ATHEROGENESIS & Myocardial Infarction

Saturated fats and monounsaturated fats are the best sources to replace the energy from carbs. CoQ10 (Q10), which is found in every cell in the body, should be taken daily starting in the teen years; it is the best of the fat soluble antioxidants. In addition women starting with menopause and continuing thereafter should take the natural HRT (estradiol and progesterone available only from a compounding pharmacy), and men starting between 60 and 70 should take testosterone at a high dose available from a compounding pharmacy. There is 50% reduction in MI with estradiol; it lack is why cardiovascular disease and heart attacks occur following menopause. Men on Testosterone are will exercise more, less likely to develop metabolic syndrome (diabetes, hypertension, obesity, and AS), and are more likely to survive an MI. Both hormones have numerous other healthful benefits such as the prevention of osteoporosis. For these reasons KOLs instruct doctors against the use of hormones. Aspirin in the anti-inflammatory dose of 325 mg with meals prevents atherogenesis, cancer, Alzheimer’s disease, and numerous other conditions. Thus pharma runs junk clinical trials and then educates doctors to warn patients of the risk of ulcers, though the risk increase is minor. The perverse outcome is because all the other NSAIDs recommended by physicians increase the risk of heart attacks—significantly enough for the American Heart Association to issue a clear warning. I’d rather double the risk of an ulcer, than not lower the risk of the much more common heart attack by 50% and cancer by over 30%. Aspirin, estradiol, and Q10 along with healthful lifestyle and low carb-sugar diet can stop the formation of new plaque, and thus over the next 4 years will greatly reduce the risk for heart attack and stroke as the body stops making young unstable plaque, the cause of over 85% of heart attacks.

You might wonder how the system could become this broken, and yet go under the radar of opinion. The short answer is that advertising and propaganda works. How did the Nazi party gain overwhelming popular support. How can people support the world popular religions given their mythic foundation? The list of dumb beliefs and actions is long. Add to this the faith in pharma. A confluence of corporate moves has created the collection of treatment myths. Pharmaceutical corporations should not be doing research, owning the results including raw data, controlling its publication, give continuing education to physicians taught by pharma’s KOLs, head the FDA, influencing treatment protocols (guidelines), and misinforming the public about drugs on television and through physicians who are taught by KOLs. Forty years ago, medical text books did a reasonable good job of providing information; that has all changed, since they are written by pharma’s KOLs. Before Regan’s Presidency, clinical trials were ran by universities, now pharma is involved in all stages of clinical trials, often through corporations whom they hire to run the trials and right the journal articles. Their influence in universities over research determines who becomes key opinion leaders (KOLs) and thus write textbooks. Ghost writing has become the norm for clinical trial. The extent of intrusion has been meticulously documented in Prof. Ben Goldacre’s Bad Pharma. Harvard prof. Marcia Angell has an equally excellent book on How Pharma deceives us. There is a fundamental conflict between short-term profit maximization and the public’s health, I call this tobacco ethic. The articles written for the recommend section of healthfully.org make adjustments for the marketing distortions of pharma. A quality study of 74 published articles comparing raw data to published results determined that positive bias averages 32%. Thus what seem to work based on the published evidence base, in the vast majority of cases doesn’t. And it gets worse because side effect weren’t considered—how could they given the reporting system is broken. Healthfully.org/rc adjust for our broken system and thus provides the information for informed choices in the best patient’s interest. As of November 2014, 18 areas of treatment and drugs have been published. An important new section is on diet and its role in CVD, metabolic syndrome, and obesity. These articles are regularly updated. In that new section are links to a number of on-point YouTube videos. Included there are videos on bad pharm, SSRIs, cholesterol myth, the use of statins, diet, and diabetes—and there are books listed. Unfortunately there aren’t quality videos on exposing hypertension, arrhythmia, acetaminophen, anticoagulants, chemotherapy, bypass operations, polypharmacy, SSRIs, Nor are there quality videos on the health benefits of aspirin, CoQ10, and hormones, but there are books on their benefits.

