25th annual American Academy of Anti-aging Medicine was held this weekend in Las Vegas. The mood was upbeat and progressive. This is what I’m talking about when I say“functional medicine “. The buzz words were intermittent fasting , FMD (Fasting Mimicking Diet, low carb/ high fat, microbiome , the “ hidden organ” and its effect on cardiovascular health , diabetes , the brain , health of newborns and aging in general .Also lots on energy medicine , artificial intelligence , and lots of really cool hi- tech stuff.

THE FUTURE OF MEDICINE IS NOW !

In this era of cost containment at the time of the passing of the Senate tax reform bill, the FDA approves Repatha as a stand alone for those with documented coronary heart disease. Repatha is a new class of medications that dramatically decreases LDL cholesterol which I name the "lousy cholesterol " It's a monoclonal antibody injected twice monthly under the skin. One problem is the cost,approximately $12,000 annually for a drug whose long term side effects are unknown.

Don't get bogged down by in the stats! Amgen the company that manufactures the drug sponsored the recent FOURIER study which led to this week's FDA approval. A 15-20% relative risk reduction may sound great,but when you break it down, the absolute risk reduction is more like 2 % ! The number of patients needed to prevent ONE cardiac event is 74 ! (not a home run in my book). It's been estimated that the cost of the drug would have to be slashed by 70% for it to be accessible to those in need.What's the chance that's ever going to happen ?

So this "victory" isn't so great when you break it down. As an integrative cardiologist, I'm all for the latest developments in testing and therapeutics.I have to say this class of meds truly decreases LDL cholesterol dramatically. I've used it is selected high-risk patients and it works ! But who's going to pay for it? Besides, have we truly exhausted lifestyle measures when it comes to heart disease prevention. Cholesterol is but one piece of the pie.

Read Original Article Here: https://www.medpagetoday.com/cardiology/prevention/69627

The new guidelines for Bp control were recently released by the American College of Cardiology and the American Heart Association. It boils down to this:
Anything above 130/80 is now considered hypertensive. That said, nearly 50% of US adults are hypertensive and only 54% of these are under adequate control. As this article mentions, it can't all be up to the doctor. We can only prescribe but so many meds before dealing with nasty side effects, drug-drug interactions and expense. Just think of how many more doctor visits will be necessary to attain these values. Patient compliance and responsibility are going to have to play a bigger role. We are talking about weight loss, exercise and cutting back on alcohol consumption. Patients need to invest in a home Bp monitor and keep an ongoing record of their Bp,

This is what I'm talking about when I say you must become your own medical advocate.

Read The Original Article Here:

 https://www.medpagetoday.com/cardiology/hypertension/69450

I've never been a fan of energy drinks. There is just something inherently unnatural and contrary to vibrant health when one needs to down such drinks to either stay awake or avoid an energy crash. Reports of the ill effects of these drinks are not new, but, attached, is a recent study linking these drinks to cardiac and blood pressure changes. It appears from this small study that such deleterious effects may not be merely related to the caffeine content. Those consuming energy drinks had a distinct electrical abnormality on EKG, commonly referred to as prolongation of the QT interval. Such electrical abnormalities carry potential risk, as dangerous rhythm disturbances (arrhythmias) can result, leading to loss of consciousness and even sudden death. FYI, there are many medications that can increase QT interval, placing patients at cardiac risk.
Again, this is a small study involving young healthy adults. Additional limitations include absence of a true placebo group. Despite these study limitations, the results are of interest, especially when you consider the popularity of energy drinks. Hopefully such interest will garner additional and larger studies to address the true effect of these drinks on the electrical system of the heart. In the meantime, I would clearly dissuade older individuals or those with hypertension or other underlying cardiac conditions to avoid consuming these drinks until we have more information regarding their impact on heart health. ~ your Medical Advocate! - H.E.

