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Heart Disease Risk Factors

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Are We Being Conned By The Cholesterol Hypothesis?

svuffe1_1_1An Interview with Uffe Ravnskov MD, PhD.  November 2009
Dr. Ravnskov is an expert in cholesterol metabolism and believes the cholesterol lowering hypothesis to be useless in preventing heart disease.  – “This kind of treatment is meaningless, costly and has transformed millions of healthy people into patients”.

Part 1 – The Cholesterol Hypothesis
Part 2 – The Trivial Benefit Of Statin Drugs
Part 3 – High Cholesterol Scam: Are We Being Conned?
Part 4 – Heart Disease – Other Risk Factors

Q: Are there other risk factors that should be followed? Such as: C-reactive protein, fibrinogen, homocysteine, lipoprotein A. Any other factors?

UR: Such analyses may be helpful for doctors to put the right diagnosis in patients with a disease of unknown origin. But to check healthy people’s blood to find deviations from normal is the freeway to unnecessary medication.

Q: Are there other alternative therapies besides statins that people might consider?

UR: There is no reason for healthy people to take drugs or anything else to prevent heart disease as long as we do not know the very cause. Don’t forget that people who die from a myocardial infarction have on average lived just s long as other people. On my talks I use to ask people, who put the same question to me, if they know a better way of dying.

Q: What diet do you recommend people follow?

UR: I do not give medical advice to people I haven’t seen and examined myself and as I am retired it means that I give no advice at all except to my family and nearest friends. I inform people by writing and lecturing. Then they have to decide themselves what to do.

Q: In 20 years, do you expect changes in how we view heart disease, its causes and treatments?

UR: I am confident that we will see a change in the next few years. There is a growing scepticism among medical scientists. What is happening in Sweden these days may hopefully inspire researchers in other countries to air their scepticism openly. Recently experts selected by WHO and FAO published a new report. Here the authors concluded that there was no satisfactory or reliable evidence to support the idea that saturated fat causes heart disease, or diabetes or obesity. A revolutionary change of direction, you may say. However, they did not change their recommendations.

Together with Kilmer McCully, the discoverer of the association between homocysteine and atherosclerosis, I have presented another hypothesis. We think it is much more likely because we are able to explain the many observations that do not fit with the present one. If anyone wants to read the full paper I shall send it on request.

Finally, I assume that much of what I have mentioned here may seem incredible, but all the facts including references to the scientific literature are available in my new book Fat And Cholesterol Are GOOD For You!

Other Risk Markers To Assess Heart Risk Not Commonly Tested

You may like to read this very comprehensive page called Heart Disease – The Best Blood Tests.

C-Reactive Protein

C-reactive protein (CRP) is a protein your liver produces as part of your body’s response to injury or infection (inflammatory response). CRP is a marker for an inflammatory response somewhere in the body. However, CRP tests can’t pinpoint exactly where in the body this may be happening. I call CRP the “smoking gun”, the shot was fired and the damage has been done but who pulled the trigger? Inflammation plays a central role in the process of atherosclerosis, in which fatty deposits clog your arteries.

Measuring CRP alone won’t tell your doctor your risk of heart disease. But factoring in CRP test results with other blood tests results (like Homocysteine and Lipoprotein a, along with your cholesterol tests) and risk factors for heart disease such as blood pressure, body weight, etc; helps create an overall picture of your heart health1. According to the American Heart Association, your CRP test result can be interpreted as putting your heart disease risk at:

  • Low risk (less than 1.0 milligrammes per liter, or mg/L)
  • Average risk (1.0 to 3.0 mg/L)
  • High risk (above 3.0 mg/L)

You will find that your cardiologist doesn’t yet recommend CRP screening for the general public — only those at known risk of heart disease. You may be told that cholesterol-lowering statin medications may reduce CRP levels and decrease your heart disease risk, but it’s not recommended that you take statin medications solely to decrease your CRP level. Talk to your doctor if you’re concerned about your CRP level.

References
1. Arad Y, Goodman KJ, Roth M, Newstein D, Guerci AD (2005). “Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events: the St. Francis Heart Study”. J. Am. Coll. Cardiol. (1): 158–65. doi:10.1016/j.jacc.2005.02.088. PMID 15992651. http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(05)01031-4.

