Mr. Salazar: Check your Lp(a)

9. July 2007 William Davis (8)
Marathon star Alberto Salazar was just released from the hospital following a heart attack and a heart catheterization that led to a stent. The MSNBC version of the report can be viewed at http://www.msnbc.msn.com/id/19653682/.

At 48 years old and holder of several American records for marathon times, Salazar's story is eerily reminiscent of Jim Fixx, who died at age 52 after writing a bestselling book, The Complete Book of Running. Thankfully, Salazar's story has a happier ending.

Fixx died at a time when prevention of heart disease was quite primitive. Lipoprotein analysis was not broadly available to the public, CT heart scans had not yet been invented. Even statin drugs were just a gleam in the pharmaceutical industry's eye.

But not so with Salazar. This Cuban-born marathoner experienced his heart attack at at a time when enormously useful steps can be taken to 1) document the extent of disease with a CT heart scan (the presence of a stent just means that one artery can't be "scored"), and 2) identify the causes of his disease.

I suspect that the fact that yet another marathoner in the limelight will once again prompt the (likely non-sensical) conversation about long-distance running and the increased risk of heart disease. Unfortunately, I fear that the real cause will be left unidentfied and untreated: Lipoprotein(a), or Lp(a).

It's almost certain that Fixx had Lp(a), given the fact that his dad had a heart attack at age 35. Running simply postponed the untreated inevitable.

I hope Mr. Salazar is surrounded by doctors who have his true interests in mind (not just procedural excitement) and ask the crucial question: Why?

The answer is almost certain to be Lp(a).
Tags :

Comments (8) -

  • JT

    7/9/2007 11:29:00 AM |

    I know a group of guys that run marathons regularly.  If you asked them why they run, they will tell you there are two reasons; one to prevent heart disease and two to drink beer with out gaining weight.  Special emphasis will be placed on drinking beer.  I was reminded this week of how much the group enjoys their beer when the head of the group CCed me on a letter he wrote to Kroger grocery store pointing out that their Miller beer price is significantly higher priced than Wal-Mart, located just across the street.  If Kroger did not lower the price, well, they might just have to shop elsewhere.  

    I'm going to send them this blog and tell them they can stop running blind.  Today there are tests to determine if you have heart disease.  I'd suggest to them to drink red wine instead of beer, but that might be asking too much.

  • Dr. Davis

    7/9/2007 11:43:00 AM |

    That's great.

    Now we can only hope that their doc's know what to do next if any of them have Lp(a) or other "obscure" factors.

  • Mike

    7/9/2007 5:58:00 PM |

    When (what age) should one have a heart scan and Lp(a) test done if there are no symptoms? What would be the approximate cost to get the recommended testing done and evaluated?

  • traderfran2001

    7/10/2007 4:17:00 AM |

    I am curious as to why you focused on LPa as the likely cause. For example I am a regular runner and my LPa is in the low normal range. Is there something about running that makes LPa abnormalities more likely?

  • Dr. Davis

    7/10/2007 11:32:00 AM |

    Hi,
    I believe that the combination of Lp(a) and marathoners is no more likely than the general population, but it makes for media hype--the apparent contradictions of ultra-fitness and a disease generally associated with poor lifestyle. Lp(a) is, more often than not, the source of the contradiction.

  • John Townsend

    7/20/2007 11:08:00 PM |

    Do you have any advice on a Vitamin C/Lysine regimen? Apparently this combination was recommended (in high doses) by Linus Pauling years ago for cardiac health, particularly in controlling high levels of Lp(a). TIA

  • Dr. Davis

    7/21/2007 1:44:00 AM |

    John--

    I can only tell you that we've tried a number of times only to see no substantial effect.

    The concept has the basis in some real--and very interesting science--but the leap from a "test tube" observation to a "cure" for heart disease and cancer is, to say the least, a big one.

  • Dr. Davis

    7/28/2007 2:52:00 PM |

    Mike--Please see the extensive commentary on these issues on the Track Your Plaque website that this Blog accompanies. You will find an enormous amount of discussion, even in the non-Member, open content section.

Add comment

Loading
Media mis-information

Media mis-information

21. April 2007 William Davis (2)
This is an excerpt from a popular health website, EverydayHealth.com:


A Cholesterol-Busting Vitamin?
Did you know that niacin, one of the B vitamins, is also a potent cholesterol fighter? Find out how niacin can help reduce cholesterol…

Niacin is safe — except in people with chronic liver disease or certain other conditions, including diabetes and peptic ulcer. It is also inexpensive. However, it has numerous side effects. It can cause rashes and aggravate gout, diabetes, or peptic ulcers. Early in therapy, it can cause facial flushing for several minutes soon after a dose, although this response often stops after about two weeks of therapy and can be reduced by taking aspirin or ibuprofen half an hour before taking the niacin. A sustained-release preparation of niacin (Niaspan) appears to have fewer side effects, but may cause more liver function abnormalities, especially when combined with a statin.

Many people begin treatment at low doses (250 mg twice a day, for example) and, over six weeks or so, gradually build up to an amount that lowers lipid levels, anywhere from 1,000 to 2,500 mg split between two doses during the day. This gradual approach may help build tolerance to side effects such as facial flushing. Although niacin is available over the counter, you should not use it in quantities sufficient to lower cholesterol without a physician’s supervision. It is important to test liver function and levels of blood sugar and uric acid before beginning niacin therapy and during the course of treatment.

(Bold emphasis mine.)

At http://www.everydayhealth.com/publicsite/index.aspx?puid=548e8630-32d6-41dd-91a7-48e1cbac65ad&p=4




After an enticing headline, the article goes on to scare the pants off you. It also sounds like accurate information, delivered in an unbiased way, cold and straight.

If we were to use niacin this way, it would indeed be intolerable for most. Do not follow the above nonsensical advice. But that may have been the intention from the start.


Very telling are the fact that, both above and below the article were colorful advertisements for Lipitor, complete with Dr. Robert Jarvik’s (inventor of an implantable mechanical heart) soothing, professorial image.

Did they want to bait us with promising information about cholesterol and niacin, only to throw water on our fire and steer us towards something else?

That would be typical drug company marketing.

All in all, I’m grateful for the attention the media provides for health issues. Perhaps many people wouldn’t even be aware of niacin and other healthy strategies if some website, newspaper, or magazine article hadn’t talked about it.

But I do worry about bias. Was this an unbiased report? Or was it more like much of the physician-directed mail I receive, cleverly concealed propaganda from the drug manufacturers? Who wrote it? No author is listed. Could it have been ghost written by someone in the drug company itself, or an arm of the drug company? That’s a very common practice for the literature physicians receive, glossy, high-class materials paid for by drug companies, written by drug company-owned companies, but no company logo or name listed.

My point: Be skeptical of what the media tells us. There’s usually a good deal of truth in the reporting, but there’s also often just enough mis-information or slanting of content to make you behave or believe a certain way. “If niacin is this dangerous, maybe I really should take the Lipitor.”
Tags :

Comments (2) -

  • Bearcub

    7/1/2007 2:34:00 PM |

    My cardiologisdt has recommended that I take Niaspan instead of using Lipitor.. can you tell me more about that ??

  • Dr. Davis

    7/1/2007 5:13:00 PM |

    Big issue. Please refer to the website that this Blog supplements, www.trackyourplaque.com.

Add comment

Loading