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Is C-reactive protein really a reliable indicator of heart disease risk?

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Is C-reactive protein really a reliable indicator of heart disease risk?

Posted by R. on March 01, 2003 at 00:10:58:

I went to a doctor with my relatives, and I happened to discuss heart disease risk indicators with him. He referred them to have some tests done, and I asked him why he didn't plan for them to have C-reactive protein level checked, considering that it's a more reliable and accurate indicator. He said that despite of recent articles for lay people, recent scientific literature says that C-reactive protein is NOT a good indicator as it gives many false positives. He said that any stress, such as even climbing stairs or something like that, or any infection in the body (e.g. throat infection) or any of many other things creates inflammation in the body and raises C-reactive protein level in the blood.

He also said that modern scientific literature doesn't support the idea that high homocystein level is associated with heart disease. He said that Lp(a) and Lp(b) are better indicators, but it's difficult to find places to test for them and insurance companies don't pay for these tests. He said one patient of him paid $600 out of his pocket to test for these and homocystein.

Alternative doctors can also be wrong... anybody can.



Re: Is C-reactive protein really a reliable indicator of heart disease risk?

Posted by
DianeAC on March 01, 2003 at 01:00:57:

In Reply to: Is C-reactive protein really a reliable indicator of heart disease risk? posted by R. on March 01, 2003 at 00:10:58:

R., I've had the same questions. After my husband had a mild stroke, was diagnosed with diabetes, and had angioplasty with a stent installed, I started asking a lot of questions (not many of which were answered, by the way).

When I asked about C-reactive protein, the (idiot) cardiologist said that the test was too non-specific. He claimed that if results showed inflammation in the body, it would not indicate which part of the body and was, therefore, not useful. My thought was that if there was inflammation, that would be a good starting point and further testing might indicate the source. He wasn't impressed with my thinking and didn't care enough to bother explaining where I was wrong.

He refused to do the homocystein level test and it wasn't until a few doctors later that I found one who would have it done (having admitted, finally, that he had had one done on himself!).

When I finally did get both those tests done on my husband, the results were excellent - low, low, if not non-existent C-reactive protein, and also low homocystein. They confirmed my hunch that the cardiologist was barking up the wrong tree with his angioplasty and stent (which, incidentally, did nothing to help the angina).

I later found, very accidentally, that an essential oil blend designed to treat spasms worked better to relieve my husband's angina than the nitro patches (caused a rash) or nitro pills (caused headaches).

Still later I found that magnesium supplements actually served to prevent most of the chest spasms.

To wind up on this, I repeatedly asked, even begged the cardiologist to discuss healthier life style choices with my husband. He always said, "next time". I finally gave up on this twerp and made an appointment with the most highly respected cardiologist in our county. HIS reply was that it's all in the genes - if your genes are good, no problem. If your genes are not good, well, there's not much that can be done.

No further comment.



Re: Is C-reactive protein really a reliable indicator of heart disease risk?

Posted by R. on March 01, 2003 at 01:49:14:

In Reply to: Re: Is C-reactive protein really a reliable indicator of heart disease risk? posted by DianeAC on March 01, 2003 at 01:00:57:

So, it appears that the test can be useful mostly if the result is negative (or normal). If the level is high, then you still don't know the risks and need to look further.

The doc said that stress test is the best to detect heart problems. I think that it doesn't pinpoint the root (to the best of ability of current state of science) cause. What do you think about it?



Re: Is C-reactive protein really a reliable indicator of heart disease risk?

Posted by Sally on March 01, 2003 at 08:06:02:

In Reply to: Re: Is C-reactive protein really a reliable indicator of heart disease risk? posted by DianeAC on March 01, 2003 at 01:00:57:

Do you think the stent and procedure were totally unnecessary? That sort of practice is malpractice, isn't it? I am glad you found alternative methods for your husband.

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Re: Is C-reactive protein really a reliable indicator of heart disease risk?