Two essential points are essential for understanding why the recommendations below are contra pharma’s position. One that pharma has tobacco ethics, the rule by which corporations function to maximize profits. Second, applying this rule, they do all that is necessary to promote their patented drugs, and to reduce the usage of off-patent drugs and drugs which would prevent chronic conditions. Research is done for marketing goals, thus bias is the norm. The drugs listed below have a compelling body of evidence published at /rc , diet at /rh. Examples of their tobacco ethics is at bad pharma and at /rep which is a collection of critical journal articles. There are links to a collection of the best of university lectures and documentaries on the issues raised.

HEALTHFUL CHOICES

Lifestyle makes a difference: The greatest gains are from weight control, low-carbohydrate-sugar diet, cessation of smoking, and vigorous exercise. Rapping the heart in a layer of fat and making the heart pump harder through miles of blood vessels are consequences of obesity. Moreover with obesity, adipose tissue affects the feedback mechanism that regulates insulin; thus the risk of type-2 diabetes increases by 30 fold. Diabetes causes a higher level of blood borne sugars increases the rate which accelerates glycation. Diabetes causes red blood cells to leak out of capillaries which cause an immune response by macrophages. For these reasons diabetes doubles the rate of MI. Diabetes shortens life an average of 5 years and with obesity more. The carbon monoxide--a reactive chemical that damages LDL-- from tobacco doubles the rate MI. A pack-a-day smoker shortens their life on an average 12 years. Carbon monoxide promotes the production of unstable plaque, thus with cessation, the risk for MI dramatically drops over the next 5 years. Vigorous exercise strengthens the heart, better vascularization, & has anti-inflammatory effect thus and healthful effects upon the epithelium (cell walls) of arties. Controlling for lifestyle contravening variables, senior runners extended life 8.7 years, & it improves quality of life. “Exercise capacity is a powerful predictor of mortality” NEJM.

Diet makes a difference, but not the diet that pharma & our government teaches which promote the fat-cholesterol myth. In 11 out of 12 studies reviewed in Wikipedia, results did not have a benefit from low fat, or increased ratio of polyunsaturated fats “A meta-analysis of 21 studies considered the effects of saturated fat intake and found that Intake of saturated fat was not associated with an increased risk of CHD (coronary heart disease), stroke, or CVD (cardiovascular disease)" Wiki. The initial cause of CVD is damage to LDL caused by sugars and by reactive chemicals. Sugars damage LDL through glycation where the monosaccharide attaches to the LDL. A high sugar diet (especially fructose) is associated with insulin resistance (high blood sugar level), diabetes, and metabolic syndrome; all are causal factors for AS. Fat as stated before is not the culprit: “Indeed, recent prospective cohort studies have not supported any significant association between saturated fat intake and cardiovascular risk” BMJ. Instead, saturated fat has been found to be protective. Trans-fats and high ratio of omega-6 to omega-3 fatty acids however promote CVD. However, in most countries trans-fats are effectively banned (not the US), and the ratio of the omega 6 acids can be reduced by decreasing the use of vegetable oils with the exception of coconut oil.

Aspirin: “Irreversibly blocks the formation of thromboxane A₂ in platelets, producing an inhibitory effect on platelet aggregation. This antithrombotic property makes aspirin useful for reducing the incidence of heart attacks.^[113] ”^[114] Since platelets have no DNA, they are unable to synthesize new PTGS once aspirin has irreversibly inhibited the enzyme, an important difference with reversible inhibitors…. aspirin induces the formation of NO-radicals in the body, which have been shown in mice to have an independent mechanism of reducing inflammation.” Wiki. The platelet effect reduces thrombosis risk over 40% (with 325 mg) and the NO (nitrous oxide) in slowing/preventing atheriogenesis. Atherogenesis slowed: “strong evidence that atherosclerosis is slowed down in a dose term … aspirin,” and stopped. This effect is dose dependent, comparing 900 to 50 mg of aspirin. At 325 mg with meals aspirin has an anti-inflammatory effect and thus prevents the formation of young unstable plaque, the cause of ischemic events. Benefits; Various mechanisms: By NO endothelial cells from oxidative damage, inhibits leukocyte attacks, cytokinies, & CD36. The anti-inflammatory effect has other healthful consequences. Also prevents cancer and cures it by stimulating the body’s necrosis factor. And has other benefits. The risk of bleeding is greatly exaggerated by pharma who opposes prevention of chronic conditions through their numerous marketing clinical trials and use of opinion leaders to instruct physicians in their required continuing education classes (the same has been done with estrogen). The increased risk of major bleed with aspirin long-term is 4%.

