"You can't reduce coronary plaque"

10. May 2009 William Davis (9)
"I told my cardiologst that I stumbled on a program called 'Track Your Plaque' that claims to be able to help reduce your coronary calcium score.

"My cardiologist said, 'That's impossible. You cannot reduce coronary plaque. I've never seen anyone reduce a heart scan score."

Who's right here?

The commenter is right; the cardiologist is wrong.

I would predict that the cardiologist is among the conventionally-thinking, "statins drugs are the only solution" group who follows his patients over the years to determine when a procedure is finally "needed." In fact, I know many of these cardiologists personally. The primary care physicians are completely in the dark, usually expressing an attitude of helplessness and submitting to the "wisdom" of their cardiology consultants.

Quantify and work to reduce the atherosclerotic plaque? No way! That's work, requires thinking, some sophisticated testing (like lipoprotein testing), even some new ideas like vitamin D. "They didn't teach that to me in medical school (back in 1980)!"

Welcome to the new age.

Atherosclerotic plaque is 1) measurable, 2) trackable, and 3) can be reduced.

We do it all the time. (Amy still holds our record: 63% reduction in plaque/heart scan score.)

Though I pooh-pooh the value of statin drug studies, there's even data from the conventional statin world documenting coronary plaque reversal. The ASTEROID Trial of rosuvastatin (Crestor), 40 mg per day for one year, demonstrated 7% reduction of atherosclerotic plaque using intracoronary ultrasound.

I have NEVER seen a heart attack or appearance of heart symptoms (angina, unstable angina) in a person who has reversed coronary plaque (unless, of course, they pitched the whole effort and returned to bad habits--that has happened). Stick to the program and coronary risk, for all practical purposes, been eliminated.

A heart scan score is not a death sentence. It is simply a tool to empower your prevention program, a measuring stick to gauge plaque progression, stabilization, or regression. Don't accept anything less.
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Comments (9) -

  • Angela

    5/10/2009 3:17:00 PM |

    "They didn't teach that to me in medical school (back in 1980)!"

    Unfortunately vitamin d is not mentioned in med school nowadays except for osteoporosis prevention...

    Dr. Davis -- thank you for your blog. I am a med student interested in REAL evidence based medicine (which makes me a bit unpopular between my teachers).

    I researched vitamin D after reading your blog, and decided to mega-dose on it. It's been 4 weeks now and my "inespecified mood disorder" (never met criteria for depression, but have never been really "well" since I was 16) is GONE. Like a "veil" has fallen or something. PMS is gone as well.Now I have discovered that the periods of my life in which I felt truly well were when I spent outside most of the day (I live in the mediterranean coast).

    I also had a single attack of MS some years ago, so vitamin D will help to prevent full blown multiple sclerosis.

    My comment is in no way related with atherosclerosis, but I just wanted to thank you, and congratulate you for having found a way to help people outside conventional medicine. I feel greatly inspired by your work.

    Regards,

    Angela Nicolas

  • antidrugrep

    5/10/2009 7:59:00 PM |

    "primary care physicians are completely in the dark"

    For the record, we aren't ALL in the dark. In fact, I stumbled across your website a few years ago as I was looking for supportive testimony from other practitioners who saw things clearly. In fact, I watched as you "caught up" with the idea of adding Vitamin K2 to your regimen - presumably based on the results of the 2004 Rotterdam Study.

    I hate to sound defensive, but such a sweeping generalization is uncharacteristically irrational of your posts up to now. Perhaps you haven't known any primary care "grunts" without a cranial suppository.

    Now you know at least one.

  • Kismet

    5/10/2009 9:43:00 PM |

    I guess it's just a matter of time until someone breaks the record again?

    I know you have talked highly of vitamin K2, I'm wondering if you've made it a staple of the TYP program already? I think there's all reason to do so.
    Below two studies using high doses of K1, but it should work via conversion to K2 (the epidemiology of K2 hints at the same phenomenon).

    Am J Clin Nutr. 2009 Apr 22. [Epub ahead of print]
    Vitamin K supplementation and progression of coronary artery calcium in older men and women.
    Shea MK, O'Donnell CJ, Hoffmann U, Dallal GE, Dawson-Hughes B, Ordovas JM, Price PA, Williamson MK, Booth SL.

    One of THE most impressive studies I've ever read:
    Thromb Haemost. 2004 Feb;91(2):373-80.
    Beneficial effects of vitamins D and K on the elastic properties of the vessel wall in postmenopausal women: a follow-up study.
    Braam LA, Hoeks AP, Brouns F, Hamulyák K, Gerichhausen MJ, Vermeer C.

  • pmpctek

    5/11/2009 4:10:00 AM |

    Over the last year, I have seen about a dozen physicians (for a reason other than heart disease).

    Be they a GP, cardiologist, pulmonologist, oncologist, or hematologist, they all tell me the same thing; we all "naturally" develop coronary plague as we age and that it can only be minimally "managed" by lowering our cholesterol with -insert your statin drug here.

