My grandfather, who had a great sense of humor, had heart disease and was a frequent visitor to the cardiologist office.  One day we were sitting in the cardiologist's waiting room and I was reading an article on doctors that get sued for malpractice.  In it was a list of doctors more likely to be sued and those not.  Leading the list of doctors least likely to be sued for malpractice was cardiologist.  I pointed this out and granddads response was, "That's because cardiologists are better at burying their mistakes."

I'm guessing the best way to make cardiologists change their ways is by using the court system - unfortunately.  Just a few weeks ago I encouraged my mom to talk to her long time friend about doing that.  The friend’s father was on a hunting trip when he experienced chest pains.  He was rushed out of the woods to his hospital.  Cardiologists performed tests and everything came back normal.  No measures were taken.  A few weeks later the guy died from a heart attack.  As I told mom, a simple CT scan would have shown he had plaque and needed to immediately take preventive measures.  With all that is known now about detection and prevention it was criminal what was done and not done to that man.

It's sad and unfortunate, but sometimes your hand is forced. I agree: Legal action in selected cases may be necessary to obtain justice and raise public awareness of the magnitude of this wrongful activity.

Dear Dr Davis; I enjoy your column...  my question is this; I lap swim three days a week. I consider it to be a every other day stress test. i can certainly tell rapidly what foods are not good for: Red meat, butter, ice cream, shrimp, those are the biggys. Certainly the other meats that i eat have cholesterol; why dont they bother me? Ive had friends that swim relate the same to me: Beef and dairy is OUT.

Hi Dr. Davis,

Speaking of prevention - at what age should we start thinking about getting a CT Heart Scan? Also, would the scan show if there were heart problems other than plaque build-up?

Thanks!

I'm a 45 yr old female with diabetes, but no history of heart disease in my family even in the other diabetics.  Obviously, I didn't die from my heart attack in May, but...

I went to the ER complaining of recurrent chest pain, got an EKG and blood work, and was sent home with an antacid for my "heartburn."

A couple days later, after vomiting and screaming off-and-on for a couple hours at a time all night, my husband took me back to the ER.  He carefully explained we already *knew* it wasn't a heart attack, but something is really wrong here - he had to speak for me because I could neither walk nor speak when we went to the ER the second time.  

This time, I was transported to another hospital for an emergency angio and subsequent bypass for my so-called "heartburn."  

Pretty amazing that I developed a heart condition requiring two surgeries two days after I didn't have a heart condition, eh?

I remember being really terrified when the surgeon told me there was a 5% chance of dying during the bypass.  She thought I misunderstood, that a 95% chance of living was good, but no... 5% *is* BAD.  I don't normally do things that have a one in twenty chance of killing me!  

It was much later at home learning about heart disease that I discovered I'd had a 50% chance of dying just from the heart attack itself; sudden death is the first symptom in half of the folks with heart disease.  

I'm a very lucky chick that my husband isn't currently suing someone for letting me die.

As the holiday approaches here in the states, I was asked what I am thankful for.  This year, just being alive at all qualifies as something I have profound gratitude for.

You are a survivor of a flawed system. To me, even worse than the mis-diagnosis of the ER, is why wasn't your heart disease diagnosed during the DECADE before your heart attack?

Have you looked at Jenny Ruhl's wonderful Diabetes Update Blog and the associated website? It provides interesting commentary on diabetes, with intelligent nutritional commentary that flies in the face of the idiocy coming from the American Diabetes Association.

Summersam--I wonder if you are just among the people who struggle with digestion of fats, regardless of type.

Paul-Men, 40 and over, women 50 and over, earlier if an outstanding source of risk is present. For other abnormalities seen on heart scans, please refer to my Heart Scan Curiosities posts on this Blog.

can you please comment on the latest study out that says the Ornish diet is best for hesrt disease. I think it ranked south beach and atkins very low. I know Dr. Ornish has a new book out soon "The Spectrum Diet" these findings were presented at the AHA.
Thoughts?

The study I believe you are referring to was a University of Massachusetts rating system, not truly a study. They simply gave grades of presumed health factors, using the so-called "Alternate Healthy Eating Index (AHEI)" that ranks fiber content and other healthy ingredients. It was NOT a real world comparison of diets, nor did it study effects on heart disease. In other words, it was just a speculative discussion.

Dr. Mike Eades blogged about the anti-Atkins poster presentation here:
http://www.proteinpower.com/drmike/2007/11/06/does-the-atkins-diet-damage-blood-vessels/

and here: http://www.proteinpower.com/drmike/2007/11/08/more-on-the-low-carb-study-at-the-aha-meeting/

And I agree, Dr. Davis, Jenny's site and blog (and her previous sites and Usenet posts) are a great resource for diabetics.

I had 2 CABG and have researched like crazy. Conclusions: we still don't know much. Cytokines & etc. from stress can be lethal regardless. 256 slice CT scan is best test but only one machine in USA. VAP combined with LIPOPRINT best blood tests. Antioxidants understudied. Mainstream medicine is mercenary, more concerned with profit that healing.

Hi, Richard--

I'm afraid you are right. However, I do believe that we still do know a fair amount. I would encourage you to read prior Heart Scan Blog posts, along with the www.trackyourplaque.com website. Our philosophy is that heart disease can be halted or reversed in most people (not all). While not perfect, it is the best approach I am aware of. It is certainly better than the "take Lipitor and pray" mentality of conventional, "mercenary," medicine.

