forums.

New here-- question #1 regarding Fish Oil
Everyone knows (or should) about the numerous therapeutic effects of fish oil. From question #1 to #1000 the TYP Forum has covered everything from allergies and accelerated dosing to its use with Xenical and Zetia. If it’s about Omega-3s and fish oil you are likely to find an in depth discussion here.

Question regarding Blood Glucose Readings and Dr. Davis's new report on BP
These posts are remarkable in that they attracted a fair amount of attention for subjects that I thought would have been so thoroughly hashed over that they were dead. However, it proves that the simplest concepts are deeply intertwined with heart disease prevention and often misunderstood.

Wheat is evil
This one was a killer – almost literally. If you had to pick something that was so endemic to American lifestyle and yet so eminently dangerous it would have to be eating wheat. This was one of the first posts that started the brushfire that has erupted into an inferno and continues in many similar posts today. Put that piece of bread down or TYP’s resident pharmacology guru Dr. BG (Member Nickname “ggglll”) may have to keep you after school and write “I will not eat wheat” 100 times!

SPLENDA: good or bad?
Once again, something so simple and common sparked an extremely erudite discussion. What was most remarkable about these posts is how it adroitly displayed the vast amount of knowledge (even about subjects as arcane as artificial sweeteners) of TYP Members and their willingness to share. It is this very feature of the TYP Forum that makes it the best of any in its category.

Boswellia and 5-Lipoxygenase Pathway Inflammation
Wow, 144 posts and 1043 views (and counting) on the subject. We added the “Emerging Medicine” Forum for this exact reason and we were treated to a treatise by “wccaguy” on a subject that is just now beginning to be seriously studied by researchers. Want to stay on the “bleeding edge” of heart disease prevention and reversal? Read the TYP Forum!

Very stubborn plaque!
This post exemplified how a first-time poster dipped their toe into the TYP Forum “Fountain” and was showered with help from Members. Equally important is the number of Members who, although they didn’t post, viewed the posts to glean information to aid their personal efforts. That is what the TYP Forum is all about!

OK, so I lied. I DO have a Number 1 item!
But it is not any specific post. What is happening on the TYP Forum is something special and it is not just the thousands of posts. Quantity is one thing but it is the quality of the posts that is so impressive and it is a sentiment I have heard Dr. Davis express frequently. It is truly outstanding and a distinct pleasure to meet so many people intent on beating heart disease and willing to help others do the same. Thanks again on behalf of our small (but committed) team at TYP. It was a heck of a year with another great one planned for 2009.

Keep Tracking and Talking . . . and have a HAPPY (and healthy) NEW YEAR!

HeartHawk

Now What?! It Pays to be Paranoid? A Panic over Panic.

2008-12-12T10:57:00.006-05:00

The European Heart Journal recently reported that heart disease is more common in patients with panic attacks than in the general population. Moreover, they found the risk in person under 50 years of age. But curiously this same group was found to be less likely to die from heart disease. Researcher Dr. Kate Walters opined, "The symptoms of panic attacks can closely mimic those of a heart attack or acute (heart) disease, and it seems that there may be a complex relationship between them."

The study compared 58,000 patients aged 16 and older who had been diagnosed with panic disorder against a random sample of 347,000 persons without panic disorder. Panic disorder was associated with a 38% increase risk of heart attack in the under 50 group. Even more startling was the finding the risk for women under 40 was more than three times the risk for the general population

Now here is the REAL kicker. As I mentioned earlier, while the risk for heart disaease was higher, researchers determined that death from heart disease was actually LOWER in patients with panic disorder. When asked what could account for this seemingly paradoxical finding researchers suggested, "people with panic present earlier or more frequently to their doctor and therefore have their (heart disease) identified and treated."

So let me get this straight. Because panic attacks can mimic heart attacks, those with panic disorder tend to present for clinical testing more often thus catch their heart disease at an earlier stage and therefore live longer! So, where heart disease is concerned, it pays to be paranoid?!

Seriously, as a person who is prone to paranoia (just because your not paranoid, it doesn't mean "they" are not still after you) I sympathize with those who have full blown panic attacks. But if this means living longer I say better safe than sorry. For those with a lower state of anxiety, I simply suggest.

1. Get a heart scan - know your score
2. Get on the Track Your Plaque program - the remarkable clinical results achieved by Dr. Davis have been independently corroborated by cardiologists like Dr. Bill Blanchet. The best part is the program keeps getting better.
3. Rest easy in the knowledge you are enploying the latest, cutting edge medical science available and have put yourself in population that appears to significantly reduce its heart attack risk at any calcium score!

'Nuff Said,

HeartHawk

Pfizer Drops Bomb on Heart Health Pipeline

2008-10-07T19:32:00.004-04:00

Research on drugs for heart disease does not always translate into a pipeline for cures but it certainly is a pipeline for hope. As much as I beat up drugs and drug companies they do provide useful tools for combatting heart disease if properly used. Well, Pfizer just dropped a bomb on that pipeline when an internal memo was leaked stating that Pfizer will drop development of drugs for hyperlipidemia, atherosclerosis, and heart failure

According to a memo obtained by Forbes magazine, Pfizer is exiting a number of areas described in this excerpt as:

"We intend to exit these Disease Areas: Anemia, Atherosclerosis/Hyperlipidemia, Bone Health/Frailty, GI, Heart Failure, Liver Fibrosis, Muscle, Obesity, Osteoarthritis (disease modifying concepts only) and Peripheral Arterial Disease."

Recall that Pfizer had invested billions and recruited leading heart disease researchers to produce blockbuster heart-related drugs such as the cholesterol-lowering drug atorvastatin (Lipitor) and the blood pressure drug amlopidine (Norvasc). No doubt their decision was fueled in part by the multi-billion dollar flop of what they thought would be their next blockbuster drug, torcetrapib, a CETP inhibitor that promised to raise HDL cholesterol by 50% or more. While it did indeed raise HDL dramatically it exhibited side-effects that increased mortality during testing.

Although long-term effect of this loss of talent and capital to heart disease drug research is murky the announcement certainly signals a delay in heart-drug development as research teams are disbanded or reassigned into other areas and new investment capital is sought. To say this is a teribble loss to heart disease sufferers is an understatement. Dr John Kastelein an investigator in several Pfizer-sponsored heart trials referred to Pfizer as "a real powerhouse" in the CV drug arena. Kastelein added, "I think this is very, very significant both for the company itself and for the whole field of CV drug development. Pfizer had truly excellent people in the development arm of their company for CV and metabolic drugs. And if they're stepping out now, that not only signifies their own problems, but it also signifies the problems in CV drug development, and how incredibly difficult and costly it has become to bring new drugs forward. And that's not good for patients."

The moral of this story is that we as heart disease sufferers must lean even harder on the weapons we have today rather than waiting for new "magic bullets." The take way message here is to stop betting on tomorrow and start working with what you have today. Fortunately, the Track Your Plaque progam works exceedingly well with the arsenal at hand. Use it!

Looking out fot your heart health,

HeartHawk

Hypothyroid Update: Common Sense Triumphs over Bureaucratic Boobs

2008-08-28T22:49:00.003-04:00

As you know, I was recently diagnosed with Hashimoto's Thyroiditis and subclinical hypothyroidism. I dug deep into this condition as a cause for my recent increase in lipoprotein(a) and homocysteine (it seems both are affected). Dissatisified with the first two Endocrinologists I saw I did some research and found the best local endo I could. I used the following criteria.

1. I wanted someone on the staff of a research and teaching hospital. I figured these were the types who saw the most varied and largest patient load and had an interest in the unusual as opposed to the "crank turners" who follow standard procedure.

2. I wanted someone who had graduated no less than 10 years ago and no more than 15 years ago. I wanted someone who was experienced yet was exposed to modern concepts and not yet set in their ways.

3. I wanted someone with an expressed interest in lipids, not just diabetes as most are.

4. It would be nice if the doc was in my insurance plan!

Well I found my guy at the Medical College of Wisconsin where they are actually doing research on the endocrine system's effect on lipids. It took some arm twisting and a little rule bending but I not only got in to see the doc I wanted but lucked into a cancelled appointment the following week (instead of having to wait 6 weeks).

The doc was excellent. He told me things the other two endos never covered.

1. My TPO and TG antibodies are indeed above the reference range but nowhere near what they see in bad cases and, most importantly, far below what they see for those suffering polyglandular auto-immune disease. That little tidbit was never mentioned before and would have been nice to know earlier.

2. He will treat me based on my symptoms not just my TSH level. How about that for forward thinking.

3. He was not opposed to Armour Thyroid although he did specify a preference for T4 only therapy. That is what is known as "open-minded."

4. My thyroid is actually small for my height and weight and is consistent for mild Hashimoto's Thyroiditis and subclinical hypothyroidism. Another little tidbit never mentioned.

5. He understood the difficulty in adjusting for sporadic hyperthyroid hormone spikes as my thyroid deteriorates and explained how we will ignore the "noise" inherent in any feedback system and focus on the trendline. Not much you can do about it but at least we had the discussion and I felt secure that the doc understood and appreciated my predicament.

Wow, I finally found the thyroid equivalent of a Track Your Plaque doc like Bill Davis! But it gets even better on the non-technical end.

Seems the Medical College has all kinds of strict rules about who the bureacratic "gate keepers" will allow in to see the docs even with an appointment. Seems the computers would not acknowledge my existence even though they had a record of me from 30 years ago when I was in for migraine headaches (those actually cleared up years later). Apparently, their auditors had not yet verified my new insurance. I was told I would not be allowed to see the doctor until I was "in the system." Just then a nurse appeared to tell the recalcitrant clerk, "The doctor wants to see this patient." When the clerk refused she gave a stern look and said, "I am taking this patient!" After additional objections from the clerk the nurse leaned in and in a forceful tone repeated, "I am taking this patient!" I thought it might come to blows.

Wow again. The nurse took me (minds out of the gutter please), the doctor saw me, and after being interrupted several times by a bevy of disturbed bureaucrats the computer gods were placated. Thank God there are still doctors and nurses who are not only competent but caring enough to put people over procedure. Outside the staff at Track Your Plaque, I was beginning to think the breed was nearly extinct!

Regards,

HeartHawk

Another Reason to Lose Weight - YIKES!

2008-08-24T14:35:00.013-04:00

Like many of you, I read a tremendous volume of online medical journals trying to keep abreast of the latest advances and atrocities in heart medicine. In yet another classic, "I don't know whether to laugh or cry" moment I stumbled across this report:

Extremely obese a cath lab problem: Some turned away because of weight restrictions on tables

In what has to be the one of the most incredulous statements ever uttered by a doctor, lead investigator Dr. Thomas Vanhecke (William Beaumont Hospital, Royal Oak, MI) offered, "It is a paradox. New research is showing us that patients are dying younger with more cardiovascular disease, and yet there are no cath lab guidelines for how to treat those who are morbidly or massively obese."

Is the good doctor worried about people getting fat and having heart attacks at an alarming rate at progressively earlier ages? No, he dithers over the fact there are no guidelines on how to treat morbidly obese patients. Hell, wouldn't want to smush any of that shiny new cath lab equipment or have the guy topple over on you! Where was the good doctor when these folks were shoving their faces full of cream pie? Here's a paradox for you doc, if not utter irony. Can you imagine being so overweight that when the inevitable angina or heart attack comes the hospital might turn you away because they fear you will break the cath lab table?!

Vanhecke also said that when faced with obese patients they are typically told to exercise and diet before they can undergo the procedure. Huh?! I'm having a heart attack and you want me to go exercise for six months then come back? Yowza!

Now, I hate to go off the deep end (not really) but if you link to the actual article you will see the quotes I lifted are not radically out of context. I've had my fun at the doctor's expense over some (ahem) rather dubious statements and it is time to get serious. These types of pronouncements speak loudly about the mindset of traditional medicine whose position appears to be "let people get morbidly ill while we invest in better "guidelines" and technologies to fix them." This might give you an inkling as to why medicine is becoming so expensive.

At the risk of being accused of using bad puns, what ever happened to the old axiom, "an ounce of prevention is worth a pound of cure?" Perhaps 500 pounds in some cases.

Excuse me while I finish my Diet Coke!

HeartHawk

OMG! Vitamin D Lowers Death Risk? No Kidding!

2008-08-12T18:25:00.009-04:00

Heh, slowly but surely the traditional medical community is beginning to realize what Track Your Plaque observed almost two years ago, low Vitamin D levels increase mortality risk. Now, I must admit, even I was slow to come around but when the overwhelming evidence of plaque reduction and Vitamin D poured in to Dr. Davis' practice I had to believe the data.

Now, years later, another study has found that that low levels of Vitamin D lead to an increased risk of death. The big difference here is that it was a rather large (13,331 persons) study that followed participants and average of 8 years (see Arch Intern Med. 2008;168(15):1629-1637).

There was one interesting fluke to this study for the numbers geeks like me. The study population statistics were striking. If you were in the lowest quartile (25%) of Vitamin D levels your morality risk was 1.26 (26% higher) within a 95% confidence interval (CI) where the CI was 1.08 - 1.46. Stats geeks realize that what this means is that if you ran this same test 100 times you would find the calculated mortality risk somewhere between 1.08 and 1.46 in 95 of the tests (but always higher than 1). The other 5 times the risk would be less than or greater than the CI range meaning you might actually find the risk to be LOWER (>1). This is enough to statistically link Vitamin D to reduced all-cause death but the similar analysis for CVD and cancer mortality only, while higher, did not meet this stringent statistical standard. I am just going to hedge my bets and keep taking Vitamin D armed with just the all-cause mortality results which this study proves and the overwhelming clinical practice experience of Dr. Davis. Melamed also offered sound advice when suggesting people should know their Vitamin D levels before pounding down supplements.

Of course, Dr. Melamed had to go and ruin everything by going off the deep end with the opinion that the most sensible advice for those wanting to ensure their levels remain optimal is to "spend 10 to 15 minutes per day in the sun and to eat vitamin-D-fortified foods, such as milk and oily fish." DOH! That, my friends, is down right malpractice in my opinion. Let me count the ways!

1. Sunlight to vitamin D conversion varies from person to person.
2. Sunlight to vitamin D conversion decreases with age.
3. Sunlight to vitamin D conversion varies with clothing, sunscreens, etc.
4. Sunlight to vitamin D conversion varies by latitude and season.
5. Sunlight to vitamin D conversion varies by race.
6. Most milk is fortified with D2 not D3 which is the more active form and what the good doctor ACTUALLY STUDIED! DOH! 25(OH)D (the study variable) is produced in the liver from the metabolism of vitamin D3.
7. Dietary sources of any kind generally will not provide enough D3 to signficanly raise blood levels.

Here is my personal regimen. Get my blood tested and take an oil-based D3 supplement. Repeat the cycle until I achieve 60ng/mL! I am now at 62ng/mL but it took a dose of 10,000IU a day. That's a lot of milk and oily fish, LOL!

It is so darn easy. What do they make it so hard?!

Regards,

HeartHawk

Dangerous Thinking about CT Radiation!

2008-07-12T14:34:00.008-04:00

I recently completed a web-based Continuing Medicial Education (CME) course on emerging strategies to combat heart disease. It was full of the standard fair of old school risk factor treatment and some novel approaches on increasing HDL. Pretty typical stuff not worth mentioning. But what really caught my attention was a comment left by - how can I say this nicely (why start now) - A DANGEROUS IDEOLOGUE! Here it is.

"In all of the discussions of risk factors there is an avoidance of primary causation. The Japanese A-bomb Life Span Study has linked ionizing radiation with an increase in cardiovascular events. Radiation in co-action with chemicals has been implicated in genetic effects in utero but few investigators have done studies in this area. Cardiologists should place less reliance on drug therapies and begin to focus on these primary causes."

Lynn Howard Ehrle, M. Ed., Senior Biomedical Policy Analyst, Organic Consumers Association and Cahir, 41-member International Science Oversight Board (an OCA project)"

As readers of my blog know I too am no fan of drugs and embrace prevention wholeheartedly. However, Mr. Ehrle has gone overboard in my not-so-humble opinion. My reading of his earlier literature leads me to believe commenters of his ilk are anti-radiation ideologues who can suffer no level of radiation exposure.

