Dysregulations in blood pressure and blood lipids/cholesterol are common issues affecting millions of Americans. The conventional approach is to treat each with medication and hope for the best. Yet millions of people die each year due to cardiometabolic illnesses connected to high blood pressure and abnormal lipids. What if medications are not the best solution to these problems? We dive into five studies that outline why lifestyle medicine is necessary to treat high blood pressure and abnormal lipids.
Dr. Richard Harris MD 00:00
What is up beautiful people? Welcome to the strive for greater health podcast with your host, Dr. Richard Harris. And today we’re going to be talking about a couple of new studies. Well, it’s actually five new studies related to high blood pressure and related to abnormal blood lipids. And these studies really reinforce why we need a holistic approach to the treatment of these cardiometabolic conditions. Are you ready to boost your health, EQ and IQ? Cue the music? Make sense? Join me Dr. Richard Harris as we strive to unlock the secret to the human body. Strive for Wellness strive for great health. Follow the show on iTunes, Spotify, Google and Android.
Dr. Richard Harris MD 01:09
And now a word from our sponsors. Our first sponsor is Nimbus healthcare, the company that I co founded personalized medicine personalized results, I’d Nimbus we don’t believe that there’s a one size fits all when it comes to treatment. And the data is starting to show that there’s a large variety of how people respond to certain things. And we’re in the Age of Science where we can use things like genetic testing and biomarkers to truly customize a plan just for you. And that’s what we do at Nimbus healthcare. We are in the hair loss and the hormone space. And what we do is we use lifestyle medicine, supplements and compounded prescription medication to tailor and individualize a plan just for you. If that sounds like something that you’re looking for, you can check out Nimbus healthcare.com. Or click the link in the show notes. Our other sponsor is CBD health collection. CBD health collection is the CBD that we use in the house. We use it, our dog uses it love CBD health collection, it meets all of the requirements that we set forth in our CBD episode, organic us grown, they do a lot of third party testing so you know exactly what you’re getting in the product. And it works. My ordering data is wonderful when I take the product for sleep, and then I also use it for inflammation and recovery. If you’re looking for a high quality CBD that is third party independently tested and who does research, they work with universities to do research on their products to push the edge on CBD and make sure they’re staying current than CBD health collection is the CBD for you. You can check the link in the show notes more head to our website, the GH wellness.com and click CBD at the top. And now to this week’s episode. We know we’ve had episodes on high blood pressure, we’ve had episodes on blood lipids. But this episode is really diving into some research studies that were published very recently. And these studies to me are very interesting because they really point to why we need the holistic approach why we need lifestyle medicine, when it comes to treating blood pressure and cholesterol. And lipids. Hypertension is very prevalent. Depending on the demographic, it can be 50% of the adult population has high blood pressure. And this is kind of a sidebar, but I don’t really care that much about Office values unless they’re just astronomically high like the common it’s like 180 over 110 I care about that. But borderline values, you really shouldn’t be measuring your blood pressure at home. And we measure blood pressure incorrectly in the office. Most people are running late you run up to the office you get the nurse comes in and immediately checks your blood pressure. Well, you’re supposed to be seated for five minutes before checking your blood pressure. Your arms are supposed to be supported. They’re not just freely dangling, and then your legs are flat on the floor not crossed. I recommend that everyone has a blood pressure cuff at home. I have one at home, I check my blood pressure frequently. And that’s just a way of monitoring just like I do with my aura ring. Unfortunately, blood pressure medications are not sticky. Only 39% of people use them continuously when they were monitored for 10 years. This is astronomical This is showing that people diagnosed with high blood pressure do not take their medication regularly. And many of them just stop taking their medication obviously we need other modalities. Now let’s talk about dyslipidemia which is abnormal blood and lipids. overall 21% of the adult population has dyslipidemia, which is a cardio metabolic condition is not a disease it’s a symptom. Have a disease. And we talked about the root causes early in the podcast series. high LDL is President 51% of people high cholesterol and 38%, low HDL, and 20%. So all of these things are cardiometabolic conditions that predisposes to a whole host of conditions. We know that high blood pressures correlated with other chronic diseases, like diabetes, like obesity, like cancer, like dementia. Same thing with dyslipidemia, all of these cardiometabolic diseases indicate systemic dysfunction puts us at risk for a whole host of other conditions.
