Pangaea Clinic of Naturopathic Medicine
interventional natural medicine for rapid, lasting health
Pangaea Clinic of Naturopathic Medicine
#120 - 12011 Second Ave
Richmond, BC
V7E 3L6
(604) 275 - 0163
(604) 677 - 5910 (fax)
What's all this stuff about Vioxx, statin drugs, and heart disease?
There is currently much confusion in the world of treating heart disease and preventing heart attacks and strokes. Much of the misunderstanding seems to have started with the terrible Vioxx scare that has plagued arthritic patients with an increased risk of heart attacks.
Vioxx is a type of pain killer that is classified as a "cox-2" drug. These drugs inhibit pain by stopping the production of inflammatory mediators called prostaglandins and leukotrienes. While effective for pain in many patients, the drugs are not specific enough, and in fact they inhibit the production of other chemicals that actually protect against heart attacks. Thus, the use of these types of drugs lower chemicals that make blood vessels relax, that make clots less likely to form, and that make platelets less likely to stick together. In fact these very actions that are inhibited are the main ways in which aspirin helps to prevent heart attacks.
Clearly however, Vioxx and other COX-2 painkillers are not creating an aspirin deficiency. What is actually being manifest is a very severe ''nutritional" imbalance in essential fatty acids. There are two types of these essential fats: one is classified as omega-3 (the good one) and the other is classified as omega -6 (the bad one). In reality, both are essential in the body for proper function, however, an excess of the 6 group is a very serious biochemical cause of degenerative disease.
In simple terms, omega-3 oils lead to chemicals that have a "less painful" inflammation, that make blood vessels relax and that make the blood more thin (less likely to clot, and easier for the heart to pump. Omega 6 fats are responsible for greater inflammation and for more cardiac risks such as easy clotting, thicker blood, and increased blood vessel tone. Further, in vitro (test tube) experiments have shown that omega-6 fats make cells more likely to turn cancerous while omega-3 does the opposite.
Having laid out some of the functions of these fats, you may think that omega-6 fats shouldn't be necessary at all! This also is not true as small amounts are needed for cellular membranes and cell signaling. In fact, an ideal ratio of 3:6 fats would be 1:2; this is the ratio that our ancestors achieved by eating grass-fed meat (wild) and grazing on plants and fruit through the day. Unfortunately, our modern diet of high grains, high meat (chickens and cows that are raised on grains) and low fruits and vegetables has led to a ratio of omega-3:omega-6 of 1:14 or even 1:20! It's no wonder our rates of cardiovascular disease and cancer have skyrocketed! It's also no wonder that aspirin seems to be helping so many patients in the prevention of heart attacks! Aspirin inhibits the enzyme that converts omega fats into their active chemicals! Therefore, aspirin seems the have its benefits because it in part masks this very large imbalance of fatty acids.
Does it make more sense to assume you hare an aspirin deficiency or to correct the original fatty acid imbalance? Vioxx probably killed the people who had this fatty acid imbalance at its worst. Fish oil is likely an important preventive nutrient for most people. (It is important to use a high EPA content oil, and one that has been third-party tested to be mercury-free. Also, it shouldn't be used in very young Children unless it is also high in DHA. Depressed patients and cardiovascular patients would benefit most from a high-EPA source).
Statin drugs, used to lower cholesterol, are another group of drugs that have been receiving more attention in the press. These are drugs that decrease the formation of cholesterol in the liver. A little touch of biochemistry: by inhibiting the cholesterol pathway, the production of an important nutrient called coQ10 is lowered. This coQ10 is a powerful anti-oxidant and also functions within the mitochondria (energy producing machines in the cell). Some of the news has lately been covering the potentially serious side-effect of skeletal muscle damage, or rhabdomyolysis. I always tend to prescribe coQ10 to my patients who are on statin drugs to replete this deficiency and make rhabdomyolysis less likely. However, I also would put these patients on a comprehensive cardiovascular program to lower all risk factors, instead of just cholesterol (described below). In fact, recent research has been showing that the life-prolonging and heart attack preventing effects of certain statin drugs is not exactly due to the lowering of cholesterol! In other words, the primary beneficial effects of certain statin drugs (the most effective ones at saving lives) come not from cholesterol lowering effects but from other effects such as lowering inflammation! Inflammation in the blood vessels is one thing that I almost always check for in cardiovascular patients, and the check is a simple blood test called c-reactive protein. Thus, a proper nutritional and naturopathic approach to treating root causes of heart disease would be to investigate and ascertain the causes of the increased inflammation. Often times, this may be related to heavy metal body burden or infectious diseases. However, for now, if you know someone who is taking cholesterol-lowering statin drugs, it may be wise for them to consider coQ10 until they can seek out underlying causes.
