Category: Heart Attacks

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Heart Attacks Heart Health

You Had a Heart Attack, Now What?

After a heart attack, it’s normal for many to fall into major depression. They will recognize their frailty for the first time. And the church of meds and doctor visits only adds to feeling overwhelmed.

Fortunately, for many of us, a myocardial infarction is a call to our health. A signal that something major happened, but we’re still getting another chance.

Not to downplay the emotional toll a heart attack has on us; not at all. Sitting with those helpless feelings and talking it through with an expert is quite valuable. But we won’t dive too much into that here today.

Surviving a Heart Attack

Sadly, only 1/2 of us will survive a heart attack. In fact, the way many find out they have arterial plaque in their coronary arteries is on autopsy.

Those who survive have an opportunity to live their healthiest lives ever. We’ve had patients who had an attack in their early 50s and changed things around to now live healthily into their 80s.

To survive a heart attack means that your myocardium suffered some damage but not enough to make it stop. It also means that your tactical approach from this point on can change your Heart Health drastically.

Book a consult with Coach Mo to review your Heart Health Plan after a heart attack.

After a Heart Attack

Step 1, address the emotional side of it. Even if you don’t believe in ‘mental health,’ your attitude towards your cardiovascular health is one of the key driving forces to healing your heart and living a long and healthy life.

1. Exercise

Early activity. Cardiologists are reluctant to recommend early activity, but with the right experts in the mix, almost everyone will benefit from movement after a heart attack to help improve their peripheral vascular response and cardiac output.

How much activity do I need and how much can I tolerate? How can I tell if I’m overdoing it or if I can keep pushing it.

Cardiac rehabilitation. Similar to exercise, this is a bit more involved, and the goal is gradually improving the person’s exercise capacity. Most insurance-based cardiac rehab programs aren’t up to snuff, but plenty of private rehab experts are great at their art.

Where can I find private cardiac rehab experts who will guide me through my heart attack recovery?

2. Medical Interventions

Medical intervention. Medications are an important part of the Heart Health recovery after a heart attack. It also depends on whether you had to have any stenting or other procedures done.

What medications do I need and for how long? What’s the purpose of each one and why is my doctor choosing them?

Blood glucose control. Blood sugar control isn’t just for diabetics. Glucose spikes will cause damage to vessels and circulation. It will impede recovery. You don’t need a fancy CGM, but you need to know how your blood glucose responds to foods & stress.

What is my blood sugar first thing in the morning and 2 hours after a meal? What is my blood sugar after certain foods, alcohol, stress, and exercise?

Address inflammation. Inflammation may be a factor in why we develop heart attacks. Atherosclerosis by itself isn’t too dangerous – it’s the instability of the plaque that matters more.

3. Lifestyle Changes

Dietary changes. Whether genetics or lifestyle habits lead to your attack, recovering from one requires fine-tuning your diet. A diet program should be tailored to you, not a cookie-cutter plan.

Am I getting enough whole foods in my diet? Is there anything processed I can cut out? Am I getting enough calories for my activity levels?

Sleep optimization. Heart muscle needs healing, arteries need to flow well again, and circulation has to go back to normal. This tissue healing can only happen with restful sleep. It doesn’t need to be perfect, but you can’t skip over it.

Did I have a restful sleep? Do I need to cut out the caffeine or alcohol? Do I need to go to bed earlier?

Stress management. Stress that you can cope with and manage is okay; it’s the excess stress that tends to make a heart attack recovery difficult.

Am I stressed? What 3 steps can I take right now to help reduce this stress level a little.

4. Empowerment

Education. Understand why the heart attack happened will help you prevent future heart attacks. The human body may be complicated but the basics of how it works and how it malfunctions is fairly easy to understand.

Categories
Heart Attacks Heart Health Hypertension

Clever Ways of Reducing Salt Intake

We loved a recent video by Nutrition Made Simple where the author points out the risks of excess salt in the diet. And he also discusses clever ways of reducing salt intake. See the link above to watch the entire video.

High Salt Intake

Most of us consume too much salt because we get it in canned food, pastries, bread, packaged foods, pasta, tofu, and even sweets. It’s tough to avoid.

It’s a habit – which is the toughest thing to overcome. Over several decades, our taste buds have gotten used to a strong salty flavor, making it hard to start using less salt suddenly.

Like heavy foods, such as fried foods, it’s often a flavor profile we are accustomed to. Over time, it’s possible to break the habit, but it takes many months, often a couple of years.