Dr. Richard Harris MD 05:41
Now, what percent of people achieve control based upon using medications? It’s very low for blood pressure, only about 25% of people achieve the guideline recommended goals, and about 35% with statins. And this is despite filling millions of these medications. In 2017, we filled about 706 million prescriptions for blood pressure medication. In 2013, about 220 million prescriptions were filled for statins. And we regularly see people on three, sometimes up to five blood pressure medications, and it’s still not controlled. Now, I’m not saying just suddenly start taking your medications. Whenever I put someone on a medication, I also give them a plan to take them off that medication. How are we going to get from A to B. And it’s always lifestyle medicine. Let’s dive into the first study. The name of this study was time to clinical benefit of intensive blood pressure lowering and patient 60 years and older with hypertension. And this was published in May of 2020. To all these studies I have in my clinical trial database, you can get access to that database in the strive for great health Facebook group, there’s a link to the Google Drive that has all the studies I read in it. So this study is relevant because 65 and above accounts for 80% of cardiovascular disease fatalities. And this study pulled data from six trials looking at how long it takes to prevent one major adverse cardiovascular event. With a follow up between two and 4.7 years. They found the treatment to goal and the goal was less than 140 over 90 was associated with a 21% reduction in major adverse cardiovascular event. So that 100% 21% reduction, they wanted to know how long does it take to prevent one incidence of one of these major adverse cardiovascular event and that’s like stroke or heart attack or sudden cardiac death. If you treated 500 patients, this is an absolute risk reduction of 0.02. You need 9.1 months to prevent one major adverse cardiovascular event. If you’re treating 200 patients, you need 19.1 months to prevent one major adverse cardiovascular event. If you’re treating 100 patients, so now we’re looking at a one in 100. You need 34.4 months, that’s almost three years. So to prevent one mace and 100 people, you need almost three years of them taking their medication. That is mind blowing to me, because there’s so much that you can do in three years to improve your overall health. And this doesn’t include the significant harms associated with intensive treatment such as falls. Low blood pressure, we see people admitted to the hospital all the time for low blood pressure because of blood pressure medications, syncope, electrolyte abnormalities and kidney injury. The author suggests that if you’re going to live for more than three years benefits likely outweigh the harms. But we know that lifestyle changes can cause beneficial cardio metabolic changes in weeks. We reviewed the study before that showed that you can reverse 3.23 years off your biological age in eight weeks in a program that included sleep nutrition, exercise and mindfulness just for interventions. Other studies have shown improvement in cardio metabolic markers like insulin resistance markers, blood sugar, a one seen in lipid markers like LDL, HDL triglycerides, in weeks with lifestyle medicine. Now the moral of the story here is do not just depend on medication, you can do a tremendous amount to improve your health in 34 months. So again, one in 134 months to prevent that one case of mace Are you going to hate those odds? Are those the best odds for you or your loved one, your brother, your sister, your kids? No, I’m going to do something else, I’m going to make sure I give myself the best chance to succeed. And 34 months for one in 100 chance is not the best way to succeed. And we’ve covered what to do holistic methods to approach high blood pressure in our holistic hypertension episode. Well, one of the things I hear is, Well, I’ve really bad genetics. So this just runs in the family’s genetic. Yeah, habits also run in your family.
