Cholesterol and Statins

1. Cholesterol and Statins The Truth about Cardiovascular Disease and Health

2. C-V Disease or Coronary Disease • Leading killer of men and women in U.S. Across all ethnic and racial groups *Almost 1 million die of CVD each year which adds up to 42% of all deaths *One must include those suffering from CVD which is 8 million world wide *This is 18X the mortality of breast cancer

3. The costs…. • CVD costs the nation $274 billion each year including health expenditures and productivity loss • The burden continues to grow as the U.S. ages • There is no federal mandate directed towards the states to target CVD

4. CIRCULATION Journal…. • “The effectiveness of conventional medicine as far as early detection and treatment in actually preventing heart attacks is questionable.”

5. The Allopathic Approach….. • Medication and Surgery - Angiograms, PTCA, CABG are a big business • Over one million heart angiograms are performed annually for a total annual cost of ten billion dollars • But based upon extensive analysis, it appears that most of this money is wasted • Surgery is physically invasive and traumatic and is 5-10X more deadly than the disease and in many cases, unnecessary!

6. Center for Disease Control • Where you live geographically might affect your exposure to factors causing heart disease (ie. Environmental pollution, daily stress, lifestyle behaviors) • A number of health-related behaviors practiced by people every day contribute markedly to C-V disease

7. These include….. • Stress (elevated stress hormones): Mental stress is a higher indicator more so than smoking, diabetes, high cholesterol or even “being a man” • For those suffering from heart disease already, this factor is responsible for more MI’s, and cardiac death itself

8. Stress……………… • People whose BP rises as a result of stress are six times more likely to have CVD than those who remain calm • This includes anger, chronic worrying and anxiety • JAMA and Circulation both agree that stress blocks blood flow to the heart

9. Stress……………………….. • The walls of the blood vessels thicken, narrowing the flow of blood to the heart • This increased pressure causes the heart to work harder (stroke volume) and faster (heart rate) • Results in increased BP while decreasing the amount of blood going to and exiting from the heart • All this happening when the heart demands oxygen and nutrients

10. Diet – Poor Nutrition – Elevated glucose levels and obesity • With almost 40% of the nation being obese, this has resulted in hypertension (HTN), high BP, high cholesterol and other chronic diseases such as diabetes • Only 27% of women and 19% of men eat the proper foods during day • One would expect that saturated (animal) fat consumption would be a major cause

11. But……………. • The consumption of saturated fat from 1920 to 2000 has dropped from 83% to 62% as has the amount of butter – 18 lbs. To 4 lbs. annually • During the past eighty years, dietary cholesterol intake has increased only 1% • Margarine, shortening and refined oils increased about 400%, while sugar consumption rose almost 60%

12. Lowering cholesterol by dietary means does NOT improve health • There is little support from trials because there is none at all! • And simply lowering the percentage of energy from total fat in the diets is unlikely to improve lipid profiles or reduce CVD incidence • The same applies to treating obesity by diet..no good evidence that reducing dietary fat leads to weight loss (in this case, it might lead to stupidity!!!!)

13. Lack of Physical Activity • People who are sedentary have twice the risk as those who are physically active • One-half of the U.S. population do not exercise at recommended levels • One quarter are completely sedentary • This may be the “key” to preventing the occurrence and morbidity of CVD

14. Tobacco Use………… • Smokers have twice the risk of heart attack • One-fifth of annual deaths directly connected to smoking • 1,000,000 young people smoke in the U.S.

15. With all these facts… • Let’s look at the myths…

16. Myth #1 High cholesterol (and LDL) is the number one cause of heart disease in the U.S. • High cholesterol is a risk factor but not the number one factor • The most prevalent risk factor is low HDL • 70% of victims have low HDL while 30% have High LDL • If this is the case why don’t we hear more about Low HDL’s?

17. The answer is simple……. • Because treating these is not profitable for drug companies!!!! • But wait!!! When a drug becomes available to treat the HDL, you will hear about the “epidemic” in this country which will justify millions being spent for a new drug!

18. What qualifies as Low HDL? • 40 mg/dL for men • 45 mg/dL for women • HDL is already available in the standard cholesterol panels • Drug Companies focus on the lowering of the LDL’s while the most important factor goes unchecked

19. Myth #2 If I take my statin, I will not get a heart attack • This simply is not true • Lowering cholesterol, even to rock-bottom levels reduces but does not eliminate heart attacks • Other factors must be considered like low HDL, homocysteine and high insulin levels • The 2003 National Health and Nutrition Survey show that 47 million U.S. adults have “Metabolic Syndrome” – low HDL’s; High triglycerides, High BP and excess abdominal fat which substantially heightens the risk of CVD even in the presence of of cholesterol levels and statin use.

20. Myth #3 I feel fine and my stress test was normal. My doctor says I do not have heart disease. • Lack of symptoms should not be reassuring as most heart disease is silent, without symptoms; undetectable by conventional means such as ECG and cholesterol testing. • Stress testing is a miserable failure for screening asymptomatic people; most future MI occur in people with normal stress tests • How many times have you heard about your neighbor passing a stress test on Tuesday only to drop dead on Thursday?

21. Cholesterol: The Lipid with the bad reputation • Hyperlipidemia refers to elevated blood levels of lipids (fats) including cholesterol and triglycerides. • Most people with hyperlipidemia have no symptoms • But hyperlipidemia is a contributing factor for coronary heart disease (CHD), a thickening or hardening of the arteries that supply blood to the heart muscle

22. Cholesterol: The Lipid with the bad reputation • CHD can in turn result in angina pectoris (chest pain), a heart attack or both • Hyperlipidemia is but one risk factor of many concerns and what causes it is also of great debate • It is not as simple as foods that contain cholesterol which elevate lipids

23. But what has been overlooked.. • The oxidation of LDL cholesterol caused from a lack of antioxidant-rich foods, herbs and nutrients and/or a large intake of foods and chemicals hat contain damaging free radicals. • When LDL cholesterol oxidizes, it promotes atherosclerosis by a process referred to as the macrophage foam cell mechanism • This is especially so in the presence of stressors like cortisol and insulin

24. Cortisol and Insulin • Act to inflame the arterial walls which are the real underlying causes of chronic disease including PVD • The production of a C-reactive protein is the essential part of the inflammatory process deep within the body • Multiple risk markers for atherosclerosis and C-V disease act in a synergistic way through inflammatory pathways

25. The immune, endothelial and smooth muscle cells are all affected • What prevents the inflammatory process is the presence of flavonoides; carotenoids, sterols, vitamin C and E; Omega 3 and 6 fatty acids (alpha linoleic) to circumvent these inflammatories • A marker of note is that of Nitric Oxide and Peryoxynitrate to reduce vascular lesion formation and induce vasodilation

26. How do we obtain these nutrients? • Arginine • Antioxidants – Vitamin C and E, lipoic acid, selenium, glutathione • Enzyme co-factors such as B2, B3, B6, B12, folate and zinc • DHA/EPA from fish oil, tocotrienols and quercetin • All help to elevate nitric oxide levels

27. The Range of Cholesterol • With a broad range from 180-240 mg/dL there is little to no evidence that this alone correlates with heart disease. • Below 180 there is risk of hemorrhagic stroke, depression and suicide • Above 240 there is increased risk of C-V disease and ischemic stroke. • Over 70, elevated cholesterol and C-V events do not correlate • All told, total serum cholesterol is a poor indicator of C-V disease. • Half of all MI have normal total cholesterol levels