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Treatment alternatives for blocked arteries

Dear Doctors, my partner, an otherwise very fit and healthy 84-year old has been diagnosed with a blocked coronary artery (LAD occlusion) and slightly elevated cholesterol of Total Cholesterol 6.1 (HDL 2.6 mmol/L, LDL 3.1 mmol/L) for which the Euro CTO study at Brighton Sussex University Hospitals NHS Trust is being offered – a trial involving the option of 1) angioplasty/stent or 2)medical combination of asprin, statin, ACE inhibitor and up to 2 anti-angina medications including one to slow the heart. For now, he has been prescribed Atorvastatin and Ramipril, but is not keen to take medication unless absolutely necessary. We have read on the British Heart Foundation’s web site, and on what appears to be an excellent US coverage of studies on cholesterol on http://www.newswithviews.com/Howenstine/james23.htm#_ftn1 that there are many studies suggesting high cholesterol is not necessarily the cause of arteriosclerosis, statins can have bad side-effects and lower Q10 thereby weakening the immune system, and there have been some links found between arteriosclerosis and 1) Lipoprotein A, 2) elevated Homocysteine, 3) inflammation tested by high C reactive protein, and 4) excessive blood clotting tested by Fibrinogen excess, 3 of which could be treated with the alternative of amino acids, high dosage vitamins or enzymes. Are there any GP’s / consultants in the UK specialising in these “alternative” treatments, how could these elements be tested and where in the Sussex area? Thanks and regards

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The answer

Your partner has a very good ratio of total:HDL cholesterol – although the standard advice is for most people to aim for a total cholesterol below 5mmol/l, or below 4mmol/l in people with a history of heart disease or type 2 diabetes, the ratio of total:HDL ratio gives a much better indication of their heart risk from cholesterol. HDL is the ‘good’ form of cholesterol and the ideal is below 5 and as low as possible.

However, there is very good evidence from studies that whatever your cholesterol is, if you have heart disease (as your partner does) taking a statin tablet greatly reduces the risk of heart attack and stroke. Sadly the same categorically cannot be said of alternative medicines. Hundreds of thousands of patients have been involved in trials with studies with statins and the message in all of them is the same – the risks outweigh the benefits for the majority of patients. All medications have side effects and statins are no exception. However, the majority of patients who take them (probably in the region of 90%) get few or no side effects, and most patients who do get side effects say they settle when they stop taking the medication. There is extremely good evidence of a completely predictable increased risk of heart attack or stroke as cholesterol, and particularly total:HDL ratio, rises.

Analysis of over a hundred thousand patients taking statins showed no evidence of them causing problems with the immune system. While homocysteine and CRP may well be linked to heart attack and stroke, a 20,000 patient study looking at the effect of statins on patients with high CRP showed that the statin reduced the risk of major cardiovascular events by 44% and the risk of stroke by 47% in patients with high CRP but no evidence of heart disease, suggesting that the benefits of statins extend to them as well.

There is absolutely no high quality scientific evidence showing that high dose vitamins or enzymes reduce the risk of heart disease. In the biggest study – the Heart Protection Study – supplements of ‘antioxidant’ vitamins A,C and E showed no benefit whatsoever. While I regularly recommend complementary therapy in some cases, I cannot recommend that your partner seeks alternative therapy for a potentially fatal condition.

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