Dr. Richard Harris MD 10:34
But let’s say you do have bad genetics. This study looked at it, it studies called the association of the interaction between familial hypercholesterolemia variants and adherence to healthy lifestyle with risk of coronary artery disease. So this study was a cross sectional study looking at people with three different genetic risk factors. And they looked at people with the risk factors people without the risk factors and they looked at the risk of cardiovascular disease by age 75. These lifestyle factors were exercise, which was basically meeting the guidelines at 150 minutes of moderate exercise, 75 minutes of vigorous exercise, nutrition, and they were paying close attention to fruit and veggie intake, fatty fish intake and red meat intake, smoking, and then a BMI less than 30. A favorable lifestyle was three or four characteristics intermediate to unfavorable one or two, with carriers favorable lifestyle have reduced the risk of cardiovascular disease by 86%.
Dr. Richard Harris MD 11:38
Now when they broke it down, non carriers at age 75 had a 10.2% risk of cardiovascular disease, with favorable lifestyle versus 24%. With unfavorable lifestyle carriers that was 34.5% with favorable lifestyle 66.2%, unfavorable lifestyle, those with genetic risk saw the most benefit from lifestyle interventions. And it was only for interventions. And this is a small subset of what we do in holistic medicine. We know that things are additive, adding in sleep, adding in meditation, adding in nutrition, adding an exercise, adding in toxin avoidance, adding in purpose, adding in gratitude, all of these things add up and work through different systems to reduce our overall risk of chronic disease. The take home point here is genetics can impart a risk, but our behaviors can reduce that risk, or they can enhance that risk. So yes, genetics play a role, but like we’ve talked about with epigenetics, you can do something about it. And in this study, they found for both non carriers of the genetic risk and carriers of the genetic risk that those with the most favorable lifestyles had a significantly lower risk of cardiovascular disease. Let’s take a look at another really cool study. In this study. The name is association of lifestyle factors and antihypertensive medication use with risk of all cause and cause specific mortality among adults with hypertension. This was a cohort study from 2008 to 2010. They follow participants for a median of 7.3 years in the in 2018. They looked at lifestyle factors including BMI, smoking, nutrition, physical activity and sleep. BMI was overweight or obese. Smoking was do smoke do not smoke, physical inactivity, they use 150 minutes 75 minutes unfavorable diet, they looked at factors like veggies, fruit intake and meat intake. And poor sleep duration was less than five hours more than 10 hours and they scaled this on a 10 point scale. Higher scores indicated favorable lifestyle unfavorable was zero to four intermediate was five to seven and favorable was eight to 10. Favorable doesn’t mean you have to be perfect. I thought that was a really interesting point that the more behaviors doesn’t necessarily mean that they had that perfect behaviors to be in that favorable group. And we’ve talked about that before. The main measures were all cause mortality, which is death from any cause. cardiovascular disease and cancer mortality. The mean age was 65.6 years, about half men, half women so this again is a high risk group for cardiovascular disease medication plus high lifestyle showed a reduction in the risk of cardiovascular disease what we call a hazard ratio the hazard ratio was 0.32. This is a 68% reduction for cardiovascular disease mortality hazard ratio is 0.33. This is a 67% reduction and for cancer mortality, it was a 67% reduction with a hazard ratio of zero point three, three went about no medication plus favorable lifestyle. The all cause mortality has a ratio of 0.3. For cardiovascular disease mortality was 0.4. cancer mortality was 0.33. If you look at medication plus high lifestyle score, then no medication plus favorable lifestyle score or high lifestyle score, the numbers were almost exactly the same, there was a 2% difference in all cause mortality, there was a 7% difference in cardiovascular disease mortality, and there’s no difference in cancer mortality. So literally, the people who had the best lifestyle scores and took medication had a small benefit, about 7% difference only in cardiovascular disease mortality, versus people who didn’t take medication and just had a very favorable lifestyle. Let’s look at the last group medication plus unfavorable lifestyle. And what they found was no significant reduction in cardiovascular disease mortality, or cancer mortality. People literally took the medication had a bad lifestyle, a disease promoting lifestyle and saw no benefit from the medication. This has huge implications, because this study found that lifestyle accounted for the majority of the reduction in all cause mortality, cancer mortality, and cardiovascular disease mortality.