Salt & Heart Disease

Studies show that heart disease is linked to higher salt intake. Lowering our overall salt intake or ensuring we get enough healthy grains and fruits into our system decreases the risk of heart disease and doesn’t just lower blood pressure alone.

Replacing Sodium with Potassium

The suggested alternative is to use a salt that isn’t made of sodium chloride (NaCl) but instead of potassium chloride (KCl), which is safer, as the studies demonstrate.

Lowering the total sodium intake and replacing it with potassium decreases the risk of death and strokes. That’s a powerful intervention, and the food’s taste isn’t sacrificed because KCl is still quite salty.

Heart Health Coaching clients also know that eating more fruits and vegetables adds potassium to their diet. Remember, adding potassium, not just the sodium replacement, is a driver of better Heart Health.

Salt Substitutes

There are lots of salt substitutes out there, and your favorite health food store should have seasoning options with no salt at all, with some potassium, or some combination of the two.

The key is to experiment and see if it tastes different. And of course, just adding less salt to your food will reset your taste buds and is a good way to crave less.

Categories
Heart Attacks Heart Health Hyperlipidemia

How To Lower ApoB Levels

We discussed the importance of measuring apoB levels to understand someone’s Heart Disease risk. Now, let’s talk about what we can do to lower apoB and by how much.

Diet: 5-10%

For most of us, reducing saturated fat intake and excess processed carbs could have an additive effect on lowering apoB levels.

Increasing fiber intake and switching to more whole plant-based foods with the occasional healthier oil options will further lower apoB levels.

Some clients believe that saturated fat can be good and cite research that it may not be as harmful as some claim. Our Heart Health Coaching Program settles this debate through lab tests by monitoring not only apoB levels but also inflammatory markers.

Exercise: 7%

Some studies show that exercising 30 minutes 5 times weekly can lower apoB levels. Most of these studies focus on aerobic exercise and less on resistance training.

At HHC, we believe that resistance training can be incredibly potent when done properly and long enough.

Insulin Resistance: 10-15%

The factors that improve insulin sensitivity and, therefore, lower insulin resistance are often the same things as above – dietary change and exercise.

However, there are independent factors that make insulin more sensitive in the body that involve VLDL production. Or perhaps it’s all related and difficult to tease out in studies.

Weight Loss: 10-20%

Some individuals have apoB production/clearance pathways incredibly sensitive to weight. Losing weight helps improve apoB by as much as 20%.

Stress Reduction: 5%

Stress is part of everyday life. It’s the type we cannot cope with that is the most damaging. There are plenty of proven coping strategies out there, as well as medication techniques.

8 weeks of meditation could lower apoB levels by up to 5%.

Sleep Improvement: 10%

When it comes to sleep, we care about restful sleep. Any number like “7-8” hours is often too vague. Some of our patients need 9-10, while others can go a few days with 6-7, and they can recover with more sleep later.

It’s rare to see someone who does well when consistently getting too little sleep. When their sleep is improved, we see apoB lowering by 10%.

Want to Lower Your ApoB?

Work with Coach Mo – he’s caring, competent, and curious. Come up with a strategy to lower your apoB and improve your Heart Health.

Book Today
Categories
Heart Attacks Heart Health Hyperlipidemia Statins

apoB and Cardiovascular Disease

Most clients in our Heart Health practice show up with their lipid profile in hand, most concerned about their LDL and HDL numbers. In this article, we’ll share our viewpoint on apoB and cardiovascular disease risk.

Old, Discarded Viewpoints

Lipidologists and preventative cardiologists no longer rely on LDL-C as a way to risk stratify someone for heart disease.

In most laboratories, LDL-C is often calculated and rarely measured directly, making LDL-C an even less reliable marker for cardiovascular disease risk.

Once believed to be protective, HDL-C is no longer believed to serve much value when assessing a lipid profile.

Modern Lipid Profile Analysis

If you have one of your old lipid profiles lying around, you can calculate your non-HDL cholesterol, which, 97% of the time, corresponds to apoB levels.

(Total cholesterol) – (HDL cholesterol) = non-HDL cholesterol

You can also use an online calculator.

Triglyceride Levels

these days, we mostly use triglyceride levels to determine if somebody’s dietary intake of simple carbohydrates is excessive.

The higher triglycerides are, or the more insulin resistance somebody is, the more likely they will have excess cholesterol needing transportation by apoB lipoproteins.

apoB Targets

apoB can be cheaply measured ($20 – $60) in most laboratories. Insurance often covers it, but that’s hardly necessary for lab testing.

