Second heart scan and heart attack risk

9. January 2007 William Davis (0)
At first, Joe felt disappointed, defeated, and frightened. After his heart scan, a radiologist at the center told him that his score of 264 was moderately high. He told Joe that he was at moderate risk for heart attack and that a nuclear stress test was going to be required.

This left Joe feeling confused. After all he'd had a heart scan 18 months earlier and his score was 278, 5% higher.

I reassured Joe that the radiologist had not been aware that Joe had a prior heart scan. The radiologist didn't know that Joe's heart scan score had actually been reduced.

In fact, Joe's risk for heart attack was not moderate--it is now very low, since his score was 5% lower. While growing plaque is active plaque, shrinking plaque is inactive plaque and thereby at far less risk for heart attack.

I wrote about this phemonenon in a previous Blog: When is a heart scan score of 400 better than 200? at http://heartscanblog.blogspot.com/2006_09_01_archive.html. When you've had more than one scan, the risk for heart attack suggested by the score takes a back seat to the rate of change of your score. In other words, even though Joe's score of 264 represented a moderate risk (of approximately 3% per year, roughly 30% over 10 years), this no longer held true, since it actually represented a 5% decrease over a previous score.

Joe's risk for heart attack is probably close to zero. ALWAYS view your second (or any subsequent) heart scan score in the context of your previous score, not in isolation.

Track Your Plaque newsletter subscribers: We will detail more of Joe's story in the coming January 2007 newsletter. If you'd like to read or subscribe to the newsletter, go to http://www.cureality.com/f_scanshow.asp.
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More on ASTEROID

More on ASTEROID

16. April 2008 William Davis (3)
Since we are on the topic of the ASTEROID trial and rosuvastatin, I'd make one more point before I start to sound like I'm plugging this drug (which I definitely am not).

In an informative Roundtable Discussion (open to subscribers to the American Journal of Cardiology; sorry) amongst Dr. Steve Nissen, principal investigator behind ASTEROID; and Drs. Vincent Friedewald, Christie Ballantyne, P. Shah, and William Roberts, Dr. Nissen made some interesting comments:


Dr. Shah: In ASTEROID, was the magnitude of atheroma volume change seen across different levels of LDL-C and HDL-C?

Dr. Nissen: No. There was no plaque regression seen in the 17 persons with LDL-Cs >/= 100 mg/dl, and there was little change in persons with LDL-Cs of 70 to 100 mg/dl. Only in persons with LDLs less than or equal to 70 mg/dl was there significant regression. The study was not powered to look for an HDL-C(which increased by 14.7%)-raising effect.



Interesting. In other words, ASTEROID, in a fairly internally consistent way, suggests that the lower the LDL is reduced, the more likely plaque regression is obtained. This is consistent with the Track Your Plaque experience, in which we've advocated reducing (calculated) LDL cholesterol to 60 mg/dl for the past several years.

Unfortunately, the message that the ASTEROID Trial sponsors, AstraZeneca, as well as the roundtable discussion panel (later in the discussion) try to make is that there is something magical about Crestor, that it yields benefits superior to other statin agents or other means of reducing LDL.

I disagree with this message. In the Track Your Plaque experience, we do aim for a similar LDL target. But we also employ a number of other strategies. We have also succeeded in regressing plaque without use of any statin drugs (though, admittedly, many people do require statin drugs to obtain LDLs in this range). We also witness magnitudes of reversal that often far exceed that seen in ASTEROID.

The Rountable Discussion is unfortunately tainted, as is the ASTEROID Trial itself, with deep drug industry financial involvement of the Roundtable participants. In fact, the discussion begins with a listing of the financial disclosures of the participants, a listing that occupies a full column of a two-column page. The potential biases of the participants doesn't necessarily invalidate the arguments, but to me suggests that participants are more likely to argue in favor of the sponsor's drug, or that participants were chosen because of these biases.

Why bother to even mention the ASTEROID Trial in a venue (the Heart Scan Blog, that is) that purports to seek unvarnished, unbiased truth in coronary plaque reversal? Because useful information can sometimes be found in unlikely places. Just like the four-year old child who blurts out an unexpected pearl of wisdom, so it can happen with the gobbledy-gook that emerges from the drug industry.

Every once in a while, they are worth paying attention to.
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Comments (3) -

  • Naruwan

    4/19/2008 11:54:00 AM |

    Dr. Davis, your readers may be interested to listen to a recent BBC Radio 4 program which takes a close look at some impressive-sounding figures obtained from statin drug trials and shows how they are in fact not in the least bit impressive (e.g. a reduction in mortality from 3 in 600 people to 2 in 600 being hyped by statin manufacturers as being an over 33% reduction! Brings to mind Disraeli's adage about damned lies and statistics.