Posted by cris on March 01, 2003 at 08:41:09:

In Reply to: Re: Is C-reactive protein really a reliable indicator of heart disease risk? posted by R. on March 01, 2003 at 01:49:14:

R--that doc could have been wrong, too. People can be very convincing in their wrongness. The only way to be sure is to comb the research for yourself and evaluate the research to make sure the experiments and results were valid.
If you don't have the time or will to do that, you end up having to trust somebody to know the truth and tell it truthfully.
If one goes on trust, be sure to keep a very open mind, and don't try to sell the world on Just One's Opinion.
Your approach was perfect: Relay the experience so others can evaluate or reevaluate, as necessary.
Thanks for the info.

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Re: Is C-reactive protein really a reliable indicator of heart disease risk?

Posted by
ANGIE on March 01, 2003 at 11:26:18:

In Reply to: Is C-reactive protein really a reliable indicator of heart disease risk? posted by R. on March 01, 2003 at 00:10:58:

I am a registered nurse on A cardiology unit and would you believe that not one time have I ever seen a doctor order a c-reactive protein test or the other tests as well. (IN 3YRS OF practice ) When I questioned one of the "best" cardiologists why? He stated that it is not an indicator and he is not intrested in that test. I feel that they just "stent em and steet em". Nobody hardly leaves with a diatary consult unless I bring it to the MD attention. Even the patients who have just had a MI(heart attack). I take it upon myself to give the patient teaching regarding diet and exercise and refer to support groups such as smoking cessation groups. It is a shame that we are good at treatments and quick to prescribe instead of investing time to help educate and use preventive measures.



Re: Is C-reactive protein really a reliable indicator of heart disease risk?

Posted by peterb on March 01, 2003 at 21:15:03:

In Reply to: Is C-reactive protein really a reliable indicator of heart disease risk? posted by R. on March 01, 2003 at 00:10:58:

the best indicator for risk is diet and you don't need a test.



Re: Is C-reactive protein really a reliable indicator of heart disease risk?

Posted by R. on March 01, 2003 at 21:55:28:

In Reply to: Re: Is C-reactive protein really a reliable indicator of heart disease risk? posted by peterb on March 01, 2003 at 21:15:03:

I have only curse words to respond to your perl of wisdom at the moment, so I will refrain from doing it.



Re: Is C-reactive protein really a reliable indicator of heart disease risk?

Posted by Sandra on March 02, 2003 at 01:07:42:

In Reply to: Is C-reactive protein really a reliable indicator of heart disease risk? posted by R. on March 01, 2003 at 00:10:58:

My C-reactive protein was checked by my rheumatologist, and it was elevated because of arthritis. Since it is only a general indicator of inflammation I would agree with the doc who said that it's too nonspecific. Echocardiography and exercise treadmill testing would be more reliable IMHO.



Is C-reactive protein a reliable indicator of heart disease REFERENCE Archive

Posted by Walt Stoll on March 02, 2003 at 06:31:01:

In Reply to: Is C-reactive protein really a reliable indicator of heart disease risk? posted by R. on March 01, 2003 at 00:10:58:

Hi, R.

Im my opinion, your relatives are wasting their money and trust with this doctor. It isn't bad enough that many conventional docs refuse to keep up with new discoveries but that they do not even keep up with the allopathic paradigm discoveries.

The newer, more sensitive CRP tests are a much better predictor of atherosclerosis than cholesterol ever was and the homocysteine and CRP levels are now linked to NO (nitrous oxide) discoveries that show at least a part of the reasons why.

Just one reference: Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of CRP and LDL cholesterol levels in the prediction of first cardiovascular events. N Engl J Med.2002;347(20)1557-1565.

Comments?

Walt



Re: Is C-reactive protein really a reliable indicator of heart disease risk?

Posted by Walt Stoll on March 02, 2003 at 07:17:53:

In Reply to: Re: Is C-reactive protein really a reliable indicator of heart disease risk? posted by ANGIE on March 01, 2003 at 11:26:18:

Thanks, Angie.