The way we determine apoB targets is to determine a person’s overall cardiovascular disease risk.

1. Very High Risk

Those at very high risk should have apoB levels below 60 mg/dl.

If apoB isn’t available, their non-HDL-C should be < 90 mg/dl.

From the old LDL-C understanding, the goal would be an LDL-C below 70 mg/dl.

2. High Risk

Those at high risk should have the following numbers with a little more wiggle room compared to someone who is at very high risk:

  • apoB < 75 mg/dl
  • non-HDL-C < 120 mg/dl
  • LDL-C < 100 mg/dl

ApoB and Cardiovascular Disease

The biggest drivers of Atherosclerotic Cardiovascular disease (ASCVD), sometimes also referred to as cardiovascular disease (CVD) are the following:

  • tobacco use
  • hypertension
  • elevated apoB
  • elevated Lp(a)
  • elevated fasting insulin levels

How to Lower apoB

It’s hard to know who responds to what treatment. Some may not be able to tolerate statins even though their apoB drops drastically.

Others may see a massive drop in apoB by changing their diet, especially if they are hyperabsorbers of cholesterol.

Just as we have hyperabsorbers, those whose intestines squeeze every last bit of cholesterol from the food, we have hyperproducers.

The hyperproducers produce a lot of cholesterol from the liver, which finds its way into the circulation, causing elevation of apoB.

These changes partly explain why some will respond well to statins and even better when we add ezetimibe.

Repeat Testing of apoB Lipoproteins

In general, we advise our clients to check their apoB levels annually. As soon as it starts to get out of range, we discuss various interventions.

build a chance of a sudden rise in this lipoprotein level is low, regular monitoring will allow for immediate intervention.

apoB Lowering Through Exercise

When it comes to lowering certain risk factors, blood pressure is quite amenable to lifestyle changes.

It does not seem to be the same case with apoB levels. For those with a high elevation of this molecule, it is always advisable to start with lifestyle modifications first.

And certainly, there are certain dietary changes, such as a very low-fat diet, that can greatly improve someone’s apoB levels. Unfortunately, this is rarely reachable.

Categories
Heart Attacks Heart Health

Understanding Atherosclerosis

Atherosclerosis, or plaque, is the process in which the arteries in the body become narrowed. Unstable plaque can sometimes rupture and lead to blood clots which cause a heart attack.

In nerd speak, atherosclerosis is referred to as atherosclerotic cardiovascular disease (ASCVD).

Understanding Plaque and Angina Symptoms

It’s normal for patients to have some plaque buildup in their coronary arteries as they age. Stable plaque rarely causes any medical problems.

The coronary arteries are under a lot of pressure, and their anatomy and blood supply make them a perfect target for plaque buildup.

Combine that with a person’s lack of exercise and stiffness of the arteries, and you can get a condition called angina, an overtreated diagnosis that we’ll discuss in future articles.

Angina

Angina is the medical term for heart-related pain. It’s when the heart doesn’t get enough oxygen temporarily when it has extra demand.

When the person stops exercising, or their anxiety level comes down, the heart’s oxygen demand goes down, and enough blood passes through the narrowed coronary arteries, stopping the chest pain.

A Heart Attack from Lack of Oxygen

A heart attack differs from angina in that the heart gets no oxygen whatsoever due to unstable plaque. It also remains starved of oxygen long enough that damage occurs.

If stable plaque is lining a coronary artery and it becomes unstable, it could break off. In its place is left a raw area on which clotting occurs.

This blood clot can grow and completely block off the artery. Without anything to break up the clot or manually open up the artery, that part of the heart muscle will die off.

That’s a heart attack.

Understanding Atherosclerosis & Cholesterol

Cholesterol is what we commonly measure in the blood. The total cholesterol value, for example, tells me how much total cholesterol is floating around in my bloodstream.

LDL cholesterol (LDL-C) tells me how much cholesterol my LDL particle carries.

Triglycerides (Tg) are a different lipoprotein altogether, not cholesterol; though they carry quite a bit of cholesterol. Tg isn’t as important when it comes to understanding atherosclerosis.

Other tests, such as HDL cholesterol and VLDL cholesterol, tell us how much cholesterol those particular proteins carry.

High cholesterol leads to atherosclerosis

The above statement is not fully accurate. Higher apolipoprotein B (apoB) directly increased atherosclerosis.

The cholesterol measurements are just surrogates for this ApoB molecule. For whatever reason, we aren’t accustomed to measuring this in the blood.

