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Cholesterol and Cardiovascular Disorders
his special issue is about cardiovascular diseases. In it, we try to answer some troubling questions. Does cholesterol really cause all the problems ascribed to it, such as plaque buildup and coronary artery disease? Do statins lower the risk of cardiovascular disease? Do statins cause a worsening of other diseases or create new health problems for those who take them? Under what medical circumstances is it best to use statin drugs? This issue of Alternative Therapies in Health and Medicine answers these and other pertinent questions. At the end of this editorial, I have listed two outstanding books that should be read by all physicians as well as their patients. I have also included one excellent review study for our readers. Human life would not exist without cholesterol. It is an essential component of myelin and necessary for nerve conduction. All our hormones are derived from cholesterol; it is needed for the biosynthesis of vitamin D and for bile acids. Cholesterol is made by every cell and is a vital component of mammalian cell membranes. We have been led to believe it is bad for our heart because it adversely affects our cardiovascular system. Life is measured by our heartbeat: we check the pulse to see if a person is alive or dead. Health care students are taught to take the pulse to obtain a heart rate: it is a vital sign the world over. Our heart beats approximately 3 billion times in our lifetime, and yet in the few moments it took you to read these lines, an American had a heart attack or, more precisely, a myocardial infarction. In the next 24 hours, this affliction will cause the same number of deaths that occurred in the tragedy of September 11. The top four leading causes of death in the United States are heart disease, with over 616 000 deaths annually, followed by cancer.1 The third most common cause of death is the medical system of the United States2 and the fourth is properly prescribed pharmaceutical drugs.3 Worldwide, cardiovascular disease caused 17.3 million deaths in 2008 according to the World Health Organization (WHO), representing 30% of deaths globally.4 Women are six times more likely to die of a heart attack than of breast cancer.5 Coronary artery disease costs the United States $109 billion each year from the cost of health care, medications, and lost productivity. The main cause is atherosclerosis, the buildup of fatty plaques in the arteries, largely believed to be due to poor diet, inactivity, and nicotine use. And the most important
consideration is that cardiovascular disease can be reversed and prevented by healthy diet and lifestyle. There is a way to reduce cardiovascular risk by 75% through diet alone: according to a study published in the British Medical Journal, a diet of wine, fish, dark chocolate, fruits, vegetables, garlic, and almonds will do it.6 Heart disease is neither new nor a product of our modern era. Two hundred years ago, in January 1812, the first issue of the New England Journal of Medicine and Surgery (NEJM) was published. The first article in the first NEJM was titled “Remarks on Angina Pectoris” and was written by Dr John Warren, a founding member of Harvard Medical School.7 Since then, the many treatment modalities we currently have, both medically and surgically, have improved the outcomes of the patient suffering from cardiovascular diseases. Almost 60 years ago, a study by Enos, Holmes, and Beyer published in JAMA in 1953 showed that of 300 soldiers killed in action in the Korean War, all healthy young men with no known heart problems, 77.3% had gross evidence of heart disease on autopsy, a startlingly large number for such a young group.8 Eventually, cholesterol in our diet was pointed out as the culprit. So why have we been taught that cholesterol is bad and that it causes heart disease? Why is this idiom so prevalent in our society, from restaurant menus to labels on food packaging at the grocery store? Why do 30% of cardiologists in the United States take statin drugs? Why does most of the public believe that elevated cholesterol is bad for health? It began with one man, Ancel Keys, PhD, who back in the 1950s proposed that heart disease was due to cholesterol in our diet. Keys picked seven countries, including the United States, and showed what he believed was a direct correlation between heart disease and cholesterol, along with saturated fats.9 However, another researcher, Malcom Kendrick, MD, looked at the same data and showed that by picking different countries, one could come to the opposite conclusion: cholesterol and fat could lower heart disease. For example, on the islands of Corfu and Crete, saturated fat intake was equal; however, heart mortality was 17 times higher in Corfu than in Crete.10 From Keys’s work, we derived the current medical and dietary recommendations regarding cholesterol including government policy.11 Statin drugs have been relied upon to lower cholesterol with the belief that this will lower cardiovascular morbidity and mortality. In 1987, Merck came out with lovastatin marCampbell—Cholesterol and Cardiovascular Disorders
ALTERNATIVE THERAPIES, Heart Health VOL. 19, suppl. 1