    The take home message is that statins appear to be hugely over-subscribed - the UK is gaining on the US in this regard - and statins are of no benefit for 99% of people taking them for primary prevention of heart disease.

    You can listen to the program online using the BBC Real Player at this link. Click Listen Live at the top right of the screen.

  • Naruwan

    4/19/2008 12:11:00 PM |

    My apologies, it appears that the BBC radio 4 program (The Investigation) about statins is no longer available. I think the show's transcript will be made available in due course.

    If anyone would like me to send them the mp3 file of the show (shhh, don't tell the BBC!), please leave a comment here. It's a worthwhile listen.

  • Anonymous

    8/22/2008 8:41:00 PM |

    I would like to know how long one can expect to lengthen their life by taking a statin How many actual years does it add to your life and what about the risk of cancer from taking statins over a 20-30 year period?

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Digging for the truth

Digging for the truth

15. July 2007 William Davis (9)
I remain continually amazed how difficult it can be to gain an understanding of what is true and what is not true. I am particularly worried about the messages provided by agencies that stand to make enormous gains by persuading us to believe their version of the "truth".

For a moment, let's strip away the charitable covers of some financially-motivated organizations and see what they really look like:


Hospitals: The dream of hospitals is to shift the proportion of patients towards those with the most profitable diseases in well-insured patients. Heart disease is among the best paying diseases. HOSPITALS WANT YOU TO HAVE HEART DISEASE.

Doctors: Many (though not all) want to deal with diseases that pay well. Implanting a stent can pay several thousand dollars. Putting in a defibrillator can likewise pay handsomely, even better than stents. DOCTORS WANT TO STEER YOU TOWARDS PROCEDURES THAT REIMBURSE GENEROUSLY. Talk is cheap and pays poorly. Heart scans? Useless, since they're cheap. CT angiography? Now we're talking! $1800 dollars is a lot more interesting than $200 or so for a simple heart scan. CT angiograms also lead to catheterization, stents, hospitalizations.

Drug manufacturers: The holy grail for drug manufacturers is a chronic condition that is present in large numbers of people. An antibiotic, for instance, is a drug manufacturers waste of time: Short courses of treatment in relatively few people. Cholesterol drugs, blood pressure drugs, drugs to modify personality or some aspect of behavior--these you take for years, decades, or a lifetime, and millions are persuaded they need them. DRUG COMPANIES WANT CHRONIC CONDITIONS (WHETHER OR NOT THEY'RE DISEASES) IN PEOPLE WHO SURVIVE FOR A LONG TIME, NOT SICK PEOPLE.

Supplement manufacturers: What don't we need in the eyes of sellers of nutritional supplement? While a program like Track Your Plaque makes liberal use of supplements in a focused and, I believe, rational way, supplement sellers want you to take dozens or preparations of dubious value: milk thistle, hawthorne, ribose, hoodia, silymarin, hydroxycitric acid . . . Unlike the larger ambitions and bigger money of the pharmaceutical industry, the supplement industry is often driven by the momentary craze and the quick payoff. THE SUPPLEMENT INDUSTRY IS LOOKING FOR SUCKERS.

Food manufacturers: The holy grail for the food industry are foods that have high markups, are convenient (e.g., eaten right out of the box or package), and are purchased repeatedly. Even better, if a health claim can be added, it can ride the current wave of the public's health consciousness. Thus, Cocoa Puffs can be labeled "Heart Healthy". How about foods that have addictive potential and virtually ensure repeat sales? Eat some and you want more within 2-4 hours! As nutritionist Marion Nestle says, the mantra of the foods industry is "Eat More". It is my firm conviction that the epidemic of obesity in the U.S. is not due to laziness, video games, and computers. It is the fault of food manufacturers. FOOD MANUFACTURERS WANT US FAT AND HUNGRY AND WANT US TO STAY THAT WAY. What pays better, a 110 lb vegetarian woman who shops at the farmer's market and buys locally produced foods, or the 260 lb glutenous and always-hungry woman who fills her supermarket shopping cart with 15 cents worth of flour and sugar priced at $4.59 (cleverly disguised as a healthy breakfast cereal), instant mixes, convenient meals, energy bars, and chips?

Government agencies: User fees for the FDA paid by drug companies have caused the FDA to be beholden to drug company pressures. The USDA, charged with crafting the food pyramid, was created to support the farm industry and distributors of their products, not to disseminate public health. The food pyramid is the watered down end result of food industry lobbying and threats, not the scientific advice of nutritionists. GOVERNMENT AGENCIES SERVE INDUSTRY FIRST, THE PUBLIC SECOND.