Does radiation, at any level, impose a risk as Mr. Ehrle implies in his published offerings impugning CT scans (e.g. heart scans)? Of course it does. But so does crossing the street or driving your car to the store. The only real question is does the risk outweigh the benefits? None of us would buy into the notion that we should stay in our homes refusing to cross a street or drive a car. Why attack CT scans in this manner? Heart disease is the number one killer of U.S. adults. If people were dropping over dead because of CT radiation induced heart disease (for which their is little direct evidence) at a similar rate as naturally induced heart disease Ehrle might have a point.

The real danger here is the spectre of old-school "cut and drug" cardiologists grasping at Ehrle's rhetoric to assail modern prevention strategies that employ CT heart scans (I am speaking here of CT calcium scoring not CT angiography which appears to be of dubious benefit at this point). Should we avoid unecessary radiation whenever possible? Absolutely! Should we continue using CT heart scans? Absolutely! It is a risk/reward decision we must all make individually. As for now, it seems imprudent to throw the baby out with the bathwater.

Regards,

HeartHawk

AHA Builds Another Shrine to Heart Disease Promotion

2008-06-29T13:29:00.020-04:00

I like to visit the American Heart Association (AHA) website from time to time as it is always a good source of bad advice to blog about. I mean, if the AHA practiced heart disease prevention instead of heart disease promotion I would have little to blog about. You might retort, "What do you mean 'Hawk, the AHA is trying to fight heart disease, you know, prevent it, not promote it." To which I would reply, "Read their screed!" The AHA appears to be most interested in giving you the best REPAIR medicine after you have crashed and burned rather than giving you the best crash prevention medicine so you won't need any repair.

Their latest shrine to heart disease promotion is their new web tool "Heart Profilers." It is an extensive and exhaustive piece of programmed "cyber-medicine" that purports to ". . . help you understand different treatments that may be appropriate for you based on your diagnosis, symptoms, and test results. Using this tool will help you better evaluate your options and make informed decisions with your doctor and health care team." Hardly, read on!

I decided to enroll, gave them all my personal info (so they can market to me) and answered an extensive questionnaire about my health, what drugs I take, etc. To say it was slanted toward doing invasive procedures is an understatement. When the entire process starts with the statement, "The chest pain known as angina is usually one of the first symptoms of CAD." you know you are dealing with neanderthal medicine. Yeah, I suppose if you have never had a heart scan it might come to that but by then it is too late - you're hooked into the "cut and drug" assembly line. See what I mean about their repair versus prevent mindset?

The questionnaire tacitly assumes that heart disease is first diagnosed by chest pain. Apparently, unable to take "No" for an answer as to whether I have chest pain, they go on to ask numerous questions about my non-existent angina, heart attacks, angiograms, stents, stress tests and other interrogatives that have little to do with prevention and presuppose extensive heart disease. I mean, how do you answer questions like (and there are many), "Has your doctor said you are a candidate for coronary artery surgery?" when it has not and hopefully never will be an issue? Catch the drift here? Think they are pushing invasive procedures?

Now comes the best part, the recommendations! Here are mine. "Your answers to the questions about risk factors indicate that you have no risk factors for coronary artery disease that need to be managed. " WHAT?! ARE YOU KIDDING ME?! What about the need to raise my HDL above 40mg/dl and further reduce my LDL below their 100mg/dl cut-offs. They never even asked about my sky-high Lp(a) or what my LDL particle size and particle count was (fortunately mine is fine). The fact is I have a high calcium score for my age and it is growing (thankfully not as fast as it would under AHA care). I am a heart attack waiting to happen and the AHA, after taking an exhaustive heart health history says I, "have no risk factors for coronary artery disease that need to be managed." Are they nuts?! Heck, they even HAD a question regarding thyroid disease but the results remained the same no matter if I answered I had no thyroid disease, hyperthyroidism, or hypothyroidism (which I have). Perhaps they need to read the upcoming Track Your Plaque report on hypothyroidism and heart disease! It is a HUGE factor.

It seems the bottom-line here is that the AHA is only interested in heart disease if it is so advanced that you need a procedure or drugs (no mention of supplements like fish oil or Vitamin D at this AHA shrine). I have heart disease that requires aggressive treatment yet the AHA thinks I have "no risk factors for coronary artery disease that need to be managed." What they really seem to mean is I do not need an invasive repair procedure yet. That is what I mean when I say the AHA is a heart disease promotion organization and not a heart disease prevention organization. Sign up, select the "Coronary Artery Disease" option and take the test yourself. It is the best way to experience their stunning ignorance.

Regards,

HeartHawk

Your Doctor Just Might Be a Gol-Darn Fool If . . .

2008-06-25T17:25:00.017-04:00

With apologies to Jeff Foxworthy . . . your doctor just might be a gol-darn fool if he or she still does not believe in the predictive power of heart scans. The latest piece of evidence, found in the Archives of Internal Medicine, is based on data from the Multi-Ethnic Study of Atherosclerosis (MESA). Researcher Dr. Aaron Folsom remarks "our data suggest that in asymptomatic 45- to 84-year-old US adults, CAC score may be the better choice over IMT." This is a powerful statement as IMT or CIMT (Carotid Intima Media Thickness) as it is sometimes known, has long been an acknowledged "gold standard" for judging global heart attack risk by the American Heart Association (AHA), National Cholesterol Education Program (NCEP), and in the widely heralded ATP-III report.

So, if you are a 45 to 85 year old US adult and your doc gives you any heat about using heart scans to quantify your heart attack risk, look them in the eye and say, "SEE YOU LATER FOOL," and calmly walk out the door - then find a doc who is not just another gol-darn fool.

Oh and by the way if they should ask for more proof than just this study, smack 'em with these studies as well

Raggi P, Gongora MC, Gopal A, et al. Coronary artery calcium to predict all-cause mortality in elderly men and women. J Am Coll Cardiol 2008; 52:17-23.

Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008; 358:1336-1345.

Weintraub WS and Diamond GA. Predicting cardiovascular events with coronary calcium scoring. N Engl J Med 2008; 358:1394-1396. (Note this is a comment that shows how even traditionalists are starting to face the truth)

As Bugs Bunny might say, "What's up doc!"

HeartHawk

Calling Dr. Wikipedia! Stat!

2008-06-20T09:31:00.014-04:00

You just knew this had to be coming but I never would have believed it had I not seen it with my own two eyes! As many readers of my blog know, I have been diagnosed with Hashimoto's Thyroiditis and subclinical hypothyroidism (elevated TPO and TG antibodies, low normal T4/T3 and high normal - depending on who you ask - TSH).

Yesterday, I submitted to an ACTH Stimulation Test to examine if I have adrenal insufficiency as a cofactor in my hypothyroidism. In this test, an initial blood draw is taken to establish a baseline serum cortisol. Then, you are injected with synthetic ACTH, the pituitary hormone that signals your adrenal glands to produce cortisol, and your levels are rechecked every 15-30 minutes for a period of time (usually an hour). I guess I had my first reservations when making an advanced reservation to have the test done. I was actually at the testing hospital for another blood test (free testosterone) but, unbelieveably, they had no method for taking a reservation in person. I called the number they gave me and it was clear the nurses and techs I spoke with were unfamiliar with the test. Finally, I convince someone to meet me in their lobby and after 15-20 minutes of private consultation, paging through 3-ring binders, and calls to other staff I had my appointment.

I show up for my test and they take me to a nice room where they have numerous vials and solutions, IV's, etc. ready for me but they are still not certain about how to do the test. I suggest they simply call the doc who ordered the test for me as he has an office right in the hospital. He faxes some additional info and we are off to the races. About 45 minutes into the process I get bored. So, I saunter outside the testing room with an IV dangling from my left arm to retrieve my chart which I know will invariable be sitting in a chart holder on the wall outside the door. I always love the " how dare you" look I get from the docs and nurses who happen to see me grab my chart but there is really nothing they can do to stop me. As I begin paging through the notes I come upon the "magic" set of faxed instructions that got things moving. My eyes roll and I can barely contain my astonishment - it is a printout of the Wikipedia entry on - you guessed it - the protocol for the ACTH Stim Test. The doc had simply crossed out the optional 45 minute interval draw and accentuated the need to heparinize the blood sample.

So, the moral of the story is, the next time you feel guilty or inadequate about doing battle against an arrogant doctor armed with nothing but web research - DON'T! You may both be practicing Wikipedia medicine!

Regards,

HeartHawk

Give Me a Freakin' Break: Need I say More?

2008-06-14T14:16:00.004-04:00

You know, you work so hard to inform people about dealing with issues like plaque and calcium and then you stumble across this crap.

I found this on WrongDiagnosis.com. Have these people no shame? This is pure, unadulterated BS! Perhaps they should change the name of the site to just plain Wrong.com.

I wish there was a nutrient that was 100% effective in flushing rogue con artists away!

Sheesh!

HeartHawk

What Next, Down is Up? An HDL Conundrum

2008-06-04T17:46:00.007-04:00

Man, and I thought quantum physics was wacky stuff! Study after study has shown that higher HDL is strongly associated with cardiovascular health. HDL Cholesterol efflux mechanisms and the entire mechanics of reverse cholestrol transport have been proposed, studied, and experimentally observed. Now this!

In what could be a landmark study recently published in the Journal of the American Medical Association, researchers conducted a meta-analysis of the data from the Copenhagen City Heart Study (over 9000 persons with two decades of followup), the Copenhagen General Population Study (an ongoing study of over 30,000 persons), and the Copenhagen Ischemic Heart Disease Study (2500 persons referred for angiography). The conclusion, "Lower plasma levels of HDL cholesterol due to heterozygosity for loss-of-function mutations in ABCA1 were not associated with an increased risk of IHD." The lead investigator added, "The principal finding of this study is that heterozygosity for loss-of-function mutations in ABCA1 associated with substantial, lifelong lowering of plasma levels of HDL cholesterol, but not with corresponding higher levels of plasma triglycerides or atherogenic remnant lipoproteins, did not predict an increased risk of ischemic heart disease."

Now, let's review their findings - this time in English! The researchers looked for mutations in a key gene (ABCA1) that lowers HDL Cholesterol (HDL) and reduces cholesterol efflux from the artery wall but does not affect triglycerides. As expected, the group with the mutations had an HDL that averaged 17mg/dl lower than the general population and that 17mg/dl reduction should have translated to a 70% risk increase based on the results of the Copenhagen City Heart Study. However, this low HDL group did not appear to have any more risk than average. It was only in the presence of low HDL and high triglycerides that they found higher heart disease risk.

The findings suggest that, although low HDL is consistently associated with higher heart disease risk, it is not, by itself, a cause. The practical implication is not to dismiss low HDL as a marker for heart disease but to question its true role. It further suggests that simply raising HDL (as is the target of many new drugs such as CETP antagonists) is not enough and it must be considered in relation to other factors that often appear in conjunction with low HDL such as high triglycerides. Of course, this provides additional validation for the 60/60/60 Track Your Plaque principle. Keep that HDL high and those TGs low!

Wacky stuff!

HeartHawk

Sub-clinical Hypothyroidism Linked to Fatal Heart Disease

2008-05-29T13:29:00.008-04:00

A study of 25,000 people recently published in the Archives of Internal Medicine has confirmed that sub-clinical hypothyroidism (those with supposedly normal TSH test results) is positively linked to fatal heart disease in women. However, there were not enough cardiac deaths to extend this conclusion to men (note that this DOES NOT mean men are not affected, it simply means there were not enough events to prove it statistically within the 95% confidence interval established for the study). This study confirms the findings of a smaller study published in the Archives last year.

The message these studies provide is clear. Persons with TSH test results even in the intermediate range of "normal" (1.14-2.52 mIU/L) may be at heightened risk for cardiac death. The practical result is that patients should no longer rely on supposedly "normal" TSH test results to rule out hypothyroidism. You KNOW I'm not. Look for a future report on how to protect yourself!

Regards,

HeartHawk

More "Customer NO-Service" in Health Care

2008-05-28T15:06:00.004-04:00

As many readers know, I have been trolling the rabbit-hole of hypothyroidism. In the past month I have been a pin-cushion for a legion of phlebotomists as I collect as much test data about myself as possible. I have already gone through two "crank turning" endocrinologists and am on my way to a third. One would think it is easy. Get your records, find a promising physician, make an appointment and voila, on we go. NOT!

The trouble all started when I went to retrieve my latest blood test results (TSH and T4) from a local clinic lab (where Endocrinologist 1 practices). I called the lab and determined the results were in. Of course, they won't give me the results and refer me to my doctor's nurse. The nurse attempts to mislead me into thinking the results aren't in. Of course, I know better and push the subject. She further argues that I need proper interpretation, diagnosis, and treatment that she cannot provide. I reply I am only interested in a number. Sorry, no can do, that's policy. So I call customer service at the clinic and they give the same inane arguments but inform me I can sign up to see all my labs online if I come down and sign up for the service (I did). Unbelievably, the nurse cannot give the info over the phone (HIPAA was not an issue), but I can see them immediately via the Internet. They finally relent and the nurse calls to give me the results. Geez, did it HAVE to be that hard? Here's the funny thing. In the interim I called the lab and asked them to fax the results to another physician. HA! They just took the fax number and sent it without even checking. I already had the results by the time the nurse called me back! Remember, there is always a way to get around bureaucrats if you are willing to think outside the box and used their allegiance to "crank turning" against them. OK, that problem is solved.

Next, I need to collect lab results from my primary care physician and Endocrinologist 2 (E2) who is part of his group. They also would not release new results to me and their group records department requires me to appear in person to sign a release. The kicker here is that they will not give me the records on the spot but will mail them to me in about one week. But, since these are somewhat older records my primary care physician's secretary agrees to mail them to me. E2's secretary is less forthcoming. She flatly refuses to send me "my file" but would release it to another physician. Finally, after arguing that I have only seen E2 a single time, that "my file" probably consists of only two sheets of paper, and that my primary care physician from her group is already sending my records she relents.

Now, armed with all my records, I try to find an endocrinologist that I think would be helpful. I first get a nice list of docs my insurance covers and select a relatively recent grad (1994) who practices at the local teaching hospital (Medical College of Wisconsin). I figure this is my best shot at finding a doc who is up to speed on the latest research and doesn't just "turn the crank." So, I call to set-up an appointment with Endocrinologist 3 (E3). Not so fast! I am rather bluntly informed that they will not set-up an appointment without a referral from my primary care physician. Further, they first must review my records and THEY will select which specialist in their group is most suited for me and set-up an appointment based on what THEY believe the severity of my problem is. Naturally, my next call is to their customer service department. I explain, for example, that I hire lawyers all the time based on MY selection criteria. I don't ask the local Sheriff for a referral to a particular group of attorneys nor do I accept whomever happens to be available that day. I wish to specifically hire one of your doctors for a consult to review my situation. Do you wish to do business with me? The nice lady said she would get back to me . . . tick . . . tick . . . tick.

Customer service? HA! Guess what pilgrims? It ain't just heart care that's screwed up. Somewhere along the line these arrogant SOBs think they are something special. They do everything they can to control information and work to keep patients from proactively becoming engaged in managing their own health care. As I have said in the past you have to take control of your health, demand good customer service, and don't take no for an answer.

Remember, stubborness can be beautiful. It can also save your life!

HeartHawk

This is Getting Embarrassing: TYP and Davis Score AGAIN!

2008-05-28T09:22:00.002-04:00

In the sports world there is a rather unsavory and embarrassing tactic called "running up the score." It is what happens when you face an inept opponent and simply thrash them because you are that much better. Since I have become a "full-fledged flack for Track Your Plaque" I never tire of pointing out when Dr. Bill Davis once again lives up to my billing of him as the "Nostradamus of Heart Disease." This time it is in relation to another of the TYP lipoprotein 60/60/60 targets (the foundation of the TYP program), HDL.

