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An excerpt from the Kurzweil and Grossman book, "Live Long Enough to Live Forever"
The large, calcified plaque
growing on the inside surface of coronary arteries is not the cause of
most heart attacks. Rather, the primary culprit is the soft, relatively
small "vulnerable" plaque that forms within the vessel walls.
Large,
calcified plaque is actually relatively stable and, because of its hard
calcified covering, less commonly cracks. The more dynamic, less stable
soft plaque is much more likely to suddenly rupture. As the body forms
a clot to try to heal such a rupture, the result may be a total
blockage of blood flow; in other words, a heart attack. The soft plaque
is hidden inside the walls of the artery and often causes no obvious
blockage or loss of blood flow until, of course, the often-fatal
rupture.
Yet there is
good news hidden in this new understanding because the buildup of soft,
vulnerable plaque is much easier to reverse than that of hard,
calcified plaque. Levels of the two types of plaque are related, since
the same process appears to result in both forms. One prevalent theory
on the origin of the hard plaque is that it's the body's attempt to
protect the artery from vulnerable plaque by covering it with a hard,
calcified layer. However, bypass surgery and balloon angioplasty do not
slow down the process of soft or hard plaque formation; they often
accelerate them.
An early research study in 1986 by Dr. Greg Brown of the
University of Washington at Seattle demonstrated that sudden blockages
causing heart attacks were occurring in locations of coronary arteries
that had very little plaque, not nearly enough to qualify for bypass or
angioplasty surgery. In the late 1980s, Dr. Steven Nissen of the
Cleveland Clinic began to examine the coronary arteries of heart
patients with an innovative ultrasound camera that he guided into the
blood vessels. He found many soft bulges of plaque, often numbering
into the hundreds in a single patient, but relatively few areas of
calcified plaque. He proposed the idea that it was these widely
distributed soft bulges of plaque, not the deposits of hard plaque,
that were the primary culprit behind heart attacks. Brown's and
Nissen's research, as well as similar studies, were slow to be
accepted. Recently, Dr. Nissen has emerged as a leading innovator in
fostering new therapies for heart disease, playing a leading role in
several new drugs. Dr. Nissen also conducted an important study that
indicates that lowering LDL cholesterol to levels significantly below
the standard recommendations reduces risk.
The pivotal study that began to rapidly change minds on the importance
of vulnerable plaque was conducted in 1999 by Dr. David D. Waters of
the University of California. In the study, which was called AVERT
(atorvastatin versus revascularization treatments), Dr. Waters randomly
assigned patients who had been referred for angioplasty surgery to two
groups. One received the surgery and standard follow-up care. The other
received cholesterol- lowering statin drugs but no surgery. The
non-surgery group actually had fewer heart attacks and fewer visits to
the hospital for chest pain than the surgery group. Dr. Waters
commented that the research "caused an uproar. We were saying that
atherosclerosis is a systemic disease. It occurs throughout all the
coronary arteries. If you fix one segment, a year later it will be
another segment that pops and gives you a heart attack, so systemic
therapy, with statins or antiplatelet drugs, has the potential to do a
lot more. There is a tradition in cardiology that doesn't want to hear
that. There is a culture that the narrowings are the problem and that
if you fix them, the patient does better."
Dr. Eric Topol, a cardiologist at the Cleveland Clinic in Ohio,
adds, "There is just this embedded belief that fixing an artery is a
good thing." Dr. Topol describes the typical situation in which a
patient has symptoms such as vague discomfort in the chest, goes to a
cardiologist, gets a heart scan that shows signs of calcified plaque,
has an angiogram - itself an invasive procedure - and then quickly
receives a recommendation for surgery. "It's this train where you can't
get off at any station along the way," Dr. Topol says. "Once you get on
the train, you're getting the stents. Once you get in the catherization
lab, it's pretty likely that something will get done."
Dr. David Hillis, a cardiologist at the University of Texas
Southwestern Medical Center in Dallas, explains some of the motivation.
"If you're an invasive cardiologist and Joe Smith, the local internist,
is sending you patients, and if you tell them they don't need the
procedure, pretty soon Joe Smith doesn't send patients anymore.
Sometimes you can talk yourself into doing it, even though in your
heart of hearts you don't think it's right." Explaining the patients'
perspective, Dr. Hillis adds, "I think they have talked to someone
along the line who convinced them that this procedure will save their
life. They are told, 'If you don't have it done, you are a walking time
bomb.'"
