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Non-technical Summation on MI & bad pharma -- 4/18/16


At http://healthfully.org/rns/id2.html


33-pageversion of this with links to justify findings at http://healthfully.org/rhi/id1.html


1 long-page of illustration and photos is at http://healthfully.org/rhi/id2.html


8-page, short non-technical version is at http://healthfully.org/rc/id11.html  


AMI     Acute myocardial infarction

 

KOL     Key opinion leader

AS        Atherosclerosis

 

MI        Myocardial infarction

CVD     Cardiovascular disease

 

PCI      Angioplasty balloon & stenting


 


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 (listed in clinical guidelines), are not worth the side effects.  There is a seamless connection between bad pharma and their system of Key Opinion Leaders (KOLs), and the production of medical textbooks, university medical training, clinical trials, journal articles, continuing medical education classes, guidelines, and why physicians give junk treatments.  The claimed miracles such as angioplasty and bypass operations fail in quality studies to extend life, and the drug interventions do even worse once the average positive bias of 32% is subtracted[1] (remember these 2 facts). Just about every clinical trial since the reforms started in the corporate honor period, beginning under Regan is designed to promote sales.  Bias is good for business.  Foreknowledge of the corporate takeover of medicine greatly increases the chances for you to understand why I won’t follow the pharma treatment generated—through their KOLs—guidelines.  I will let my doctor or cardiologist know that I am calling the shots.  My library of documentaries and lectures available on the internet will drive home the reality of “corporate honor” while providing valuable information—Video Library.  Pharma’s mantra is safe and effective.  Nearly all of the improvement in management of cardiovascular disease (CVD) has come through reduction in use of tobacco from 46% in 1960 to 16% today, defibrillation, and the use of anticoagulants both during acute event and during the recovery phase.  We have been fed a steady meal of safe and effective as too the physicians by an $800 billion global gorilla.  Having said that, what would I do for an acute MI and for CVD? 


 