While doing additional research on Hypothyroidism I stumbled across another bit of research I had previously missed involving the Honolulu Heart Program. This is a decades-old study of Japanese men in Honolulu and San Francisco that researchers have drawn upon to develop numerous hypotheses and conclusions about heart disease. A study published in the Journal of Lipid Research not only verified the need to establish an HDL of at least 40mg/dl (old news) but went on to show that raising HDL to at least (you guessed it) 60mg/dl conferred a rather large additional reduction of risk.

Thank you, sir. May I have another! (a hip, trendy reference for all you "Animal House" fans out there). Dr. D., please feel free to score at will!

Regards,

HeartHawk

Hypothyroidism and Heart Disease: Now What?

2008-05-19T18:09:00.002-04:00

When I went to see the second of my "dueling endocrinologists" I was was in the midst of a full blown episode I often experience where my stomach feels like it is trying to regurgitate a rock coupled with a nasty spate of heart palpitations (PACs confirmed by holter monitor). My research found that there is evidence to suggest that people with Hashimoto's Thyroiditis (my confirmed diagnosis by both Endo's) can episodically become hyperthyroid due to the thyroid releasing stored hormones as it deteriorates.

Because I was in mid-episode I thought it would be interesting to see if my thyroid could be the culprit and the doc agreed to retest my TSH and Free T4 that day. Wouldn't ya know it, my TSH was a sterling 2.0 with a 1.2 Free T4. The second doc has now has refused to prescribe hormone replacement therapy (too bad, the first one already did) and wants to do repeat testing for several more months. This test result is just what you might expect if for some unknown reason my diseased thyroid started dumping hormones. Hmmmm! Well, the episode has passed and I'm back to normal (stomach's fine and no palpitations). You just know I'll be getting another blood draw soon to see if my TSH shoots back up! I'll find a third endo if need be.

While the docs diddle I'll be doing my own thing. If they think I am going to sit around feeling like I was hit by a truck while they test me for another few months - they're nuts!

Regards,

HeartHawk

Hypothyroidism and Heart Disease: Round 2

2008-05-16T22:03:00.002-04:00

Well, saw the second endocrinologist today. Let's compare notes!

1. Both agreed I have Hashimoto's Thyroiditis.
2. Both preferred synthetic T4 to the natural Armour Thyroid (AT) preparation citing inconsistency between lots of the AT (the company's website disputes this).
3. Both defended synthetic T4 as being preferable because T4 is longer acting, has to be taken only once per day (AT should be taken more often as it contains shorter acting T3) , and both say most of the body's T3 comes from T4 anyway.
4. Doc 2 also went on to say he wants me on name brand (Levoxyl, Synthroid, etc.) rather than a generic to ensure I get a consistent level of T4. His argument is that the generics are OK if you could ensure you got the same brand everytime but with generics pharmacies can substitute freely between generic brands.
5. Doc 1 wanted to start me at 75mcg (I talked him down to 25mcg). Doc 2 wanted to start me at 25mcg unprompted. I agree!
6. Doc 2 want to treat me to achieve a level of between (1.0 and 2.0). Doc 1 was never really mentioned a treatment level.
7. Doc 1 set me up for a sleep apnea test to see if that was the true source of tiredness. Seems that is not uncommon in thyroiditis. I also got the impression he was pushing it for financial reasons.
8. I mentioned having another TSH test and Doc 2 jumped right on it and ordered the test which was done at his onsite lab. Think perhaps he makes a buck there?
9. Both docs took fairly extensive health histories and physical exams with Doc 2 taking a little more health data and Doc 1 doing a little more physical examination.
10. Neither doc hurried me and answered any questions I had.

Well that's all for now. Pretty dry and clinical. Neither doc was a ball of fire! I'll add more as I think of it. Next, let's see what results I get from treatment but that may be a while!

Regards,

HeartHawk

Hypothyroidism and Heart Disease: The Saga Continues

2008-05-15T22:29:00.006-04:00

Well, saw the endocrinologist this morning and he confirmed my self-diagnosis; I have Hashimoto's Thyroiditis a condition where my own antibodies are attacking and slowly destroying my thyroid. I am starting tomorrow on a daily regimen of 25mcg of levothyroxine (synthetic T4). I lobbied for Armour Thyroid (a natural compound made from pig thyroids that contains both T4 and T3) but, despite the company's assurances, the doc belives there is too much variation in composition from lot to lot. He also pointed out that 80% of the body's T3 is synthesized from T4 anyway. He wanted to start me out at 75mcg but I insisted we go more slowly. No sense taking more than I need and any additive treatment will get me moving in the right direction. I can always take more and will probably have to as my thyroid self-destructs!

Now for some fun! I actually made appointments with TWO endocrinologists and see the second one tomorrow. Won't it be interesting to compare notes. I'll keep you posted on the "dueling endos" and my treatment results. Of particular interest will be how it affects my rising Lp(a) and homocysteine.

Regards, HeartHawk

Hypothyroidism and Heart Disease: An Update

2008-05-14T11:25:00.003-04:00

OK, folks, read 'em and weep. My thyroglobulin antibody test was a whopping 37.9 IU/ml (0-14.4 reference range) and my thyroid peroxidase antibody test was worse at 22.8 IU/ml (0-3.9 reference range). Guess what, I likely have a thyroid autoimmune disease, probably Hashimoto's Thyroiditis. Well, at least I now KNOW (think I know anyway) what is causing my symptoms!

Next step, find a doctor to confirm my own diagnosis and properly treat me. Good luck. I called the top endocrinologists in my area and the wait is out one to two months or more. So, I took what I could get and will see somebody this week. Hopefully, the doc can get me started on a thyroid hormone replacement strategy so I can see how it affects my lipoproteins as well as my general well-being. However, I kept my appointment with the other guy - just in case I need a second opinion.

You know, it's funny. When I started this gig seven years ago (well before this blog) I thought I would be researching the heart and its arteries and peripherally the liver (as it makes most lipoproteins). Now, I'm digging around in my neck! Go figure. Well, you go where the cure takes you. The lesson to be learned here is to take matters into your own hands, be proactive, leave no stone unturned, and keep searching until you unearth all the root causes of your disease.

I'll heep you posted on my journey!

HeartHawk

P.S. The good news is we won't have to start our own foundation as we are with Lipoprotein(a). There are LOTS of thyroid groups!

Hypothyroidism and Heart Disease: The Plot Thickens

2008-05-13T09:18:00.009-04:00

Wow! This rabbit hole goes a lot deeper than I could have ever imagined. It seems hypothyroidism is clearly connected with heart disease, is largely undiagnosed/misdiagnosed, and generally misunderstood. If anything, the real problem is, because thyroid hormones are used in just about every body tissue, hypothyroidism is connected with a huge list of symptoms and conditions. Now, on to my sad story.

Here I am, feeling like crap, disgestive problems, myalgias, fatigue, anemia, rising lipoprotein(a) and homocysteine, palpitations, mild depression, lack of concentration - yeah all that fuzzy, amorphous, undifferentiated, "feel like a truck hit" me stuff. One day I am so fatigued that I drop by the local walk-in clinic (because I can't get a freakin' appointment with my internist for a month - sound familiar) where they find me to be anemic. I luck out and finally get in to see my "regular" doc and he orders tests that show I have a moderately high TSH (4.5) and a lower (but in range) Free T4 (1.0ng/dl) and T3 (2.68 pg/ml). Of course, the internist's staff won't give me the results because they want me to schedule another appointment in ANOTHER MONTH! With a little subterfuge, I get them to fax the results "elsewhere" for "continued care" (the magic words) where I retrieve them. (DON'T GET ME STARTED ON THIS PET PEEVE - THAT WAS MY GODDAM BLOOD AND MY TEST RESULTS THAT I PAID FOR. HOW DARE THEY WITHHOLD MY HEALTH DATA FROM ME!)

So armed with this data I start my investigation. It seems that the new upper limit for TSH is really around 3.0 (not 4.5 or 5.5). Upper and lower limits form test "Reference ranges" and are not absolutes. They are set by testing lots of people who are categorized as "healthy" and determining their blood levels. The problem is you can have a lot of people who are subjectively categorized as healthy but are really not. That appears to be the case with hypothyroidism. It is likely there were numerous undiagnosed subjects included in the old "normal" range. As I mentioned in my last post on this subject, the more enlightened docs in the medical community now use these tests as guides rather than absolutes and treat based on symptoms rather than blood levels.

Now here is where it gets good (or bad depending on whether you are manic or depressive today). I also mentioned that hypothyroidism is connected with rising Lipoprotein(a) and now discover it is also connected with rising homocysteine (that would be me on both counts) as well as other hyperlipidemias. It also seems that certain drugs and supplememts can interfere with thyroid production (like niacin - also me). The link in the previous sentence is a multi-page article I would recommend reviewing. I also recommend this well-reasoned discussion on the treatment of hypothyroidism (especially the undiagnosed and border-line variety).

Hypothyroidism, it is real and it can screw you up. But it is easy to detect and treat. If you have symptoms or suspect it, get a doc to test your TSH, T4 and T3. To reduce delays try to get them done all at once. Many docs will do just the TSH and then only do T4 and T3 if your TSH is elevated. This is just medical "crank turning" by docs who don't like to think. In my NOT so humble opinion, you really have to look at all three and interpret the results. I'll post my results once I start treatment.

Regards from the human guinea pig,

HeartHawk

Track Your Plaque: Continued Validation!

2008-05-08T19:42:00.009-04:00

OK, since I am now pretty much a full-fledged flack for Track Your Plaque (ya gotta love the alliteration and rhyming), I don't feel quite as bashful about saying, "I told you so." Dr. William R. Davis continues his unbroken record of prognostication and retains the title I gave him as the "Nostradamus of curing heart disease" as I find yet another vindication of the Track Your Plaque principles, in particular the 60/60/60 precept (LDL/HDL/Triglycerides).

A new report from the Stop Atherosclerosis in Native Diabetics (SANDS) study suggests that aggressive lowering of LDL (<70mg/dl) and blood pressure (<115mmHG) regresses heart disease as compared to standard targets (100mg/dl and 130mmHg respectively). Admittedly, the researchers used carotid intima media thickness (CIMT) which is the easiest surrogate end point to regress. Also, the study only looked at Native American diabetics but diabetics are traditionally the TOUGHEST group to treat. It is also possible this result only applies to persons with Native American genetics but I doubt it. Either way, it is good news and pushes us closer to a cure.

The other nugget to come away with is the TYP principle that says plaque growth rates below 10% are nearly as effective as reversal (in terms of clinical events) is also supported by SANDS. While not a cure for all, this is still great news and another win for the lower is better philosophy.

The Lipoprotein(a) Foundation: An Update

2008-05-07T10:45:00.004-04:00

Here is a synopsis of what is going on to establish the Lipoprotein(a) Foundation (LF).

1. I met with Mary Lou Ballweg, the head of the Endometriosis Association, an extremely successful group with many similarities to our proposed foundation. She informed me that the Milwaukee, WI area is a hotbed of start-up medical fiundations so I hope to take advantage of my location. Mary Lou provided a wealth of information and, I think, a powerful idea for jump starting LF. She recounted the key event in the growth of EA was the establishment of a database of self-reported information about endometriosis sufferers. The method they used was a simple brochure she mailed with instructions to fill it out and return it with a dollar to cover data-entry costs (this was the 1980's, no Internet). Universities like Dartmouth and Vanderbuilt were eager to get this type of research data as it was not available anywhere else and, voila, the research began in earnest. We should do the same and it will be a whole lot easier with the Internet (see next item).

2. Dr. Davis has formally agreed to donate all the necessary Track Your Plaque web resources to implementing the LF website. I now have admin privileges on the new development site and will begin to implement a web-based data collection tool within the TYP framework. Doc Davis also offered to donate the 501(c)(3) non-profit filing fee. When he mentioned the effort on his blog, several commenters offered their assistance as well (as they did on this blog). I would request that anyone still interested in donating skills or making contributions to contact me directly at hearthawk(at)wi.rr.com with their contact information. I have helped start two other non-profits but I am not an expert and could use all the help I can get. (see next item).

3. In addition to the web work I have also started the IRS filing process. I guess the only thing I can say is I'll work as fast as time will allow. Obviously, anyone with knowledge of this process would be extremely helpful. We do have to form a board of directors at some point. Major contributors of time, talent, and financial resources are always prime candidates for these roles.

4. If we can attract an "angel" investor we can obviously move a lot faster! I have broached the subject of investment capital with a professional fundraiser that would consider helping us at a reduced fee as time permits but she is booked for at least six month to a year. Whether it's a million people with one dollar or one person with a million dollars we will need to start raising money to fund research. Frankly, at the risk of appearing mercenary (I am), our best bets are people plagued (or "plaqued") with Lp(a)! The beauty of medicals breakthroughs is that once a cure is found for/by one person's efforts, it cures almost everybody.

5. If anyone has any medical/research/academic contacts they would be useful to help form our advisory board. The University of Wisconsin is a top medical research facility and I have scheduled a meeting with a blood researcher there. As luck would have it, my daughter is a biochem major at UW working on here senior research thesis and is searching for addtional contacts (I oughta get something back for all those tuition payments!).

That's where we are. Let's slay the Lp(a) dragon!

Regards,

HeartHawk

Hypothyroidism and Heart Disease: Here we go!

2008-05-03T09:20:00.005-04:00

Now what?! I just finished clearing up a low blood count and a mild case of anemia (watch your aspirin intake folks - it's hard on the tummy) only to find my Thyroid Stimulating Hormone (TSH) was above normal. TSH is excreted by the pituitary gland and stimulates the thyroid gland (nice video here - after the ad ends) to produce the hormones thyroxine (T4) and triiodothyronine (T3) which in turn is used by various organs and tissues of the of the body. Suffice to say your whole body pretty much needs the stuff (follow or Google these blog links if you want to dig into this stuff). The key here is to realize that a high TSH means low thyroid function or hypothyroidism. The pituitary essentially tries to kick-start the thyroid to secrete more of its hormones by overproducing TSH.

Hypothyroidism has a number of irritating symptoms (severe cases can result in a life threatening condition known as myxedema coma). The most common are fatigue and depression. Here is the list of symptoms from the American Association of Clinical Endocrinologists (AACE) for all of us hypochondriacs:

• Dry skin and cold intolerance
• Yellow skin
• Coarseness or loss of hair
• Hoarseness
• Goiter
• Reflex delay, relaxation phase
• Ataxia
• Constipation
• Memory and mental impairment
• Decreased concentration
• Depression
• Irregular or heavy menses and infertility
• Myalgias
• Hyperlipidemia
• Bradycardia and hypothermia
• Myxedema fluid infiltration of tissues

There is also additional evidence (About.com, American Thyroid Association) to suggest hypothyroidism (as well as hyperthyroidism) can have negative effects on the heart.

The real problem here is when and how to treat sub-clinical or mild hyperthyroidism. AACE has waffled in the past but their most recent statement is typical of head-in-the-sand traditional medicine; esentially, do nothing (gee, thanks, I was already doing that, slowly dying of heart disease, and feeling crappy in the process). Others disagree. Amazingly, the American Academy of Family Physicians (AAFP) makes a cautiously worded statement that suggests treating patients based on their symptoms rather than their TSH levels (what a concept). Mary Shomon (perhaps the "ThyroidHawk" of bloggers) takes a shot at the medical establishment in this article. Doubtlessly, the indifference and incompetence heart disease sufferers face is common among all the halls of traditional medicine.

I'll continue to update you on what happens in my "heart disease and thyroid saga." This is of particular importance to me since I discovered this article that suggests T3 rapidly lowers lipoprotein(a)! Oh, and you know darn well I'll be pestering Doctor Davis to chime in on the subject.

Regards,

HeartHawk

P.S. My next blog will update everyone on how the formation of the Lipoprotein(a) Foundation is coming. Suffice to say I am moving forward.

