The Relationship of your Heart with Cholesterol [transcript] [audio]

Guest: Dr. Ross Walker

Presenter: Henry Acosta

Guest Bio: Dr. Ross Walker is one of Australia’s top cardiologists and he has a medical practice in Lindfield on the upper north shore of Sydney. He introduced a great number of processes that helped improve the heart and lives of Australians through his medical research and practice.

Segment Overview: In this segment, Dr. Ross expounds on what you are supposed to know when it comes to your heart, cholesterol levels and lifestyle changes. Building on those topics, he reminds us and our listeners about the importance of having healthy relationships, how it affects our lives and the importance of awareness and knowledge when it comes to talking to your cardiologist.

Transcript

Henry Acosta: You’re listening to Health Professional Radio. I’m Henry Acosta, the host for today. Our guest today is Dr. Ross Walker, one of Australia’s leading cardiologists with the passion for people and health. Today, we’re talking about statins and some drugs that are being prescribed a lot lately and we’re just going to go ahead and talk about that. And with all that said, thank you so much for coming back on the show Dr. Ross, I’m glad to have you back.

Dr. Ross Walker: My pleasure Henry.

H: Well to get things started again for our listeners who haven’t heard about you, can tell us a little bit more about yourself?

W: I’ve been a cardiologist for over 35 years and probably about 20 years ago, I had a bit of an epiphany when I realized that and then this is going to come as a shock to you and all the listeners Henry that the best treatment of heart disease, cancer or any modern disease is not to get them in the first place, this little world called “Prevention.” So I’ve really been working in the field of prevention very heavily for the last 20 years, probably most of my career because when I was a trainee registrar in cardiology, I thought it was always quite odd when I go down to the post cardiac surgical ward and you’d see a bunch of people there having their second lot of bypass still quite big or still smoking cigarettes. And Albert Einstein once said, “there’s a more certain sign of insanity than to do the same thing over and over again and expect a different result.” So I thought to myself, “Well how do you prevent heart disease? Is it preventable? What things can you do to prevent it?” And over the last 20-30 years, there’s been an explosion of drugs. Things like statin drugs to lower cholesterol, blood pressure medications, low-dose aspirin which have really become the cornerstone of management of heart disease. But in reality, I don’t think that’s enough and in reality, there are side effects with doing this. And in fact, one of the great frustrations for me as a preventive cardiologist is the fact that the general public are still not getting the message despite the fact that many doctors do talk about it about what I call the “five keys of being healthy” and those five keys I’ll just summarize them very briefly. Number one, you cannot be healthy and smoke. Number two, you need good quality sleep. Number three, good quality eating and less of it. Number four, 3 to 5 hours every week of some form of exercise. And number 5, the best drug on the planet is something called “Happiness.” Now a recent study called the “Morgan Trial” from MORGAN from Holland showed that if you do those five things well, that’s an 83% reduction in cardiovascular disease. Now one of the big concerns I have in cardiology or just in the general practice of medicine is the fact that people are being thrown statins like lowly water. In fact in Australia there are 19 million prescriptions for statin drugs written every year, so if you think of 12 scripts per person per year, that’s just under 2 million people out of our population of around 24 million that are taking statin drugs. Now the question is, “Are statins always that necessary?” So in 1999, I introduced a technique in conjunction with the Sydney Adventist Hospital and another senior cardiologist by the name of Dr. David Grouse and this technique was called “Coronary Calcium Scoring” and what the coronary calcium score does is take a non-invasive picture of the arteries and measures how much muck you have in the walls. Now the studies are showing these days that if you have nothing in your arteries, a zero calcium score which means very low level disease, you do not need statin drugs. But people are still going into the doctor with just a high cholesterol and immediately they put on a statin or toll to go onto a diet for a few months and if it’s still not low, the cholesterol hasn’t come down, they must be on a statin. There is no evidence for doing this whatsoever but it’s being done all the time all over the world which is why Lipitor and Crestor are the two biggest selling drugs in the world. Now what people don’t realize Henry is that if you throw these drugs around to people, in my view and clinical practice there’s about a 20% rate of muscle disease, they get muscle pain, stiffness, weakness, aching and even atrophy and cramping and people, if you look at the clinical trials, the rates are only around 5%, but that’s only if you have a very strict definition of muscle effect being muscle pain with an elevated CPK level. But I’m talking across the board of people getting muscle symptoms and problems by taking statin drugs. Now the question is what the statins actually do to the muscles? How do they affect the muscles? Well how statins work is they block an enzyme called “HMG-CoA Reductase” which is the main enzyme in the production of cholesterol. But a lot of people don’t realize they also block Coenzyme Q10 Metabolism, Vitamin K2 metabolism, Selenium Metabolism, so you’re getting a lot of side effects from the statin drugs that people aren’t even considering. So what I do in my practice is I give all my patients Ubiquinol because Ubiquinol is the active version of Coenzyme Q10. So you can take statin Coenzyme Q10 but it still has to be metabolized in the body to Ubiquinol and the problem is when people hit around 50, there’s an enzyme called “Diaphorase” that does the conversion from Ubiquinone, that’s inactive CoQ10 to Ubiquinol which is the active one and that starts to drop off in the body. So we’re not getting enough ubiquinol to actually give us the replacement for what the statins are taking away.