The makers of stents acknowledge that the research fails to
show a benefit in terms of avoiding heart attacks and death. Paul
LaBiolette, senior vice president of Boston Scientific, a leading stent
maker, says, "It's really not about preventing heart attacks per se;
the obvious purpose of the procedure is palliation and symptom relief."
However, angina pain can be managed without surgery in most
cases, often very quickly. "The results are now snowballing," says Dr.
Peter Libby of Harvard Medical School. "The disease is more stable than
we had thought."
This new perspective explains why bypass and angioplasty
surgeries don't work, and it helps explain why heart attacks typically
strike with no warning and often to people who appear to be "perfectly
healthy," according to conventional diagnostic methods. Armed with this
more accurate model, we can apply noninvasive methods to address each
stage of this progressive and degenerative process. By combining
targeted therapeutic approaches, we can rapidly and dramatically reduce
the risk of a heart attack to very low levels. With few exceptions, no
one need suffer a heart attack.
With the recent recognition that inflammation plays a crucial role
in every step of plaque formation, as well as in the final eruption of
vulnerable plaque that initiates a heart attack, another major front in
the war against heart disease has emerged. Following are some important
tips for combating inflammation.
Inflammation — The Latest "Smoking Gun"
Testing
• Get a fasting hs-CRP
• If at high risk of heart disease, Alzheimer's, or cancer (because of
family history or lifestyle), consider genomic testing for inflammatory
markers and essential fatty acid testing
Treatment
• Decrease insulin sensitivity and excess silent inflammation by eating a lower-glycemic-load diet
• Avoid excessive amounts of foods rich in inflammatory arachadonic acid (egg yolks, shellfish, red meat)
• Increase dietary anti-inflammatory foods and spices, such as
cold water fish, green tea, onion, garlic, turmeric, ginger, rosemary
• Decrease exposure to sources of inflammation (dietary, infectious)
• Practice good dental hygiene
• Employ EFA supplementation with EPA/DHA and GLA
• Patients at high risk for cardiovascular or Alzheimer's disease should consider low dose aspirin therapy (81 mg/ day).
About the Author
Ray Kurzweil is one of the world's leading inventors, thinkers, and futurists. Called "the restless genius" by the Wall Street Journal and "the ultimate thinking machine" by Forbes magazine. Kurzweil's ideas on the future have been touted by his many fans, who range from Bill Gates to Bill Clinton. Time
magazine writes, "Kurzweil's eclectic career and propensity of
combining science with practical - often humanitarian - applications
have inspired comparisons with Thomas Edison." A recipient of the
National Medal of Technology and an inductee in the National Inventors
Hall of Fame, among many other honors, he is the author of three
previous books: The Age of Spiritual Machines, The 10% Solution for a Healthy Life, and The Age of Intelligent Machines.
1. The New Understanding: Most Heart Attacks Are Caused By Vulnerable Plaque and Inflammation
(Excerpted from Fantastic Voyage)
Heart
disease is the number one killer of both men and women. About 68
million Americans have heart disease, and more than a million suffer
heart attacks each year, 40 percent of them fatal. But there has been a
recent revolution in our understanding of
2. You Can Live Long Enough To Live Forever
(Excerpted from Fantastic Voyage)
Immortality
is within our grasp. The knowledge exists, if aggressively applied, for
you to slow aging and disease processes to such a degree that you can
be in good health and good spirit when the more radical life-extending
and life-enhancing technologie
3. Prevention of Cancer
(Excerpted from Fantastic Voyage)
Let's
move now from early detection and determination of genetic risk to
cancer prevention. An effective program for avoiding cancer in the
first place entails diet and nutrition, lifestyle modification, and
chemoprevention. Diet and Nutrition.
Terry Grossman, M.D., is the founder and medical director of Frontier
Medical Institute in Denver, Colorado, a leading longevity clinic.
certified in anti-aging medicine, he lectures internationally on
longevity and anti-aging strategies. In the words of Arline Brecher,
coauthor of Forty Something Forever, "I've met good writers and
good doctors, but seldom are they one and the same. Dr. Terry Grossman
breaks the mold and sets a new standard for physicians." He is the
author of The Baby Boomer's Guide to Living Forever.
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