Vitamin D: The Evidence Keeps Rolling In

2008-04-23T22:44:00.004-04:00

I guess I shouldn't be surprised but Dr. Davis of Track Your Plaque continues to demonstrate he is the Nostradamus of heart disease prevention medicine. For the last year he has trumpeted the powerful effects of Vitamin D in regressing plaque and presented his findings in early April at the Experimental Biology Symposium in San Diego.

Now, researchers using data from the National Health and Nutrition Examination Survey (NHANES) study have presented their similar findings at the Arteriosclerosis, Thrombosis and Vascular Biology Annual Conference. They found that persons with low Vitamin D levels have a higher incidence of Peripheral Artery Disease (PAD). PAD, also known as intermittent claudication, is a condition where blood vessels in the extremities become narrowed or occluded by plaque.

Once again, Dr. Davis proves to be ahead of the curve!

Regards,

HeartHawk

More on the Lipoprotein(a) Foundation

2008-04-16T12:36:00.003-04:00

Looks like we may be on to something here. We have already had interest from several blog readers about keeping this idea going (see previous blog entry). Here is what has transpired in the past day.

1. Track Your Plaque (TYP) has graciously offered to host the Lipoprotein(a) website. I am meeting with their head web programmer on April 18th to lay the ground work.

2. I am meeting with Mary Lou Ballweg one of the founders of the Endometriosis Association (EA) on April 23rd to pick her brain on how to start and run a successful medical Foundation. Endometriosis was a little known disease and, similar to Lp(a), had little or no research or funding. Mary Lou grew (EA) from a humble start of one person working from her living room to an international association with its own headquarters building. She will be a fantastic resource for us.

3. I have talked briefly with Dr. Davis of TYP and while he cannot become directly involved due to time constraints, he has agreed to help us in any way he is able. He can be our "in" in the medical community.

4. I am about to contact other Lp(a) researchers such as Drs. Marcovina and Scanu to get their input.

The rest is pretty much up to us to keep the "viral marketing" campaign going and build a list of potential members and contributors. I will also attempt to start scaring up a few bucks and will talk to the programmer on the 18th about setting up a PayPal online contributions page as well. The oft repeated bromide is true here, "If every Lp(a) sufferer kicked in just $1, we would have millions." Finally, anybody know any non-profit lawyers and accountants who suffer from Lp(a) and want to help save their own lives? Sooner or later we will have to form a board of directors if we get this thing off the ground. Say, you don't suppose Warren Buffet or Bill Gates has Lp(a) do you?

The Lipoprotein(a) Foundation: Time to Start One?

2008-04-15T09:43:00.008-04:00

I just received some disheartening news from Dr. Sally McCormick one of the world's few Lipoprotein(a) researchers. I had asked her how her lead anti-Lp(a) compound was fairing in trials and the answer was not good, "some of the animals were quite sick after dosing with the peptide, we think due to the peptide being unstable and aggregating in the circulation."

On the bright side she also mentioned she is about to publish some preliminary research on DMPC (dimyristoylphosphatidylcholine which is not to be confused with PPC or phosphatidylcholine being studied in the Track Your Plaque Virtual Clinical Trial). Additionally, Dr. McCormick does have one other lead compound in the pipeline but it is not in trials yet.

Sally did make one other statement at the end of her letter that stuck with me, "Sorry I can't be of more help to you and other high Lp(a) sufferers as yet, we are trying to develop something but its just really slow when time and funding is limited." This reminded me of a woman I know (right here in my hometown) with another neglected medical condition called endometriosis. Like Lp(a), few people were doing any research and fewer companies were investing any money in finding a cure. She started the Endometriosis Association to provide support and create pressure to find remedies for persons with her condition and was immensely successful.

Perhaps all of us Lp(a) sufferers should do the same. I have started a 501(c)(3) educational charity in the past - it's not fast or easy thanks to the U.S. government. It takes lawyers (or really knowledgeable people) at least a little money (the filing fee alone is around $500) , and a lot of work to grow the organization. My vision would also include raising a boat load of money to fund independent medical research similar to what is being done by some of the pioneers like Dr. McCormick (I'll bet there are as many wealthy people as poor people slowly dying of Lp(a)).

So there you have it, the Lipoprotein(a) Foundation! I know Track Your Plaque will front us the web presence and let us use their new community/networking software they are developing. Dr. Davis as well as several other professionals associated with Track Your Plaque have expressed interest but they are too busy to start it or run it. Now, can the rest of us develop the critical mass to put something like this together and cure ourselves?!

Regards,

HeartHawk

More on Vitamin D and Testosterone

2008-03-30T22:10:00.002-04:00

Lot's of great comments on my last blog concerning Vitamin D and testosterone. A few commenters rightly took me to task for my less than rigorous data regarding the association between my Vitamin D intake and my testosterone level. So, here is what we can say.

1. For my "n of one" study there is an "association" between between Vitamin D and testosterone levels. However, it cannot be concluded it is causative. It could be that can of "Coke Zero" I drink every day that's doing the trick!

2. It is not outrageous to speculate that there could be a link between Vitamin D and testosterone given chemistry. We just cannot prove it with my results. There is some excellent material on Vitamin D pharmacology put out by the Vitamin D Council (really level-headed stuff not marketing hyperbole) and for those who lean toward the "geeky" side this cite from AACC is nice.

3. It is unlikely my low testosterone stayed high several years after stopping my use of topical testosterone. What I really need to do is stop the Vitamin D for several months and re-check my testosterone to see if it goes lower. The problem is that Vitamin D is good for so many other things that it does not seem appropriate to discontinue it. Perhaps a new Track Your Plaque Virtual Clinical Trial might be useful where we measure "before" and "after" testosterone levels.

We certainly need more clinical data on the relationship between Vitamin D and testosterone. We have chicken data (and more chicken data here - what is it with chickens anyway) and we have rat data that suggests Vitamin D increases male (rat) fertility but we just do not have anything that says Vitamin D increases human testosterone (yet).

Anecdotally Yours,

HeartHawk

Vitamin D and Testosterone: Another "Fountain of Youth" Find

2008-03-22T14:13:00.011-04:00

When Dr. Davis of Track Your Plaque first reported his phenomenal success using Vitamin D to reverse coronary plaque I pretty much blew it off as coincidental and too good to be true. But, once again, Dr. Davis has proven to be the "Nostradamus of Heart Disease Reversal" as breaking data continues to support his prediction and clinical evidence.

After much brow beating, I finally decided to try Vitamin D. With some rather interesting results. Let's first set the table for my experience.

When I first became a follower of Dr. Davis (long before there was a Track Your Plaque) I had my testosterone tested and it was fairly low (near the bottom end of normal). Because testosterone can be an effective Lp(a) remedy (my scourge) I tried using a testosterone cream to raise my level and it promptly went up to the high end of normal. But, for various reasons (no effect on Lp(a), lowering of HDL, and it's inconvenient as hell to use) I stopped. But look at my Testosterone (T) blood levels since I started using Vitamin D!

Date	T (ng/dL)	Vit D (ng/mL)	Notes
10/18/01	328	Unknown	Baseline testosterone
02/06/03	774	Unknown	Started topical testosterone
08/04/06	792	53.0	Stopped T 1 year earlier/started 2100IU D
12/26/07	735	40.7	8000IU Vitamin D (increased for winter)
03/06/08	728	69.2	10000IU Vitamin D (needed more to hit TYP threshhold)

As you can see the Vitamin D was just as effective at raising my endogenous testosterone as was using synthetic, topically applied testosterone cream. Also note that I had to signficantly raise my D dosage in winter months to offset the lack of sun. The other goofy thing is that for some reason there is a threshhold effect at around 50ng/mL (although mine kicked in at 40). This Vitamin D stuff is damn interesting. The numbers do not lie and for a numbers guy like me its all the proof I need.

Regards,

HeartHawk

Mammography and Calcium: More Steadfast Denial

2008-03-12T14:56:00.006-05:00

It is often absolutely stunning how tradition medicine continues to remain in a state of denial over the efficacy of calcium scoring as a measure of heart disease risk. A new study revealed that women who display arterial calcification on their mammograms are over twice as likely to develop cardiovascular disease. Ya think?!

Dr. Michelle A. Rotter (University of Connecticut School of Medicine, Farmington) and colleagues reported their findings in the March/April 2008 issue of Menopause. Dr. Rotter went on to comment, "it has yet to be determined whether screening for BACs is an effective tool in screening for CAD." But that is not the point as the evidence continues to mount and doctors continue to ignore it. Arterial calcium is the strongest predictor of heart disease and future events - period - and it appears that detection via routine mammography can be an important predictive tool much like heart scans.

Although the link between arterial calcification, especially calcification in coronary arteries, has long been established as the single greatest predictor of heart disease, the traditional medical community continues to dither over supportive findings such as this lastest study. It is not as though this were the first time such a study came up with this discovery. Another study published in 2000 found a similar association between breast arterial calcifications and atherosclerosis.

When is traditional medicine going to 'fess up to the truth and stop letting people become so sick they have no choice but to pay big bucks to be butchered on their operating tables. This is utterly repugnant! We already know that arterial calcium is the greatest predictor of future heart disease in asymptomatic individuals and the COURAGE trial proved that non-surgical therapies are just as effective as surgical therapies in non-acute patients. One day, this is going to come back to bite these negligent hospitals, doctors, and insurers in the butt to the tune of billions!

Still holding my nose and holding out hope,

HeartHawk

Additional commentary on this study from Medscape, heartWire

More on Aspirin Resistance, NSAIDs, and Stroke

2008-03-04T19:35:00.005-05:00

In an earlier blog I discussed aspirin resistance as a factor in heart attack. A new study now confirms similar results in stroke victims. You are 14 times more likely to have a recurrence of stroke if you are aspirin resistant.

Similar to previous studies, 20% of partcipants were found to be resistant to the effects of aspirin on the interruption of the arachodonic acid cascade that inhibits platelet aggregation (clotting). Of the 87 patients who had recurrent strokes while taking aspirin, 57 (66%) were nonresponsive to aspirin. That an odds ratio of more than 14 times greater. Put another way, of the patients who were aspirin responsive, only 5% were among those who suffered recurrent symptoms while taking aspirin.

In another paper in the Journal of Clinical Pharmacology, the same researchers found an interesting association between people taking both aspirin and NSAIDs (ibuprofen for example). All of the participants who took both aspirin along with some other NSAID showed signs of aspirin resistance. However, when they stopped taking the NSAID, the aspirin resistance disappeared.

Dr. Gengo, one the head researchers commented in a Heartwire interview, "There are many people out there who are taking an NSAID while on aspirin and therefore putting themselves at increased risk of ischemic events (e.g. heart attack and stroke - HH). This study shows that there are many strokes every year that could be prevented."

The New Hub-Bub Over Metabolic Syndrome

2008-02-28T14:49:00.003-05:00

Metabolic Syndrome has long been identified as a risk factor for heart disease. However, idientifying exactly what it is and what its cause or causes are has been a subject of much debate. Now, a new study published in Cell Metabolism has thrown the issue into a full-fledged brouhaha over whether Metabolic Syndrome is a multi-cause condition or more simply a single cause condition with multiple symptoms. For example, is small-LDL a contributor to a diagnosis of Metabolic Syndrome or is some other single root cause driving a host of symptoms such as small-LDL to appear.

The Multi-Cause camp has labored long and hard at defining what group of causes is sufficient to render a diagnosis of Metabolic Syndrome. Different organizations have different standards but all require having some combination of common symptoms such as:

Presence of diabetes
Microalbuminuria
High blood pressure
High triglycerides
Low HDL
Overabundnace of small-LDL
Insulin resistance
High fasting blood glucose
High waist to hip ratio

Here are links to the various guidelines NCEP ATP III (what most U.S. doctors use), American Heart Association, World Health Organization (pages 32 and 33), European Group on Insulin Resistance (EGIR).

This latest study by the Joslin Diabetes Center focuses on insulin resistance in the liver as the key factor in the cause of metabolic syndrome and its association with heart disease. It advances the theory that metabolic syndrome is not simply a collection of abnormalities that should be treated independently but a group of closely linked disturbances in glucose and cholesterol metabolism that stem from a defect in insulin signaling in the liver. This thinking suggests the cure for Metabolic Syndrome is not to treat a variety of symptoms but rather to find and treat the underlying cause perhaps with a single "magic bullet." This is tantatmount to treating and eliminating a cold virus rather than treating the associated symptoms aches, sore thoat, congestions, and sniffles associated with the cold.

OK, great! Now let's find that magic bullet!

HeartHawk

Do YOU Worship at the Alter of LDL Cholesterol?

2008-02-13T19:44:00.007-05:00

Many years ago, doctors would simply measure total cholesterol and call it a day. As the snail-slow medical community progressed it identified LDL Cholesterol as the "bad" guy and basically did little else for decades but beat up on LDL and develop LDL lowering drugs like statins and, more recently, ezetimibe. But a funny thing happened on the way to the temple.

Much like the COURAGE trial delivered a much different than expected result on stenting (it's not much better than drug therapy for non-acute heart disease) , the ENHANCE trial found that lowering LDL with ezetimibe provided little improvement in outcomes. Track Your Plaque proponent Dr. William Davis often opines, "The average LDL Cholesterol of a heart attack victim is 134mg/dl, the average LDL Cholesterol for someone who does not have a heart attack is 131mg/dl." It is a statistical dead heat!

The latest theory is that what matters most is not merely how low you drive LDL Cholesterol but how you go about lowering it (statins deliver pleiotropic effects beyond simply lowering LDL). Ezetimibe can dramatically lower LDL when taken in combination with a statin. You have probably seen the commercials for Vytorin (simvastatin plus ezetimibe) that proclaim it treats the "two sources of cholesterol" (genetic and dietary). The ENHANCE studiers naturally expected to prove ezetimibe was a blockbuster drug that whose LDL lowering effects would earn billions. But it didn't happen. Moreover, the researchers were accused of delaying publication of the bad news.

Dr. Eric Topol has an interesting Video Blog on the subject that is worth the 4-1/2 minutes of your time to see and hear. He suggests that the true cuplrit is oxidized LDL. It makes a lot of sense as we begin to "peel back the onion" on LDL Cholesterol. Stay tuned! You know my next move. Find a test for it so I can hang on number on it!

Regards,

HeartHawk

Is Your Aspirin Resisting You?

2008-01-13T21:59:00.000-05:00

Like most of you I take aspirin daily, 325mg. Even traditional cardiologists recommend aspirin for heart disease sufferers. Aspirin works by interfering with the generation of thromboxane A2 (TXA2) which is needed for platelet aggregation (clotting). The COX-1 enzyme acts on arachidonic acid (AA) to produce endoperoxides that in turn produce TXA2 . Aspirin interferes with the generation of TXA2 by irreversably acetylating the platelet COX-1 enzyme thereby blocking its access to AA. Because platelets are anucleate, they cannot generate additional COX-1. In the absence of TXA2, platelet aggregation does not occur. Got all that?!

Most practitioners prescribe anywhere from 81mg to 325mg. Studies such as CURE suggest 81mg is optimal. The ISIS-2 study puts the dose at 162mg (for recent heart attack sufferers) and, frankly, since aspirin is so cheap, many (like me) simply make the leap to "more must be better." Ahh, but there are downsides to higher dose aspirin, among them bleeding and stomach problems (me again). But there is another dosing consideration, aspirin resistance, a reduced response to aspirin that one study suggests affects 27% of the general population.

Once again, like many of you, I am also a Track Your Plaque convert (see my early posts and disclaimers). As a numbers geek it appeals to me to have hard data to track and make intelligent decisions about controlling my heart disease. So the question those like me have is, "Is there any way to determine if I am aspirin resistant and if so, how resistant am I and how much aspirin do I need to take?" The biggest problem is that there is currently NO clinically valid definition or measurement of "aspirin resistance". However, here is the latest on available tests to provide some answers.

The PFA-100 is US Food and Drug Administration (FDA)-approved to detect platelet dysfunction, von Willebrand disease, and aspirin-induced platelet inhibition. The instrument measures collagen-induced platelet plug formation as time in seconds to occlude an aperture. Its sensitivity as a screen for platelet dysfunction is approximately 95%.

