Does Heart Disease Treatment Need Major Revision?

[The following is copied from my blog site quantitativemedicine.net– worth looking at in its own right – and should be of interest to anyone, as it illustrates how dysfunctional translation from medical science to medical practice has become. What we are told to do and what any sound reading of the scientific literature actually suggests is almost comically at odds with one another.]

DOES HEART DISEASE TREATMENT NEED MAJOR REVISION?

It does if a recent editorial in the British Medical Journal, found here, is correct. In this editorial, saturated fat is pronounced healthy, LDL (bad) cholesterol irrelevant, and stents useless.

The British Medical Journal frequently takes an iconoclastic view of things, but this article topples at least three sacred cows, calling for a major revision in primary and secondary heart disease prevention.

Such heresy, we predict, will be thoroughly ignored by the medical establishment and we beseech you, dear reader, to ensure that this information gets shoved under the noses of any medical folk you may have access to, whether they want to read it or not.

The paper talks about primary and secondary prevention. Primary prevention means you haven’t had your first (primary) heart attack. Secondary prevention is aimed at preventing you from having another one.

Let’s look at the sacred cows, one by one.

Low fat diet

The paper immediately mentions the Mediterranean diet. Besides being delicious, this is a relatively high fat diet. This diet reduces secondary heart attack 30% compared to the standard low fat fare recommended by the American Heart Association. Don’t know what the American Heart Association is recommending these days? Here it is:

• a variety of fruits and vegetables,
• whole grains,
• low-fat dairy products,
• skinless poultry and fish
• nuts and legumes
• non-tropical vegetable oils

Plenty of carbs and not much fat here.

But, you will say, the Mediterranean diet uses olive oil. That’s a healthy oil. Well it is, but what about other sorts of fats?

Saturated Fat

The paper opens with research results that show no association with “saturated fat consumption and (1) all-cause mortality, (2) coronary heart disease (CHD), (3) CHD mortality, (4 ) ischaemic stroke or (5) type 2 diabetes in healthy adults.” Well that pretty well covers it, and such a broad exculpation of saturated fat would in and of itself be grounds for medical heresy, but it gets worse. Consider this one:

“It is instructive to note that in an angiographic study of postmenopausal women with CHD [cardiac heart disease], greater intake of saturated fat was associated with less progression of atherosclerosis whereas carbohydrate and polyunsaturated fat intake were associated with greater progression.”

Huh? Saturated fat beats polyunsaturated? Ooh. Poly was supposed to be sooo good for you. They don’t mention monounsaturated fat, so we suppose that was a tie.

The interesting thing about saturated fat is that there never was any proof that it was bad. It was basically just seized upon as somehow self-evident in the 70s and took on a life of its own. And the notion is certainly alive and well 50 years later.

What about Stents?

They say stenting fails to reduce heart attacks or overall mortality. Odd track record, considering that there are over one million stent procedures done annually in the U.S. alone.

And Good ‘Ol Cholesterol

The authors pull no punches here: “Decades of emphasis on the primacy of lowering plasma cholesterol, as if this was an end in itself and driving a market of ‘proven to lower cholesterol’ and ‘low-fat’ foods and medications, has been misguided.”

They instead say that HDL to total cholesterol ratio is the most important. This is another way of saying that it is all about HDL cholesterol, an anti-inflammatory artery cleaner that is significantly increased by exercise.

In Conclusion…

The authors are generally stating that heart disease is currently treated as a plumbing problem—fix those clogged pipes—whereas it is actually an inflammation problem (which we thoroughly believe) and the solution is to reduce inflammation, pro-inflammatory insulin in particular.

The editorial is short, easy to read, and their ten references further bolster their findings. And, no, QM did not write the editorial, though we sure could have.