Heart Health Advances in 2010
While we've begun to witness a transformation of thinking about heart disease in 2008, I believe that this trend will continue in 2009.
Sadly, it won't be a deluge of change. Much of the heart disease world clings to the notion that hospital heart procedures and drugs are the answers to heart health.
Nonetheless, in 2009 I believe that we will see the momentum for heart health grow.
Among the trends that we will see develop are:
- Vitamin D - We are going to hear more and more about the benefits of vitamin D when used as a "treatment." I predict that we will see formal confirmation of the effects we see everyday: dramatic increases in good HDL cholesterol, reductions in triglycerides, reductions in blood sugar, improved insulin responses, reduced inflammatory responses like c-reactive protein (a BIG effect). All these findings require formal quantification in treatment studies. When available, it will fuel the enthusiasm for purposeful replacement of vitamin D using blood levels of vitamin D for confirmation (a practice I advocate strongly).
- Broader acceptance of low-carbohydrate diets - While I personally advocate a wheat-free concept to my patients (not gluten-free, a different and distinct phenomenon), the related low-carb concept will gain more traction among the public and enjoy more validation in formal published clinical studies. There is no doubt that low-carb reduces cholesterol enormously. It seems counter-intuitive, since the traditional argument is that reducing saturated fat reduces cholesterol, which it does - modestly. But low-carb approaches, such as South Beach, Atkins', Sugar-Busters, Protein Power, and others (or my favorite: elimination of wheat, cornstarch, and sugars that I articulate in our New Track Your Plaque Diet), commonly reduce cholesterol 50, 60 mg/dl or more. What's more, many diabetics become non-diabetics, excess weight drops, blood pressure drops. The debate will eventually evolve away from low-carb versus low-fat, and instead focus on what aspects of carbohydrate-restricted diets provide superior outcomes (e.g., how much meat, should we continue to limit saturated fat, does omega-3 fatty acid content of meat make a difference, should we choose pasture- or grass-fed vs. factory-farmed livestock, etc.?).
- The statin drug market will plateau - This is counter to the predictions and urgings of many of my colleagues, who have been calling for substantial expansion of the statin drug market, particularly since release of the JUPITER study results, the 18,000-participant study that showed 54% reduction in heart attack with the drug, Crestor®, 20 mg per day. However, I believe there is growing skepticism among the public that statins are the best path to heart health. I agree with the public. While, in the foreseeable future, there will always be a role for statin drugs, in my view much of the apparent "need" for statin drugs has been created by the misguided dietary advice of the USDA, American Heart Association, and the food industry, as well as the need for expansion of the statin market by the drug manufacturers. The low-carb movement and attention to healthier eating, I believe, will gain momentum indirectly in response to the push for more statins.
- Heart procedures will decline - Over the past 10 years, heart procedures like coronary angioplasty and stent implantation have been on a boom cycle, growing 30% annually: cardiologists have made out like bandits, hospitals have expanded and put up billboards on highways to advertise bypass surgery, an entire cardiovascular industry has been created to manufacture catheters, stents, supplies, drugs, etc. 10,000 procedures are performed each and every day, 365 days a year. That will change, thanks in part to the COURAGE trial, which showed that people with stable anginal (chest pain) symptoms fared no better with stent implantation than with medication. (And people can do far better with an intelligent program of prevention beyond medication, like adding fish oil, correcting vitamin D, and eliminating wheat.) Consensus statements from the American College of Cardiology and similar organizations are putting a damper on the widespread overuse of heart procedures. 2006 and 2007 witnessed a plateau in procedure use. In 2009 I predict that, for the first time in the last 20 years, heart procedures will decline sharply. I believe that, while procedures continue to be overused and preventive efforts underused, the divide will narrow. That's a good trend.
All in all, I see a lot of healthy trends gaining ground in 2009. In the years I've been preaching the benefits of intensive prevention and the grotesque overuse of hospital procedures, I often felt like we were making no progress and yelling on deaf ears. But the tides are turning. I only wish it could happen faster.