Family message sent this morning

[Guest guest]

Prompted by an important NEJM article released just five days ago, I

sent this e-mail to members of my family/relatives this morning. My

family has an incredibly high rate of premature coronary artery

disease, clearly genetically induced. This e-mail could potentially

be of interest to some others as well.

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Team--

On March 8, 2004 a study was published in the New England J of

Medicine that has significance for heart disease risk.

Please see below if you are interested in this. You will find links

taking you directly to the study and commentary. If the clickable

links don't work, just copy and paste the URL into your browser.

http://content.nejm.org/cgi/content/abstract/NEJMoa040583

http://content.nejm.org/cgi/reprint/NEJMoa040583v1.pdf

http://content.nejm.org/cgi/content/abstract/NEJMe048061

http://content.nejm.org/cgi/reprint/NEJMe048061v2.pdf

From the published commentary on the study:

" There will soon be a sea change in the prevention

and management of atherosclerotic vascular dis-

ease. The proportional reduction in major clinical

outcomes that results from aggressive statin thera-

py is of the same order of magnitude as that seen

when statins were compared with placebo in con-

trolled trials. Intensive therapy with statins, moni-

tored by means of measurements of LDL cholesterol

concentrations and awareness, treatment, and control of

hypercholesterolemia among US adults...... "

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One thing the study found was that aggressively lowering LDL

cholesterol (to levels far below what physicians currently target)

resulted in superior cardiac outcomes.

If this study gets confirmed by other studies, we will see the LDL

cholesterol target(currently <100 mg/dl) lowered, possibly

substantially.

This may turn out to be a very important, landmark study.

I have been aggressively lowering my LDL-C for about two years now,

without statins, and have been able to cut my LDL-C in half, from

approx. 100 to approx. 50 mg/dl. Dr.xxxxx, the research cardiologist

who is doing our genetic study, believes that the only function of

LDL cholesterol is to promote atherosclerosis, and therefore, the

lower the better. While that is not the conventional viewpoint,

studies like the one mentioned above certainly lean in the direction

of his opinion on this matter.

For those interested in substantially lowering their risk of a

cardiac event, I recommend the following strategies:

1. Reduce body weight to optimal levels, which is almost certainly

lower than what you think your optimal body weight should be. One

strategy is to reduce to what you think is your optimal body weight

and then drop another five to ten pounds. Reduce body fat to 5-15%

(for males). This is not easy, but is very important.

2. Eat large amounts of leafy vegetables, non-leafy vegetables, and

fruits. Berries in particular (blueberries, strawberries,

cranberries, raspberries, blackberries, etc.) have high levels of

polyphenol antioxidants, which appear to be cardioprotective. So do

apples. Oranges and other citrus fruits also fit the bill. Papayas,

mangoes, pineapples....... Examples of good vegetables to eat

include romaine, red leaf, green leaf and other varieties of

lettuce, " spring mix " (a mix of a large number of baby leafy vegs.),

the many varieties of cabbages, broccoli, green-red-orange-yellow

bell peppers, spinach, kale, turnip greens, collard greens, red and

green swiss chard.......

3. Eliminate the consumption of trans-fatty acids (look for the

words hydrogenated or partially hydrogenated vegetable oils). These

are found in almost all bakery products and thousands of prepared

foods. Trans-fatty acids are highly atherogenic. Also substantially

reduce the consumption of saturated fatty acids, typically found in

animal foods (as well as in palm oil and coconut oil). Fish is by

far the most healthy " animal food. " Monounsaturated fatty acids and

unsaturated fatty acids (especially of the omega-3 type unsaturated

FA's) are far healthier than saturated fatty acids. The debate is

still ongoing regarding very low fat diet (<10% of calories from fat)

versus not so low fat but consuming monounsaturated and unsaturated

fatty acids instead of saturated FA's.

4. A handful of raw nuts daily appears to be cardioprotective (not

recommended to eat peanuts raw---aflatoxin).

5. Reduce your blood pressure to as low as you can get it without

feeling any symptoms of lightheadedness, etc. A blood pressure of

120/80 mm Hg is NOT NORMAL, but rather is pre-hypertensive. Over the

past two years, I have reduced my blood pressure from 120/80 to its

current level of about 96/64, without any blood pressure lowering

medications, and without experiencing any untoward symptoms.

Interventions that may prove successful in lowering blood pressure

include weight loss, regular (5-7 days per week) exercise,

eliminating or substantially reducing the use of salt (sodium

chloride), getting enough potassium (fruits)......

6. Exercise: the new public health message is to exercise at least

30 minutes every day, or at least 6 days a week. However, ramping

this up to at least an hour almost every day will provide

substantially more benefits. You should have a treadmill stress test

performed by a cardiologist prior to beginning an exercise program.

Even just walking is extremely beneficial.

7. For those not at risk of over-indulgence, consider having one

glass of red wine daily. This is cardioprotective along the lines of

about 24% risk reduction (so are other alcoholic beverages, however

red wine contains large amounts of polyphenol antioxidants, as well

as a very healthy molecule known as trans-resveratrol). For those at

risk of over-indulgence, forget this idea entirely. The risk is far

greater than the benefit. With more than one drink daily, negative

consequences of alcohol consumption may occur (e.g. increased risk of

colon and other gastrointestinal cancers). (For some other types of

cancer, such as breast cancer, probably any alcohol at all increases

the risk).

8. Fish oil capsules (about 2 per day, 1000 mg capsules), for those

not eating fish high in omega-3 fatty acids (sardines, salmon, etc.),

is recommended. Fish oil stabilizes the electrical rhythms of the

heart, reduces triglyceride levels, and reduces the coagulability of

the blood (be aware of this if you are on an anticoagulant). Use

pharmaceutical grade fish oil, which is molecularly distilled to

remove heavy metals and other pollutants.

9. Medications as per your cardiologist. The AHA's " Get With the

Guidelines " program recommends 5 things: a statin, ACE inhibitor,

Beta-blocker, anticoagulant, and elimination of smoking.

Bob Bessen