The Goal of Treating Atherosclerosis

To understand atherosclerosis, it’s important to realize that apoB is the main molecule that must be managed.

We aren’t trying to lower LDL-C or Triglyceride or raise HDL; none of that! It’s important to understand how those relate to the apoB molecules, but they don’t correlate in some individuals.

Some patients have high cholesterol, and they have no atherosclerosis. Others have low cholesterol and a lot of atherosclerosis.

This isn’t confusing. Remember that the vehicle is the lipoprotein – the apoB – while the passengers are the cholesterol molecules.

When we measure the LDL-C, then we are only told how many passengers exist on the bus. But the bus is what actually causes atherosclerosis.

Measuring Atherosclerosis

We can look for symptoms like angina or signs of limb ischemia which can tell us there is atherosclerosis.

X-rays of the body will sometimes show calcified vessels. This is the calcium deposit inside atherosclerotic arteries.

Coronary CT Angiogram

CT angiograms aren’t the most accurate studies for visualizing coronary arteries. But they have a place in certain populations.

Angiograms visualize the coronary arteries by injecting dye into the coronary artery directly.

Some studies show that a CTA can show high-risk plaque and help us identify those at the highest risk of plaque rupture.

Coronary Calcium Load

Another common test is the coronary artery calcium measurement; often referred to as the CAC score. This also utilizes a CT scan to calculate the amount of calcified plaque in the coronary arteries.

When understanding atherosclerosis, it’s important to point out that in most coronary vessels, calcified plaque makes up about 20% – or the tip of the iceberg – while fibrotic plaque and lipid-rich plaque make up the other 80%.

The most accurate measurement is intravascular ultrasound, but that’s not yet a viable option.

Developing Atherosclerotic Plaques

How do these “atheromatous plaques” develop?

There are many theories, but we know that something inflames the inner endothelial lining of the arteries, making it susceptible to fatty deposits.

The floating LDL particles (different from LDL-Cholesterol) can enter the endothelium. The cholesterol particle might then release and oxidize there, which starts the inflammatory cascade.

HDL particles can extract some of this cholesterol and return it back to the liver. But that process wouldn’t be enough on its own. Which is why raising HDL doesn’t help.

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Heart Attacks Heart Health

Fearing a Heart Attack

The health anxiety surrounding a heart attack can be overwhelming. Every little pain or twinge makes you wonder if your heart is about to give out. The reality is that your heart is much more resilient than you might think. Fearing a heart attack is definitely worth discussing but often not as dangerous as you think.

Heart Attacks Aren’t Always Fatal

Having seen many patients in the urgent care and emergency room, they present with chest pains. I order an EKG and see they have a heart attack or perhaps had one recently.

Unfortunately, a little under 50% of adults might have a fatal heart attack, but symptoms are often quite telling.

They might have sudden fatigue or nausea or chest pains or shortness of breath with certain actions. But of course, there are cases where the plaque breaks off suddenly without previous underlying coronary artery stenosis.

The Fear of a Heart Attack

Fearing a heart attack – the fear itself – is often detrimental. And we fear it because we worry that if we don’t fear a heart attack, we may not do anything about it.

The hearty attacks which kill you won’t have any control over. At least not the heart attack (myocardial infarction) itself. But you can affect the chance of a heart attack by living a “heart healthy” life.

The anxiety and stress of fearing a heart attack have little value. It adds little to your decision matrix and keeps you in a negative loop.

Preventing a Heart Attack

It’s never too late to start working on your heart health. I’m not a fan of terms like a “heart-healthy” diet or lifestyle because they reduce the problem to a few individual actions.

The body and the mind are connected even if we wish they weren’t. The outlook and expectations you have feed back into your cellular health, down to the last cardiac myocyte.

To prevent a heart attack, the key factors are:

  1. stress
  2. sleep
  3. diet
  4. inflammation
  5. activity
  6. individual risks
  7. environment

Your individual risk might be the genetic factors predisposing you to your particular cardiovascular condition.

Your environment may not be conducive to your optimal heart health, etc.

When the Fear Comes

You’re sitting somewhere or coming back from the gym and feeling off. You feel something in your chest, and your heart rate goes up. You think you’re damaging your heart or having a heart attack causing you to sweat.

Everything spirals down quickly, and you fear the worst.

A deep breath at this point is the best medicine. Sit down, just be present. Feel what’s going on in the chest. Feel what’s going through your head.

Sit with it without trying to change it. They call this mindset a mindful approach to anxiety or stress, or any feeling. It works because you don’t try to take full control of the situation.