Estradiol with progesterone (natural HRT): Estrogen is why women prior to menopause don’t have cardiovascular disease. Estrogen lowered by 20% cholesterol, 37% LDL (bad cholesterol) and raised by 14% HDL 14%, extends life 2.1 years, Braunwald, Heart Disease …, 5^th Ed, 1997, p 1708 tables. “Estrogen-replacement therapy decreases CAD morbidity and CAD mortality … was 0.56 compared to subjects not taking estrogen” [a 44% reduction] Braunwald supra 1142. Another study found a 50% reduction in CHD. Estradiol blocks oxidation of LDL to prevent atherosclerosis. “Estradiol completely reverses the effects induced by OX-LDL on the DDAH/ADMA/NO pathway,” Avoid MPA and LNG (levonorgestrel). Another study found 26 deaths for estradiol vs. 56 for placebo. A meta-study found and a 50% reduction of Coronary Heart Disease. AHA study explains mechanisms of cardio protection. Angina pain (cardiac syndrome X) associated with low estrogen, treated. Estradiol plus progesterone for CVD & death is the best HRT. Other benefits of natural HRT: the prevention of osteoporosis, Alzheimer’s disease, colon cancer, and arthritis.

Testosterone: Prevents metabolic syndrome MetS (poor cholesterol profile, obesity, and high blood pressure): “Emerging evidence suggests that testosterone therapy may be able to reverse some aspects of metabolic syndrome” And another. “These results suggest that low SHBG [sex hormone-binding globulin] and/or AD [androgen deficiency, TTT] may provide early warning signs for cardiovascular risk and an opportunity for early intervention in non-obese men.” In a matched study followed ten years published by the AHA found that the lowest quarter of men were 41% more likely to die from cancer and cardiovascular disease compared to the highest quarter. Low TTT is associated with cardiovascular disease. TTT Inhibits atherogenesis: in a survey paper, “Positive correlation between total or free testosterone level and HDL and a negative association the LDL” and. Conclusion: “A normal physiological level of TTT in men protects against the development of high cholesterol, insulin resistance, hypertensions, clots that cause heart attacks, obesity, and increased waist:hip ratio, all of which predispose to the development of CVD. Low or low normal TTT is implicated in the pathogenesis of acute MI and acute stroke. The decline of TTT with age may explain the greater risk of CVD with advancing years” [medical terminology simplified by jk]. TTT is good for your heart, muscles, and blood vessels. Heart Attack, after controlling for factors low TTT associated with MI, positive effect upon fibrinolytic pathway, reduces angina.

Coenzyme Q10 (CoQ10, Q10): For heart failure (HF): the heart isn't able to adequately pump blood, thus it pools in parts of the body, such as the lungs and legs. “Several clinical studies suggests that Q10 supplements help reduce swelling in the legs; reduce fluid in the lungs to making breathing easier; and increase exercise capacity in people with heart failure, and reduces hospital admissions by 61%”, similar, also, long-term and safety. After Heart Attack and Angina pain: A clinical study found that people who took daily CoQ10 supplements within 3 days of a heart attack were less likely to have subsequent heart attacks, less chest pains, die of heart disease. The capacity for exercise improved about 30% for those with chronic heart failure on taking Q10, also. High blood pressure: In a meta-analysis of 12 clinical studies, Cochrane concluded that Q10 lowers systolic blood pressure by up to 17 mm Hg and diastolic blood pressure by 10 mm Hg, probably from improved heart functions. Bad cholesterol: Q10 attaches to LDL. It reduces oxidative damage and thus slows atherogenesis. The mitochondria produce ATP, the energy source for nearly all bodily functions. Q10 protects the mitochondria from oxidative damage, and thus will very significantly improve, when taken long term, endurance for those over 60 years. The decline in function of the mitochondria is the reason for the dramatic drop in endurance of the elderly. More ATP entails that the elderly are more likely to survive an MI. For this anti-oxidant effect in the mitochondria and upon atherogenesis, Q10 should like vitamins be taken life-long. There are numerous other benefits including improving blood sugar level in diabetics, for Parkinson’s disease, migraines, and macular degeneration, and it should be used with statin therapy, since stains partially block Q10 production.

