Do stents prevent reversal?

27. January 2007 William Davis (3)
I've seen this phenomenon several times now: A highly-motivated Track Your Plaque participant with a stent in one artery will do all the right things--lose weight, achieve 60:60:60 in basic lipids, identify and correct hidden lipoprotein disorders, take fish oil, correct vitamin D, etc.

Follow-up heart scan shows dramatic reduction in scoring in the two arteries without stents--30% per artery. But the artery with the stent will show marked increase in scoring above and/or below the stent. (It's impossible to tell what happens in or around the stent itself from a calcium scoring standpoint, since steel looks just like calcium on a CT heart scan.) In other words, there is marked plaque growth in the vicinity of the stent, despite the fact that dramatic reversal of atherosclerosis has occurred in other arteries without stents.

Should we take this to mean that a stent destroys the opportunity for atherosclerotic plaque reversal in the stented artery? I don't know, but I fear this may be true. What dangers does this different sort of plaque pose? Is it the result of the injury imposed at time of stent implantation, some modification of flow or biologic responses as a result of the presence of the stent?

These are all unanswered questions. But I believe that it is yet another suggestive piece of evidence that the best stent is no stent at all.
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Comments (3) -

  • neil

    1/29/2007 4:38:00 AM |

    While I certainly enjoyed your book and am extremely grateful for your generous sharing in your daily blog, I am very troubled by this blog entry. Over the last day I have been thinking quite a lot about it off and on, and that would be because I have three stents implanted; two Cypher and one Taxus.

    Since my dates in the hospital cath lab in early 2004 I have been following along with TYP principles carefully with the hope of being additional plaque neutral or even a bit of regression, but I see from this entry my hopes might be dashed.

    Your statement in the blog entry "I've seen this phenomenon several times now", does this mean it happens most always, or sometimes, or occasionally? What is the game plan now for these patients? Do they (or did) have any similarities that might be contributing to their plaque growth (LPa, diabetes, vit. D, BMI, gender, etc), or are their lipoproteins and assays corrected to perfection?

    Thanks again for all that you do, your program and willingness to share is unique and very special to many of us. If you could follow up sometime on this situation with a future blog entry or observations, I would be most appreciative.

    With concern,

    Neil

  • Dr. Davis

    1/29/2007 1:29:00 PM |

    Neil--
    All this means is that the presence of a stent may modify the potential for reversal ONLY IN THE VICINITY OF THE STENT. Other areas, meaning the majority of your other arteries' lengths, are still subject to your control and the benefits of your prevention program.

    Keep in mind that this is an experience involving just a handful of patients. To my knowledge, there are no formal published experiences like this to compare to. All patients had their patterns corrected to perfection by Track Your Plaque standards and don't seem to be distinguished by any one single lipoprotein pattern.

    My "gut sense" is that the sort of plaque growth that we see around stents and tracked by heart scanning does not carry the same implications that non-stent associated plaque does.

  • Anonymous

    2/27/2008 12:43:00 AM |

    I just found your site recently and have been reading through the posts.  I find it very educational.  Thanks!  

    I'm curious.  Were the stents medicated stents (since it is my understanding that they prevent this kind of thing)?

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The Russert Protocol at work

The Russert Protocol at work

25. June 2008 William Davis (6)
Without a concerted effort at prevention, heart scan scores (coronary calcium scores) grow like weeds. The average rate of growth is 30% per year.

Keith is an illustrative case. At age 39, Keith's heart scan score was 29, in the 99th percentile due to his young age. (In other words, young people before age 40 have no business having plaque. If they do, it's bad.)

True to conventional practice, Keith's doctor prescribed a cholesterol drug (Zocor), asked him to take a baby aspirin, and prescribed a blood pressure medicine. He asked Keith to cut the fat in his diet. His doctor even exceeded conventional (ATP-III) LDL cholesterol treatment targets.

Keith, an intelligent and motivated businessman, happily complied with his doctor's instructions. Eighteen months later, a 2nd heart scan showed a score of 68, representing an increase of 135%, or 76% per year.

This is the very same approach that the late Mr. Tim Russert's doctors employed: treat (calculated) LDL cholesterol with a statin drug, treat high blood pressure, reduce saturated fat, take aspirin. It was a miserable failure in Keith, whose plaque continued to grow at a frightening rate of 76% per year. It was also an obvious failure in poor Tim Russert.

Further investigation in Keith uncovered:

--Severe small LDL--80% of all LDL was small (despite a favorable HDL of 58 mg/dl)
--Measured LDL particle number (NMR) showed that "true" LDL was actually about 60 mg/dl higher than suggested by the crude calculated LDL
--An after-eating (postprandial) disorder (IDL)
--A pre-diabetic blood sugar and insulin
--Severe vitamin D deficiency
--Very low testosterone

All these patterns were present despite the steps Keith and his doctor had instituted. It's no wonder his plaque was undergoing explosive growth.

The conventional approach to coronary disease prevention is inadequate, more often than not a mindless adherence to one-size-fits-all template crafted to a great degree by drug industry interests and "experts" who often stand at arm's length from real live patients.

Keith's "residual" abnormalities are all readily correctable. He has since made dramatic improvements in all parameters. Among the strategies used is a wheat- and cornstarch-free diet that resulted in 12 lbs lost within the first few weeks of effort.

If you are on the "Russert Protocol," have a serious conversation with your doctor about the continued advisability of remaining on this half-assed approach to heart disease. Or, consider finding another doctor.
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Comments (6) -

  • Anonymous

    6/25/2008 10:23:00 AM |

    Testosterone deficiency is indeed another important factor, perhaps before vitamin D for some men.

    I guess it's no co-incidence that men's sperm rates are declining due to the range of chemicals in our environment which have an adverse affect on testosterone levels.

  • Stargazey

    6/25/2008 1:24:00 PM |

    I don't normally leave comments at your blog, but I wanted you to know that I read it regularly. Thanks for the all work you put into your posts and for the inspiration you provide!

  • Anonymous

    6/25/2008 3:01:00 PM |

    Except that for people with low testosterone (and I am one of those)when you try to correct the low testosterone with testosterone it lowers HDL. Its almost a "choose your poison" proposition.

  • Anonymous

    6/26/2008 9:44:00 AM |

    "However, only testosterone pills have been shown to lower blood levels of the good HDL cholesterol and cause heart attacks. Testosterone injections and skin patches do not (5,6,9)."
    http://www.drmirkin.com/men/M169.htm

  • Anonymous

    6/27/2008 3:09:00 PM |

    You don't mention testosterone cream, I'm on that and my testosterone went from 66 to 50,with no other changes in eating, weight, medicine . . . not a good trend.

  • Anonymous

    6/29/2008 10:37:00 AM |

    You should try Nebido (if available in the US), it's an injection that lasts up to 12 weeks - give or take a few weeks according to how you feel. It seems to be the most popular treatment in Europe due to being something you only think about 4x a year and achieves steady state levels.

    "The observed changes in the lipid profile under treatment with Nebido® were assessed as beneficial. Serum concentrations of total cholesterol, LDL cholesterol and apolipoproteins A1 and B were lowered, while HDL cholesterol, triglycerides and lipoprotein A remained unchanged.1,2,3"
    http://www.nebido.com/scripts/en/professionals/productinfo/lipid.php

    Where trigylcerides and HDL remain unchanged I guess this is where vit D and fish oil steps in.

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