The VerifyNow Aspirin Assay is FDA-approved for detection of aspirin-dependent platelet aggregation. Its sensitivity as a screen for aspirin-induced platelet dysfunction is approximately 91%.

PlateletWorks is FDA-approved to detect platelet dysfunction due to inhibition secondary to diet, aspirin, and/or other drugs. PlateletWorks has limitations. There is a very short time allowed -- 10 minutes -- between sample collection and assay. Also, there may be unacceptably high false-positive rate because of interference by dietary substances such as chocolate and red wine.

AspirinWorks is FDA-approved to provide a quantitative measurement of aspirin-induced inhibition of TXA2 generation from a urine sample. Results are ranged in quartiles with different quartiles represent differing degrees of risk for heart attack. A patient whose results are in the first quartile has a relative risk 1 (average). A patient whose results are in the second quartile has a 1.3 times greater risk of heart attack than a patient in the first quartile. A patient whose results are in the third quartile has a 1.5 times greater risk, and a patient in the fourth quartile has twice the risk. As with many lipid tests, there are still problems to work out in comparing results based on different assay methods.

The bottom-line is there is no perfect way to determine to what degree you are aspirin resistant but the technology is improving. However, if you are looking for some way to put a hard number on where you stand there are several interesting tests available. For now, I simply take the high-end of the dose range until my tummy starts to hurt then take a break or reduce my dose.

Regards,

HeartHawk

New Year's Eve: A Cure for Lp(a) Sufferers?

2007-12-30T17:26:00.000-05:00

FIRST A LITTLE NEW YEAR'S FUN & SARCASM

I, like many people with early heart disease, suffer from high lipoprotein(a) - about 140 nmol/l. Naturally, I spend a great deal of time looking for novel methods to reduce it. Unfortunately, the front line remedies like niacin and testosterone (estrogen if you are a woman) have only been marginally effective in my case. In perhaps the most twisted ignominy of Lp(a), many of the things that will reduce it will harm or kill you some other way. For Example, neomycin is an effective Lp(a) treatment but it has nasty kidney and nervous system side effects. Additionally, a relatively new study (http://circ.ahajournals.org/cgi/reprint/85/6/2034.pdf) has determined that tissue plasminogen activator (tPA) also drastically reduces Lp(a). Great, instead I'll just die from internal hemoraghing.

So what does this have to do with New Year's Eve? Well, it turns out that several other studies have found that high alcohol intake may reduce Lp(a) (for example http://invention.swmed.edu/cgi-bin/etblast/abstract_local?pmid=1827857&user=hobbs&application=2) and the same is true of severe burns and sepsis (http://invention.swmed.edu/cgi-bin/etblast/abstract_local?pmid=10764684&user=hobbs&application=2). So all I have to do to reduce my Lp(a) is get drunk on New Year's Eve and set myself on fire in a wild celebration. Lucky me!

NOW ON TO SERIOUS STUFF

All the studies I cited above are in what is the most complete compendium of research studies on Lp(a) I have ever come across. You can peruse this link http://invention.swmed.edu/frisc/faculty/hobbs/profile.shtml for hours on end to get the skinny on what is going on regarding Lp(a), both the weird and the wonderful.

Happy New Year!

HeartHawk

The Revolution Moves Forward: It's About(.com) Time

2007-12-30T16:30:00.000-05:00

One of the most promising signs that the traditional heart disease "wait until broken and repair" medical model is slowly giving way to the prevention model is that more and more doctors are jumping on the bandwagon. Track Your Plaque recently ran an interview with Colorado prevention pioneer Dr. William Blanchet who independently arrived at the same conclusions and treatment strategies as Track Your Plaque author Dr. William Davis.

Back in September I took some shots at Dr. Richard Fogoros, a contributor to About.com's heart disease pages. At the time I mentioned what a pity it was because "he almost got it right!" I considered the flaw in his position to be the same as many cardiologists, a blind obsession with obstructive disease. My disparaging of Fogoros was a rehash about how traditional medicine waits until it finds coronary obstruction via stress testing, which is end stage heart disease, rather than finding - and treating - early stage heart disease after detection and tracking via heart scanning.

Despite my rather scathing accusations, Dr. Fogoros was kind enough to take the high high road and write to me explaining that his statements as posted on About.com were from 2003 and his views since then have evolved. He has more recently published a new and reasonably objective review of the traditional "repair" versus "prevent" debate that is raging in the medical marketplace.

Here it is. http://heartdisease.about.com/od/coronaryarterydisease/a/noninvasiveCAD.htm

I encourage everyone concerned with heart diease to read Dr. Fogoros' insightful analysis and decide which camp you want to be in, with the traditional "repair" folks, or the "prevention" team.

Thank you Dr. Fogoros. The Revolution continues!

HeartHawk

Great Resource for Understanding Clinical Trials

2007-12-10T10:08:00.000-05:00

I often talk about clinical trials and, if you are not a numbers and statistics geek like me, the lingo can be downright confusing and the results difficult to properly interpret. Enter, MedPage Today to offer this little gem to bring you up to speed on understanding clinical trial geek-speak.
http://www.medpagetoday.com/Medpage-Guide-to-Biostatistics.pdf

Enjoy,

HeartHawk

Cypher Stent Commercial: Not Very COURAGE-OUS

2007-12-10T08:54:00.000-05:00

In my last post I took Johnson & Johnson to task for their decision to push stents on the public. Kartik asked that I find and publish a video of the commercial for people to view. YouTube did not have it as of the date of this post but it is available by clicking this link.

Cypher Video

It seems I am not the only one who is having ethical concerns.

From the New York Times

"Not surprisingly, the campaign has stirred criticism among doctors who oppose direct-to-consumer advertising of drugs and devices, and especially among doctors who contend that stents are being implanted too often in patients who might do better with other treatments."

From leading doctors

"It's deplorable," said Dr. William E. Boden, a professor of medicine at the State University of New York at Buffalo. "You've got to wonder whether it's a sign of desperation."

Raymond Gibbons, M.D. Mayo Clinic, "Angiopplasty should be reserved for patients who are refractory to medical therapy for chest pain."

Judith S. Hochman, M.D., of New York University School of Medicine, and P. Gabriel Steg, M.D., of the Centre Hospitalier Bichat-Claude Bernard at the University of Paris, concluded that "patients . . . who have failed to control symptoms remain candidates for revascularization, but percutaneous coronary intervention should not play a major role as part of a secondary prevention strategy."

And, of course, we have the COURAGE trial (the inspiration for this post's title)

which found that stenting is no more effective than non-surgical methods for managing stable (not in the throes of a heart attack) heart disease.

CLICK HERE to watch a short video explaining the COURAGE trial

Stent manufactures will stop at nothing to push their product on an unsuspecting public. Remember, the American College of Cardiology and New England Journal of Medicine actually sanctioned researcher and interventional cardiologist (fancy title for some stent pushers) Dr. Martin Leon for attempting to sabotage the COURAGE trial once it was clear that, contrary to his expectations, it would not support stenting as a superior therapy. More chilling is that Dr. Leon was considered an important and well-respected cardiologist who has held titles such as Chairman Emeritus and Founder of the Cardiovascular Research Foundation, Associate Director of the Center for Interventional Vascular Therapy (CIVT) at Columbia University Medical Center, Director of Clinical Research at the Washington Cardiology Center, Clinical Professor of Medicine at Georgetown University Medical Center, Director of the Catheterization Laboratories in the Cardiology Branch of the National Heart, Lung, and Blood Institute at the National Institutes of Health (that's a mouthful), among others.

Kinda make you wonder just who you can trust! You know, if this were just two "corn flakes" manufacturers competing in the marketplace I would say, "Have at it. Sell me YOUR corn flake." But this isn't about breakfast, it is about cutting people open, it's about life and death.

We all know what is going on here. Since the COURAGE trial and revelation about stent thrombosis, Cypher stent sales have plummeted. The Cypher Stent commercial is all about trying to get past doctors who have started to put the brakes on the overzealous implantation of stents. This, in a word, is DISGUSTING!

Yuck,

HeartHawk

Over the Edge. Cypher Stent Commercial Goes Too Far

2007-11-30T19:29:00.000-05:00

There I sat watching Brett Favre and my beloved Green Bay Packers getting stomped by the Dallas Cowboys (so my BP is already high) and what do my eyes behold at the commercial break? Why none other than Cordis Corporation running a commercial touting their Cypher stent. The message being delivered while the band Guster is belting out its tune "C'mon" in the background is "If you have narrowed arteries that are limiting your activity, go see your doctor about getting a Cypher stent to open up those bad boys." What is most galling is their new slogan, "Life Wide Open." Yeah for about six months until your sirolimus-eluting stent produces another case of late stent thrombosis or the artery plugs up further down the line.

Nevermind that the COURAGE trial said drug and lifestyle changes are just as or more effective. Nevermind that stents DO NOT reduce your risk of having a heart attack or reduce the underlying disease that caused your arteries to narrow. Nevermind that stent insertion is a surgical procedure with significant risk of its own. Never mind that sirolimus-eluting stents have increased risk of stent thrombosis and you have to take Plavix for six months as a precaution (which has its own increased bleeding risks). Nevermind that relying exclusively on stents means you will likely need another and then another before your untimely death. No, go right out and have your doctor cut a hole in your side and snake our product into your heart all in the name of a short-term fix.

What Cordis (a Johnson and Johnsn Company) is doing is UNCONSCIONABLE! We already have unscrupulous cardiologists running "cath factories." Now Cordis is egging on heart disease sufferers to pester their doctors to put more stents in and being disingenuous in the process by not telling the whole story. Tough shit if there are better ways to manage heart disease. We only make money when stents are used.

Stents are for acute situations. There are better, safer, and more effective ways to reduce stable angina than surgical intervention. Shame on Cordis for playing the "quick fix" card and putting profits ahead of patient well-being. Perhaps they should watch this commercial.

Or this one!

Just when ya think you've seen it all!

HeartHawk

OK, This is Too Cool To Miss!

2007-11-30T19:23:00.000-05:00

Ever wonder about HDL reverse cholesterol transport and how it works to reduce plaque. Now, this is a pure commercial play by the drug giant Merck and normally I would not pass it on, but they have put together a pretty cool animation about the mechanism by which HDL removes cholesterol from artery walls. Here is the link http://www.totallipids.com/total_lipids/totallipids/mechanism_of_action/index.jsp

They also have an amimation that explains why we sometimes get that nasty flushed feeling when we take niacin. Do ya think they spent all this money on the cool animations out of the kindness of their hearts? Or, do ya think that maybe they are setting us up for some new presciption drug that raises HDL without the flushing side effect?

Hmmmm, I wonder - NOT!

HeartHawk

Diet: This is getting spooky real FAST!

2007-11-15T14:22:00.000-05:00

I have had many long-winded arguments with Dr. Davis of Track Your Plaque but I'll be damned if he isn't right again! I kind of raised an eyebrow over one of his articles titled "Fasting: Fast Track to Control Plaque" until this study recently released at the American Heart Association Scientific Sessions entitled "People who skip meals: are they better off?" corroborated his position.

The study provided fascinating evidence that suggests a fast as short and sweet as skipping two consecutive meals provides additional protection against heart disease. Dr. Benjamin D. Horne, Ph.D., M.P.H., study author and director of cardiovascular and genetic epidemiology at Intermountain Medical Center and adjunct assistant professor of biomedical informatics at the University of Utah in Salt Lake City offered two provocative quotes ...

“Fasting was the strongest predictor of lower heart disease risk in the people we surveyed."

based on the possible theory that ...

“When you abstain from food for 24 hours or so, it reduces the constant exposure of the body to foods and glucose,” he said. “One of the major problems in the development of the metabolic syndrome and the pathway to diabetes is that the insulin-producing beta cells become desensitized. Routine fasting may allow them to resensitize — to reset to a baseline level so they work better.”

OK, seems reasonable. Now, my next question is "Exactly how often do I have to "reset my baseline level?" Call me anything (and people do), just don't call me late for dinner.

Regards,

HeartHawk

And Now, Even the Stent Mongers are Starting to GET It!

2007-10-28T10:56:00.000-05:00

Let's make this clear yet again. Needing a stent, any stent, is a prevention failure. But, they are effective life-savers once you are "over the edge." Perhaps the COURAGE trials (which showed that non-interventional therapy was as effective as inteventional therapy for non-acute heart disease sufferers) has helped pushed technology in the right direction.

The TRIAS HR study has shown that the new Genous R stent to be as or more effective in patients at high risk for restenosis than paclitaxel drug-eluting stents. What is noteworthy about the Genous stent is that it has been bioengineered with a coating that attracts Endothelial Progenitor Cells (EPCs). The idea is that the stent will form a natural endothelial lining similar to healthy arteries. Recall that it is the one-cell thick endothelial lining that regulates artery dilation (by producing nitric oxide) and provides a protective barrier. Once that lining is compromised the atherosclerotic process begins.

Of course, this whole area of innovation begs the question, "Can a method be devised to get EPCs to damaged endothelial sites BEFORE lesions become acute and require a stent?" If so, you might be talking about a REAL cure to heart disease before too long!

Given that hearts in my family are genetically predisposed to fail at age 65, that gives them about 13 years to figure it out.

Stay tuned,

HeartHawk

FINALLY! A Few Docs that GET it!

2007-10-27T19:31:00.000-04:00

I spend a great deal of time exposing members of the traditional medical community who, for one reason or another, remain rooted in the "stone age" of cardiovascular care. Perhaps they are lazy, have a profit motive or are, sadly, simply ignorant. Happily, there are a few who get it like those associated with the Society for Heart Attack Prevention and Eradication (SHAPE).

The SHAPE docs have been taking quite a bit of heat for promoting heart scanning and calcium scoring as the new standard for detecting and managing heart disease. They have recently fired back at their major critics such as Dr. Michael Lauer and the Cleveland Clinic Journal of Medicine with this rebuttal.

Shape doctors such as Dr. Harvey Hecht, Dr. Arthur Agatston, and Dr. Matt Budoff understand the simple truth. Using risk factors such as the popular Framingham Risk Score can tell you if you MIGHT have heart diesase. Heart scans tell you if you DO have heart disease. If you have a non-zero calcium score you must:

1. Understand YOU HAVE HEART DISEASE. There are no ifs, ands, or buts. Deal with it!

2. You need to find out WHY you, specifically, have heart disease. The risk factors for MOST people is unimportant. What is YOUR specific cause or causes.

3. You need to take measures to counteract YOUR specific causes. Starting treatments (like statins) just because they help some or most people is just plain stupid if your specific problem cannot be helped (or is less than optimum) by the treatment.

Slowly, but surely, the truth about heart disease prevention and reversal will prevail. Heart scanning and lipoprotein analysis are proving to be the first two steps.

The truth shall set you free from heart disease!

Regards,

HearHawk

Breaking Medical News - The Pope is Catholic!

2007-10-13T16:22:00.000-04:00

This just in from the cutting-edge of traditional medical research.

"The addition of an omega-3 fatty-acid supplement to statin therapy in patients with persistent hypertriglyceridemia significantly reduced triglyceride levels and non-HDL-cholesterol levels, all without a significant increase in LDL-cholesterol levels."

YA THINK?!! Now tell me something I DON'T know. It never ceases to amaze me what the traditional medical community regards as "news." But what really irks me about this latest study is the following.

1. They only care about studying compounds as they relate to patentable prescription drugs like statins.

2. They only studied a prescription form of Omega-3 fatty acids when you can easily achieve equivalent doses with cheap, over-the-counter, equivalents.

3. They persist in maintaining "it is not clear what clinical benefit would arise from further lowering triglycerides in patients with levels between 200 mg/dL and 500 mg/dL."