I would not have believed what I am going to say 25 years ago. Prevention goes directly against the bottom line and so it is put at the bottom of the list of what to do to help patients. Then physicians wonder why they are no longer enjoying the practice of medicine!

Walt

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Re: Is C-reactive protein a reliable indicator of heart disease REFERENCE Archive

Posted by H on March 02, 2003 at 08:25:43:

In Reply to: Is C-reactive protein a reliable indicator of heart disease REFERENCE Archive posted by Walt Stoll on March 02, 2003 at 06:31:01:

Naturopath sent article on this via e mail last year.

Worth reading. There are several articles on CRP at New England Journal of Med. web site alone, searchable.

This is, from my understanding, quite likely going to be a new standard in the future.


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Re: Is C-reactive protein really a reliable indicator of heart disease risk?

Posted by R. on March 02, 2003 at 14:28:48:

In Reply to: Re: Is C-reactive protein really a reliable indicator of heart disease risk? posted by Sandra on March 02, 2003 at 01:07:42:

I understand this logic too, but if the test is normal, does this mean that you are not likely to develop a heart disease if you keep having CRP level low?



Re: Is C-reactive protein a reliable indicator of heart disease REFERENCE Archive

Posted by R. on March 02, 2003 at 14:36:23:

In Reply to: Is C-reactive protein a reliable indicator of heart disease REFERENCE Archive posted by Walt Stoll on March 02, 2003 at 06:31:01:

They are on Medicaid, so they're wasting someone else's money... including mine, of course. They can't afford to see other doctors.

As to the doc's being up-to-date with the science, my perception was that he actually reads a lot, but he probably happened to read different papers and come to different conclusions.

Please comment on his specific statement that CRP test is unreliable due to high number of false positives because CRP rises because of many things which are part of normal (and even desirable) daily activities, such as exercise, and other diseases that involve inflammation.



Re: Is C-reactive protein really a reliable indicator of heart disease risk?

Posted by peterb on March 02, 2003 at 18:45:14:

In Reply to: Re: Is C-reactive protein really a reliable indicator of heart disease risk? posted by R. on March 01, 2003 at 21:55:28:

so you don't agree that diet is the best factor we could use to predict heart disease?




Re: Is C-reactive protein really a reliable indicator of heart disease risk?

Posted by R. on March 03, 2003 at 02:48:42:

In Reply to: Re: Is C-reactive protein really a reliable indicator of heart disease risk? posted by peterb on March 02, 2003 at 18:45:14:

No, I don't.



Is C-reactive protein really a reliable indicator of heart disease risk? Archive

Posted by Walt Stoll on March 03, 2003 at 06:08:44:

In Reply to: Re: Is C-reactive protein really a reliable indicator of heart disease risk? posted by R. on March 02, 2003 at 14:28:48:

Hi, R.

Inflammation is but one of many already discovered, and probably more that have not been discovered, that are predictors of atherosclerotic disease. Even though this predictor was postulated more than 100 years ago it took modern testing procedures and computer analysis to prove the postulate.

Hope this helps.

Walt

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Re: Is C-reactive protein a reliable indicator of heart disease REFERENCE Archive

Posted by Walt Stoll on March 03, 2003 at 07:19:47:

In Reply to: Re: Is C-reactive protein a reliable indicator of heart disease REFERENCE Archive posted by R. on March 02, 2003 at 14:36:23:

Thanks, R.

This is somewhat true of the old CRP test. For the newer much more sensitive test is much less true.

If the individuals are worried, why do they not just go on the Pritikin Program (library) and reverse any susceptibility factors? That costs nothing but effort and discipline. Why do they need a blood test to convince them?

At the very least they would all be a lot healthier. Perhaps their increased health would improve their horsepower enough to get off Medicaid.

