Groundbreaking drug for heart disease — really?
A few weeks ago there was a lot of press about a new drug to prevent heart attacks. The Associated Press title was: “A first: Drug lowers heart risks by curbing inflammation.”
The new drug is called canakinumab (brand name Ilaris), and it decreases inflammation as measured by a blood test called hsCRP (highly sensitive C-reactive protein). Ilaris was given to 10,000 heart attack survivors who were already on a statin and had normal cholesterol, but elevated hsCRPs. The patients on Ilaris were followed for four years and, compared with a placebo group, had a 15 percent lower risk of recurrent heart attacks and strokes, and “surprisingly a lower rate of cancer.”
New treatments for heart attack prevention are always welcome, because heart attacks are the primary cause of death in the U.S. However, this story illustrates some of the factors that make our health care system expensive and result in relatively poor outcomes.
First of all, we Americans tend to depend on new, headline-grabbing breakthroughs by the pharmaceutical industry to make us well, instead of the free and more effective option of lifestyle change. Drs. Dean Ornish and Calwell Esselstyn have shown heart disease can be prevented and even reversed by regular exercise and a plant-based, whole (unprocessed) food, no-added-oil diet with avoidance of salt and sugar.
So heart attacks, which are fatal in some 20 percent of people, don’t have to happen in the first place. And when people do have a heart attack, they should be told how to treat the cause, atherosclerosis (“hardening of the arteries”), and how to prevent another one — something that rarely happens.
Second, heart attack prevention doctors have known for years that heart disease is not all about cholesterol, that inflammation plays an important role, so this is nothing new. For example, people with inflammatory diseases such as rheumatoid arthritis have seven times the risk of suffering a heart attack compared with other people.
For the rest of us, dental inflammation is often what causes inflammation of blood vessels and heart attacks.
Brad Bale, M.D., my mentor in heart attack prevention for 15 years, is a family physician who started doing heart attack prevention over 20 years ago, before anyone else was doing it, and he is now recognized nationally and internationally as an expert.
He and his nurse practitioner, Amy Doneen, RN, Ph.D., wrote a book called “Beat the Heart Attack Gene” a few years ago. They recommend checking inflammatory markers such as MPO and LpPLA2, which are much more specific to the cardiovascular system than hsCRP, and they recommend treating inflammation aggressively when present.
They do this by lowering cholesterol with statins, which are anti-inflammatory; by looking for and treating prediabetes and diabetes, which cause inflammation; by referring patients with dental problems to dentists who are familiar with the mouth-vascular connection; and by asking their patients to improve their lifestyle.
Third, physicians who understand the power of nutrition know that an animal-based diet causes inflammation and a plant-based diet reduces inflammation. We know that inflammation contributes to cardiovascular diseases and to many other diseases as well, such as cancer, which is one of the reasons plant-based people have less cancer. So again, this is nothing new.
In summary, it’s nice to have this new, expensive drug, because not everyone is going to adopt a healthy lifestyle. However, the 15 percent reduction in heart attack risk is not very impressive. The much more effective approach of lifestyle change, which doesn’t cost anything, has been right in front of us forever. Unfortunately, lifestyle modification isn’t glitzy or sexy and therefore doesn’t get much press.
Some readers might wonder why NSIDS such as ibuprofen or naproxen wouldn’t prevent heart attacks, since they are anti-inflammatory. In reality, they increase heart attack risk. Aspirin is anti-inflammatory but helps prevent heart attacks by preventing the blood clot that forms when plaque ruptures.
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, now has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at firstname.lastname@example.org.
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