primary prevention of cad

[Guest guest]

caution: long winded...

Dear Drs.,

I sent a question yesterday regarding primary prevention of coronary artery

disease which was driving me nuts. I have a person that I am working with

who is 57, avid (and i mean avid) runner and healthful eater (plant based ).

He has a genetic predisposition or true genetically elevated total

cholesterol which is diet sensitive if he eats only raw vegetables and ice

water. Due to his healthful lifestyle the HDLs are in a very good range. He

has taken aspirin for years for coronary artery disease prevention (

anti-inflammatory effect) and for the blood thinning effect. Recently he was

placed on tocotrienol ( a form of vitamin e with different biologic action

than e, from rice bran oil ) which is a liver HMG-coA reductase inhibitor.

The HMG-coA inhibition is the same action as Zocor and Lipitor, both

prescription drugs. The tocotrienol brought down his total cholesterol and

his LDLs. He went off the tocotrienol for a month and his levels went up and

now his internist wants to place him on Zocor which I questioned. Zocor and

Lipitor both have the potential side effect of rhabdomyolysis which sounds

horrible. If this condition is due to the HMG-coA action then the

tocotrienol, despite being from a natural substance, could potentially have

the same effect, although there is no warning about that from the

manufacturer.

Anyways, my thinking was that if you took aspirin then you would worry less

or not at all about the cholesterol if you were eating well and exercising.

I wanted to know if this was true but I couldn't find the answer...

Dr. Tim a commentator from abcnews did a bit on TV and in a chat

room on anticholesterol lowering medications and his rationale as to why he

chose to take it even though he has no known coronary artery disease and

apparently no elevation in his cholesterol ( i could be wrong about that ).

See link below.

http://abcnews.go.com/onair/DailyNews/2020_000121_heartplaque_chat.html

So, given my natural propensity to question prescription medication I went

on to ask the question about whether or not aspirin could be used for

primary prevention of cad in a person with elevated cholesterol , good

lifestyle, and no known cad. This idea was postulated several years ago in

the New England Journal of Medicine.

Given the answers from the list serve and from a literature search I have

come to the following conclusions :

It is standard medical practice, with no known cad, to give both aspirin

and cholesterol lowering medication if the cholesterol is elevated. Dr.

's idea is still not standard of care yet ( although interesting).

Aspirin is given (baby asa) for both the anti-inflammatory effect ,which

is part of the cad process, and also for the anti-platelet effect.

Diet and exercise is essential. So is non-smoking.

With known cad, give asa for mi prevention and treatment, as well as

reduce risk factors ie cholesterol and every other thing possible ie diet,

exercise, vitamins, herbs, enzymes, chelation ?, etc.

What I want to know now, given the ideas from all of you is, what vitamins,

herbs, enzymes, relaxation techniques etc. would you prescribe in addition

to or as a known effective alternative to the asa or cholesterol lowering

medication for either primary or secondary prevention and or treatment

(reversal) of cad ? (be specific)

Thanks.

vty,

sharron fuchs dc

Responses:

Dr. Freeman:

Hi Sharon,

My understanding of current medical practice is that aspirin cannot be used

in lieu of a statin-type drug for lowering plasma cholesterol.

Dr. Lumsden:

I agree with Willard. It can be reversed but only by the hard way as is

outlined. Damaged vessels and stasis can increase tendency to form clots

and so the aspirin, enzymes, or even onions/garlic reduce the tendency to

form them. It is a matter of lifestyle management. This is where DC's

should really shine in health care at large. My sister had a mild MI last

week at 47 years of age, high stress, poor diet, no aerobic exercise, mild

to moderately overweight. In speaking with her last eve, I hope she gets

serious about lifestyle factors as there just ain't no silver bullet.

Steve Lumsden, D.C., D.A.C.B.I.

Dr. Bertrand:

No to aspirin as prevention of CAD. No to drugs for prevention of CAD. To

reverse CAD only 1 safe and effective way: diet, exercise, and relaxation.

Vitamins and herbs to stabilize damage, baby aspirin (or proteolytic

enzymes) to block clotting factors, but will not reverse CAD. No magic

bullets, that's life.