H: So can you take statin and Ubiquinol at the same time?

W: Absolutely and in fact there’s been a number of studies over the past few years and I’ll just go through them briefly. In 2008, there was a study done by a fellow called Pacanowski where he gave people 80 milligrams of a statin and he reduced the plasma Coenzyme Q10 levels by about 45%. So that started people thinking that maybe this is how statins cause the muscle pain. Now a similar study done in September 2015, a journal called “Cell Metabolism” showed that statins directly affect a thing called “Mitochondrial Complex 3” inhibition which is where Coenzyme Q10 has its effect. The studies done in Germany of over 6 months giving Ubiquinol 60 milligrams a day reduce muscle pain, 54% reduced weakness by 44% and the most recent trial in the European Journal of Pharmacology just published in the last couple of months showed that a very high dose of Ubiquinol 300 milligrams per day actually reduced some of the damage caused in the muscles by statins. So there is a very synergistic action you can use the Ubiquinol with statins, there’s no interaction. All you’re doing is stopping one of the bad side effects of statins which is damaging the muscles.

H: Why do you think doctors all around the world just assume that they can hand out prescriptions of statins rather than finding a better and healthier way for treating the cholesterol?
W: Well in greatest respect Henry, I think that’s the wrong question. I think what they’ve got to be asking themselves is in this particular case, is this person’s cholesterol spilling into their arteries to cause problems? So I’ll give you a great anecdote, this is not a clinical trial, this is just a patient from my own practice. This woman came to see me at the age of 58 with a lifelong cholesterol of 9.5 millimoles per liter. Every doctor would treat that because it’s far too high. She had statins on and off for a few years and every time she took the statins, her muscles ached. She came to see me at age 58, I did a coronary calcium score on her. Her coronary calcium score despite the high cholesterol was zero. So I said, “Look, the statins are knocking your body around. Your coronary calcium score is zero. I personally don’t think you need statins.” Now for the next 8 years, she went to doctor after doctor that said, “If you don’t take Lipitor, you’re going to die”, this is scaremongering nonsense. There’s no evidence for this in some with the zero calcium score. So I said, “Look, it’s 8 years on. Let’s get another calcium score done,” she’s now mid to late 60s. I did another coronary calcium score on her with a cholesterol still of 9.5 and her calcium score rocketed from zero up to zero, so it’s still zero. So what I’m saying is that not everyone who has a high cholesterol even needs to worry about their cholesterol because here’s again where we’re getting it wrong. Everyone’s heard of the bad cholesterol LDL and the good cholesterol HDL and that is not true. Both LDL and HDL are divided into small bits and large bits, so it’s what we call the “Small Dense LDL and the Large Buoyant LDL” the “Small Dense HDL, the Large Buoyant HDL.” And this is where size is important Henry – small is bad, large is good. So we’re not measuring the subcomponents of cholesterol. So what I’m saying is the big flaws in medicine as far as I’m concerned, people who have got a high cholesterol should firstly have a coronary calcium score. Now let me make a really important point, if you’ve already had a heart attack a stent or a bypass, those people all need treatment and the data there is if you’re a very high risk which means you already have disease which is the highest risk, you do need to have your cholesterol damage, your blood pressure damage, you need to be on low-dose aspirin. There’s no dispute there. I’m an integrative cardiologist doesn’t mean I’m an alternative