Wow. I hadn't realised that a short period of over-eating could trigger such big changes.

Is there any danger from triglycerides going much below the target of 60?

Dr. Davis --

What might cause a substantial rise in LDL, while triglycerides and HDL are lower than ever?

Here's what happened with my tests over the last year and a half:

** Summer 2007, eating the standard American diet **
Total Cholesterol: 266
Triglycerides: 109
HDL: 79
LDL: 165

** Summer 2008, just a few weeks into my new diet (no processed foods, no grains, no sugars, no vegetable oils) **
Total Cholesterol: 225
Triglycerides: 63
HDL: 72
LDL: 140

And now, January 2009 (same diet as before):
Total Cholesterol: 341
Triglycerides: 55
HDL: 99
LDL: 231

My triglycerides and HDL are better than ever, but my LDL has gone way up.  I didn't overindulge over the holidays, but I was losing weight (slowly) when I got that latest test.

I know -- thanks to your blogging -- that inferred LDL values are highly unreliable.  And I also know that there's a difference between small LDL (bad, caused by eating high carb) and the bigger, fluffier (okay) LDL.  The LDL number doesn't differentiate between those values.  Or might something else be the cause?

My doctor wants to do a cholesterol recheck next month -- and I'm thinking that I ought to ask for a measured LDL value and a particle size test.  Does that seem reasonable to you?  

BTW, my heart scan from six months ago is totally clear.  So I don't care how much my doc pushes, I absolutely refuse to go on any kind of cholesterol-lowering medication.

Also, thanks to you, I got a vitamin D test -- and my values were excellent.  (I do supplement.)  Yeah!

Dr. Davis,

While it is true that overindulging in carbs causes all the changes you cite here, if your patient really wants to stick with the program life-long, she'll do better learning how to carb up a bit at the holidays, and then correct afterwards, rather than getting into a lifestyle of self-denial that will build up an undercurrent of feelings of deprivation that will eventually blow her completely off course.

I've been there, done that. Three family holiday seasons without eating any of our traditional foods left me depressed and miserable. Food is a complex issue with deep emotional roots.

Something like a family death or a cancer diagnosis can trigger binges that derive from that deprivation and really derail the diet.

I have found it much better to build in safety valves into the diet, here and there.  The lipids will recover very fast once she goes back to eating the low carb diet.  

I've been doing a low carb lifestyle for going on 11 years now, and I attribute its success to the safety valves. Yes, I do gain a few pounds over the holidays, but I take them off in January.  

The psychology of successful dieting is often to accept "good enough" rather than perfect. Perfect has a nasty way of ending up in disaster.

If you doubt this, just read the low carb diet boards where for every person who has maintained perfectly for 5+ years there are 25 people back after catastrophic regains caused by being too stringent.

Is it carbs in general or should we be more consciously eliminating the wheat and corn products?  
I eat quinoa,oatmeal,  buckwheat,beans,brown rice, etc. Not to excess but as a part of my usual diet.
Just wondering?

Question: I understand no wheat and what it does to the LDLs, but does that include potatoes? Thank you!

Dr. Davis,

I have a similar issue as Diana Hsieh.  

My Total Cholesterol: 258
Triglycerides : 60
HDL : 61
LDL- 181

I've been on a low carb diet avoiding wheat, rice, starches, sugar, high fructose corn syrups and fruits for the last 6 months.  I've lost 35 pounds and reduced my triglycerides from 296 to 60.  Taking fish oil and slo-niacin. I have been eating alot of saturated animal fats (rib-eye steaks, baby back pork ribs, eggs) Is eating the saturated animal fat causing my total cholesterol to be too high?  Is total cholesterol above 200 dangerous if Triglycerides and HDL are in the 60's?

I am trying for last three years to get my HDL numbers high. So far without success. I have tried exercise and cutting out wheat but without significant improvement. I have now added 4000iu vitamin D. Will do a follow up blood test after about two months to see if HDL level increases.

Any other tips?

Dr. Davis,

Is there often a direct correlation between low triglycerides and a greater proportion of large LDL particles?  Thanks

- John

Here were my lipids on a Heart Healthy (sarcasm) Diet

Trigs 380
HDL 25
LDL 165

Add simvastatin

Trigs 185
HDL 33
LDL 75

Here they are on a low carb diet with my BG more or less normalised
(70 - 90 and postprandials mostly below 110 and seldom over 120)

Trigs 39
HDL 47
LDL 105

Adding more saturated fat

Trigs 62
HDL 55
LDL 94

Spot the reversal of HDL to LDL

IME low carbing decimates the trigs and tends to increase HDL and LDL both, tinkering with the fat content and type adjusts the balance between these BUT there's a lot of individual variation as to exactly how this works. Some people just seem to have high LDL whatever they do, maybe a long term change from years of insulin resistance and hyperinsulinemia, maybe genes which would respond to a different balance of fat types in the diet.

My #1 weapon has been BG testing

http://www.alt-support-diabetes.org/NewlyDiagnosed.htm

which is deprecated in the UK. Lipid breakdowns are often unavailable and Full Lipid Panel is deprecated in favour of TChol which is pointless but cheaper. The money saving is probably to pay for the blanket prescription of statins, and it also serves to conceal the toxic nature of the diet

http://www.nhs.uk/Change4Life/Pages/default.aspx

here's the diabetic version

http://www.diabetes.org.uk/Guide-to-diabetes/Food_and_recipes/Food_and_diabetes/Balancing_your_diet/

I feel like part of a eugenics experiment