Pharma treatments summarized with healthful alternatives

Subsection coronary vascular issues

Heart issues:  The biological process leading to cardiovascular disease explains (1) why pharma’s drugs are not effective (once their side effects and costs are included in the calculations); and (2) why the prevention of hardening of the arties is the best approach.  Hardening of the arteries is caused by an inflammatory by lymphocytes which causes a scavenger response by macrophages to engulf the oxidative damaged LDL (low density lipoproteins, bad cholesterol).  The macrophages die and form foam cells which constitute most of the plaque in hardening of the arteries.  As the load of plaque accumulates and ages it causes cardiovascular disease (CVD), which makes the arteries stiff and occluded and this causes high blood pressure.  When the plaque breaks off, a thrombosis can result, and when it occurs in the coronary artery it can cause a heart attack, and in the brain a strokes (acute events),   Acute events are only moderately associated with high levels of LDL.  LDL causes CVD only when it undergoes oxidative damage.  The principle cause for oxidative damage of LDL is carbon monoxide (found in smoke) and other blood-borne reactive chemicals.  The more LDL, the more targets for reactive chemicals and thus a faster the rate of formation of plaque.  However, over 85% of acute events are caused by young, unstable plaque (not old hard) that leaks, when the plaque occlusion is from 20% to 50%—young plaque is not encapsulated.  Thus about 20% of heart attacks occur in those without the signs of CVD:  high blood pressure, angina, or high levels of cholesterol.   Another factor is chronic inflammation (such as by gingivitis of the gums and pylori bacteria in the stomach).  It is estimated that about 1/6^th of all heart attacks and strokes are caused by chronic inflammation.  The common type of heart attack results when plaque breaks loose in the coronary artery and form a partial plugs down-stream, and then a clot forms to totally occlude the coronary artery.  Blood turbulence increases with the occlusion caused by the plaque plug which can result in a clot forming.  High blood pressure increases the turbulence and thus the likeliness that a clot will form.  That is why high blood pressure is a causal factor for a heart attack.   A like process can happen in the brain, a stroke.    The best treatments is to prevent hardening of the arteries starting early in life, and thus less plaque and normal blood pressure. This is best accomplished by 1) healthful lifestyle including avoiding carbon monoxide, 2) inhibiting oxidative damage to LDL and 3) inhibiting the inflammation response of white blood cells to damaged LDL.  Lowering LDL when it is high is far less effective way to prevent hardening of the arteries—for which doctors prescribe statins.  For one thing, high LDL might not occur until after there is a large amount of plaque in the arteries.   Clearly the best drugs are 325 mg aspirin, 300 mg Q10, and natural estrogen post-menopause, or testosterone past the age of 70 .  These choices are much better than statins and blood pressure drugs (see below).  If these were taken by teenagers and continued throughout life, pharma’s income would eventually be cut in half.  Pharma thus teaches that aspirin, estrogen, and testosterone pose major health risks that outweigh their coronary benefits, and they ignore their other benefit of them and Q10.  And all this is supported by their tobacco science, which is taught to doctors in their continuing education classes and pushed through treatment guidelines.  Pharma also teaches doctors that high blood pressure and high levels of LDL cause CVD in order to promote their sales of drugs that treat these health issues, for which they make billions.  Their mantra is “safe and effective.”

Anticoagulants (blood thinners):  They are widely prescribed to prevent or treat thrombosis (blood clots), which can damage the brain (stroke), heart (myocardial infarction), lung (pulmonary embolism), and other organs.  They are commonly given to those who undergo major surgery, are hospitalized for 3 days and longer, or have arrhythmia (irregular heart beat) because of their higher risk of thrombosis.  With a few exceptions, they aren’t worth the side effects.  Pharma exaggerates the risks and benefits; their sales mantra is “safe and effective”.  Once out of the hospital this treatment is normally continued.  They aren’t worth the side effects.  A much, much better choice is to take a 325 mg of aspirin in the morning and another in the evening, and it has many other health benefits (see aspirin above).  At this higher dose it is a better long-term anticoagulant for preventing heart attacks and strokes (by about 50%), and it lowers the risk of most cancer overs 40%.  Cardio-exercise and weight control offer significant benefits because a poor flow of blood is the major causal factor, and it lowers blood pressure another causal factor for blood clots.