To start with allow me to explain SOME ESSENTIALS.  I have been a full time college student for 11 years, spent over 40 years studying health science and medicine, and since 2004 been editing the healthfully.org website.  A solid foundation is essential for my making choices with a reasonable degree of confidence.  Most arrhythmia (irregular heart beat) goes unnoticed and is quite common, especially among the elderly.  However there is life-threatening arrhythmia for which little can be done unless in a hospital and half of all those who die from a heart attack have this type and they don’t make it to the hospital.  Over 80% of life-threatening arrhythmia is a result of damage to the heart muscles from the lack of oxygen, called an ischemic event also myocardial infarction (MI) and AMI with “A” for acute.  Nearly all AMIs consists of two events:  first the leaking of young-immature plaque (remember this) from within the coronary artery.  This leaked plaque partially restricts the blood flow, and then can cause platelets to aggregate around the plaque to form a clot (called a thrombosis) that cuts off the blood flow.  Depending on the degree and duration of blockage, this thrombosis type of AMI causes heart muscle tissue to die within the first 60 minutes of complete occlusion (remember this).  Often this will produce symptoms of an AMI.  Chest pain is the most common symptom of acute myocardial infarction and is often described as a sensation of tightness, pressure, or squeezing…. Pain radiates most often to the left arm, but may also radiate to the lower jawneck, right arm, back, and epigastrium [upper-middle abdomen], shortness of breath (dyspnea) occurs when the damage to the heart limits the output of the left ventricle, causing left ventricular failure and consequent pulmonary edema [fluid in the lungs].  Other symptoms include diaphoresis (an excessive form of sweating), weakness, light-headednessnauseavomiting, and palpitations and sudden death (frequently due to ventricular fibrillation[arrhythmia]) can occur in myocardial infarctions.  Women also report more numerous symptoms compared with men (2.6 on average vs. 1.8 symptoms in men)”[2] Wiki.  About half of all AMIs occur to people without signs of cardiovascular CVD.  We are all at risk because we could be forming young-immature plaque which is the type that leaks (remember this); and on an average those with CVD are forming unstable plaque at 3 times the amount of those without CVD, thus their higher risk.  The typical young atheroma (plaque formation) causes around 20% occlusion—not more than 50% (remember this).  With this little occlusion there are no signs.  It doesn’t even show up during an angiogram (remember this).  This invasive imaging involves a tube entering a main artery and being pushed up to the heart where a dye is injected that shows up on x-rays.  These x-rays show only restrictions in blood flow of greater than 50% in the major coronary arteries, thus it shows only the mature plaque with a fibrous cap which won’t leak (remember this).  Think of the young plaque as being like an inflamed boil, while the fibrous plaque is like a lump from a serval year old boil that now isn’t inflamed.  The cardiologist can only treat what he sees, and what he sees with the angiogram does NOT leak to cause an AMI.  Thus 1.5 million Americans yearly undergo a PCI (an angioplasty which results in a sent being placed in a coronary artery) or CABG (coronary bypass operation) even though they don’t prevents heart attacks and deaths.  But those who undergo these procedures are far more likely to take all the drugs his cardiologist prescribes; far more so than the family doctor who is treating the patient for CVD.  If all the drugs the cardiologist prescribes are patented, their wholesale price totals over $100,000 yearly.  Pharma knows how to butter its bread.  Since the cardiologist doesn’t have life-saving interventions, I certainly wouldn’t go to one if I had CVD, and if experiencing an AMI, I would not undergo an angiogram, which is one step away from a PCI.  One more very important point, pharma has doctors treating the symptoms rather than the cause.  The disease is atherosclerosis of the coronary arteries.  This is caused by pathogens living in the artery walls.  These pathogens cause an immune response which results in white blood cells entering the muscular wall of the artery to attack the pathogens.  To help in rebuilding the damage, the cells lining the artery (endothelial cells) permit the LDL to enter the artery wall.  LDL has a protein exterior and carries cholesterol and fat (triglycerides) through the blood.  The fat and cholesterol are needed to build the cell walls and membranes of the new cells that are forming as part of the healing process.  Fats and cholesterol are good things, they are needed for cell growth.  However, pharma makes billions lowering the level of cholesterol and LDL, and the food manufacturers make billions more feeding us grains and sugars, both low in cholesterol and saturated fats (the good fats).  There is a chorus of critics pointing this out.  I suggest that you watch the documentary put out by the Australian Broadcast Corporation, Hear of the matter (part 1 & part 2, each 29 minutes); it will convince you that our media and the doctors pharma educates have been feeding up crap. Or you can go to Amazon.com and enter cholesterol myth. Pharma is in the business of treating illness, thus they treat symptoms rather than the disease.  It is like lowering fever instead of using an antibiotic to help clear up bronchitis—and statins are their most profitable family of drugs. 




[1] Positive bias averaged 32% (range 11 to 69%) for clinical trials --NEJM article, 2008.  The study of neuroleptic drugs compared 74 journal articles to the raw data supplied the FDA for phase III trials.  Complete records are required of these trials when pharma applies for a patent.  This data was obtained by 4 professors through the FOIA (Freedom of Information Act).  See http://healthfully.org/index/id9.html, or http://content.nejm.org/cgi/content/short/358/3/252

[2] This is mainly due to size:  tall people have a bigger heart and bigger coronary blood vessels; thus complete blockage by a thrombosis is less likely.  This results in less symptoms and greater survival rate. 


Plaque accumulates in the tunica intima
artery-tunica-layers-drawing.jpg

The transport system for cholesterol and
ldl-diagram.jpg
tryglycerides to targets in need of them


WHAT I WOULD DO:  I would take sublingually (under tongue for quick absorption) a 325 mg uncoated aspirin and 3 more with water, then take another under my tongue.  I carry in my car a small pill container with 20 aspirin.  This use of aspirin is the most important of all possible treatments.  Remember, that the second part to an AMI is the formation of a blood clot (thrombosis), and the aspirin at a high dose (325 mg) permanently blocks the action of platelets thus prevent the clot.  I also take a 325 mg daily because it lowers the risk of CVD, AMI, and cancer very significantly.[1]     


 


Atherogenesis leading to CVD, its principle cause is the Western diet with its large amount of carbohydrates and fructose, this combination screws up the liver to cause insulin resistance and carbs are causal for endothelia cell dysfunction of those lining the arteries as is smoking—link.       