Walt



Re: Is C-reactive protein a reliable indicator of heart disease REFERENCE Archive

Posted by R. on March 03, 2003 at 17:11:27:

In Reply to: Re: Is C-reactive protein a reliable indicator of heart disease REFERENCE Archive posted by Walt Stoll on March 03, 2003 at 07:19:47:

If the individuals are worried, why do they not just go on the Pritikin Program (library) and reverse any susceptibility factors?

Well, they are not really worried. It was me who wanted the doctor to check CRP.

That costs nothing but effort and discipline

No. That would also cost them whatever joy they still get from life. Who wants to get depressed from being on an unnatural and harmful diet such as Pritikin's?

At the very least they would all be a lot healthier

As I have said before, Pritikin's program and interpretations of its results had many flaws. The program consisted of many lifestyle changing factors, with regular stress reduction being one of them. If changes are multifactorial, crediting only one of them (the diet) for results is pseudoscientific. To my knowledge, no has shown conclusively (or at least with a good amount of evidence) that it was the diet in Pritikin's program that allegedly improved heart disease symptoms. It could be (and negative side effects of his experiments support this idea) that it was despite his low fat diet nonsense that some people showed some improvement.

Do you remember that his test subjects developed eczema, dry skin, premenstrual tension, and
depression while being on his ultra low fat diet? I don't see how anyone can call that health improvement.

Pritikin's diet program did result in low-cholesterol, but new studies have shown that a person with low cholesterol has an increased risk of committing suicide. Perhaps his low cholesterol as well as his leukemia contributed to his death by suicide. Very unconvincing that his program is the one to follow. Here's something from Epidemiology 2001 Mar;12:168-72:
"Canadian investigators examined the relation between low serum total cholesterol and deaths from suicide. Adjusting for age and sex, they found that those in the lowest quarter of total cholesterol concentration had more than six times the risk of committing suicide as did those in the highest quarter.

This effect persisted after the exclusion from the analysis of the first 5 years of follow-up and after the removal of those who were unemployed or who had been treated for depression.

These data indicate that low serum total cholesterol level is associated with an increased risk of suicide."

And why suffer through this horrible diet when simply limiting carbohydrates (with refined ones first) has been shown to bring about great overall health improvements (weight normalization, mood stabilization, energy level improvement, blood sugar normalization, reversal of insulin resistance, etc.)? The latter dietary approach is much more natural, enjoyable, and easier to sustain long term.

I really don't understand why you cling to low fat diets, Dr. Stoll. I see so many reports from individuals who had followed a low fat diet but developed serious health problems. Higher protein and fat diet replacements have fixed those.

Oh, and having some sort of medical insurance is a good thing even if one his/her improves health dramatically because accidents happen. So, getting of Medicaid is not desirable. Only having to use it is.



Re: Is C-reactive protein a reliable indicator of heart disease REFERENCE Archive

Posted by cris on March 03, 2003 at 20:48:53:

In Reply to: Re: Is C-reactive protein a reliable indicator of heart disease REFERENCE Archive posted by R. on March 03, 2003 at 17:11:27:

Very good points, R.

Follow Ups:


New CRP test

Posted by R. on March 03, 2003 at 23:52:48:

In Reply to: Re: Is C-reactive protein a reliable indicator of heart disease REFERENCE Archive posted by Walt Stoll on March 03, 2003 at 07:19:47:

Dr. Stoll, would please name this new CRP test that you mentioned, for my references?



Re: Is C-reactive protein a reliable indicator of heart disease REFERENCE Archive

Posted by Walt Stoll on March 04, 2003 at 07:56:43:

In Reply to: Re: Is C-reactive protein a reliable indicator of heart disease REFERENCE Archive posted by R. on March 03, 2003 at 17:11:27:

Thanks, R.

Two separate "60 Minutes" programs, about a year apart, puts the lie to the impresion that all the joy goes out of life while doing the program.

This is a therapeutic program and not a maintenance program--something Pritikin never understood. All the problems ascribed to this program happened when the individual continued the 10% fat diet beyond the 12-18 months needed to totally clean out their arteries. The diet needs to be a 15% fat diet after that.