Dr. Richard Harris MD 16:26
The moral of the story here is again, do not just depend on medications for cardio metabolic disorders, we have more medications and ever there’s so many blood pressure medications, high blood pressure is the number one cause of heart disease. And yet more than 600,000 people a year die from cardiovascular disease. Let’s move on. Let’s look at the other thing we’re going to talk about today. And that is abnormal blood lipids, we’re going to look at the efficacy of statins. That’s billion dollar drug millions of prescriptions per year for statins, like we talked about. The name of this study was evaluating the association between low density lipoprotein cholesterol reduction and relative and absolute effects of statin treatment. This was a trial from March 2022. This is a meta analysis. So pulling data from 21 clinical trials in primary and secondary prevention, the average duration of the studies was about 4.5 years, they found the absolute risk reduction for all cause mortality was
Dr. Richard Harris MD 17:32
point 8% 1.3% for heart attack, point 4%. For stroke, the author said they could not establish a conclusive association between absolute reductions and LDLC and clinical individual outcomes. What does that mean? We know that statins very effectively lower LDL C very effectively, you can get up to 50% reductions in LDL C with statins. That’s a significant reduction. But like we’ve talked about, if you don’t address the underlying cause of why that LDL is dysregulated, do the medication. And this study shows us offers very little benefit for preventing first instance of a heart attack. Well, the credits are like the studies that we’re in here, we’re short duration, only 4.5 years. Okay, let’s say we extrapolated it out to 20 years. And let’s just say, to make things easier, the effect is linear, you’d have to take that medication every day for 20 years. And that would yield the absolute risk reduction of 3.2% for all cause mortality, 5.2% for myocardial infarction, heart attack, and 1.6% for stroke. Does that sound like the awesome amazing thing that everybody should be on? Take something for 20 years for a 3.2% reduction in all cause mortality. I’m not going to do that. I’m going to look at something else. 20 years is a long time. And again, we know that lifestyle medicine can have dramatic improvements in these markers in reduction of LDL, in increasing HDL, in reduction of particle numbers, right? We talked about this all in the cholesterol episode The truth about cholesterol. Make sure you check your APR lipid protein, A and B or your particle counts through an NMR lipid protein. Because many people have heart attacks and strokes with normal LDLC. But then you look at their particle counts. They’re high you look at their homocysteine, it’s high. You look at insulin resistance markers and their insulin resistance. You look at CRP and they haven’t elevated CRP. You look at other oxidative stress markers, like 808, D G or lipid peroxides. And those are high. How we approach this and we talked about this in this episode is it’s a Bayesian approach. You aggregate all of the available data data, you cannot just look at LDL C and adequately say someone’s risk for cardiovascular disease just based on LDL C, you have to take into account all of these other factors. The last study looked at the time to benefit for statins. The name of this study was evaluation of the time the benefit of statins for primary prevention of cardiovascular events in adults aged 50 to 75. Again, a high risk bracket for cardiovascular disease. Right now, the guidelines recommend using statins for people aged 40 to 75 with risk of a major adverse cardiovascular event greater than 7.5% within 10 years. And this equation takes into account your age, your sex, your race, your total cholesterol, your HDL, your blood pressure, diabetes, smoking. And this was a meta analysis of previous studies, they looked at AID trials with over 65,000 adults 66% were men. The age range was from mostly 55 to 69. On average, and follow up was between two to six years to prevent one mais major adverse cardiovascular event for 100 patients, you wouldn’t need to take a statin for 2.5 years. That’s an absolute risk reduction of 0.01 up for one mace for 200 patients 1.3 years, what makes for 500 patients was point eight years. So again, that one in 100 Chance 2.5 years of therapy, they also found no evidence of mortality benefit from statin therapy for primary prevention. Again, no evidence of preventing death from statin therapy for use in preventing first episode of cardiovascular disease. Only one out of the eight trials found the mortality benefit for all cause mortality, and then you have to talk about the harm. Statins could cause significant effects including muscle aches and pains. Sometimes they’re severe enough to cause permanent muscle damage or in a