 


PCI (balloon angioplasty with insertion of a stent) and thrombolysis when administered in the first 90 minutes supposedly increases survival no more than 5% (probably less); and even then it isn’t worth the side effects.  One real-world study showed that only 1 in 125 patients meet this window of time from first symptoms to treatment.  Because of pharma’s control of the information, including clinical guidelines, side effects are grossly underestimated by cardiologist.  For a list of them, go to the in depth heart attack paper, #s 17-24).   For arrhythmia the drugs are not worth taking, and physical interventions should be limited to a pacemaker or defibrillation.  The best drugs are nitroglycerine for angina pain and improved circulation, morphine for pain, spasms, and sedation, lidocaine for pain and arrhythmia, epinephrine (adrenalin) for low blood pressure and weak pulse, and uncoated aspirin in high dose, up to 2.5 grams per day because of its blood antiplatelet (clotting) and anti-inflammatory effects.  (Note:  3.5 gram daily is the recommended dose for arthritis--Merck Manual 1987, p. 960, and prior issues.)  Aspirin has been attacked by pharma using junk science trials and results fed to doctors through pharma’s key opinion leaders (KOLs).  For recovery the typical well insured patient is treated long-term for a variety of issues with drugs that cost on an average over $65,000 per year. All of them have better alternatives.  CRITICAL CARE AVOID:  (in order of importance):  downers (psychotropic drug, sedatives)[2], Protein Pump Inhibitor (PPI), heparin & other blood thinners, high blood pressure medication except if extreme 180 over 110, antiarrhythmics except for lidocaine and morphine.   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).  Some have been approved for hypertension.  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, warfarin, 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, all justified by guideline though they lack quality evidence (more bad-pharma).  Because of guideline all of these drugs 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, I would 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[3].  They are referring the hard mature plaque with a fibrous cap, it doesn’t leak.  Cardiologists are treating what doesn’t cause a heart attack; that is why PCI and bypass surgery don’t reduce mortality in the real-world population.  The plaque that causes heart attacks doesn’t show up on the angiogram (angiography) so it can be treated with surgery or stent.  It is the young, unstable plaque with less than 50% occlusion (typically around 20%).  Thus I would refuse angiogram which provides the evidence that is used to sell the bypass surgery and stenting.  The best long-term way to prevent MI is to exercise (see bottom of page at link).  For the real causes for cardiovascular disease go to rl.  I now take 1,000 mg of CoQ10 and 1,000 mg of vitamin C daily because they are antioxidants protect the arteries.  I also apply testosterone lotion in sufficient dose to raise my serum level to above 700 ng/dL.  As an androgen it keeps my muscles including my heart strong.  The natural estradiol 2mg lowers the risk for women of MI by 50%; my wife takes it.  325 mg of aspirin  has an anti-inflammatory effect that prevents atherogenesis, blood clots, and also cancer, while the baby aspirin is at 1 year useless because of tolerance.    For these reasons bad pharma teaches care givers that aspirin is so dangerous that only the baby does can be safely taken.  Unfortunately the physician is not a reliable source of information, reasons provide at beginning of the paper.   The best thing I can do is to do strenuous exercise; I run, swim, and go to the gym. Exercise promotes revascularization, which means that the body makes more coronary arteries because the heart needs more oxygen.   There are a number of studies that prove its very significant benefits for seniors. 


