An Optimal Medical Therapy Miracle?
Multiple medications reduce the size of experimentally induced heart attacks. The experiments are done by blocking a heart artery for 30 minutes and then opening it again. My last few threads have reviewed the information for metformin. Statins also provide this protection as do SGLT2 inhibitors like Jardiance. ACE inhibitors (lisinopril) and ARBs (losartan) do the same. Spironolactone and aspirin also reduce infarct size. The same mechanisms involved in the heart also protect other organs. We know that combining ACE inhibitors, statins, metformin, and aspirin in optimal medical treatment (OMT) dramatically reduces the likelihood of heart attack, stroke, or death. All those medications switch off mTOR and switch on AMPK.
About 20 years ago, a male patient of mine who was about sixty years old with type 2 diabetes had heart artery bypass surgery and had a terrible stroke as a complication. He was in a coma for at least a week. Prior to that episode he had been very active with no complications. He was an excellent golfer. I remember the episode very clearly. I was driving toward the eastern shore of Lake Michigan for a short vacation. When I heard the report of his condition over the phone. I remember being very upset. His stroke was so severe that I thought he would die. To my great surprise, he woke up and they sent him to rehab. Within a month after the surgery, he was home. He was on an ACE inhibitor (lisinopril), a statin, metformin, and aspirin. It took a while, but ultimately, he fully recovered apart from adding a stroke or two to his golf handicap. I know it is just one patient, but we should at least entertain the idea that the combination of optimal medical therapy medications he was on protected his brain.
We know that statins and metformin reduce heart attack size dramatically. We know that all the OMT drugs he was on reduce the number of strokes five-fold when combined compared with usual care. It may be that in combination; they protected the brain. When his stroke occurred, it may be that his brain cells were stunned rather than killed and they eventually recovered.