crisis. And this can happen in depending on the study, you read up to 30% of people have these myalgias and muscle pains. statins can cause significant drug interactions, they can deplete nutrients like Coenzyme Q 10, they can impair the synthesis of adrenal and sex hormones like testosterone, they can increase the risk of developing diabetes, depending on the study you read between 36 to 100%. Is that insane to increase insulin resistance and impair insulin resistance from the pancreas. These are not medications without harm, and you’re looking at something that can cause harm. And then you’re looking at the benefit. And you’re saying this doesn’t really add up. And we’re talking about mainly for primary prevention, we’re not talking about if you’ve already had a heart attack, the data is better for secondary prevention than it is for primary prevention, for primary prevention or preventing cardiometabolic diseases. The best thing is lifestyle medicine period. The take home point, again, here is lifestyle medicine can moderate CVD risk, you can normalize blood lipids, you can normalize inflammation, you can normalize oxidative stress, I’m not here to tell you to stop taking your medications, I’m just saying don’t solely depend on your medications to prevent these bad effects. And the really sad part is most doctors have no idea. The absolute risk reduction, they have no idea about the number needed to treat to prevent one event, no idea about the number needed to harm I look at these things because I’m a pharmacist, this is what they teach us in pharmacy school. But I’m using a medication, there’s a very good reason I’m using that medication. And I’m giving a plan to get off that medication typically, and this is just in general, I will put someone on a medication, if their numbers are so bad. And I think they’re high risk for an event
Dr. Richard Harris MD 24:03 soon. If I have time, then I’m going to give them all of the lifestyle information, bring them back in a month, two months, maybe three months, recheck their values, I tell him look, if you’re not making these improvements, if these aren’t coming down, you’re going to head to medication, you’re going to head towards cancer, you’re going to head towards stroke, you’re going to head towards heart attack, you’re going to head towards autoimmune disease. I don’t know which one, but these lab results are putting you at high risk for one of these things springing up. This isn’t to be doom and gloom. This is just to be aware for you so you can be aware of the actual impact of these medications for these common conditions and know that the medications by themselves are not going to prevent the bad things that you don’t want to happen in the life changing things. A stroke is a life changing thing going on dialysis. A life changing thing. And having a heart attack is a life changing thing. And a lot of these things are preventable. A lot of these things can be normalized, you know, high blood pressure, high cholesterol, high blood sugars can be normalized through lifestyle medicine. And that’s why I am so passionate as a pharmacist as a physician, about lifestyle medicine, because I know the data on these medications. And I know so many people are just depending on the medications to prevent these things from happening. And the data is very clear that that’s not going to cut it just the medication alone. Alright guys, going forward, I probably won’t do the very long like one or two study reviews I was doing before you guys probably found that boring me going super in depth about studies. So I’m going to tell you what you need to know about the studies and tell you how they impact your life or things that you can do related to those studies to prevent the effect or achieve the effect. And I’ll probably batch them like this. Like these was five studies related to two topics that I thought were very interesting. The guys liked the format. shout me out. Let me know. If you guys missed the old format, let me know. Well, this has been a another episode of The strive for great health podcast with your host, Dr. Richard Harris. Y’all have a blessed day. Thank you for listening in to strive for great health podcast with your host Dr. Richard Harris. It’s our mission and goal at the podcast to impact as many lives as possible to empower individuals to take control of their health, and live a life full of joy and purpose. You may help us achieve this mission by leaving a five star rating and review on your preferred podcast platform. And by sharing this podcast with anyone you think it may help. You can also support the podcast by making a donation to your favorite charity. If you do so and send us an email. We’ll give you a shout out on the podcast. Because here’s the strive for great health podcasts. We’re all about charitable giving and making the world a better place. Thank you for listening and God bless