Now American Cardiology Guidelines Support Optimal Medical Treatment First: It is so Easy!
It Can be Industrialized and Scaled!
Over the last week we have reviewed new American guidelines that call for optimal medical treatment before heart cath and stents. Very few medical systems are set up to deliver OMT. Only 44% of Americans with high blood pressure achieve a blood pressure of 140/90 or less. Organizations set up to deliver OMT achieve that goal in 90% of patients. That is the benchmark. Most organizations are falling far short. The result is death, disability, suffering, and costs that are way too high.
Now we are moving on to how you can do it and it is surprisingly simple. It is all spelled out in the simple steps outlined in the slide that comes with this post. I used the first two posts to outline the benefits of optimal medical treatment. I would not expect you to do these things “because I said so.” You should do it because good research proves it works.
As you can see from the slide, blood pressure, sugar, and cholesterol reduction continues to be important. Our approach differs in two ways. We have learned that there is additional benefit from driving these numbers even lower. There is even more benefit from using specific medications to achieve these lower levels.
Goals
1. High blood pressure- Use lisinopril or losartan, spironolactone or eplerenone. Add hydrochlorothiazide or amlodipine as needed to achieve pressure of 130/80 or less.
2. Prediabetes or diabetes- Use metformin for type 2 diabetes regardless of the sugar level. Add empagliflozin if needed to achieve hemoglobin A1c under 8.
3. LDL-cholesterol- Use atorvastatin or rosuvastatin. If you have trouble taking atorvastatin, you may tolerate rosuvastatin. This is such an important part of treating artery disease, our main job is to find some dose of some statin that you can take. Almost everyone can take small doses of pravastatin.
Treatments
1. Take 81 mg. of aspirin every day. Heart attack occurs when a soft cholesterol deposit on the artery wall breaks open and the raw surface starts the clotting process causing a clot to form. If the clot gets big enough to block the artery, the heart muscle downstream dies and is replaced by scar tissue. Aspirin is an anti-clotting medication. By blocking clot formation, it prevents additional heart attacks.
2. Stop Smoking. Remember we discussed vitamin E as an antioxidant to improve health and prevent heart attack. That did not work out. Vitamin E made no difference, but every puff of cigarette smoke contains 10 to the 15th oxidative particles. That is a huge number. Oxidative particles combine with proteins and DNA to damage them and speed up aging and chronic disease onset. Stopping smoking is an antioxidant that works very powerfully to improve your health. Certain medications can help you stop smoking and counseling is also helpful. There is nothing more powerful than stopping smoking to improve your health.
3. Take Atorvastatin or rosuvastatin regardless of LDL cholesterol level. Taking a statin does not just lower your LDL-cholesterol level. That is not the main way that it works, although achieving a very low LDL is important. Statins lower your risk of heart attack more than they lower the cholesterol. Statins are also powerful antioxidants and anti-inflammatories. The enzyme that statins block has many functions beyond making cholesterol and a fetus that lacks it does not survive. Excess nutrition and weight activate the enzyme that makes too much cholesterol and too many oxidative particles, making the arteries thicker, scarred, and inflamed. Small amounts of a statin are antioxidant and anti-inflammatory. Statins restore arterial health and that is why they are so critical.
4. Take Lisinopril or losartan regardless of your blood pressure level. Taking one of these medications does not just help lower your blood pressure to 130/80. These medications are also powerful antioxidants and anti-inflammatories like statins. They interfere with the activity of a hormone that increases oxidative particles and inflammation. They also restore arterial health and reduce the likelihood of heart attack beyond their impact on the risk factor.
5. Take metformin if diabetic or prediabetic. Metformin impacts the same oxidative particle pathways as atorvastatin and losartan, it just does it downstream. The newer stents contain a chemical that keeps the stent open and reduces inflammation. Metformin provides the same benefit in all the arteries. In diabetics, metformin reduces the risk of heart attack by 39% compared with other treatments that achieve the same sugar level.
6. Take spironolactone or eplerenone regardless of blood pressure level. These are also blood pressure medications that are powerful antioxidants and anti-inflammatories. They interfere with the activity of a hormone that increases oxidative particles and inflammation. They restore arterial health and reduce the likelihood of heart attack beyond their impact on the risk factor.
7. Take carvedilol or metoprolol for chest pain or history of heart attack. Heart attack increases sympathetic nervous system activity and using beta blockers to block that effect right after discharge reduces mortality.
8. Take nitroglycerin and long-acting nitro as needed for chest pain management with angina or history of MI. As age and artery disease progress, your body no longer makes adequate amounts of a natural chemical that dilates arteries, makes them larger, and increases flow. Nitroglycerin temporarily increases levels of that chemical and relieves chest pain. Lisinopril, losartan, statins, metformin, and spironolactone all increase the levels of that natural chemical on a more long term basis.
The good news for you is this is so easy. I have these problems myself. I have a proven blockage of 20% in one of my heart arteries. I had a fasting sugar of 107 fifteen years ago and so I am prediabetic (anything over 100) My top number on my blood pressure was 160 and my cholesterol was high. Currently my blood pressure is 116/82, my last fasting sugar was in the 80s, and LDL cholesterol is well below 70. I follow these steps faithfully. I take metformin, losartan, atorvastatin, eplerenone and Plavix. I have a weekly pill organizer that I put beside my tooth brush. I brush my teeth morning and evening and that reminds me to take my medications. I never miss and I have no side effects. I reload my organizer once a week and it only takes about fifteen minutes. I order my medications through a mail order pharmacy and they show up in my mail once every three months. Simple. Done.
If you have had a heart attack, there is solid proof that following these simple steps reduces your risk of dying in five years by 90% while saving over $20,000 dollars a year compared to the care that most people get. Why wouldn’t you do that? You should be able to depend on receiving this kind of care wherever you live until we have proof that another approach works better. This treatment also works for people who have not had a heart attack, including individuals with heart artery disease, other artery disease, or a high risk of artery disease. If you have any of these conditions, you should be on optimal medical treatment for arterial disease. Medicare Advantage programs should be rewarded for consistently producing optimal medical treatment.