published in 2010 in the Journal of Lipid Nutrition. The Blood Sugar Solution. This was a double-blind. To share or copy this article. placebo-controlled trial testing to see if 10 mg of rosuvastatin compared to a placebo would reduce mortality and cardiac complications in patients with heart failure. At the end of the study.9% to 11. which included over 153 000 postmenopausal women. the study known as the GISSI-HF was published.” We hope that the information contained in this issue will bypass the first two stages. there was no difference in either group with regard to cardiovascular deaths or worsening heart failure. and fibrinogen tests are usually ordered as well. statins can contribute to an increase in cardiovascular problems. The Great Cholesterol Myth.18 Furthermore. a 2012 study showed that statin drugs are associated with progression of coronary artery calcification and abdominal aortic artery calcification in type 2 diabetics with advanced atherosclerosis. with $12. 19.13 If one is to believe that statins lower death rates due to cardiovascular diseases by lowering cholesterol. and titled “Recent Cholesterol Lowering Drug Trials: New Data.19 There is a concern that statins may cause cancer as well. MD Editor in Chief 5 ALTERNATIVE THERAPIES. and the phosphodiesterase inhibitors for erectile dysfunction. patients with a previous myocardial infarction and with left ventricular dysfunction were given a placebo or 10 mg of rosuvastatin. which is invaluable to physicians and patients alike. heart disease. NO treatment of neonates suffering from pulmonary hypertension. the FDA has warned about increased risk of developing type 2 diabetes when a patient starts taking statin drugs.6% to 32.12. even though low-density lipoprotein (LDL) cholesterol was reduced by 45% and C-reactive protein (CRP) by 37% in the rosuvastatin group. it is violently opposed.This article is protected by copyright. visit alternative-therapies. Second.15 Less than a year later. A number of supplements can and do help cardiovascular diseases: omega-3 fatty acids. Other tests. New Questions. why has the percentage of population over age 18 with heart disease risen in the United States from 10. niacin. An excellent review can be found in Dr Bowden’s and Dr Sinatra’s book. L-carnitine. statin use was associated with an increased prevalence and extent of coronary plaques. Heart Health VOL. magnesium. published in 2012. and it became the best-selling pharmaceutical drug in history. please visit copyright.16 Two more recent studies have shown that. why has the rate of heart disease in those 65 and over in the United States risen from 29. Third. One example is the CARE study in which there was a higher rate of breast cancer in postmenopausal women taking statins compared to the control group. (3) Dr Hyman’s book. 1 . has an entire chapter devoted to this. resveratrol. These three publications should be part of every health care professional’s library: (1) Dr de Lorgeril’s and Dr Salen’s review of the clinical trials of statin drugs and their conclusions. In the CORONA trial. it is accepted as being self-evident. to the contrary. In the Women’s Health Initiative. Campbell.20 Is there a place for statins in the treatment of cardiovascular disorders? It seems that there is one: adult males who have had a cardiac event such as a heart attack and are at a high risk for another one. FOR THE READER I highly recommend three publications to our readers who are interested in cardiovascular disease and helping their patients. The conclusion showed that although rosuvastatin lowered LDL cholesterol by 36%. homocysteine.com.”22 (2) Dr Sinatra’s and Dr Bowden’s excellent book.4 billion in sales in 2008.21 However. published in 2012. In a study of over 6600 individuals. derived from the fungus Aspergillus.6% in the same 8 years.11 Is there some new treatment on the horizon for cardiovascular diseases? Nitric oxide (NO) is a relatively new advancement in medicine with many studies having been published showing its effectiveness in cardiovascular and other disorders. Use ISSN#1078-6791. The Great Cholesterol Myth. The only drugs available are nitroglycerine for treatment of angina.11 This text is the most readable and enjoyable book that brings to light the facts about cholesterol. suppl. there was no difference in mortality or cardiovascular morbidity in the patients in either group.8% in the last 8 years? If statins work to reduce death from cardiovascular events as they have been touted to do. there is still no standard laboratory tests available to measure NO.11 The German philosopher Arthur Shoppenhauer (17881860) wrote: “All truth passes through three stages.com keted as Mevacor. To subscribe. Dr Bowden’s and Dr Sinatra’s book.23 Andrew W. and statins. First. such as CRP. statin use was associated with an increased risk of diabetes. known as Lipitor.17 In Diabetes Care. and curcumin. all of this with better access to medical care and better management of cardiovascular disease?14 Could the answer be that statins don’t reduce heart disease and that cholesterol is not the cause? Two studies have recently shown that statins don’t help much at all. Its discovery earned the Nobel Prize in Medicine and it was name “Molecule of the Year” by Science in 1992. it is ridiculed. Other pharmaceutical companies followed suit with different statins and eventually Pfizer came out with atorvastatin. What do we measure to learn if a patient is at risk for cardiovascular problems and heart disease if the well-known and heavily used lipid panel is no longer the helpful predicCampbell—Cholesterol and Cardiovascular Disorders tor? The measurement of particulate size of LDL cholesterol is essential.