There is a large body of clinical trials and epidemiological studies that have shown that cholesterol and high fat diet have minimal effect upon promotion of CVD, and conversely that a low fat & low cholesterol diet is not cardiovascular protective (see Cholesterol Myth). As stated prior reactive chemical damage to LDL (especially glycation) and the immune response is the primary cause, thus drugs listed below and low sugar diet have significant effect while Statins for an assortment of reasons are not worth taking. Since so many believe in the cholesterol myth, the natural, safer method of lowering blood cholesterol with niacin and its inositol form are included below.

Niacin improves cholesterol profile by lowering of plasma triglycerides mobilization from adipose tissue, and inhibiting hepatocyte diacylglycerol acyltransferace synthesis of triglyceride thereby lowering cholesterol and thus “inhibits the synthesis of apo-lipoproteins and the influx of free fatty acids (FFA) into the liver, which is the precursor of triglycerides.” “A single dose of niacin 200 mg given in the fasting state [at bedtime] provides a prompt and marked fall in serum FFA level, with a rebound after some hours. A comparable fall in plasma FFA occurs normally following a carbohydrate-containing meal, when adipose tissue lipolysis [making lipoproteins] is inhibited by insulin, and re-esterification of FA in adipose tissue cells is increased by glucose. Therefore, the FFA level is usually low during the day, when carbohydrates are the predominant source of calories [thus preventing a niacin caused reduction in FFA]. Lipolysis becomes active in the post-absorptive state at night, when the FFA-level is approximately double the daily mean level. “Oral administration of niacin … during the day does not appreciably alter this pattern.” This is why blood cholesterol blood work requires fasting, and why niacin and IHN should be taken at night, when the insulin level is low. Thus a low dose at night-- 200 to 500 mg--is sufficient. Plasma peak is for niacin 30 minutes, half life under 1 hour. This entails rapid absorption and excretion during a time when it is ineffective because of low level of FFA. Pharma’s recommendation of a mega dose of niacin (ignores INH) creates very low compliance due flushing, and during the day for minimal effectiveness. This pattern of marketing first is the norm for Pharma.

Inositol hexanicotinate (IHN, a source of niacin): The literature is thin, since Pharma members won’t research a flush-free, effective treatment for high cholesterol. Though IHN releases niacin, it does at too low a rate to affect the same bio-pathway as niacin (peak for Niacin is 45 minutes, IHN 8 hours). (A criticism by Pharma of INH, but shown false in a quality study using blood samples drawn at night). INH affects Free Fatty Acids (FFA), rather than lipolysis as does niacin and statins. “FFA is a precursor of plasma triglycerides. Lipolysis becomes active in the post-absorptive state at night, when the FFA-level is approximately double the daily mean level…. The Xanintol esters and IHN were superior at lowering FFA,” at Eur. J. Clin. Pharmacol. 16, 11-15 1979. In another study “At 6 weeks of usage [1650 mg IHN] found a nearly 20% improvement in cholesterol profile”. Given a bio-pathway not effecting CoQ10 (as does statins and niacin), on thin evidence jk recommends INH over niacin.