Arrhythmia (irregular heartbeat):  is any of a large and heterogeneous group of conditions in which there is abnormal electrical [nerve] activity in the heart. Although many arrhythmias are not life-threatening, some can cause sudden death.  Most such sudden deaths occur during a major heart attack due to the destruction of heart muscle.  A basic problem with treating an irregular heart beat with drugs is that they are not magic bullets that just work upon the cardiac nerves.  They inhibit neurotransmitters; thus upset cognitive and bodily functions.  Arrhythmia is a disease of mostly seniors, and most drugs are on the American Geriatric Society’s avoid list.   Moreover, they don’t stop arrhythmia (just modestly reduce them short term) and can cause pro-arrhythmia (drug induced arrhythmia), and they have at best minimal effect upon death.  Other treatments include physical maneuvers, electricity conversion, and electro or cryocautery.  Just like drugs, the merits of these physical interventions are oversold.  

Hardening of the arteries (atherosclerosis, cardiovascular disease):  Aspirin and Q10 are the best first line of defense and should be taken daily starting in the teen years (see Q10 and aspirin).  In addition women starting with menopause and continuing thereafter should take the natural estrogen (estradiol), and men starting between 60 and 75 should take testosterone.  There is major cardiovascular protection with estradiol; it is why cardiovascular disease and heart attacks occur following menopause. Men on testosterone are less likely to develop metabolic syndrome (diabetes, hypertension, and atherosclerosis) and are more likely to survive a heart attack.  Cardiovascular disease results from oxidative damage to LDL and VDL (the bad cholesterols) that stimulates an inflammatory response in macrophages.  They also ingest the damaged LDL and become foam cells that become part of the plaque, and this sequence of events causes plaque formation.  Macrophages are a type of white blood cell that scavenges damage cells, and also oxidative damaged LDL.  Estrogen and Q10 protect LDL and VDL from oxidative damage, and aspirin and estrogen inhibit the inflammatory process.  As for statins:  pharma hypes its benefit and hides their side effects.  (See section below as to their failure to reduce mortality though they lower LDL.)  Once hardening of the arteries occurs, since the plaque is encapsulated, it is beyond the reach of drugs.  Aspirin, estradiol, and Q10 along with healthful lifestyle can stop the formation of new plaque, and in most cases over the years there will be a gradual improvement through revascularization. 

Heart Attacks (MI) and treatments:  “Each year [2005] 1.5 million Americans experience a heart attack and nearly 460,000 are fatal.  Of those who die, almost half die suddenly, before they can get to a hospital” AHA.   As with most acute conditions the list of standard treatments, most are not worth the side effects.   Following the list below when the patient is depending upon the help requires making the doctor aware of who is the ultimate decider.  With MI, there are two phases acute and recovery.  For recovery the typical well insured patient is treated long-term for a variety of issues that cost on an average over $70,000 per year.  Nearly all of them have better alternatives.  CRITICAL CARE AVOID:  (in order of importance):  downers (psychotropic drug), Protein Pump Inhibitor (PPI), heparin & other blood thinners, high blood pressure medication except if extreme 180 over 110, antiarrhythmics except for lidocaine, and oxygen.   Downers (psychotropic drugs) have many indications such as anti-nauseas, muscle relaxant, sedative. If drowsiness or mental confusion is a side effect, it is probably a downer (or an opiate).  Drugged, the patient is less likely to inform the nurse of a negative turn in their condition, or resist their doctor’s advice.  PPIs for acid indigestion are addicting.  Instead of heparin or similar anticoagulant promptly take 975 mgs aspirin, followed by one every 4 hours.  Drugs for hypertension other than nitroglycerin do not lower morality Cochrane Library  and many of them are downers.  RECOVERY AVOID:  PPI is given with the anticoagulant, but PPIs are addicting because of the rebound effect, and long-term usage causes serious life-shortening, side effects such as osteoporosis & colitis.  Tums, when needed, is a better choice.  Statins are totally over sold, and are justified only by marketing science.  Counter to their marketing science, they are not cardiovascular protective through they improved the lipid profile and thus are not worth the side effects.   PPI, statin, blood pressure drugs, blood thinner, antiarrhythmics drug therapy, and downer lack quality evidence that proves their net worth and superiority to other choices; yet they are routinely administered in the hospital and nursing home, when the patient is most vulnerable.  Avoid polypharmacy because it multiplies the risk of major side effects.  All too often their side effects are treated with additional drugs.  All side effects are grossly under-reported.  Most drugs started in the hospital and nursing home will be continued long-term. While recovering, avoid both stent and bypass operation, they do not prolong significantly life, though they reduce angina pain.  “The vast majority of MIs do not originate with obstructions that narrow arteries" Wiki.  An exception would for acute STEMI with unstable refractory angina with objective evidence of ischemia, UK study. The best choice is to follow the recommendations in the section on Niacin below.

