Archive for the 'Cardiovascular disease' Category

Unsettling news for statinators

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Olmsted County, MN

A recent paper in the Archives of Internal Medicine should give pause to those dispensing statins like candy. According to some fairly persuasive autopsy data, it appears that the rate of heart disease may be back on the rise after being in a slow decline over the past 40 years.

In Olmsted County, Minnesota, home of the Mayo Clinic, autopsies are much more common than in other parts of the country. So much so that the autopsy records of this county are often used in scientific inquiry as a surrogate for the country as a whole. Autopsies used to be more common nationwide but had fallen in 2003 to only 8.3 percent of deaths. Autopsies are conducted in Olmsted County at rates an order of magnitude greater than they are throughout the rest of the country.

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Ruminations on the halted ACCORD study

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A few days ago the National Heart, Lung, and Blood Institute (NHLBI), the organization coordinating the ACCORD study (Action to Control Cardiovascular Risk in Diabetes), pulled the plug on the glucose lowering part of it. Why? Because in a stunning mid-trial finding, subjects in the arm of the study who were edging their glucose levels closer to normal were dying in significantly greater numbers than those whose glucose levels remained elevated.

What the heck is going on? Conventional wisdom has it that the lower (toward the normal range) the blood sugar the better. It has been the goal of diabetic management to reduce blood sugar levels as close as possible to the normal range; now comes this disastrous study presenting dramatic evidence to the contrary. Amazingly, those subjects who died in the lowered-blood-sugar group succumbed to some form of cardiovascular disease, the very condition the more aggressive blood-sugar lowering was crafted to prevent. Do these tragic deaths invalidate the sugar hypothesis of heart disease?

I don’t think so, but before we get into why, let’s summarize this experiment.

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High triglycerides driven by carbohydrate consumption

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Harvard strikes again.

The February 2008 issue of the Harvard Heart Letter (subscription only) contains an article titled Triglycerides: A Big Fat Problem. The article discusses the correlation of elevated triglyceride levels with the development of coronary artery disease, then lists eight methods for reducing elevated triglyceride levels. It’s this list I want to discuss, but first let’s consider what triglycerides are and what they do.

Triglycerides are storage fats composed of three fatty acid chains hooked onto a glycerol (a 3-carbon carbohydrate) molecule. Fats travel in the blood as triglycerides and are stored in the cells as triglycerides. Each time a triglyceride moves into or out of a cell, the three fatty acids must first be removed from the glycerol backbone. After the fatty acids move across the cell membrane into or out of the cell, the fatty acids are then reattached in a process called esterification. (The particular bond between the fatty acids and the glycerol molecule is called an ester bond.)

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A statinator speaks

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After the Enhance study came out Katie Couric interviewed Dr. Steve Nissen, a statinator of renown.

Although Dr. Nissen, who is the Chairman of Cardiology at the Cleveland Clinic, is upset over the findings of the Enhance study, it hasn’t dimmed his enthusiasm for statin drugs a whit. As you watch the video, note the quotes I’ve excerpted. They demonstrate how a famous cardiologist is firmly in the grip of the lipid hypothesis despite considerable evidence that the hypothesis has been built on a very shaky foundation.

Here is the video.

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