It is bad enough that the FDA does not approve Omega-3 supplementation in patients with triglycerides below 500mg/dl, now we get this "old news" study that, despite its "revelation," will continue to bolster the hopelessly inept FDA. Hell, Dr. Davis of Track Your Plaque recommends a triglyceride level of 60mg/dl while these guys are still speculating about 200. One of the lead researchers even suggests that effects on LDL particle size has a threshold BELOW 200 (more non-news)!

It is pretty clear to me that this study is nothing more than an attempt to create a market for prescription Omega-3 products and take a share of the huge market for the non-prescription Omega-3 supplements. I can't wait for more "breaking news" from traditional medicine, even if it will be at least 10 years late!

Regards,

HeartHawk

Blessed with Brilliant Commenters

2007-10-04T08:24:00.001-04:00

I continue to be nothing less than impressed with the intelligence and insight of the commenters on this blog. The blog was started as an outlet to vent my frustration with what I see as cardiological malpractice and to hopefully help others by sharing my experiences. Instead, it is slowly developing into a community of ideas on the subject driven by mostly thoughtful comments from those who both agree and disagree with the way I state my case.

"Anonymous" (a scan technician) recently replied to my last post "It's STILL the Plaque, Stupid!" decrying how heart scan results are often misinterpretted by doctors who alternately tell really sick patients to ignore the results or blindly rush them to the cath lab for no good reason (and I think also in reply to a comment by "Bix"). The money quote from the comment was "You wouldn't consider a "small amount" of cancer to be normal, why do you think this disease is any different?" Of course, I will be stealing this line in the future!

Oh, and to all you "Anonymouses" out there, take credit when you say something brilliant!

Regards,

HeartHawk

It's STILL About the Plaque, Stupid!

2007-09-26T23:00:00.000-04:00

I like About.com. In fact, I use it to keep up on my Spanish. But, just as with Yahoo!, it leaves a lot to be desired in terms of heart health advice. Since I took the time to "go off" on Dr.Margolis at Yahoo! Health, it's only fair I treat the drivel being pushed by Dr. Fogoros at About.com with the same disdain. Such a pity too because he ALMOST got it right.

The good doctor attempts to answer the provocative question, "EBT (Ultrafast CT) Scans - Godsend, or Scam?" in the About.com: Heart Disease section. He actually does a pretty good job explaining everything until he gets to the real meat of the issue; the efficacy of using heart scans to track heart disease. Unfortunately, like many other traditional practitioners, he remains blinded by the hopelessly outdated fixation on OBSTRUCTIVE heart disease.

For many years heart disease theory and practice was centered on treating heart disease like a "plumbing" problem. You simply test the coronary arteries for flow and if it's adequate everything is just fine. If not, you hope you catch it in time and call "roto-rooter." Everything was focused on finding and fixing obstruction to flow. But a not-so-funny phenomenon kept occurring. People would pass their stress test and then die of a heart attack the next day! What the hell?

It is now known that most heart attacks actually occur at sites with no symptomatic or even detectable flow obstruction. Unstable, previously undetectable "silent" plaques rupture exposing their lipid core to blood, a clot forms, and bang, you're dead! The bottom-line is that what you need to know is NOT the amount of obstruction you have but your total PLAQUE burden. A heart scan will tell you this, a stress test or even a catheterization often WILL NOT.

Dr. Fogoros completely misses the point when he laments that a heart scan does not have the power to accurately predict who has an obstruction at any given instant. That is what a stress test is for. It will tell you if you currently have obstructive heart disease and are in imminent danger of dying immediately. However, it will not tell you a thing about what will happen at any point in the future - like tomorrow! A heart scan is the most accurate predictor of your risk for future heart attack.

Here is the bottom-line. Get a freakin' scan heart scan. If your score is zero, throw a party. If it is non-zero find a doc who understands what your risk is, how to determine the root cause of whatever is causing the problem (hint: High LDL cholesterol is not the most common problem), and put together a program to treat your root causes. Get a yearly repeat scan to see if your plaque burden is growing or shrinking. If it has been arrested or starts reversing - again - throw a party. This means your heart attack risk is almost as low as a zero score. If it is growing, you need to be more aggressive in your current program or change it. The key here is that without a follow-up scan you have no idea of what to do next.

So stop worrying about obstructive heart disease (OK, so don't worry quite so much). Focus on plaque burden.

Plaque is Where It's At!

HeartHawk

The Davis/Walton-Shirley Dilemma - What's the Answer?

2007-09-25T15:41:00.000-04:00

WOW! The recent comments elicited by my latest blogs on PCI demonstrate a profound concern and understanding about the dilemma of heart attack prevention versus intervention. It does my heart good (pun intended) to realize there are so many people out there who not only give this issue thought but are willing to share those thoughts. Thanks go out to Dr. Walton-Shirley and Dr. Davis for taking time out of what I am certain are very hectic schedules and the legion of commenters like Bix, wccaguy, warren, and the ever-enigmatic "Anonymous."

This issue has many real life similarities. For example, even though my parents, teachers, insurance agent, and Smoky the Bear all extol the virtues of fire prevention, it is still nice to know the fire department is only a call away to bail you out when you do something stupid (like when I went into my backyard to pitch a few golf balls while waiting for a pan of oil to heat up on my oven top). The same could be said for heart disease prevention except for the fact that, unlike fire prevention, figures of authority preaching prevention are few and far between. It leads the conspiracy theorists among us to wonder if this peculiar situation is a matter of incompetence or perhaps planned obsolescence! Remember, it was not that long ago that Detroit purposely designed cars to need expensive repairs after several years.

So what to do? On the one hand preventionists have a hell of a point, the technology to prevent most heart attacks exists today and is simply not being made available on a widespread basis. On the other hand, we have a large segment of society that either blindly follows outdated health practices or are simply to dumb or lazy to take responsibility for their health. What do we do, let them die? (Darwinists might argue that this is a valid option).

I believe the comments made on this blog point the way. Yes, let's continue to develop fast, cost-effective rescue measures for the unlucky few who infarct despite prevention or those too blind to help themselves. But, at the same time, let's DEMAND that the medical establishment educate and discipline itself to practice modern prevention. Let's have the interventionalists actively put pressure on their own colleagues to balance their practice with prevention and throw out the ones who operate "catheterization factories." There is no room in medicine for putting unethical profit and "God complexes" above lives. Remember, even if there were an interventionalist in every "pot" and a cath lab in every "garage" many people would still die needlessly.

So, there's my compromise. Any takers?

HeartHawk

Dr. Melissa Walton-Shirley States Her Case

2007-09-19T09:35:00.000-04:00

Back in June I wrote a rather scathing blog that took Dr. Walton-Shirley to task for her position on Primary PCI. She was understandably upset that I would read into her comments something that she claims was either misread or simply not there and wrote this comment to take me to task.

I guess I really cannot blame her for being upset that I used her as the latest scapegoat for the failing medical establishment, but, I felt, and still do, that my position on the medical community as a whole was right on the money. So, in an effort to set the record straight on numerous fronts, let's get down to the nuts and bolts of my position. Then YOU can decide.

1. First, let's all understand something. In any debate there are two sides and both sides must anchor their end of the spectrum. Dr. Walton-Shirley feels the best use of time, talent, and money is to build more cath labs and train more people in how to use them so that IF you have a heart attack, you stand a better chance of being pulled back from the brink of death. Unfortunately, you have to first let people get so sick that they are about to die. My position is to use those same resources to prevent such disasters from happening in the first place. Take your pick. You cannot spend the money twice.

2. My role in this melodrama is to be as aggressive and relentless as the other side. This is not Little League. Like it or not this a "blood-sport" and that is not just a metaphor. People's lives and quality of life are at stake. I am not above spilling a little blood of my own along the way.

3. In my blog I praised Primary PCI as a wonderful tool. I miss my mother, my grandfather, and my uncle and wish a cath lab had been across the street when they were in the throes of their heart attacks. But, I wish, even more, that they had access to enlightened medical care 5-10-20 years before those sudden, life-ending events, care that would have PREVENTED them having a heart attack in the first place.

4. My biggest complaint is the complete lack of self-policing within the traditional medical community. There are ways to effectively prevent and treat heart disease that simply are not being disseminated by the so-called guardians of our health. I have had top-flight, (previously) trusted internists and cardiologists make the following statements to me and my relatives.

- (after a routine cholesterol panel) "I have seen 50 patients today and your LDL cholesterol is lower than all of them. Now stop worrying." (NOTE: My doctor said NOTHING about my abnormally low HDL cholesterol nor, given my family history, do more than a conventional Friedewald lipid panel).

- (after my brother was tested at my urging - not his doctor's - and diagnosed with high lipoprotein(a)) "Here, take this statin. It's magic!" (NOTE: Statins are completely useless for reducing lipoprotein(a))

- (after my first nuclear stress test) "There is no evidence of any obstructive disease. I would not do anything at this point." (NOTE: It has been established that you can have extesive CVD with no detectable obstruction)

-(a conversation after an uncle's triple bypass) "ME: Too bad you didn't have a heart scan. UNCLE: I did, seven years ago. My score was 1200 but my doctor said as long as my stress test was OK to ignore it." (NOTE: 1150 of the 1200 was in his LAD, the only artery receiving - count 'em, not 1, not 2, but 3 bypasses)

- (2 weeks before my mother's fatal heart attack) "Congratulations, you passed your physical. Looks like you escaped your family's curse."

These were not schmucks but the best physicians we could find (and I'm damned good at it). Sorry, but I am not exactly the trusting sort anymore. In fact, I am as mad as hell!

SO WHERE IS THIS ALL GOING?

I do not fault Dr. Walton-Shirley for studying hard, working late, saving lives, and espousing ideas to save even more lives. If her ONLY intent was to make Primary PCI more available my ONLY question is whether this is the best use of resources. However, I am totally frustrated when the medical establishment continues to blindly put the cart before the horse. Dammit, it is just wrong to constantly beat the drum for more heart procedures when the overwhelming majority of them can be avoided. How about a little balance?

So, thanks for all the hard work and please do keep saving lives Dr. Walton-Shirley. As someone whose style is to be aggressive I admire the fact that you cared enough to fire back. Perhaps this will be the start of a wonderful professional relationship. We owe it to everyone to work together and limit "friendly fire." In fact, if I see your next published editorial is about cutting-edge prevention I guarantee I will write an equally effusive blog about a doc who "gets it." God knows we need more of them. But, don't be too surprised if I still get a little irritated when your colleagues fail to speak out about prevention and malpractice within your own ranks. But, I guess that's my job.

Regards,

HeartHawk

I told you so ... you Yahoos!

2007-09-18T23:24:00.000-04:00

I hate to gloat (so I lie) but this breaking news just came in.

A few days ago I took Yahoo Health expert Dr. Margolis to task for suggesting in his health quiz that Vitamin D was of no value for fighting heart disease. Guess again! Experts like Dr. William Davis have been extolling the virtues of Vitamin D supplementation for well over a year now. He credits D with remarkable instances of heart scan score reversal when used in conjunction with his Track Your Plaque program (note that honest brokers of heart health information will never promote a single "magic bullet" because there ain't no "one size fits all" answer in this game).

Anyone who still doubts the efficaciousness of Vitamin D should take notice of the study recently released by Drs. Autier and Gandini in the September 10th issue of the Archives of Internal Medicine. They found that doses of Vitamin D ranging from 300IU to 2000IU correlated with decreased risk of ALL CAUSE mortality (that includes heart disease, cancer, etc.) with no toxic effects. The study was a meta-analysis of 18 independent trials involving 57,311 participants.

Of course, this study does not have the power to differentiate effectiveness against any specific disease (say CVD for example) or determine recommended doses. The good doctors leave it to future studies to ferret out that information. But, considering the size of the study, it is a sure 20 to 1 bet (the study used the standard 95% confidence interval) that something phenomenal is going on.

So let me say it for the hundreth time. Traditional medicine is hopeles sly behind the curve when it comes to heart disease prevention and reversal. Unfortunately,they are largely invested in letting you get so sick you have to buy their surgical interventions and drug therapies. You have to dig and dig deep, gleaning information from many sources, in order to to have fighting chance to beat heart disease. Yes, there are quacks looking to snow you. But, if you don't fall hook line and sinker for every gimmick and snake oil salesman, if you do your research and believe in hard data over anecdotal instances, if you find praticitioners and patients with a history of success over years rather than days, if you just use COMMON SENSE, you can, and will, beat heart disease.

Now go take your Vitamin D!

HeartHawk

You Just Might be a Yahoo if . . .

2007-09-14T22:40:00.000-04:00

. . . if you get all your heart health info from Yahoo!

Now, don't get me wrong, Yahoo is a fine search engine. Heck, how could I have made the above obervation if I never used it? But, it is yet another example of how hopelessly confused and inadequate traditional, mainstream medicine is.

The latest example can be found at Yahoo Health in a Heart Health nutrition quiz authored by Simeon Margolis, M.D., Ph.D. (although I also must admit that as a basketball junkie I am thoroughly impressed that Dr. Margolis still holds the record for most points scored in a game at his prestigious alma mater, Johns Hopkins). However, in question #5 of the quiz, the good doctor dismisses the heart health value of a long list of supplements - including Vitamin D! There have been numerous reports and studies published in the last year that support the use of Vitamin D supplementation as a preventive measure for heart disease. I am sworn to secrecy but I know of a small clinical study (which won't be available for at least six months) that will validate the latest research about the ability of Vitamin D to actually reverse heart disease. That study is too small to provide conclusive proof but the data is astounding.

The point is that many, if not most, physicians today are hopelessly out of date and out of touch with the fast pace of heart disease detection and prevention. So, at the risk of endless repetition, get your information from as many sources as possible. Relying on the advice of your local physician, or even the celebrity docs on Yahoo!, could be a fatal mistake!

Yippity Yahoo,

HeartHawk

It's the Plaque - Stupid!

2007-09-13T23:58:00.001-04:00

I remember when I first met Dr. William Davis and we discussed the book he was writing titled "Track Your Plaque." My first thought was, "What a goofy name!" In retrospect, focusing on plaque and methods to track and reverse it was brilliant.

The latest debate about relative risk ratios and antioxidants reminds me about how traditional medicine relies on all manner of risk factors to determine how to treat heart disease. However, risk deals only with might or could happen. Yes, if you have high LDL cholesterol, low HDL cholesterol, or any number of other risk factors you might have heart disease. But, why live in the world of "maybe" when you could know exactly whether you have heart disease, how serious it is, and whether what you are doing is effective in treating it?! Get a heart scan and you will know for certain. As Homer Simpson would say, "DOH!"

The efficicacy of heart scans is no longer in question. Recent studies, statements by the AHA, the SHAPE guidelines all agree - heart scans are the best predictor of heart attack. I have always been impressed by the powerful statements issued by noted and independent heart disease experts and researchers.

Dr. Steven Nissen, Cleveland Clinic: "We now know that 95% to 99% of the heart disease occurs at sites WITHOUT artery narrowing. Thus, the old tests we perform to detect narrowing and blockages have really misled us. We miss over 95% of the heart disease that causes heart attacks."

Dr. Harvey Hecht, The Heart and Vascular Institute: "plaque imaging is ...not to be confused with risk factors, which merely estimate a probability of developing atherosclerosis. Rather, [plaque imaging] directly measures atherosclerosis, irrespective of the presence or absence of risk factors; it provides the final common denominator and is the most powerful predictor of cardiac events."

Regardless of cholesterol or the supplements you may or may not be taking, settle the question. Get a heart scan and, if you have a non-zero score, repeat it every year to see if you are gaining or losing ground. The plaque that is the root cause of heart disease can be treated - but only if you know how much you have!

Plaque, it's not just for teeth anymore!

HeartHawk

Dr. Cook Weighs in on WACS Antioxidant Study

2007-09-11T09:55:00.000-04:00

Given all the commotion over the WACS Antioxidant Study, I contacted Dr. Nancy Cook who served as the lead bio-statistician on the study. She has agreed to let me publish her verbatim replies to a number of questions that are central to the debate. Here they are!

HeartHawk: What was the significance of setting the noncompliance threshold at using 2/3 of supplied study agents?

