Which Risk Matters Most?(repost with new link)

Due to the level of importance this post is being republished today. The topic includes the importance of waist circumference as a marker of disease risk. Click here to learn more and to see a picture on how to use a tape measure to get your WC number.   

Dr. Michael Miller, a heart doctor and professor, recently answered some questions about heart disease as it relates to metabolic dysfunction.  Metabolism has to do with how the body breaks things down and processes them.  Certain tests can tell us if the body is having difficulty with those activities, because if it is, health problems could follow.   
   The article with Dr. Millers suggestions is published in the Nutrition Action News Letter July/August 2012 issue.  Within that piece, is a reference to a study that showed the increased risk of both heart disease/attack and diabetes incidence with each factor of metabolic dysfunction that a person has.  The figure from the article was originally published in the AHA journal Circulation.  You can access the article here, for free.  I include the figure below, as it is one of the best representations I have seen.
   First let me explain what factors make up the Metabolic Syndrome while noting that the importance of each one is the subject of debate amongst professionals/scientists.  The 5 factors that were the focus of both the AHA and Dr. Miller articles are:

• Blood pressure equal to or higher than 130/85 mmHg
• Fasting blood sugar (glucose) equal to or higher than 100 mg/dL
• Large waist circumference (length around the waist):
  
  • Men - 40 inches or more
  • Women - 35 inches or more
• Low HDL cholesterol:
  
  • Men - under 40 mg/dL
  • Women - under 50 mg/dL
• Triglycerides equal to or higher than 150 mg/dL

   A person is said to have Metabolic Syndrome if they have any 3 of the above 5 conditions.  As I said, not everyone believes that each is a factor in heart disease nor that each has the same level of impact.  Dr. Miller's assessment makes the most sense to me, based on other articles I have read.  The two most important factors that he notes are triglycerides(TG) and waist circumference (WC).
  Dr. Miller has some quote worthy comments for you to consider, they include:

When the gut is the first thing you see when a patient walks in the door, that is not a good sign

....a lot of men have disturbed metabolism before they reach 40 inches (WC).

Even too much of the right foods can be a problem.

People shouldn't douse their salad with olive oil or they might get too many calories. (in response to a question about healthy oils - douse means use a lot!)

    He also spoke to the issue of getting your TG levels from a health fair, which usually does not include a fasting level.  He said that he has heard of people having a TG level of 400 and being told not to worry about it because it was not a fasting level.  He contends that someone should very much be worried about that level because even immediately after an "unhealthy" meal the TG levels do not rise more than 50% - though they may, in rare instances, double.  So if ones non-fasting TG level is 400, then their fasting level could be 200 and that is TOO high.
   The good news is that TG are directly and substantially reduced through exercise and meal patterns.  Exercise causes the body to release an enzyme that breaks down TGs.  Also, limiting sugar and saturated and trans fats is important.  Dr. Miller recommends very little added sugar - 24 g a day.  He enthusiastically recommends fish oil - but in fish not capsules. There is more but you get the idea.
     Below is the chart I mentioned earlier.  Notice how much higher the risk for adverse health outcomes is when a person has 4 or 5 of the risk factors.  The figure is more readable if you go to the article.

 

Drugs Not Needed

I was pretty dumbfounded this morning when I heard a commercial regarding a medication created to treat the very condition discussed in my last blog. The reason I was taken aback is because as I wrote here, the experts state that the most effective treatment for lowering triglycerides and raising HDL-C is NOT a medication but watching your weight, exercising and eating lean proteins and including unsaturated fats in ones diet.

So why in the world would the FDA approve a medication for this. A medication which does not lower any heart disease death or disability over the statin therapy one takes for lowering their LDL-C. Even the TV ad tells us that the medicine will not do that.

The reason we lower any of the numbers, whether it is cholesterol, blood pressure, CReactive protein, triglycerides, etc is to lower the risk of disease and death. If this new medication lowers triglycerides while putting the patient at great risk for side effects for NO OTHER REASON than to have a lower number.... WHY would a person take it, a doctor prescribe it or an insurance company PAY for it. This is how our country spends so much money on health care without having the best healthy life expectancy.

So, I am blasting about a drug called Trilipix... cute huh. The scientific name is fenofibric acid. The drug company did complete severe phase III trials before gaining FDA approval and I was able to read a little about that. The company used the drug in conjunction with statins (i.e. Zocor and Lipitor) of different strengths compared to a group that just used the new drug. In the combo therapy all numbers changed to the better, lower LDL and TG and higher HDL but again, there are no improved health outcomes so why would you subject yourself to the risk factors and the cost of another medicine?

Better than that, the TV ads and the literature on the drug insist that it is to be used WITH a diet regimen. In fact, the print warnings and prescribing info for clinicians states that diet and other non medicine strategies should be exhausted before prescribing Trilipix. The consumer ads and website just say to talk to your doctor about this new drug. Heck they even give you a print out of talking points so that you, the patient, can educate the doctor and advocate for this treatment on your own behalf. This is certainly playing to our cultural leanings toward pill focused solutions.

But pills come with more than a financial cost. The physical risk can be great as well. For this drug, side effects include

Muscle Pain
Tenderness
Weakness
Tiredness
Fever
Abdominal Pain
Nausea
Vomiting

And more seriously, muscle wasting and possibly kidney and liver problems. The serious side effect risks go up when the drug is used in combo with the statins, but it is with statins that it works. Again, why would one take this drug.

Eat Smart Move More... Live better, longer... Extend your life not your death...