Step 10: Medicines

Magic Bullets and BB Guns

Aspirin to Prevent a Heart Attack?

Once upon a time in California, long before the Idaho Realtor of the Year became the governor, there was a family practice doctor named Lawrence Craven.  Prior to performing tonsillectomies, he would have his patients chew gum laced with aspirin.  Several patients were hospitalized after their surgeries from bleeding.  He recognized that aspirin prevented blood clotting.   He then gave 400 of his patients daily aspirin and reported after two years that none of them had a heart attack.  In time, over 8,000 of his patients were given daily aspirin and he reported that none of them had a heart attack.  Truth is stranger than fiction as Dr. Craven died of a heart attack (I don’t know if he was taking aspirin at the time).  After decades of studies in the 1970s and 1980s, science demonstrated that daily aspirin indeed prevented heart attacks.

Aspirin Causes Bleeding

The small benefit of aspirin at preventing heart attacks must be tempered with the known side effect of aspirin.  Aspirin prevents the stomach from making a protective lining.  In fact if you have ulcers you are 2-3 times more likely to have stomach bleeding from aspirin than people who don’t have ulcers.  Aspirin leads to other bleeding problems as well ranging from bruising to strokes.  All in all, a daily aspirin probably causes more bleeding problems than less heart attacks.  

The Benefits of Aspirin Happen Only After Many Years

If one decides to take a daily aspirin, one must take it for at least 5 years before it lowers the risk of a heart attack, and 10 years to obtain protection from colon cancer.    

The Current Recommendations For Aspirin

If you have had a heart attack, heart stent, bypass surgery or prior stroke you should take 81mg of aspirin daily.  If you’ve not had those things then you probably should NOT take a daily aspirin – especially if you’re over 60.  If you’re between 40-59 years of age, a daily aspirin may benefit you but ONLY if you’re high risk to have a heart attack.  Talk to your doc.  

Statins, BB Guns and Lions

So many people take other things to lower their cholesterol to get out of taking a statin.  The analogy I use with my patients is:  Don’t take a BB-gun on a lion hunt.  The “gun” to take on a lion hunt is a statin.

   

Statins Are “Natural”

One beef people have with statins is that they are not natural.  Statins come from the following natural sourcesaspergillum terreus, penicillium citrinum, pleurotus ostreatus, monascus purpureus, and ripe leaves of camellia sinensis.  In fact a common supplement red yeast rice is monascus purpureus growing on rice.

Four Groups of People Who Should Take Statins

1).  Anyone with an LDL cholesterol >190mg/dl.

2).  Diabetics after the age of 40.

3).  Anyone with a heart attack, stroke, bypass surgery, heart stent, or peripheral arterial disease.

4).  Anyone with a 10 year risk of heart attacks >7.5% (you can calculate your risk here.

Statins Prevent Heart Attacks

Of all the medications to lower cholesterol, only statins have been demonstrated to create protective coverings over blood vessel plaques to prevent the plaque from developing a clot and causing a heart attack.  On the flip side, they occasionally cause muscle aches and muscle cramps.  There are other foods and medications to lower cholesterol you can read about here.

Real World Numbers

How many people do you need to give statins to prevent one heart attack?  In statin users without heart disease, 1 in every 56 statin users will avoid a heart attack over 5 years. If you’ve had a heart attack, 1 in 20 statin users will prevent a heart attack over 5 years. The benefit increases with time. Believe it or not, those are pretty good numbers for a medicine! 

Multivitamins Do Not Prevent Heart Attacks

In 2011, 11.8 billion dollars was spent on over the counter supplements.  The first question is how do you get a piece of that $11.8 billion pie?  The second question is do multivitamins and supplements work to prevent a heart attack?  The answer, to quote one researcher from Johns Hopkins:  “Enough is enough.  Stop wasting money on vitamin and mineral supplements.”

CoQ10 Does Not Prevent Heart Attacks 

CoQ10 (scientifically known as 2[(2E,6E,10E,14E,18E,22E,26E,30E,34E) -3,7,11,15,19,23,27,31,35,39-Decamethyltetraconta-2,6,10,14,18, 22,26,30,34,38-decaen-1-yl]-5,6-dimethoxy-3-methylcyclohexa-2,5-diene-1,4-dione) is a substance in our body that helps with energy production and cleaning up the pollution from making that energy.  You’re more likely to find a way to get the scientific name to fit on a medicine bottle than it prevent a heart attack in you.  I just saved you $312 a year.     

CoQ10 With Statins?  

Statin medications do lower CoQ10 blood levels by 16-54%. One thought is that this lowering of CoQ10 may cause the muscle aches that are so common with statins.  Studies do not really show that CoQ10 supplements stop the muscle aches some people get from statins.  You’d have better luck switching statins instead.

Garlic May Lower Cholesterol     

There are no studies saying that garlic prevents heart attacks but daily garlic supplementation can lower cholesterol by about 10 points.  You can read more about that here.  Garlic cloves are inexpensive when bought at the store as opposed to supplements that can run you $20-25 for a month.  Real garlic will provide you more of the active compounds anyway and might keep vampires away.

 

Niacin Doesn’t Prevent Heart Attacks

Niacin is also known as Vitamin B3 and is found in tuna, turkey, pork, wheat, barley, rice, corn, peppers, sesame seeds and ginger.  At high doses, Niacin has been shown to increase good cholesterol and lower bad cholesterol.  Taking high doses needed to lower cholesterol causes one to feel flushed and may also cause nausea, itchy skin and a rash.  Niacin however has not shown any usefulness in preventing heart attacks.     

Eat Fish Not Fish Oil

About 8% of the population takes some form of fish oil.  However, the science of fish oil is as murky as the water most fish live in. Healthy people who take fish oil and who do not have heart disease will NOT prevent heart attacks.  In those with a prior heart attack, most studies with fish oil show no reduction in future heart attacks.   One study has even shown that supplementing with fish oil may lead one to develop atrial fibrillation.

Summary

I would eat a healthy diet as discussed here which we know prevents heart disease.  Statins are the closest thing we have to a magic bullet to prevent heart attacks.  Remember that aspirin is not recommended in most people to prevent heart disease.  You don’t need to contribute to the supplement industry.  

This Post Has One Comment

  1. Scott

    As usual, strong work.

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