Dr. Cook: The threshold of 2/3 was pre-specified, but not particularly based on biologic activity. However, I can say that most of the women in the study either took all (or at least 90%) of the study pills or none. We didn't have many at intermediate levels, so the exact choice of cut point would probably not make much difference to the analysis.

HeartHawk: Please comment regarding the significance of the improved risk-ratio for Vitamin-E when noncompliant subjects were censored.

Dr. Cook: It's true that some significant effects emerged in our analyses censoring on noncompliance. This analysis, though, is not intent-to-treat, and can be subject to bias since those who take the study pills are likely to be very different from those who don't. It's also possible that intervening changes in risk factors are related to the lack of compliance, possibly differentially by treatment group (similar to confounding by indication). The outside use of these supplements also needs to be taken into account. The analysis censoring on compliance thus needs to be interpreted with caution. The results among compliers could be due to this self-selection bias, to a true preventive effect in those who keep taking the vitamin E regularly, to a possible early effect that goes away with time, or to a false positive finding due to the multiple comparisons. At this point we can't separate these out. So, while some of the findings for vitamin E are indeed tantalizing, they don't hold up to strict statistical or clinical trial standards. And the body of evidence for anti-oxidant trials in general has largely been disappointing. The most straightforward interpretation is based on our primary result, that there is overall no effect of this particular supplement on the composite endpoint. We cannot trust the secondary analyses to be reliable at this point.

HeartHawk: Any thoughts or comments about what WACS results may intimate about the value of naturally occurring antioxidants in foods as compared to supplements in any dosage or combination.

Dr. Cook: It's true that not everything is known about anti-oxidants, either by type or in combinations. As suggested in the discussion in the paper, some scientists have suggested that other forms of the anti-oxidants (eg. gamma- vs alpha- tocopherol) may be more beneficial. It's also possible that it is a combination of nutrients that has an effect. At this point it seems from a vast array of observational studies that diets high in fruits and vegetables are protective, which has also been supported by intervention studies such as DASH. So perhaps we haven't been studying the right form of anti-oxidant, or maybe a combination is needed, or maybe it is other nutrients in fruits and vegetables that are protective. There is still a lot that is uncertain. The best advice to the public is to eat a diet high in fruits and vegetables as well as to follow other healthy lifestyle habits, such as exercising regularly, rather than relying on supplements.

Thank you for your time and interest Dr. Cook!

HeartHawk

More on Antioxidants and the WACS Controversey

2007-09-09T21:58:00.000-04:00

Hey, Hey! Looks like old "Hawky" hit a nerve with my jab at antioxidants! That's great because it's an area that deserves considerable debate given the fact that many of us consume significant amounts of them. Thanks go to "Captnsaj" and "Anonymous" for getting the debate going. Let's see where it goes!

First, let me confirm I am not an antioxidant "hater." Although, I do think Linus Pauling's and Mathias Rath's advice about ingesting mega-doses of Vitamin C is kinda loopy. What I AM saying is that, statistically, the WACS Study says they are not effective at reducing CVD. Lord knows I believe in the value of supplements and have had my share of disagreements with the drug companies. Drug company funding is ALWAYS problematic in any study but WACS was funded by the National Heart, Lung, and Blood Institute.

It seems Mike Adams is taking the lead in attacking the WACS study. So, for the time being, I will play devil's advocate and take the opposite side. Here goes ...

1. Let's start by refuting Mike's claim the study supports the use of antioxidants. In fact, the ONLY conclusion it draws is they are no more effective than placebo. The two exceptions were the findings that Vitamin E reduced risk once non-compliant subjects were removed and was duly noted in the report. However, the study produced dozens of statistical findings and the only one that showed statistical significance (just barely with a P=0.04) was the use of Vitamin E in women with confirmed prior CVD (but not women with risk factors but no confirmed CVD). There was also a "suggestion" Vitamin E in combination with Vitamin C should be looked at for effectiveness as reducing stroke risk as it showed statistical significance (P=0.o3). Frankly, when you generate that many statistics on a sample population, one or two may produce a false positive (in fact, statistics say it is likely). You have to consider the overwhelming body of statistics generated.

2. One needs to understand a little bit more of the math behind statistics. The study said the relative risk ratio (RR) for heart disease related events (heart attack, stoke, revascularization, and death) was not improved by any of the supplements. The key is to look at the confidence intervals (CI) and "P" values for each statistic. When P values exceed the "significance level" (o.o5 in this case) or the CI encompasses the value "1" then statisticians assume the null hypothesis is not rejected. In other words the tested agent did not produce any result that could not be explained by other than random chance. Note that the P values are all far greater than 0.05 in almost every case and the CI's encompass "1". In the few cases where marginal significance was achieved, the P values where only modestly below 0.05. Normally, I like to see these values in the range of 0.001 to 0.01 before I completely reject the null hypothesis. Required reading at this point should be Chapter 3 of Steven Milloy's treatise SCIENCE WITHOUT SENSE: The Risky Business of Public Health Research. There is also a good layman's description of the subject at http://sportsci.org/resource/stats/pvalues.html

3. Mr. Adams claims that non-compliant subjects were used to "dilute" the results. Unfortunately, that is not neccesarily the way statistics work. I put a call in to Dr. Nancy Cook the bio-statistician that oversaw the project. Perhaps she will provide more data. The example Adams gives where 50% of the test subjects did not receive "sandwiches" is a little outrageous and does not correspond at all with the way the WACS Study was run. I might also add that even using his fictitious example, the efficaciousness of "sandwiches" would still be borne out using the WACS statistical methodology.

4. Mr. Adams makes patently ridiculous statements like "If we taught people the truth about nutrition, they wouldn't need prescription drugs!" and "Drugs don't make people healthy." Tell that to all the people who died of infections or lost limbs before the advent of antibiotics (yeah, I know what you are thinking, but ANYTHING can be over-prescribed and misused). These sorts of patently false claims leads me to discount much of his other rhetoric.

5. Most drugs are simply purified and concentrated forms of naturally occurring substances. And just because a supplement is not a prescription agent does not mean it is not a drug. In fact, supplements like L-Carnitine require a prescription in Canada. Also, I doubt the Vitamin C Mr. Adams takes is distilled from oranges. It is likely made in a big chemical plant just like all the drugs he rants about. Finally, he mentions what he feels to be relatively low doses used in the WACS study. Linus Pauling routinely advises doses like 10 grams of Vitamin-C. How is THAT natural?

As always, the truth is somewhere in the middle. That is why I always advise people get their info from multiple sources - even zealots like HeartHawk and Mike Adams!

As for me, what the heck, I say hedge your bet. If you got the time, inclination, and money, a daily dose of 1000mg C and 400IU of E can't hurt. In fact, the WACS study makes a point of saying that it did not find any dangerous effects as were found for Vitamin E in earlier studies. Just don't expect any miracles!

More comments are encouraged!

Regards,

HeartHawk

Another Nail in the Antioxidant Coffin?

2007-08-21T22:41:00.000-04:00

The WACS (Women's Antioxidant Cardiovascular Study) followed 8171 women over an approximately 10-year period to study the effects of antioxidant supplements Vitamin C, Vitamin E, and Beta-Carotene. Their conclusion was that none of these supplements improved cardiovascular outcomes in any combination as compared to placebo. The study also added Folic Acid about half-way into the experiment.

While the study authors were quick to single out and pan antioxidant supplements, they did not go so far as to exclude dietary sources of these vitamins. The implication (in my mind) is that small amounts of antioxidants may provide some benefit but that benefit cannot be magnified by loading up on antioxidants via supplements. Keep in mind, nobody refuted the finding that cholesterol oxidation plays a significant factor in atherosclerosis. They simply said that supplementing dietary sources of the studied antioxidants provides no benefit. But, they also determined that, contrary to other findings, these supplements did little or no harm.

A big fat "I told you so" goes to Drs. Linus Pauling and Mathias Rath (yeah, yeah, I know, they used FAR less than what YOU recommend and didn't include L-Lysine and Proline in the study).

Regards,

HeartHawk

Glycemic Index Versus Load - Another Diet Myth

2007-08-08T20:10:00.000-04:00

Yet another study confirms that diets composed of low Glycemic Index (GI) foods are better for both lipid management and weight loss. But, by only stressing GI they overlook the other half of the equation, Glycemic Load (GL). Put simply, it's not just how high the GI is of a particular food but how much of the high GI component is in the food product per gram or unit volume consumed.

GI is a measure of how quickly the carbohydrate portion of a food is converted to glucose and raises blood sugar. High GI foods raise your blood sugar rapidly and provoke a rapid and equally high insulin response. The body really hates this! However, GI is ONLY a measure of rate of change, not how much glucose/insulin is actually generated.

GL is a measure of the grams of carbohydrates in a quantity of food times its GI (divided by 100) and is a better indicator of how the body will respond to eating it. You can eat low GI food and still provoke a high insulin response if you eat enough of it. Similarly, eating small amounts of a high GI food may do little damage.

But foods are not composed purely of carbohydrates. There is another factor that must also be considered, carbohydrate density. For example, corn, and therefore popcorn, has a high GI. That would suggest popcorn is a food to avoid. However, popcorn is mostly air and does not contain many carbohydrates per unit volume. While the few carbohydrates in popcorn does indeed have a very high GI, you have to eat a fair amount to raise blood sugar.

Compare a cup of watermelon to a cup of high-fructose sweetened soda. Both have an identical volume. Watermelon also has a slightly higher GI than soda (72 versus 68). Yet a cup of watermelon has a GL of less than 1/3 that of soda simply because it is less than 1/3 as carbohydrate dense as soda. You are far better off consuming a cup of watermelon than a cup of soda even though watermelon has a higher GI.

I suppose if you are dealing with simpletons who cannot comprehend math or portion size you simply tell them to avoid high GI foods entirely. If you consider yourself a simpleton then just ignore this rant! Otherwise, pay attention to GL rather than GI.

Simply said,

HeartHawk

Diet Coke Dilemma: Junk Food Junk Science

2007-08-08T10:30:00.000-04:00

This is the kind of statistical nonsense that makes a numbers guy's blood boil (like mine). A recent study by a researcher at the Boston University School of Medicine found that persons who drank more than one soft drink per day had a higher risk of developing the dreaded "metabolic syndrome" and IT DIDN'T MATTER IF THE SOFT DRINK WAS SUGAR FREE. Of course, the bonehead media jumped on this paradoxical statement as they always do to generate provocative headlines. And, of course, the conclusion is, in a word, BULLSHIT!

Of course, we all know that metabolic syndrome is a major heart disease risk and that it has grown to epidemic proportions largely because of Americans (especially kids) consume a great deal of sugar and processed carbohydrates. So let's set a few things straight and rehash once again how figures lie and liars figure.

First, the study never said that sugar-free soda caused metabolic syndrome. It merely stated there was an association. I wish I could remember the name of the medical researcher who offered this great analogy.

"Everytime a plane flies over my backyard, my dog barks at it. Everytime my dog barks at a plane it continues to fly away and does not land in my backyard. Therefore, while I can say my dog's bark is ASSOCIATED with planes not landing in my backyard, I cannot say my dogs bark CAUSED the plane to fly away." Get the picture? Barking dogs clearly scare away postmen, robbers, cats, and rabbits but not airplanes even though from, a statistical association standpoint, the observations may be identical.

The same is true in this instance. It is likely that people who consume soft drinks of any kind are more likely to engage in other high risk behavior that IS causal (like eating a Big Mac and fries). But does that mean it makes no difference if you drink Diet Coke or regular Coke? HELL NO! But, that's not the way the press writes it.

Sheesh! It never ends.

HeartHawk

OK - Time to Stop Holding Back - TYP is King

2007-08-07T23:46:00.000-04:00

Because I am so close to Track Your Plaque (TYP) and author Dr. William Davis I have been reluctant to be too effusive about the TYP heart disease reversal program on this blog for fear of losing my objectivity. But at some point, when a concept keeps proving to be right you have to finally give in to the notion that perhaps, just perhaps, a guy is on to something.

First, it was the begrudging admittal by the American Heart Association that heart scans really are effective measures of heart disease. TYP was the first to incorporate heart scans as the basis for developing personalized heart disease reversal programs.

Next, TYP was on the cusp of recognizing the potential of several novel treatments like L-Arginine and Vitamin D.

Then TYP starting seeing tremendous amounts of heart disease reversal in their clinical practice (double-digit reversal percentages are common under the TYP program in a universe where even a 1% reversal may mean a HUGE reduction in heart attack risk) .

But the final straw for me was the latest Stanford University School of Medicine study proving the efficaciousness of the bedrock TYP 60/60/60 principle (lipoprotein targets 0f 60 LDL cholesterol, 60 HDL cholesterol, 60 Triglycerides). The HDL and Triglyceride targets were never really in question but there had been much concern that an LDL level of 60 or less might actually be harmful (cancer risks were the primary concern). The Stanford Study of 6000 persons laid this worry to rest showing that, even at LDL levels as low as 40mg/dl, all cause mortality dropped almost 50%. The joke among the researchers was that "you can't be too rich or too thin or have too low a cholesterol level."

The TYP program continues to be right time after time after time. I am one of the most skeptical guys in the world. Dr. Davis himself will tell you I constantly challenge his work (OK, in the past it may have bordered on harrassment). But, geez, I am a numbers guy. When you are right this many times in a row, it just can't be dumb luck. I guess that makes me a Track Your Plaque partisan. At least I'm warnin' ya!

Track, Smack, and Jack That Damn Plaque!

HeartHawk

Looky What I Found!

2007-07-15T13:24:00.000-04:00

I recently came across this little gem as I was doing research for the article I mentioned in my previous blog. It's a radio interview of Dr. Davis debating with a "Neanderthal" Harvard School of Medicine professor about the value of heart scans. Davis pretty much chews up the poor, knuckle-dragging, old-school cardiologist. This is a "must hear" primer on how to approach heart disease. I'm going to suggest that Davis consider posting it in the open content area of the Track Your Plaque website.

CLICK HERE to listen (this is a .ram file so you will need the free RealPlayer to play). It's a twenty minute interview so, unless you download the file to your computer before playing, it takes a while to queue up - be patient.

Enjoy!

HeartHawk

So, Where Ya Been HeartHawk?

2007-07-15T13:14:00.001-04:00

The answer? Finishing my latest expose' as a feature article for Track Your Plaque. You can find it by clicking this link The Bankrupting of American Healthcare: $20 Billion, Many Lives Lost Each Year. It's in the open content area so you don't have to be a member to read it.

WARNING: Being a numbers guy I went a little nuts but the functional cost calculator I put at the end of the article lets anyone change my assumptions and run their own "what if" scenarios. I can't wait for people to start throwing stones at my calculations. Fire away!

Still Kicking,

HeartHawk

Yet Another Idiot Doctor with a BUTCHER SHOP Mentality

2007-06-12T17:46:00.000-04:00

A recent headline at WebMD's Medscape site proclaimed "It Should Be the Right of All Americans to Have Primary Percutaneous-Based Intervention for Acute Coronary Syndrome" (http://www.medscape.com/viewarticle/557124?src=mp).

In the accompanying editorial, Dr. Melissa Walton-Shirley calls for the "greatest push in the history of American cardiac medicine" in order to "improve accessibility to primary percutaneous-based intervention" (angioplasty, stents, etc.). She suggests that "All invasive cardiac laboratories with access to interventionalists should be urgently brought into programs that will allow for appropriate support staff training ..." given the "Improved pharmacologic therapy, better stent platforms, and the advancement of wire technology."

Now, let me get this straight. According to "Doctor" Walton-Shirley "It Should Be the Right of All Americans" and we should have the "greatest push in the history of American cardiac medicine" to cut people open and snake wires up their chests after she, and other "doctors" of her ilk, let their patients become so diseased that they have a heart attack simply because we have great "technology" to fix it.

I HAVE A BETTER IDEA DOCTOR WALTON-SHIRLEY!!!