This leads us into what I consider a proper comprehensive program for coronary artery disease and heart attack / stroke prevention.
The main crux of the problem is that we have to keep the end in sight; meaning my patients and I have a fundamental goal of reversing the biological process that is responsible for the plaque build-up in the arteries that causes heart attacks and strokes. Therefore, instead of using metformin or glyburide to control high blood sugar, instead of using a statin drug to lower cholesterol, and instead of using a diuretic to lower blood pressure, we focus on reversing plaque build-up, reversing inflammation, and reversing hardening of the arteries.
A typical patient who has had a heart attack previously or is at high-risk for a first one will first undergo an evaluation of risk factors. This includes the traditional lipid panel tested by most MDs but extends to other biochemical markers. Ferritin (a measure of iron status in the body) is definitely done as this is an independent risk factor (ie it doesn't matter if your cholesterol is normal, elevated ferritin to a certain degree will increase your risk of having a heart attack). C-reactive protein is measured also to see if there is an increased level of inflammation in the arteries. A person with a level of 3.0 or above has roughly twice the risk of someone who has a level below 1.0. The body burden of heavy metals is assessed through a provocative urine challenge, where a chelation treatment is administered and then the urine analyzed for toxic heavy metals such as lead and mercury. Antibodies to certain bacteria, including Chlamydia, are done to assess an infectious component to coronary artery disease. Both infections and heavy metals can contribute to an increased CRP or increased inflammatory level. Please note that a blood lead is useless except in acute exposure situations. Some patients may benefit from analyzing oxidized cholesterols, levels of magnesium, levels of antioxidants in the blood, and clotting factors such as fibrinogen. If finances permit, then I recommend an EBT (electron beam tomography) test out of Swedish hospital in Seattle, which scans the heart arteries for the level of calcified plaque. This scan does two things: firstly, it motivates patients to make important dietary and lifestyle changes, and secondly it allows us to ensure that plaque reduction is occurring with our program.
Basic treatment for prevention of heart attacks and reduction of risk begins with chelation therapy. This is an intravenous treatment done to reduce the stiffness of arteries and especially to reduce the toxic metal load as tested in the first challenge. Alongside this main therapy, dietary and lifestyle changes are suggested. Wobenzyme is added for most patients as a substitute for daily aspirin (remember aspirin is covering up an essential fatty acid imbalance; wobenzyme reduces the viscosity of the blood through different mechanisms), and fish oils (high EPA) are used. If necessary, phytosterols are added to lower cholesterol (a temporary measure until the biological treatments have built up momentum).
The chelation program is implemented immediately as a first-line therapy. Chelation affects mainly the small arteries, and thus there is no advantage to waiting until the EBT test is done. For patients who do choose to do the EBT test, we will then have a "calcium score" that quantitatively tells us how much plaque is in the arteries. With this information, plaquex therapy (www.plaquex.ch) can be implemented with good scientific reason, ie we can check the EBT again after therapy and see the decrease in plaque! For patients who for financial reasons choose not to do an EBT test (it costs $550 USD), plaquex is still the treatment of choice for plaque build-up. With out quantitatively testing how much calcified plaque is in the arteries, I am more confident that I am reducing my patients risks by using chelation, particularly if the heavy metal analysis shows high toxic metals and high levels of inflammation, as in many patients lowering inflammation and preventing rupture of something called vulnerable plaque is more important than reducing the levels of calcified plaque.
Over-all, in a comprehensive cardiovascular program (different from just chelation at so-called chelation clinics) plaque burden can be reversed, and the other risk factors such as toxic metals, inflammation, and infection, can be reversed. Such a program entails understanding the biological processes of atherosclerosis and coronary artery disease from the macroscopic viewpoint of plaque in the arteries to the smallest chemical imbalance caused by a dietary imbalance in essential fatty acids. It's complicated, but relatively easy to grasp once a few fundamental theorems are understood. If you have any questions, be sure to email them or call to set up an appointment where we can go over them in detail.
Articles for your browsing. These are past newsletters emailed to our patients and also responses for requests for information. If you have a specific topic you'd like a comment on, please email us.
The information presented within this web site is solely for education. It is copyrighted and protected as intellectual property. As all physicians have their unique opinions, this information is not to be taken as the opinion of any association or regulatory body. This website is not a substitute for personalized care by Dr Eric Chan or Dr Tawnya Ward; liability is excluded for misuse.