cardiologist. I still use Orthodox medicine as much as everyone else but I just try to combine it with other things like good quality Ubiquinol things like that. But what I’m saying here is that we need to get that for people who are at high risk, they all need treatment. But we need to say what risk is this person. So I don’t treat cholesterol at all, I treat risk. If the risk is low, the cholesterol can be ignored. Now when I say that, I don’t mean people should ignore their lifestyle, to me those five keys of being healthy should be there in everyone. But I’ve got people who do all the right things, they lose weight and their cholesterol doesn’t change because in their case if they go to zero calcium score, their cholesterol isn’t a problem. So I think that’s the first question, “What is my level of risk at the moment?’, if it’s very low, forget about your cholesterol. And then if you do to be at high risk, so with a calcium score, zero is what you want, 1 to 10 is trivial, 10 to 100 is mild, 100 to 400 is moderate, and above 400 is don’t read Tolstoy. So I’ll give you another great example. I saw a professional colleague the other day and we were chatting and she was telling me that in her 40s, she went to see another cardiologist because she’s got a very strong family history of heart disease. Her coronary calcium score was 2 which is basically zero, I mean it’s in the trivial range and you should consider that zero because you have a repeat scan and miss the tiny speck that gave you the score of 2. She was given a statin in her 40s with a calcium score of 2, I mean it’s complete nonsense and ignorance of the test. But if she’d have come to see me as a patient in her 40s and her calcium score was 150, I would have given her a statin. Do you can see what I’m saying? You assess someone’s level of risk and that’s the concern I have and also another concern I have here that I think is really important to the listeners, we now have a test called an “Intravenous CT Coronary Angiogram” which gives you beautiful pictures of the arteries but it doesn’t give you any more information than a coronary calcium score. So it’s the same machine but instead of just having a snapshot without any injections or dye, with the intravenous CT coronary angiogram, you have an injection of dye and the difference between the calcium score and the intravenous CT coronary angiogram is A the injection, so it’s a potential dye reaction, B the coronary calcium scores typically around five chest x-rays of radiation whereas the intravenous CT coronary angiogram can be up to 300 chest x-rays of radiation and the intravenous CT coronary angiogram makes your wallet $500 lighter, it’s neither of the tests are covered by Medicare. A standard coronary calcium score cost about $150 whereas the standards intravenous CT coronary angiograms anywhere between $600-1,000. And so what I’m saying is we’re doing these extra tests that people don’t need. All males at 50 in my view should have a coronary calcium score or females at 60 should have a coronary calcium score but just say for example I see a 51 year-old woman who’s got a high cholesterol, the GP wants to give them a statin, what I do in that situation get the coronary calcium score. I don’t do it before age 50 unless there’s a very good reason. I’ve got one patient who’s a 42 year old woman whose mother had a heart attack at 48. So she had a coronary calcium score and it was 550 telling me she had a lot of muck in her arteries already, she needs aggressive risk factor modification. So these are the messages I’m trying to get people. All people on statins should be taking Ubiquinol but the first question you ask, “Is do they really need the statin in the first place?” and in most cases, they don’t and that’s the key message here.

H: And can they go to their doctors and ask for the test before they say, “I don’t want the statins anymore.”

