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April 3, 2023

Cholesterol VII- Follow up

It is imperative that all readers know that any time you go against conventional wisdom, you run the risk of negative reactions from providers of care that disagree or do not know about this depth of hypothetical disease etiology. This set of lipid and cardiology articles was meant to stimulate the reader to think beyond the simple answer that "statin medications" and cholesterol lowering are the primary or only answers to coronary artery heart disease. 

The treatment of any disease must start at the headwaters of pathophysiological dysfunction. To wait until a medicine is the only way to a healthy home is not in anyones best interest.

I will state that the statin class of medications may or may not be a part of the solution for an at risk heart disease patient. Every patient needs to weigh the risks and benefits of cholesterol lowering medications in the context of a broader picture of disease. I firmly believe that a large part of the population could avoid drugs by following the prescription laid out in article V. I have been practicing these principles for years and have seen my risk for disease plummet based on blood lipid parameters, markers of inflammation and general well being. This is not to say that I am medicine free, because I am not free of it. Despite 15 years of aggressive lifestyle interventions that align perfectly with article V, my inherent genetic risk screamed not so fast buddy! My risk scores including a coronary artery calcium score were lovely, but my apolipoprotein B level would not find a happy resting spot that would allow me to feel comfortable medicine free for the next decade. My family history is full of early onset heart disease with multiple deaths and heart attacks in the 50s and 60s age range. Thus, I recently began a PCSK9 inhibitor and a medicine that reduces intestinal cholesterol uptake. Now, every marker of risk is normalized. I state this as an example of how even with the best intentions, medicine may still be a necessary part of a risk reduction reality. Who knows, maybe a heart attack will still grab me before I want it to. I will tell you this though, it won't be because I was lazy and or uninterested in my personal longevity. Knowledge is one key to change. Desire is the second. Support is the third. Action is the final step.

Furthermore, as a pediatrician, I see the world through a child's eyes which changes my viewpoint. Working to get children to understand these principles at a very young age in order to prevent heart disease is my goal. Kids are strong, resilient and rapidly repairing themselves. Therefore, if every child followed the protocol in article V, I think that our disease risk nationwide would fall like a lead balloon. Unfortunately, this is not happening almost anywhere. Actually, we are on the opposite trajectory.

We are failing. Most major disease parameters seem to be on a rapid upswing.

Pre covid there were tiny signs of slowing and reduced death. With covid, these parameters have exploded, especially with heart disease. Death remains the ultimate statistic to try and ameliorate. However, health span and quality of life is a close second and economically is even more important than death in general. There are many reasons that we are dying less in general up to Covid including: reduced smoking, better rapid treatments and detection techniques, improved environmental standards for pollution of air and water, improved public health strategies for healthy lifestyle decisions. However, despite the falling death rates, the incidence of CVD is rising.

Looking at a large Veterans Administration study in Nature Medicine, we see a hazard ratio of 1.66 for ischemic CVD which is a big jump related to Covid viral disease. (Xie et. al. 2022) These issues were in high risk groups as would be expected.

Overall, we are attempting to reduce death through medical management in a crisis, but losing the battle to morbidity, disease frequency and poor quality of life. We have much more work to do. Covid has taught us so much about our poor lifestyle decisions.

Every day in clinic, I see the average American child living in ways opposite of article V's protocol. I believe that this is the reason that the disease rates will continue to climb. These activities bring about all of the risk factors for heart disease including diabetes, obesity, high blood pressure and systemic inflammation. The same risk factors for Covid death and morbidity.

Dr. M

Xie Nature Medicine