Health websites: Read popular websites like WebMD for information and the conversation quickly steers towards drugs. "Natural treatments for cholesterol" talks about reducing saturated fat and then gushes about the wonders of statin drugs. Guess where 80% of WebMD's revenues come from? Yup, the drug industry. The same goes for many magazines, TV shows, and other media. MEDIA IS OFTEN THE TOOL OF BIG INDUSTRY.



I'm sounding like a conspiracy theorist. I don't believe that I am, but I am skeptical of the messages we often receive from the media, advertisements, news reports, websites, etc. It's left to you and me to use our judgment and decide what is truth and what is someone's version of a message crafted towards their hidden agenda.

I am hoping that the real truth will grow through a wiki-like phenomena driven and supervised by a collective knowledge that we all contribute towards. That will happen, most likely, on the internet. Just as Wikipedia overtook the revered Encylopedia Britannica in the blink of an eye at far less cost yet with greater depth and equivalent accuracy, so will it happen in health information. I'm uncertain of the eventual form this health-wiki will take, but it will shatter many smug and deeply-entrenched powers that at present continue to profit from mis-information.
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Comments (9) -

  • JT

    7/15/2007 4:29:00 PM |

    Unfortunately you don't sound like a conspiracy theorist.  I even know of an example of a fortune 500 company receiving air time for one of their products by "respected" news agencies.  

    Back in the summer of 1999 or 00 one would have thought the supplement SAMe was the cure all for depression and arthritis.  Magazines Time, & Newsweek ran articles on it.  My memory isn't so good anymore but I believe one of them even placed SAMe on the front cover.  The nightly news NBC, CBS, and ABC all ran gushing reports on SAMe and its natural curing abilities.    

    I'd like to say that the news reporting was done because SAMe is truly a wonder supplement.  That is not the case.  It is a fine product I suppose but not the kind of product that deserves the enormous press coverage that it did.  The reason it received so much press is because the large multi national company asked them to do so.

  • Rich

    7/15/2007 9:41:00 PM |

    Dr. Davis, these comments are a huge inspiration.

    As a b-school prof, I know that pharma and hospitals are not intentionally exploitative, but the profit motive inexorably works its effects in all aspects of the decision process, and ethical standards are gradually stretched to the minimum limits of acceptability.

    I recently did a casual analysis of the ads in Reader's Digest. About 80% of the ads are for prescription drugs to treat lifestyle-inflicted illnesses, such as high BP, type 2 diabetes, and inability to sleep, as wells other highly questionable illnesses such as "restless leg syndrome, or RLS." Daytime TV is about the same. You may notice that the ads now say "talk to your prescriber" instead of "talk to your doctor" -- in other words, they don't care who prescribes it, only that it gets prescribed.

    THESE ADS ARE THE REVENUE SOURCES FOR THE MEDIA, WHICH MUST CATER TO THE ADVERTISERS IN ORDER TO STAY IN BUSINESS. PHARMA PAYS FOR THE RESEARCH IN UNIVERSITIES, AS WELL.

    People don't bite the hand that feeds them!

  • Dr. Davis

    7/16/2007 12:30:00 AM |

    Wow! I wasn't aware of that.

    Would you know who the company was?

  • Dr. Davis

    7/16/2007 12:36:00 AM |

    Rich--

    I had no idea that the proportion of pharmaceutical ads had grown to such an extraordinary number. The drug industry is not stupid--their direct-to-consumer advertising must be working in a big way.

  • JT

    7/16/2007 12:48:00 AM |

    Yeah, maybe I'm too cautious, but giving the companies name shouldn't be a problem in this case.  The SAMe pills were made by an Italian firm that had/has a contract with BASF.  (They could be a division of BASF.)  

    I was told by a BASF employee that their press department is very good and persuasive.  They wanted to create a buzz for the product.  70% of sales for health foods are generated on new products.  People like to rush out and try the new thing.

  • Anne

    7/17/2007 11:33:00 AM |

    Don't forget to include the "non-profits". Back in the 1950's my father, a physician, told me that the American Cancer Society did not really want to find a cure for cancer. From some of the things the American Heart Associaton promotes, I don't think they really want to stop heart disease.
    Anne

  • Dr. Davis

    7/17/2007 12:00:00 PM |

    I couldn't agree more.

  • Anonymous

    7/17/2007 5:42:00 PM |

    Thank goodness we have someone like you, Dr. Davis, who can help us sort through all these industries who are looking for "suckers".

  • Anonymous

    11/19/2008 3:07:00 AM |

    There is a very interesting 6 part documentary on youtube about marketing and the pharmaceutical industry. "Big Bucks, Big Pharma"
    Here is the link to part 6.

    http://www.youtube.com/watch?v=IVDTo8Rm1rE&feature=related

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