W: Absolutely. And I think one of the great things about the world where all this information command now about Dr. Google and everything else. The great thing about the world is people are getting more educated and we don’t have this God doctor complex that people used to have 40, 50 years ago. Doctors are just advisers and servants to people and I think people listening to this information, I know this is geared to health professionals, but people should be asking for these tests and doctors should not be judgmental about these tests. There’s still a lot of conservative people in Med, “this calcium score hasn’t been proven yet.” It’s been around now for 25 years, the evidence for this is rock-solid that a coronary calcium score is a much better predictor of risk for heart disease than is a cholesterol level. And these are messages that people need to get because it’s such important information for the long-term management of people because I tell you we don’t know what the 20-year effects of being on statin drugs in high doses are. There’s no information at all what they’re doing to the body as opposed to blood pressure treatment which has been around for 30, 40 years. So these ACE inhibitors which are one of the key parts of blood pressure management. They’ve been there for 30, 40 years there’s no nasty surprises with them but I can tell you now having practiced cardiology for 35 years, people are coming in to see me who’ve been on one of these drugs, one of these statin drugs for 20 years and they’re saying “Doctor, I don’t have any muscle bulk left.” And another interesting anecdote, one of my good friends said to me and I’ve kept him off statins because his calcium scores always been zero, but he’s got a high cholesterol and he said he’s the only person at his Golf Club who can still hit the ball 250 – 300 meters. All of his mates in the 60s their arms are just not working properly because they’ve been on statins for so long. So I think we really have to be mindful when someone comes in to you in their 40s, 50s or 60s, they could still be alive for another 20, 30, 40 years and we’re saying to them, “We’re going to commit you to a drug for the rest of your life.”. When we have no long-term data and really Henry, the only thing we have long-term data about is the benefits of long-term lifestyle, the best diet in the world is a thing called the “Mediterranean Diet.” It’s been around for thousands of years, it has been proven beyond a doubt to reduce all forms of disease somewhere between 30 to 50 percent, regular exercise, the benefits there are enormous. And we’re getting more and more evidence now in the literature about the enormous benefits of being a happy contented person, of having good long-term relationships. Thirty five years study out of Harvard University came out last year showed clearly the one key to health and happiness is not being on a damn statin. The one key to health and happiness is having a long-term relationship where someone cares and loves you and you care and love that person. It beats everything else hands down, a much better message than all the other messages coming out from the medical base world.

H: And if it’s from Harvard, I’m sure it is very legitimate.

W: Absolutely.

H: I just have one more question before we end the interview. So let’s say you have high cholesterol and you’re already aware of it and you still haven’t done anything about it, how would you know when you should go to the doctor and say, “Okay, maybe something’s wrong with my body.” What are the symptoms that people should watch out for?

W: Well firstly, there are no symptoms of high cholesterol. Cholesterol is just a number in your bloodstream. So what I’m saying is firstly, if it’s been recognized that you have a high cholesterol, the first thing you do is you look at your age. So if you’re a 20 year old who’s got a high cholesterol and there’s no family history of heart disease, I’d ignore it. I don’t even want to measure a 20 year olds cholesterol in the first place. But just say you’re 45 and your cholesterol is high and your father had a heart attack at at age 50, then I’d go off and have a coronary calcium score and I prefer to wait to age 50 because we lose our sensitivity to radiation by about age 50 and even at 75, five chest x-rays of radiation, it’s still radiation. So I like to wait to 50 but if you’ve got a very strong risk factor profile and the five key risk factors are some sort of cholesterol issue but I still think that’s overdone. The major risk factor for heart disease is high blood pressure. Number three, cigarette smoking. Number four which has become the really emerging risk factor for heart disease, probably the commonest cause of heart disease these days, probably 70% of heart disease is what I call “Diabesity” which is the combination of tendency or frank diabetes with being overweight. And then number five is a family history of someone who’s had a heart attack in your family or a stroke probably before about age 60, 65 depending on whether it’s male or female. So if you’ve got any of those factors, you should be going off and having a thorough check up and if there’s any question about it especially in your 40s, 50s go and have the coronary calcium score. If it’s zero, you can be relieved, if it’s high, you should be treated. It’s very simple, it’s not not difficult. Any general practitioner can organize and order a coronary calcium score but the most important thing is regardless of the result, if the GP doesn’t understand what it means, it’s a phone call to a cardiologist who knows about it. I’ve probably now over the last 20 years ordered something like 80,000 coronary calcium scores and easily to me, it’s the most important medical tool in my practice.

H: Awesome. Well that’s all our questions for today. And for those curious about you Dr. Ross Walker, what’s the best way that they can get in touch with you?

W: Through my website which is drrosswalker.com.

H: Sounds great and I’m gonna say that again one more time, for all our listeners, you get in touch with Dr. Ross Walker at drrosswalker.com. Thank you so much for coming back on the show Dr. Ross. It was great having you back on the show.

W: Anytime, Henry. Lovely to talk to you.

H: And that was Dr. Ross Walker one of Australia’s leading cardiologists. We just talked about statins and mainly we talked about how to live a healthy lifestyle and what you can do about your cholesterol. And if you’d like this interview, you can visit us at www.hpr.fm. I’m Henry Acosta and this is Health Professional Radio.

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