I believe "It Should Be the Right of All Americans" and there should be the "greatest push in the history of American cardiac medicine" to provide access to even more remarkable "technology" that provides early-detection and treatment for heart disease BEFORE they have no other alternative than to go under your BUTCHER SHOP care! That IS what doctors are SUPPOSED to do, isn't it?

Now, don't get me wrong. Percutaneous intervention is a wonderful technology that can save the lives of acutely diseased patients. But the priorities, if not position, of Walton-Shirley is so grisly and perverse I don't know what else to say. For her, the solution to heart disease is to demand the opening of more butcher shops rather than demand the institution of pervasive early-detection and prevention programs. What next, expand the distribution of leeches in hospitals? Wake-up and join the 21st century, would ya?

Unbelieveable,

HeartHawk

Co-Q10: Are these docs out of their minds?

2007-06-07T11:12:00.000-04:00

A recent report in the Journal of the American College of Cardiology (http://content.onlinejacc.org/cgi/content/short/49/23/2231) authored by Drs. Leo Marcoff and Paul Thompson proclaims, "The routine use of CoQ10 cannot be recommended in statin-treated patients." Let's take a moment and review key findings from their abstract and see if we come to the same INANE conclusion. Italicized items are quotes. Items in parenthesis are my admittedly sarcastic comments.

1. Statins block production of farnesyl pyrophosphate, an intermediate in the synthesis of ubiquinone or coenzyme Q10 ... (So, we agree that statins reduce production of Co-Q10.)

2. This fact, plus the role of CoQ10 in mitochondrial energy production, has prompted the hypothesis that statin-induced CoQ10 deficiency is involved in the pathogenesis of statin myopathy. (Hmmm, that seems to make sense too!)

3. We identified English language articles relating statin treatment and CoQ10 (Translation: We did no original research of our own.)

4. Statin treatment reduces circulating levels of CoQ10. (So, we agree on that too.)

5. ... data on intramuscular CoQ10 levels in symptomatic patients with statin-associated myopathy are scarce. (So, the bottom-line is you really do not have much data to base ANY sort of recommendation.)

6. Mitochondrial function may be impaired by statin therapy, and this effect may be exacerbated by exercise (OK, I'm still with you.)

7. Supplementation can raise the circulating levels of CoQ10, ... (What am I missing? It seems you agree that Co-Q10 supplementation will raise bioavailability.)

8. ... but data on the effect of CoQ10 supplementation on myopathic symptoms are scarce and contradictory (Yeah, you already said you don't really know ANYTHING for certain in item 3.)

9. We conclude that there is insufficient evidence to prove the etiologic role of CoQ10 deficiency in statin-associated myopathy (You keep telling us you don't really know - we BELIEVE you!)

10. ... well-designed clinical trials are required to address this issue (Well DUH!)

11. Nevertheless, there are no known risks to this supplement and there is some anecdotal and preliminary trial evidence of its effectiveness. (So, then why would you NOT recommend supplemental Co-Q10 in an attempt to save your patients the pain and debilitation associated with statin-related myalgia?)

12. Consequently, CoQ10 can be tested in patients requiring statin treatment, who develop statin myalgia, and who cannot be satisfactorily treated with other agents. (WTF?! OK, now I am really confused! Holy contradiction, Batman!)

Gee whiz, what was their idiotic conclusion again? Oh,Yeah.

"The routine use of CoQ10 cannot be recommended in statin-treated patients."

Excuse me, but do I look stupid? What kind of crap are these guys peddling? Did they miss the lecture on deductive reasoning? Did their mothers drop them on their heads when they were infants? Somebody please tell me how simpletons like these two manage to pass their medical boards?

To make matters worse, this ridiculous, off-the-hook statement is the headline in one my favorite online cardiological news sources (http://www.theheart.org/viewArticle.do?primaryKey=794465&nl_id=tho05jun07).

This type of sloppy and insane research and reporting should be EXHIBIT 1 in my constant rant that you have to get your information from multiple sources and use your own reasoning. Just because someone lists "doctor" or "reporter" as their title does not guarantee they have an even an ounce of common sense. Trust your own mind and body. I will keep taking my Co-Q10 for one simple reason - it hurts when I don't!

Give me a break,

HeartHawk

Another Gene-Based Heart Disease Discovery

2007-05-09T02:49:00.000-04:00

Dr.Davis of Track Your Plaque likes to emphasize the benefit of having a positive attitude when battling heart disease. Well, here is some additional optimism. Researchers are continuing their search for the "Holy Grail" of heart disease and have found yet another gene-marker for heart disease on human chromosome 9 (you may recall my earlier blog on another gene marker - it is a good refresher on genomics). Better yet, the discovery was made independently by two separate labs which greatly increases its validity. The abstracts for the two studies can be found at http://www.sciencemag.org/cgi/content/abstract/1142842v1 and http://www.sciencemag.org/cgi/content/abstract/1142447v1 while a synopsis of both pieces of research appears on Medscape at http://www.medscape.com/viewarticle/556019?src=mp (free membership needed to access).

What is most interesting is that the DNA sequence is not part of any known gene so it does not code to produce any protein. These areas were once thought to be nothing but "junk" DNA but this discovery leads credence to the theory that these areas serve some yet unknown purpose.

Of course, just knowing you have the gene sequence or "SNP" (my daughter tells me to say "snip" if you want to speak like a savyy biochemist - you can read more at my earlier blog on another heart disease gene) would be useful. A company in Iceland reports it hopes to have a home test kit on the market in about one year. However, the real prize is to develop techniques to alter heart disease genes to render them harmless. Once all the genes for high cholesterol and other heart disease factors factors been identified and can be corrected, heart disease will truly be cured - and with no drugs!

We are getting closer every day!

Optimistically Yours,

HeatHawk

Will Someone Please STOP the Insanity

2007-04-27T16:41:00.000-04:00

I recently completed another one of those online "Heart Disease Risk Analyses" that are becoming more and more frequent on hospital websites (You can find this particular one at https://inspirahealth.com/apps/nahrs/index.htm?hospID=103). They all involve filling out an online questionnaire asking questions about height, weight, blood pressure, cholesterol, etc. They then electronically compare your answers with the motherload of all heart health studies, the Framingham Heart Study experience.

Now, don't get me wrong, the Framingham Study is the "motherload" of all heart disease risk analyses. It has an unbelievable amount of data catalogued over decades of experience. It's problem, like most risk analysis of this ilk, is that all it tells you is your risk. It does not tell you whether you actually have heart disease. BUT A HEART SCAN WILL!!!

For example, my risk for developing heart disease, based on all the data I supplied, was a mere 9%! Nine percent?!!! My actual risk for heart disease is 100%! I have it and it has been confirmed by a half dozen heart scans over the last six years! If all I did was take this online test I might still be eating McDonald's hamburgers and fries for lunch everyday.

This type of health care practice is INSANE! Look, all the "risk factors" tell you is whether you might have heart disease. Regardless of risk factors and "probabilities" the answer is maybe "yes" and maybe "no." There are plenty of people like me with low "risk factors" that still have heart disease and others whose risks are high yet never develop heart disease. A heart scan will tell you with damn near 100% certainty whether you do or do not.

It amazes me that so-called health care professionals still engage in such "hocus pocus" (perhaps for profit, maybe). Remember, I am still a numbers guy. Risk factors are a wonderful tool when you do not have the means to determine an outcome with any certainty. BUT, THIS IS NO LONGER THE CASE WHEN IT COMES TO HEART DISEASE. Stop the insanity. Get a heart scan and learn the truth. Gee whiz! This ain't rocket science!

Regards,

HeartHawk

Fish Oil + Low-Dose Statins = 19% Heart Attack Reduction!

2007-04-18T16:04:00.000-04:00

I once asked Dr. William Davis of Track Your Plaque fame if he could use only one supplement what it would be. He quickly answered, "Fish Oil!"

Many have touted the heart health benefits of the Mediterranean Diet (high in fish products) or simply taking fish oil as a supplement. Now, the new JELIS study (PubMed Abstract, HeartWire Article), an 18,645 participant study over 5 years shows that major cardiac events are reduced 19% when fish oil is used to supplement a low-dose statin regimen.

This finding could be a real boon to many heart disease sufferers who cannot tolerate high-dose statin therapy!

Regards,

HeartHawk

Round 2: Cocoa Kicks Tea's Butt

2007-04-15T00:16:00.000-04:00

Yes, another study is out and cocoa is the clear winner over tea as far as lowering blood pressure is concerned. In a study recently released in the Archives of Internal Medicine (see the free PubMed Abstract), the polyphenols (the group composed of phenols and the more abundant and popularly known flavonoids) in cocoa products (such as dark chocolate) produced significant reductions in both diastolic blood pressure (-4.7 mmHg) and systolic blood pressure (-2.8 mmHg) as compared to tea (both black and green).

The study made some rather dubious claims that the drop in blood pressure was comparable to monotherapy with either beta-blockers or ACE inhibitors but my limited experience (I don't have high blood pressure) suggests that is a bit of a stretch (i.e. most people I know have significantly greater drops on prescription drugs). But, hey, it's nice to know a little cocoa goes a long way. The authors were also quick to point out that this only works if the cocoa calories ingested did not exceed a healthy total caloric intake. Sorry, you cannot pig out and then eat chocolate to get healthy. If you take a cocoa supplement you must cut back an equal number of calories elsewhere!

Bon Appetit!

HeartHawk

Eagle Eye: New Gene Research Target

2007-04-14T16:09:00.000-04:00

The 'Eagle Eye' is a new recurring blog item that will look at cutting edge research into the root causes and potential 'cures' for heart disease. The latest item is the research into the 'kalirin' (KALRN) gene and the 'Rh0-GTPase' signaling pathway. The abstract can be found at http://hum-molgen.org/NewsGen/03-2007/000023.html Let's break it down in layman's terms for all those who slept through Bio-Chem lecture with special thanks to University of Wisconsin Honors Bio-Chem major - and my daughter - Caitlin (you didn't really think I was that smart did you?).

Researchers looked at chromosome 3q13-21 (a specific section of a human DNA strand), a site already established as playing a role in early onset atherosclerosis. We remember (yeah, sure) that DNA is simply a 'biological program' for creating the basic proteins that make up living organisms. It is composed of a long sequence of nucleotides (a fancy word for a group of four chemical compounds adenine, cytosine, guanine, thymine abbreviated A, C, G, and T respectively) that are organized into what we know as 'genes'. These sequences of A, T, C, and G, our genes, determine what proteins are made (thousands of them) and ultimately determine what the end result of the process is (an artery for example).

The researchers also considered little glitches in our genes called 'Single Nucleotide Polymorphisms' (SNP). SNPs are simply gene sequences where a single nucleotide (remember A, G, C, T) is replaced with another, incorrect, nucleotide. SNPs in genes sometimes code to produce the same protein, but they can also create subtle differences that are beyond the space in this blog to describe.

Finally, researchers used the '1-LOD-unit-down' method which is a statistical method of determining whether a gene is likely to be linked or associated with another gene in a given chromosome (wonks can review Genetic Linkage for a complete description and the math).

Now to the good stuff. Here is what they found.

A strong association between SNPs and heart disease was found in the KALRN (kalirin) gene. Three SNPs in the kalirin gene in particular were found in patients with early-onset heart disease. The kalirin gene is also responsible for the inhibition of 'inducible' (i.e. endothelial) nitric oxide synthase (iNOS/eNOS) which we all know regulates artery dilation (the body synthesizes endothelial nitric oxide from l-arginine which is why this is such a popular supplement). Finally, researchers discovered the kalirin gene is part of the Rho-GTPase signaling pathway that regulates behaviors such as clotting (see http://atvb.ahajournals.org/cgi/content/full/22/6/1029), reverse cholesterol transport (see http://www.jlr.org/cgi/content/full/47/1/78), and arterial stenosis (see http://ajpheart.physiology.org/cgi/content/full/278/6/H1733)

What does this all mean?

The bottom line is that if you find ways to manipulate the kalirin gene or its manufactured proteins you may be able to do things like increase eNOS (like we do with l-arginine), improve the reverse-cholesterol transport efficiency of HDL, inhibit the formation of the clots associated with heart attack, and affect the process by which arteries accumulate plaques. One study (see http://circres.ahajournals.org/cgi/reprint/97/12/1232.pdf) found that statins actually inhibit Rho-GTPases which might account for the additional or pleiotropic effects they have beyond LDL cholesterol reduction. Realistically, commercial applications of these findings are at least 5-10 years away. So work extra hard with what you've already got and buy that extra decade! There is more than this exciting research already in the pipeline. LET'S BEAT HEART DISEASE TO A PULP! The way to do it is one day at a time.

Regards,

HeartHawk

Let the Chelation Battle Rage

2007-03-29T19:04:00.000-04:00

It seems my "venom-laden" tirade against Angioprim ruffled a few feathers! So, I'll swear off the swearing (for a few weeks anyway) and get to the point in a, ahhhh, kinder and gentler way. Yeah, that's the ticket! I say chelation therapy and it's proponents are FULL OF SHHHHH . . . OCKINGLY misguided and perhaps even larcenous motives. Most of what I have to say can be found here:

http://quackwatch.org/01QuackeryRelatedTopics/chelation.html

and here:

PubMed

Perhaps the whole thing will be settled when then alternative medicine boys finish their first real study found here.

http://nccam.nih.gov/news/2002/chelation/q-and-a.htm

Of course, they are almost five years in and you would think if anything positive came up you would have some early evidence!

Yours Truly,

HeartHawk

Don't Know Whether to Laugh or Cry

2007-03-27T21:38:00.000-04:00

So instead I'll swear a lot. NOTICE: IF YOU HAVE SENSITIVE EYES READ NO FURTHER . . .

OK - I WARNED YOU!! I AM PRESENTING ANOTHER LAME DUCK AWARD AND IT WON'T BE PRETTY!

While doing some research on exercise-induced hypertension, I bumped into this abomination on the web www.yourticker.com . Peruse it if you must but it is about the greasiest, lie-filled, Goddam pile of crap I have come across in quite a while (and those invectives are just a warm-up).

The latest HeartHawk "Lame Duck" award goes to "Angioprim the Original Liquid Oral Plaque Dissolver" hailed as "the most effective method to clean blocked arteries and renew health without surgery, stents, needles or hazardous drugs." MY ASS!

These little butt-monkeys go on to claim thousands of customers over ten years have "proven its effectiveness in opening blocked arteries." Geez, where are the signed affidavits and angiographic evidence? You say you have none? WELL NO SHIT! IT'S BECAUSE YOU'RE TELLING GODDAM LIES! These flesh-sacks actually have the audacity to publish what they claim is a list of customer telephone numbers you can call for testimonials. Well guess who these ass-hats REALLY are? THEIR F*CKIN' SALES REPS! I don't know what pisses me off more, being lied to or treated like an idiot. Note to the Angioprim marketing department: you might want to consider asking the pot-heads who program your website to change your URL query-string variable from "RepID" to something the average ASP programmer like myself can't decipher. The illusion really disappears when you call one of the numbers and the phone is answered something like, "ACME Distributors." What a bunch of morons, but, we already knew that.

Now here is the kicker. What do these lying SACKS OF SHIT want to bill you for a standard "Primary Cleaning" pack of Angioprim? Hey, only $399 (more if they manage to set the hook deeper)! Can you say, "BITE ME?!" They even have a "Dream Big" page where you can sign-up to be a sales rep if you're willing to pay a monthly fee for the right to sell into one or more selected zip codes (that's right, you pay a seperate monthly fee for each zip code you select and they bill your credit card directly). You can quit anytime but OF COURSE they will bill you for one extra month. Talk about having big cajones! These money-grubbers are off the hook!

At the end of the day, what we have here are a bunch of chelation therapy charlatans looking to make a quick buck off desperate heart disease patients. I mean c'mon, how low can you get? Next stop, my local consumer fraud agency. Seems some of their reps are right here in Wisconsin. How convenient! HeartHawk's a comin' boys. I'd call a lawyer if I wuz you!

Gosh, I get ornery when I'm sick!

HeartHawk