Hypertension:  First choice is Q10 (300 mgs), exercise, sodium restriction, and weight control.  Over half of those who follow this program will have normal blood by 1 year.  Moreover, the prestigious Cochrane review concluded that:  “Drugs for mild hypertension have not been proven to benefit patients.” Mild hypertension is a systolic 140-159 and diastolic 90-99.  If after 2 year there isn’t sufficient progress at lowering blood pressure below 160 over 100, then the second choice is “thiazide and thiazide-like diuretics [lowers the amount of water in the body].  [They] have good evidence of beneficial effects on important endpoints of hypertension … [and they] also increase calcium re-absorption at the distal tubule” Wiki, and they are among the cheapest drugs.  They are widely recommended as first line in treatment guidelines.  Treating hypertension with pharma’s drug arsenal (over 100 drugs of which 3 are typically prescribed at one time) has serious side effects including drowsiness, cognitive impairment, ED, and low libido.  Moreover, pharma’s régime of drugs when taken long-term doesn’t extend life.  For example the very popular group of calcium channel blockers cause a “higher mortality rate over extended periods of use” Wiki.  The first approach (Q10, diet, etc) is the only reasonable choice.  Long term prevention of further development of hardening of the arteries through aspirin 325 mgs, Q10, and estrogen will in most cases result in a gradual lowering of blood pressure, and a significant long-term reduction in mortality. 

Statins and cholesterol:  Cardiovascular disease (CVD) results from oxidative damage to LDL and VDL (the bad cholesterols) that stimulates an inflammatory in T-lymphocytes which then causes macrophages to engulf the oxidized LDL.  This result in the formation of foam cells (dead macrophages), which constitute most of plaque.  Macrophages are a type of white blood cell that scavenges damage cells and oxidative damaged LDL.   A lower level of cholesterol entail that there is less LDL to be damage by reactive chemicals, the most significant being carbon monoxide--a product of incomplete combustion.  Thus some of the carbon monoxide will react with other molecules.  Thus lower level of cholesterol only has a modest effect upon plaque formation.  For a complex set of reasons, statins positive effect of lowering cholesterol is undone by its promotion of oxidative damage through inhibition of COX enzymes and its slowing the process of converting unstable to stable plaque.  Statins don’t protect against coronary artery disease and its deadly consequences.  Several large proper scientific studies have failed to find significant health benefits—though of course there are marketing studies that produce positive results.  Statins side effects (especially its negative effects upon cognitive function, sexual activity, and physical energy) make it not worth taking.  Pharma, as is their norm, has done marketing studies to show that statins are safe and effective.  That 90% of doctors believe that statins are safe and effective is testimony to the effectiveness of pharma’s use of continuing education to promote sales.  Moreover, those above 70 years and those with congestive heart failure definitely should not take statins, a fact that most doctors are not aware of.  The critics lack an effective forum to affect medical practice.  Only those with a familial genetic defect that causes cholesterol levels that are twice the norm should be on statins, which is what the first statin was approved for.    For high cholesterol the best choices are Q10 300 mg, which prevents oxidative damage to LDL, aspirin 325 twice daily, which lowers the inflammatory response of macrophages, and estradiol 4 mg (the best of the 4 natural estrogens) and testosterone 100 mg.  These hormones lower the risk for CVD, metabolic syndrome, and the resultant much higher rates for heart attacks and strokes.  Estrogen is significantly more effective than testosterone.  Best source for hormones is a compounding pharmacy.