If your gut tells you that you should call 911, then that’s what you’ll do. If you feel it could be benign, you can decide to wait.

It feels good to have faith in your instincts and your body.

Categories
Heart Attacks Heart Health Prevention Treatment

Heart Health in Traditional Medicine

Traditional medicine, also called western medicine, is exalted for its evidence-based, scientific approach. It has proven capable of treating some of the most life-threatening and severe conditions. However, heart health in traditional medicine remains less advanced.

First Signs of Heart Disease

Most adults don’t necessarily know they have heart disease. And unfortunately, death is the first presenting symptom in a little less than half of those presenting for the first time.

That means 50% will have a fatal heart attack and not just a high cholesterol level or atherosclerosis seen on imaging.

We haven’t figured out a way to decrease that number fast enough. This means that heart health in traditional medicine can only help 50% of adults.

Traditional Medicine and Heart Disease

In traditional medicine, assuming you have good insurance, you can get excellent care to lower your cholesterol levels and blood pressure by using medications.

This requires regular visits for blood testing to make sure your liver and kidney can handle the medications. Refills cost money and time spent in the pharmacy.

These treatments don’t work for everyone. However, traditional medicine views all high-lipid and hypertensive patients similarly and treats them the same. This is one of the downsides of this practice model.

But if you need a stent or need to be resuscitated, western medicine is as good as it gets. We have incredible talent that can perform heart transplants and perform bypass grafting.

Heart Health is About Prevention

I can treat the high cholesterol with statins and perform a stent in the coronary artery, followed by a coronary artery bypass graft later in life. This is treating the symptom and not the condition.

Heart Health Coaching, which is what I do, focuses on lifestyle factors. It’s more about prevention and diving deep into potential causes for not-so-great metabolic health.

Heart Health and Pills

A pill can lower your blood pressure and decrease the chance of atherosclerosis plaque progression.

But it cannot prevent a heart attack or prevent you from getting fatty liver or diabetes from the factors which lead to high cholesterol or high blood pressure, to begin with.

Perhaps somewhere around 2-3% of individuals have genetic factors causing high cholesterol and high blood pressure. All methods other than pills will likely fail these individuals. For the rest of us, pills may not be as effective.

Prevention + Treatment

In the perfect world, everyone would have a Heart Health Coach and work to overcome hurdles toward ideal heart health.

If that fails and heart disease develops, they have the excellent skills of capable cardiologists, surgeons, and intensivists who can help restore their cardiovascular health.

Categories
Heart Attacks Heart Health Metabolic Statins

Atherosclerosis and Inflammation

Coronary plaque undergoes a specific transformation that ends up causing a blockage of the vessel and eventual ischemia. In this article, I will discuss the basics of how atherosclerosis and inflammation play a role in heart health.

Atherosclerosis

Plaque is the buildup inside an artery, leading to decreased blood flow and sometimes complete lack of blood flow – obstruction. It begins far deeper in the vessel wall before you see anything protruding through into the lumen of the artery.

With obstruction comes ischemia – lack of oxygen to the nearby tissue, not just muscle but the vessels themselves, the nerves, and connective tissue.

You need cholesterol to form this plaque. With a total cholesterol value below 150, achieved naturally without medications, it’s rare to see someone develop much plaque in their arteries.

Another ingredient for plaque buildup is hardened vessels and increased pressures or turbulent blood flow through those vessels. Hypertension can cause this; lack of exercise or inflammation can also contribute.

Unstable Plaque

Let’s lay the cards flat on the table – we know little about inflammation. Astute clinicians can recognize inflammation when they see it. There are specific biomarkers that are helpful as well.

Inflammation adds to the problem of atherosclerotic and negatively affects heart health because it leads to unstable plaques.

A plaque is like a scab on a wound. If it’s the right time for it to come off, it’ll fall off without any bleeding. Rip it off prematurely, and you’ll get fresh blood.

Fresh blood will clot in the artery and create an unstable plaque that is prone to rupturing and exposing those raw surfaces. Suddenly you go from a tiny plaque to a massive clot that halts all blood flow in that artery.

Measuring Inflammation

Several biomarkers can tell us there is inflammation. But it’s not biomarkers alone we use in our risk stratification.

Some people with inflammation in their bodies may never develop unstable plaque. And some with inflammation may not have much plaque to begin with.

If someone has atherosclerosis, the goal is to increase their exercise capacity – both cardiovascular and anaerobic. Next, we want their systemic inflammation to be as low as possible.