Hypertension: Hypertension is a result of atherosclerosis, thus lowering blood pressure has little effect upon ischemic events. The best approach is to prevent formation of young unstable plaque and thus atherogenesis. Start with lifestyle changes of exercise, weight control, healthful diet low in salt and saturated fats, Q10, and use of aspirin, hormone replace if suitable, and see if that brings it to a safe level within 2 years, systolic under 180 and diastolic under 110.[1] Blood pressure will drop slowly. Moreover fluctuation during the day is significant, and dependent on situation when taken. Relax when blood pressure is taken; it will reduce systolic pressure by at least 10. “One study found that 41% of patients 50 and older who were carefully taken off their high blood pressure medications did not need them, having normal blood pressure 11 months after the drug was stopped”¹⁸ Worst Pill. “Only the thiazide and loop diuretics have good evidence of beneficial effects on important endpoints of hypertension, and hence, should usually be the first choice when selecting a diuretic to treat hypertension. They are the recommended as first-line treatment in the US (JNC VII) ^[5] and European (ESC/ESH) ^[6] guidelines…. Thiazide diuretics also increase calcium re-absorption at the distal tubule” Wiki. Thiazides are “associated with an increase in bone mineral density and reduction in fracture rates attributed to osteoporosis” Wiki. And their cost is under $100/year. Pharma to promote their drugs distorts the pathology cause of primary hypertensions (90% of cases). It is the same as that which causes CVD, atherosclerosis, namely clogged, stiff arteries. Pharma pushes 8-families drugs all of whom but diuretics aren’t worth the side effects.

RECOMMENDATIONS FOR HEALTH: Healthful lifestyle of normal weight, diet low in salt and sugar, and regular exercise. For those with CVD or cholesterol above 280 or blood pressure systolic above 180 (markers for CVD) 325 mg of aspirin with each meal for its anti-inflammatory effect. For everyone because CoQ10 is an effective anti-oxidant in found in LDL thus reducing atherogenesis and it protects the mitochondria from oxidative damage, the reason for age related decline in peak athletic performance and physical endurance. Given Q10’s safety and benefits, I would give it to children (atherogenesis is present in all children). Aspirin 325 mg lowers risk of ischemic event and increases survival of cancer over 40%, plus MI by 30%, and prevents atherosclerosis. Testosterone lowers risk of MI, heart failure, and metabolic syndrome. Estradiol is why women don’t develop cardiovascular disease until after menopause. If systolic blood pressure remains above 160 after 2 years of doing what has been recommended, then try a low dose thiazide (see section above). Read Marking Science, and Junk Treatments, and be skeptical of medical (marketing) “wisdom” and physicians whom have been co-opted by corporate medicine. Thus avoid their push for polypharmacy: statins, blood thinners, hypertension drugs, arrhythmia drugs, and drugs with cognitive side effects (downers dressed in drag). Doctors are very good at impressing patients with sophisticated tests, scare tactics, and magic bullet drugs that affect a specific bodily process, while they are fulfilling a pharma-friendly protocol, all supported by market science. Memorize the words of Harvard Prof. Dr. Marcia Angell: “We certainly are in a health care crisis, ... If we had set out to design the worst system that we could imagine, we couldn't have imagined one as bad as we have.” Author of the Truth About Drug Companies, and former Editor in Chief of NEMJ. Put another way: “The pharmaceutical industry is the most lucrative, the most cynical and the least ethical of all the industries," and watch her lecture on YouTube. Dr. Philippe Even tells The Guardian. "It is like an octopus with tentacles that has infiltrated all the decision-making bodies: world health organizations, government agencies, parliaments, high administrations in health and hospitals and the medical profession." JK from 1991 to 1996 took 2.5 gm of aspirin for chronic back pain, and 325 thereafter, daily exercise since 1974, and 5 gm daily of nutritional yeast (source of niacin) sprinkled on foods since 1981, testosterone from a compounding pharmacy since 2003—his total cholesterol is 165 and blood pressure 125 over 73, BMI of 21, and he is in his 7^th decade, and he doesn’t get heart burn.

[1] “Drugs for mild HPB have not been proven to benefit patients” prestigious Cochrane review, also