Besides the diet was only 1/3 of the program.

A little knowledge can be a dangerous thing!

Walt



Re: New CRP test

Posted by Walt Stoll on March 04, 2003 at 08:15:37:

In Reply to: New CRP test posted by R. on March 03, 2003 at 23:52:48:

Hi, R.

Your local labs would know the name of the procedure. They probably each have their own term. Just ask them what the name of the newer, more sensitive, CRP test is.

Walt

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Re: Is C-reactive protein really a reliable indicator of heart disease risk?

Posted by peterb on March 04, 2003 at 22:04:36:

In Reply to: Re: Is C-reactive protein really a reliable indicator of heart disease risk? posted by R. on March 03, 2003 at 02:48:42:

sorry if i was abrupt earlier. just stating my views. i know NOTHING about c-reactive proteins, but i do know that lots of sugar spiking eventually wears down the organs, including the heart.

thots?



Re: Is C-reactive protein really a reliable indicator of heart disease risk?

Posted by R. on March 04, 2003 at 23:44:00:

In Reply to: Re: Is C-reactive protein really a reliable indicator of heart disease risk? posted by peterb on March 04, 2003 at 22:04:36:

Yes, sugar spiking is not good, but diets rich in refined foods is only one danger. There are different dietary practices that can be inappropriate for a particular individual (at least, due to allergies). Then there are other lifestyle aspects. Having a perfect (and what is it?) diet doesn't necessarily mean your risk of getting a heart disease (or any other disease) is low. So, if you judge risks only by one's diet, you mind find yourself deep in ...



Re: Is C-reactive protein a reliable indicator of heart disease REFERENCE Archive

Posted by R. on March 05, 2003 at 00:04:56:

In Reply to: Re: Is C-reactive protein a reliable indicator of heart disease REFERENCE Archive posted by Walt Stoll on March 04, 2003 at 07:56:43:

All the problems ascribed to this program happened when the individual continued the 10% fat diet beyond the 12-18 months needed to totally clean out their arteries. The diet needs to be a 15% fat diet after that.

Do you believe you know for sure why plaque forms in the arteries? There's a theory that it forms to protect injured arteries. If you "clean" them, couldn't it be similar to removing a scab from an unhealed wound, figuratively speaking? There've been experiments that show that insulin damages arteries. If you go with low fat, a diet would automatically have to be high carb. That may create high levels of insulin in the blood, especially in those who are prone to insulin resistance.



Re: Is C-reactive protein a reliable indicator of heart disease REFERENCE Archive

Posted by Walt Stoll on March 05, 2003 at 09:18:02:

In Reply to: Re: Is C-reactive protein a reliable indicator of heart disease REFERENCE Archive posted by R. on March 05, 2003 at 00:04:56:

Hi, R.

I really appreciate your wanting to know the cutting edge of this process. The most recent review of the world literature can be obtained by an appropriate donation to the organizaation that does it for me. This organization has been the world leader for doing this world-wide service for more than 20 years. I suggest you contact Functional Medicine Update at (800) 843-9660 and ask for sample tapes from November and December 2002 and perhaps the February tape from 2003.

Since the yearly subscription cost is more than $20/ monthly 90 minute tape (which includes a timed hard copy of the contents), an appropriate donation would be about $25/tape requested.

There certainly is a lot more to learn but, for the first time the pieces and interrelationships are beginning to come together. Presently the key seems to be NO (nitrous oxide).

Let us know what you learn.

Walt

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Re: Is C-reactive protein really a reliable indicator of heart disease risk?

Posted by peterb on March 05, 2003 at 14:35:05:

In Reply to: Re: Is C-reactive protein really a reliable indicator of heart disease risk? posted by R. on March 04, 2003 at 23:44:00:

a very astute observation, no factor alone is ever the whole story. with studies showing ~40% reduction in heart disease for those taking 200iu of E a day, however, in my view nutrition will always be the biggest factor.

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