Written in Response to Article: Check it out HERE

https://www.medpagetoday.com/PrimaryCare/DietNutrition/64812

I just returned from an incredibly informative 2 day conference, CONTROVERSIES & ADVANCES IN CARDIOLOGY given by Cedars Sinai Medical Center. The latest and greatest in both the invasive and non-invasive aspects of my specialty were brilliantly presented by renown cardiologists.. What's particularly exciting to me is how Artificial Intelligence and the entire spectrum of the digital world is making a difference in patient care. The focus needs to be on HEALTH rather than just providing health care. Virtual reality systems are being set up in hospitals so that patients in pain can engage in a 3-D program,rather than stare at the blank walls, The results are quite promising.

Statins are still the buzz word. The new thinking is that anyone undergoing a coronary artery scan with a calcium score greater than 1 needs to be on a statin ,or whatever it takes to get the Ldl (lousy cholesterol) to a level less than 70. Now as an integrative cardiologist, I don't really buy that (at least in regard to the patients I see). Ldl cholesterol is but one piece of he pie. But I get it, Most cardiologists base their decision making on the conclusions of large randomized trials. The problem is that not all patients fall into a certain class. Some are truly committed to making lifestyle changes. 
Stay tuned!

There has been this ongoing debate about percutaneous coronary intervention (PCI), be it balloons and/or stents. Is it truly being overused ? As cardiologists, are we too quick to jump to intervention ? As an interventionist,I can say without a doubt that in the throngs of a heart attack OR unstable angina( known as Acute Ischemic Syndromes) that prompt intervention is life saving. But what about those with chronic symptoms who are clinically stable? We've known from previous studies that such patients do fine on medical therapy. Enter the recent ORBITA trial. This was a small study comprised of 200 patients with clear-cut blockage in a coronary artery.All patients underwent intensive medical therapy for 6 weeks. In the 2nd phase of the study, they were randomized to undergo the real deal (stenting of the affected artery) or a sham procedure in which the artery was left alone.(without the patient's knowledge) The outcome in both groups was the same. There was no difference in symptoms of chest pain , or differences in exercise stress testing..

So should we leave behind a significant blockage that we discover by invasive testing vs. stent it since we are already there? Are we too quick to bring patients to the cardiac cath lab? What constitutes optimal medical therapy anyway? With multiple drugs come multiple risks and costs. Fortunately in my office we offer EECP which is a FDA approved treatment for coronary artery disease. This is a great adjunct to those on medical therapy.

The bottom line is that there are too many variables that this study fails to address. Expect to hear a lot of debate about this trial in the coming weeks and months.

Read Original Article Here

http://www.cardiobrief.org/2017/11/02/small-trial-raises-big-concerns-that-pci-in-stable-angina-is-just-a-placebo/

For months I've been speaking and blogging about the benefits of a high healthy fat diet. I've gone on record disagreeing with the recent advisory statement by the AHA who decried the use of saturated fat (including coconut oil) in our diet. Their statement was based on studies dating from the 60's.But old science is not necessarily good science. Released last week in the prestigious British journal the LANCET, are the findings of the PURE study.This was a huge study from 18 countries in 5 continents over a 7 year period.A significant survival advantage was noted in those following a high fat diet. Yes, that even included the often maligned saturated fat.

Those consuming the highest level of fat had a reduced risk of fat of 23%. On the other hand, the higher the carbohydrate intake, the greater risk of total mortality.

Isn't it time to embrace new ideas based on new data?

View Original Article HERE

https://www.drperlmutter.com/powerful-new-study-confirms-high-fat-diet-is-best/

Fasting of some sort seems to be the buzz word these days when it comes to longevity medicine. Dr. Valter Longo was one of the keynote speakers at last month's American Academy of Anti-aging (A4M) meeting held in Las Vegas. He brings a new twist on fasting ; FMD =Fasting Mimicking Diet where one doesn't actually fast ,but drastically reduces calories 5 days of the month. His research is pretty compelling. Potential benefits run the gamut from cancer treatment and prevention to cardiovascular disease prevention, improved cognition with aging, and stem cell proliferation. I don't believe this is merely a fad. I believe we will be hearing quite a bit about FMD in the very near future.