Fibrinogen

Fibrinogen is a protein in your blood that helps blood clot. But too much fibrinogen can cause a clot to form in an artery, leading to a heart attack or stroke1. Having too much fibrinogen may also mean that you have an inflammatory response that accompanies atherosclerosis. It may also worsen existing injury to artery walls.

I always recommend that our patients check their fibrinogen levels if they have an increased risk of heart disease. Smoking, inactivity, excessive alcohol consumption and supplemental oestrogen — whether from birth control pills or hormone therapy — may increase your fibrinogen level 2. A normal fibrinogen level is considered to be between 200 and 400 milligrammes per liter (mg/L).

References

1. Muszbek L, Bagoly Z, Bereczky Z, Katona E (July 2008). “The involvement of blood coagulation factor XIII in fibrinolysis and thrombosis”. Cardiovascular & Hematological Agents in Medicinal Chemistry (3): 190–205. doi:10.2174/187152508784871990. PMID 18673233.
2. Hermans J, McDonagh J (January 1982). “Fibrin: structure and interactions”. Semin. Thromb. Hemost. (1): 11–24. doi:10.1055/s-2007-1005039. PMID 7036348.

Lipoprotein A

Lipoprotein (a), or Lp(a), is a type of LDL cholesterol. Your Lp(a) level is determined by your genes and according to conventional medicine isn’t affected by lifestyle. Others would beg to differ, and research has shown that it is possible to reduce LP (a) levels with Vitamin C, for example.

High levels of Lp(a) may be a sign of increased risk of heart disease1, though it’s not clear how much risk. I have not found any doctor in New Zealand to order an Lp(a) test if you already have atherosclerosis or heart disease but appear to have otherwise normal cholesterol levels. (apart from a few NZ doctors with specialised nutritional medicine training). Lp(a) should certainly be tested if you have a family history of early-onset heart disease or sudden death or a stroke2. It should also be tested if your LDL cholesterol doesn’t respond well to drug treatment3.

References

1. Danesh J, Collins R, Peto R (2000). “Lipoprotein(a) and coronary heart disease. Meta-analysis of prospective studies”. Circulation (10): 1082–5. PMID10973834. http://circ.ahajournals.org/cgi/content/abstract/102/10/1082 .
2. Smolders B, Lemmens R, Thijs V (2007). “Lipoprotein (a) and stroke: a meta-analysis of observational studies”. Stroke (6): 1959–66. doi:10.1161/STROKEAHA.106.480657. PMID17478739.
3. Christian Wilde (2003). Hidden Causes of Heart Attack and Stroke: Inflammation, Cardiology’s New Frontier. Abigon Press. pp. 182–183. ISBN0-9724959-0-8.

Homocysteine

Homocysteine is a substance your body uses to make protein and to build and maintain tissue, and prevention of high levels may be a significant step towards reducing your risk of a heart attack or stroke and ample research has revealed that too much homocysteine may increase your risk of stroke, certain types of heart disease, and disease of the blood vessels of the arms, legs and feet (peripheral artery disease)1. You can read more about Homocysteine on the Homocysteine page. Your enlightened nutritional medicine doctor may check your homocysteine level if you’ve had cardiovascular problems but don’t have any of the traditional risk factors such as smoking. Your practitioner may also suggest screening 2 if any family members developed heart problems at a young age or have high homocysteine levels.Your homocysteine level may drop if you get plenty of folate (folic acid) and B vitamins in your diet through foods such as green, leafy vegetables and fortified grain products or through specialised supplements.

You may like to read this very comprehensive page called Heart Disease – The Best Blood Tests.

References

1. Martí-Carvajal AJ, Solà I, Lathyris D, Salanti G (2009). “Homocysteine lowering interventions for preventing cardiovascular events”. Cochrane Database Syst Rev (4): CD006612.doi:10.1002/14651858.CD006612.pub2.PMID19821378.
2. Selhub, J. (1999). “Homocysteine metabolism.”. Annual Review of Nutrition 217–246. doi:10.1146/annurev.nutr.19.1.217. PMID10448523.
3. Champe, PC and Harvey, RA. “Biochemistry. Lippincott’s Illustrated Reviews” 4th ed. Lippincott Williams and Wilkins, 2008