    Every time I reply with; there is nothing natural about having calcified plaque build up in our coronary arteries at any age and that it can be very effectively managed by following Dr. Davis' "Track Your Plaque" protocol. (As I pull out your book to show them.)

    The physician then usually looks at me like I have two heads and dismisses me by standing up to signal that the visit is over.  Except for one physician, honestly, who responded by reaching for his script pad and saying that he would like to start me on an antidepressant medication right away... lmao.

    I have now given up looking for any local physician who would be willing to help me in any way with the heart scan/track-your-plaque program.

  • Dr. William Davis

    5/12/2009 1:06:00 AM |

    Antidrugrep--

    Actually, that generalization was intended principally for the sorts of primary care docs who wouldn't read a blog like this. You are clearly the exception.

    If you had responded that most cardiologists are knuckleheads out for a buck, I would have agreed, too.

  • Dr. William Davis

    5/12/2009 1:08:00 AM |

    Kismet--

    Thanks for the references. I hadn't seen the Shea study; the findings are interesting.

    We haven't had enough people have pre-K2 and post-K2 heart scans, so it's hard to know what effect it ADDS to the existing battery of strategies. Nonetheless, K2 is definitely on the list of most promising. Given its benign nature, I do encourage people to add it, though dosing remains entirely uncertain.

  • Anonymous

    6/2/2009 1:25:26 PM |

    I seem to be developing atherosclerosis at age 26 and I've been doing a lot of research. B12 and Vitamin D are related, but you should also be aware of magnesium. See the study at Comparison of Mechanism and Functional Effects of Magnesium and Statin Pharmaceuticals. In this study they basically explain how magnesium works as a natural statin and calcium channel blocker. If you do further research online you may become convinced, as I am, that magnesium deficiency is just as widespread as Vitamin D deficiency.

    You need to take a chelated form of magnesium, such as glycinate, because other forms (like magnesium oxide) are poorly absorbed by the body and not worth the money.

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    11/3/2010 6:34:52 PM |

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Lipoprotein(a) and small LDL

Lipoprotein(a) and small LDL

4. May 2006 William Davis (1)
It's been my suspicion for some time that the combination of lipoprotein(a), or Lp(a), in combination with small LDL particles is a really bad risk for heart disease. People with this combination seem to have much higher heart scan scores for age than others. This seems to be a pattern that we'll see in the occasional woman less than 50 years old who already has a high heaert scan score. (It's unusual for women to have detectable coronary plaque before age 50.)

Very little data exists to support this idea and we are in the process of performing a small study to see whether it's true or not. My gut sense: it's among the most potent causes of coronary plaque around.

Case in point: Even though I spend a great deal of my time and energy advocating heart disease prevention, I still maintain my hospital privileges and skills. I had to cover one of the emergency rooms in town this past weekend (a requirement to maintain my hospital privileges).

One of the patients I saw was a 40-year old man--we'll call him Roland-- suffering a very large heart attack, a so-called "anterior myocardial infarction", or a heart attack involving the most important front portion of the heart. Thankfully, he came to the ER within 45 minutes after his chest pain started. The situation was immediately obvious and I was called to the ER. We quickly took him to the cardiac catheterization laboratory and put a stent in the left anterior descending artery and flow was restored. His chest pain dissipated over the next few minutes.

Nonetheless, Roland was left with a large area of reduced contraction of his heart muscle. Only time will tell how much recovery he'll have.

Roland was extremely lucky. The majority of people with closure of the artery that he'd experienced die within minutes. He did, in fact, "arrest" briefly, i.e., his heart became electrically unstable, though he recovered promptly.

Along with the multiple tubes of blood we required to run tests for his heart attack management, we had Roland's lipids and other measures sent off, as well. Wouldn't you know: Lp(a) and small LDL. This may have accounted for a heart attack at age 40.

Keep a lookout for this when you have lipoprotein testing. Conveniently, niacin can be used to treat both patterns, though higher doses are generally required for the Lp(a) part of the pattern. It's also my belief that the sort of Lp(a) measurement performed by the Liposcience laboratory (www.liposcience.com) is superior. They use a particle number based measure, not a weight-based measure. It is therefore independent of particle size, which can vary. Further work will, I believe, reveal some very important insights into the dreaded Lp(a).
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Comments (1) -

  • wccaguy

    10/20/2007 4:18:00 PM |

    Just getting around to reading some of your older blog posts.

    Although I'm not completely certain, it's my impression that Marcovina was a student of Professor Sally McCormick of Otago University in New Zealand.

    http://biochem.otago.ac.nz/staff/mccormick/smccormick.html

    Notice they both participated in this seminal article.

    Sharp RH, Perugini MA, Marcovina SM, McCormick SPA: Structural features of apolipoprotein B synthetic peptides that inhibit lipoprotein(a) assembly. J Lipid Res 45:2227-2234, 2004.

    I'm very certain that Rebeca Sharp was a student at Otago.

    More importantly, Sally McCormick has applied for a patent mirroring the article title linked to above at wipo.int.  Don't have the link handy.

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