 




[1] Your doctor is told that there is high risk of ulcer from aspirin, however it is far safer than the anticoagulants hawked by pharma.   Moreover long term usage lowers the risk of cancers over 40%.  The low dose recommended by physicians is ineffective because of tolerance and it is too low to prevent cancers.  Your physician will not read this in the required continuing education class funded by pharma, nor in the textbooks written by pharma’s KOLs.  See my paper on aspirin, on CVD protect, on cancer protection.

[2] They are given under a long list of deceptive names including muscle relaxants, anti-nausea, anti-hypertension, anti-anxiety, antidepressants, anti-spasms, anti-arrhythmia, and pain.  If drowsiness is one of its side effects, unless it is a in the opiate family, it is very likely a sedative.  Tramadol is a popular downer (SSRI) whose claim as an analogic is based on a very weak opioid action.   

[3] A reaffirmation in Wiki, 2016 that the procedure dose not treat the major cause of MI:  It has been increasingly recognized, since the late 1980s, that coronary catheterization does not allow the recognition of the presence or absence of coronary atherosclerosis itself  [namely the immature soft plaque that causes under 20% occlusion and 80% of AMIs], only significant luminal changes [over 50%] which have occurred as a result of end-stage complications of the atherosclerotic process. See IVUS and atheroma for a better understanding of this issue” Wiki, 2016.  So why are over a half-million patient sold on its value??? 


plaque-composition.jpg


6 clinical events in the exercise group and 15 in the PCI group


http://circ.ahajournals.org/content/109/11/1371.full, Circulation 3109; 1371-1378, 3/8/2004 


Percutaneous Coronary Angioplasty Compared with Exercise Training in Patients with Stable Coronary Artery Disease:  A Randomized Trial, Circulation--Hambrecht R. et al. 


Abstract


Background— Regular exercise in patients with stable coronary artery disease has been shown to improve myocardial perfusion and to retard disease progression. We therefore conducted a randomized study to compare the effects of exercise training versus standard percutaneous coronary intervention (PCI) with stenting on clinical symptoms, angina-free exercise capacity, myocardial perfusion, cost-effectiveness, and frequency of a combined clinical end point (death of cardiac cause, stroke, CABG [bypass surgery], angioplasty, acute myocardial infarction, and worsening angina with objective evidence resulting in hospitalization).


 


Methods and Results— A total of 101 male patients aged ≤70 years were recruited after routine coronary angiography and randomized to 12 months of exercise training (20 minutes of bicycle ergometry per day)[1] or to PCI. Cost efficiency was calculated as the average expense (in US dollars) needed to improve the Canadian Cardiovascular Society class by 1 class. Exercise training was associated with a higher event-free survival (88% versus 70% in the PCI group, P=0.023) and increased maximal oxygen uptake (+16%, from 22.70.7 to 26.20.8 mL O2/kg,P<0.001 versus baseline, P<0.001 versus PCI group after 12 months). To gain 1 Canadian Cardiovascular Society class, $6956 was spent in the PCI group versus $3429 in the training group (P<0.001).  [This cost for exercise could be greatly reduced if after instructions by a physical therapist, the patient joined a local gym and used their exercise bike, or bought one.  I have done both, and my costs yearly membership is $300 at LA Fitness, and a quality exercise bike stand ran me under $275]


 


Conclusions— Compared with PCI, a 12-month program of regular physical exercise in selected patients with stable coronary artery disease resulted in superior event-free survival and exercise capacity at lower costs, notably owing to reduced re-hospitalizations and repeat revascularizations.



From Full: 


In a large meta-analysis that included 8440 patients in 32 trials, exercise training as part of coronary rehabilitation programs [for those who had a PCI] was associated with a 31% reduction in the mortality rate in patients with stable CAD/myocardial infarction.12  [The study above is compared exercise alone to PCI.]




[1] Those in the exercise group “participated in one 60-minute group training session of aerobic exercise per week” full supra.  This group session would cause a greater compliance of the daily 20 minute exercise part of the program.


Cholesterol is vital
cholesterol-steroid-conversion.jpg

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