Heart Muscle Regenerates
Once damaged, heart muscle does not recover – or does it? British scientists have reported that it may be possible for the heart to repair itself after injury, and they have discovered a protein molecule that stimulates this process.
Dr Peter Weissberg, medical director of the British Heart Foundation, which funded the research, said: “We have always believed that the heart has no capacity to heal itself, but this research suggests that this is not the case. We think we have discovered a natural process that brings about repair of the heart. Until now, this has been science fiction. We are trying to understand what the triggers are for this process. The cells that are capable of this healing are already there in the heart muscle. They just need to be tweaked and primed and the effect scaled up. If this works, we might be able to heal cardiac injury caused by heart attacks without resorting to stem cells.”
Researchers injected mice with a protein called thymosin 4 which triggered dormant heart muscle cells called “progenitors” to develop into functioning heart muscle cells. Having shown this is possible the quest is now on for more potent triggers and clinical trials in humans.
FDA restricts use of simvastatin 80 mg
In June 2011 the FDA recommended that physicians restrict prescribing high-dose simvastatin (Zocor, Merck) to patients, given an increased risk of muscle damage. The new FDA drug safety communication states that physicians should limit using the 80-mg dose unless the patient has already been taking the drug for 12 months and there is no evidence of muscle damage.
The FDA also mandated new labeling for simvastatin that warns of interactions with other medications even at the 10 to 20mg dosages. The risk of muscle damage was highest in the first year of use, highest in females, and increased with age.
Too little too late? Many expert lipid specialists and observant primary care doctors quit using high dose statin drugs years ago. Aside from a 10-15% rate of muscle damage, we routinely observe other side effects such as joint pains, weakness, mental confusion and memory loss.
Worse yet, studies indicate physicians are not receptive to patient complaints of side effects. A 2007 study by Golomb from the journal Drug Safety showed that patients had to initiate conversations about statin side effects over 90% of the time. Furthermore, physicians were reportedly more likely to deny than affirm the possibility of a connection. Rejection of a possible connection was reported to occur even for symptoms with strong literature support for a drug connection, and even in patients for whom the symptom met presumptive literature-based criteria for probable or definite drug-adverse effect causality.
Since statin drugs also inhibit the production of our natural energy producer, coenzyme Q, there has been much research looking at whether administering coenzyme Q with statin drugs would lower the risk of muscle damage. Mixed results come out of the literature. There is strong evidence that low vitamin D levels increase the risk of muscle damage from statins and that increasing vitamin D levels reverses this risk.
A January 2011 Cochrane review has provoked controversy by concluding that there is not enough evidence to recommend the widespread use of statins in the primary prevention of heart disease. The authors of the mate-analysis, led by Dr Fiona Taylor, issued a press release questioning the benefit of statins in primary prevention and suggesting that the previous data showing benefit may have been biased by industry-funded studies. This has led to headlines in many UK newspapers saying that the drugs are being overused and that millions of people are needlessly exposing themselves to potential side effects.
The pharmaceutical industry would like to put statin drugs in the water and many physicians agree. Proven strategies to reverse heart disease include first and foremost lifestyle habits, such as eating a Mediterranean diet, regular exercise, weight control, and not smoking. Numerous supplements such as fish oil, policosanol, sytrinol, red yeast rice and L-Arginine complexers are shown to have positive effects on blood cholesterol and artery health.
NIH pulls plug on AIM-HIGH trial with niacin
A trial of high-dose extended-release niacin (Niaspan, Abbott) given in addition to statin therapy in patients with a history of cardiovascular disease, high triglycerides (TG), and low levels of HDL cholesterol has been halted prematurely, 18 months ahead of schedule, because niacin offered no additional benefits in this patient population.
The AIM-HIGH trial illuminates several issues. One, increasing the good HDL cholesterol in addition to the LDL lowering effects of statin drugs, does not appear to be as helpful as once thought. Two, medication trials need to focus more on clinical outcomes than surrogate markers, such as lowering this or raising that in the lipid profile. As a case in point, remember the drug Zetia, which lowered cholesterol but did not lower the incidence of heart attacks. So for now, doctors should be using more caution with statin drugs and questioning whether adding niacin to the list is really that helpful.
For me, this underscores the saying “you’ll never medicate patients out of diseases they behave themselves into”. Rather than micro-managing numbers with medications we should employ a much broader approach that really cures disease. Start with a partnership that uses a holistic base to address behaviors – patients have to eat right, exercise, get good sleep, and manage stress. Moderate your vices. Participate in proven strategies that foster a healthy mind and body, such as meditation or yoga. Do your research and seek guidance from health providers that are knowledgeable in the use of natural supplements. Primum non nocere, “First, do no harm”. As with medications, choose supplements based on their safety profile coupled with evidence they work.
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement for men and women, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call (970) 245-6911 for an appointment or more information.