Examples of inflammatory biomarkers are below. Some are nonspecific markers, and others are specific to the atherosclerotic cardiovascular disease.

Atherosclerosis and Inflammation

In regards to heart health, atherosclerosis isn’t a death sentence. Most of us will develop it, and less than half of us will suffer heart attacks or other complications because of it.

Preventing atherosclerosis is what we encourage in our Heart Health program. But most of those who come to us already have atherosclerosis.

Plaque and inflammation have an essential relationship in Heart Health which we address with this second group. We want to decrease their total body inflammation to allow newly formed plaques or old plaques to stabilize.

Statins lower inflammatory markers independent of their lipid-lowering effects. Perhaps this is another reason why they are effective and reducing cardiovascular death.

In a meta-analysis of 26 randomized controlled trials involving over 160,000 participants, statins were shown to reduce the risk of all-cause mortality by 10% and the risk of cardiovascular mortality by 15%.

Other Inflammatory Markers

Even without serology, we can tell if someone has inflammation. More importantly, how much more actionable information do we get beyond the basic inflammatory markers?

The following are inflammatory markers I use based on signs and symptoms:

  • obesity
  • acne
  • rosacea
  • seborrheic dermatitis
  • joint pain
  • fatigue
  • sleep disturbance
  • agitation
  • sound sensitivity
  • GI changes
  • heavy menses
  • concentration issue

As you can imagine, these are rather subjective. Even if you have a little bit of all of this, it doesn’t mean there is inflammation.

We use these data points as a guide. With them, we change our diet and lifestyle and reevaluate. If these markers decrease, then inflammation is likely.

Interventional Steps to Consider

First, where’s the fire? What we mean by this is that the person likely isn’t about to have a heart attack or die from their inflammation.

Let’s figure out why the inflammation is there; stress, insomnia, too much exercise, dairy, wheat, or environmental exposures.

Next, we recommend testing those values, which are the most sensitive markers of inflammation, and see if there was any change.

Nattokinase or curcumin decreases inflammatory markers such as the commonly tested hs-CRP and fibrinogen.

Normal LDL Levels?

Imagine the LDL-C levels of a person are normal. How could we predict what their heart attack and death from heart attack risk would be?

Paul Ridker et al. did a wonderful study highlighting this relationship and showed that hs-CRP would be a bigger predictor of a heart attack or death when a person has normal or even high LDL-C levels.

Categories
Heart Attacks Heart Health Statins

Statins for Heart Disease Prevention

Statins are prescribed either for existing heart disease or to prevent heart disease. Preventing heart disease is referred to as a primary prevention strategy. Let’s discuss if statins for heart disease prevention are as effective as advertised and what other factors one should consider.

Statins to Prevent Heart Disease

Statins have gone through a lot of recommendation changes over the years. Some statins stand out more than others.

But there are still a lot of disagreements when it comes to using statins for the prevention of heart disease. This means using a statin for someone who is otherwise healthy but wants to prevent a heart attack.

In western medicine, it’s the standard of care to prescribe this medication to individuals with high cholesterol or diabetes, hoping it will prevent a heart attack.

The Actual Numbers

Think back to your high school class. Let’s say you had 150 people in that class. If everyone in that class took a statin to prevent a stroke, then only 1 out of 150 would benefit.

In other words, 150 people would have to be treated to prevent 1 stroke. And 100 would have to be treated to prevent 1 heart attack.

We refer to this as the NNT – the number needed to treat.

The Harm of Statins

Fortunately, statins are relatively safe medications. Yes, some people develop terrible side effects with them. Some even can develop diabetes or muscle or liver damage.

Obviously, we wouldn’t prescribe medication unless it was absolutely necessary. If only those who really needed this medication took it, the risk of statins would be far lower than its benefits.

But the actual harms of this medication – 1 in 50 would potentially develop diabetes, and 1 in 10 would develop muscle pains or damage.

Preventing Heart Disease

So what does work if not statins?

Controlling your blood pressure, eating a healthy diet, and maintaining a healthy activity level seems to decrease your risk of a heart attack.

Other factors like stress and cholesterol matter but are closely tied to your diet and activity levels.

The Individual Factor

As a physician, I don’t like talking about medication or an illness in general terms. Each person is unique, and all things matter. I learned this phrase from my functional nutrition course.

Each person is unique, so we must approach each person’s risk factors and decisions individually.

All things matter means that the patient’s individual abilities and lifestyle factors determine what intervention we choose or don’t choose.