Beyond Convention: 5 Heart Disease Tips That Could Save Your Life

It is, indeed, easy to second-guess Mr. Russert’s doctors, fumbling their way through explanations of why their popular talk show host died suddenly despite the appearances of receiving good healthcare. The fault doesn’t really lie with Mr. Russert’s doctors. We should point fingers at the system that perpetuates the least-common-denominator level of preventive advice that is usually provided, advice that fails too many people. 

Those of you following the conversations here may know that there are a number of additional and powerful strategies that Mr. Russert could have been advised to follow.

Sadly, many of the most effective strategies for prevention, even reversal, of coronary disease will not be found in standard discussions of heart disease prevention. Standard advice generally consists of “eat a balanced diet low in saturated fat, exercise, and talk to your doctor about medication for cholesterol.”

Of course, that’s the─fatal─advice given Mr. Russert.

Let’s face it: Standard heart disease prevention advice does no such thing. Events like heart attack and sudden cardiac death continue to occur on standard preventive treatments. Yes, risk may be modestly reduced. But it is not eliminated.

In fact, I would argue that the fascination of “official” organizations with “eat more whole grains,” eat “heart-healthy” foods like fiber-rich breakfast cereals to lower cholesterol is the sort of advice that caused Mr. Russert to gain weight in his abdomen, develop high blood pressure and diabetes, and eventually trigger coronary plaque rupture.

Imagine Mr. Russert or his doctor called me today and asked, “I had a concerningly high heart scan score of 210 in 1998. What exactly could I do to improve my heart disease prevention program? What can I do to try and stop or reduce my heart scan score?”

My response:

1) Do not rely only on conventional cholesterol (lipid) testing. Standard cholesterol panels all too often fail to identify the full extent of coronary plaque causes. A superior approach is to identify and quantify all sources of cardiovascular risk. This means lipoprotein testing to look for such plaque causes as small LDL, Lp(a), and IDL. (There are several methods available to you and your doctor, such as NMR from Liposcience, Inc; electropheresis from Berkeley HeartLab, Inc.; and VAP from Atherotech.) Lipoprotein testing makes the causes of heart disease clear, even obvious, where standard cholesterol testing fails.

2) Correct all causes of heart disease identified, including aiming for LDL-HDL-triglyceride of 60-60-60, i.e., LDL 60 mg/dl, HDL 60 mg/dl or greater, triglycerides 60 mg/dl or less. This goes farther than standard advice, of course, but is not as hard as it sounds when the proper dietary advice has been provided (see below). Hidden causes like Lp(a) should be corrected, as well. Mr. Russert apparently had an HDL cholesterol in the 30-some mg/dl range along with high triglycerides on a standard lipid panel, which is commonly associated with a whole range of other undesirable lipoproteins. Adding niacin for these patterns would have been very helpful. The HATS Trial, for instance, documented 85-90% reduction of cardiovascular risk when niacin was added to a statin drug.