new questions.08. Franco OH. Accessed March 28. Progression of vascular calcification is increased with statin use in the Veterans Affairs Diabetes Trial (VADT). 17. safer. 4. and probably tastier (than the Polypill) strateg y to reduce cardiovascular disease by more than 75%.nhlbi. Accessed March 25. suppl. Accessed March 27. Bethesda.32(1):140-146. please visit copyright. 2013. Simons J.35(11):2390-2392. New York. The Hundred-Year Lie: How to Protect Yourself From Chemicals That Are Destroying Your Health.org/content/heartdisease/heart_disease_facts. Women and heart disease facts. Nash RA.gov/nchs/data/ hus/hus10. Fortune. Saremi A. http://www. The $10 billion pill. Kjekshus J. Salen P. United States. 11. 2010 with special feature on health and dying. Keys A. 2010. Women’s Heart Foundation. MD: National Heart.258(5090):1861. 13. placebo-controlled trial. US Department of Health and Human Services. preliminary report. Warren J.1056/ NEJM181201010010101.pfizer. MA: Fair Winds Press. 2000. Ignore the Awkward: How the Cholesterol Myths Are Kept Alive.cnn. Alt Ther Health Med. doi:10.225(1):148-153. Statins use and coronary artery plaque composition: results from the International Multicenter CONFIRM Registry. 1999. NY: Hachette Book Group. To share or copy this article. To subscribe. 18. complementary. Fitzgerald R. Centers for Disease Control and Prevention and National Center for Health and Statistics. WA: Create Space. Health. FDA expands advice on statin risks.com. N Engl J Med. 5.int/cardiovascular_diseases/en/. The Blood Sugar Solution.357(22):2248-2261. Accessed March 25. Accessed March 25. doi:10. The Polymeal: a more natural.gov/resources/docs/ cht-book.pdf. http://www.19(1):65-92.jsp. Lung. 2004. 2012.284(4):483-485.cdc. Doing things differently: annual review 2008.gov/ForConsumers/ConsumerUpdates/ucm293330. 8. No authors listed.This article is protected by copyright. et al. The molecule of the year. Bahn G. Accessed March 27. GISSI-HF Investigators. Published 2011. Lung. Recent cholesterol lowering drug trials: new data. No authors listed. Bonneux L. 19.152(12):1090-1093. Ravnskov U.41(1):1-211. doi:10. Atherosclerosis. 2012. Maggioni AP. Effects of pravastatin on cardiovascular events in women after myocardial infarction: the Cholesterol and Recurrent Events (CARE) trial.htm. 23. Tavazzi L. BMJ. http://money. Accessed March 27.329(7480):1447-1450. 12.1:1-11. Beverly. 1998. J Lipid Nutr. 24. Sacks FM. Mitchell JS. 2012. 2007. 6. http://www. US Food and Drug Administration.atherosclerosis. et al. 2013. Nakazato R. http:// www. et al. Koshland DE Jr. 14. Hyman M. JAMA.who. Diabetes Care. Bowden J. 7.372(9645):12311239.com REFERENCES 1. Updated August 9. 1970. 1 Campbell—Cholesterol and Cardiovascular Disorders . 6 ALTERNATIVE THERAPIES. and integrative medicine. 2013. 1812. and Blood Diseases.htm. 2003.com/ magazines/fortune/fortune_archive/2003/01/20/335643/. double-blind. Apetrei E. 1992. and Blood Institute. de Laet C. Heart Health VOL.womensheart.1016/j. Remarks on angina pectoris. Morbidity and Mortality: 2012 Chart Book on Cardiovascular. N Engl J Med. visit alternative-therapies.nih.com/ investors/financial_reports/financial_reports. Coronary heart disease in seven countries. 2007. 22.2012. 16.fda. Is US health really the best in the world? JAMA. NY: Penguin Books. et al. National Institutes of Health. 20. Coronary disease among United States soldiers killed in action in Korea. 10. Beyer J. 2012. Starfield B. Enos WF. Seattle. World Health Organization. 2013. Gransar H. Berman DS. The biomedical ethics of alternative. January 20. Barrios V. Holmes RH. http://www. Mackenbach JP. Circulation. Science. Lancet. VADT Investigators. 2012. Steyerberg EW. 2. Global atlas on cardiovascular disease prevention and control. Pfizer. 3. Marchioli R. Published April 23.002. Sinatra S. 1953. New York. 2013. 9. Published 2011. Rosuvastatin in older patients with systolic heart failure. Peeters A. de Lorgeril M. The Great Cholesterol Myth: Why Lowering Your Cholesterol Won’t Prevent Heart Disease—and the Statin-Free Plan That Will. Reaven PD. Use ISSN#1078-6791. http://www.asp. 19.5(5):92-95. 2013. Lewis SJ. 2008. 2009. 15. J Am Coll Cardiol.2337/dc12-0464. Effect of rosuvastatin in patients with chronic heart failure (the GISSI-HF trial): a randomized. 21. 2010. 2013.
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