Marc Joseph Nutrition - Blog

As discussed in this article, there has been some recent research that suggests drug-coated heart stents may increase the risk of blood clots. Sales of drug-coated stents have fallen over the last year, and there is now more scrutiny on the use of stents in general.

Currently more than 1.5 million stents are placed in procedures every year in the U.S. Manufacturers of the stents pull in more than $6 billion and many times that is spent on the medical care for the procedures. It’s big business.

Some of these procedures are definitely necessary and save lives. As the article notes, though, the improvement in long-term survival rates using stents relative to other forms of treatment is less clear.

Yet, the prevailing attitude among some patients (and even some doctors) seems to be, “Well, if a problem develops, we can just fix it. It’s covered by insurance.”

“I see it all the time,” said Dr. Sanjay Kaul, a co-author of the recent Cardiosource editorial. He said his cardiology practice at Cedars Sinai Medical Center in Los Angeles included many “high-powered executives” who did not want to be bothered with taking pills to manage attacks of angina, the chest pains associated with narrowing coronary arteries.

Dr. Kaul said the overuse of stenting reflected a quick-fix mentality among patients and the financial incentives of doctors and hospitals to implant stents instead of prescribing drugs.

But stent advocates like Dr. Holland said patients demanded the stents because they provided more complete relief from pain, and because they wanted to avoid the potential side effects of the cocktails of heart drugs, which can include fatigue, sexual dysfunction, depression and light-headedness.

Dr. Holland says a typical patient profile might be a 55-year-old engineer at one of Boulder’s high-technology companies who is an avid outdoorsman and cyclist but hobbled by chest pains. To offer such a person drug therapy instead of the quick and more reliable relief of a stent, Dr. Holland said, “just doesn’t fly.”

And people wonder why health care costs so much? We all end up paying for the focus on the quick-fix, whether a pill or a procedure, in the form of higher drug, medical, and insurance costs.

Obviously, people with well-developed heart disease may need drugs and/or surgery to stabilize their situations. But, how many of these drastic interventions could have been prevented in the first place?

It’s no mystery why most people develop heart disease — a combination of poor diet and little exercise. There are good nutritional alternatives, without the medical and financial side effects of drugs and surgery, for people looking to avoid the development of and slow the progression of heart disease. For the sake of both health care and the health of individuals, the focus has to shift from repair/recovery to health promotion and disease prevention.

A large recent study looked at how vitamin K intake might affect cardiovascular disease and stroke in men. The study found that risk of cardiovascular disease and stroke fell by as much as 18 percent in individuals consuming higher levels of vitamin K.

The results did not remain significant after adjusting for lifestyle and other dietary factors. In other words, it wasn’t clear whether the risk declined because of the vitamin K intake or just as a result of healthier living.

Yet, there are good scientific reasons to believe that vitamin K is important in helping to maintain vascular health. Specifically, vitamin K helps the body to keep calcium in the bones and teeth, where most of it belongs, thus helping to reduce the calcification of soft tissues, such as blood vessels. The exact mechanism is not known, but it is thought to be related to a protein (MGP - Matrix Gla Protein), which inhibits calcification and is vitamin K dependent.

A 2004 study found that higher vitamin K2* dietary intake was associated with reduced cardiovascular mortality, overall mortality, and aortic calcification.

* There are three different forms of vitamin K:

• K1 (phylloquinone) - found primarily in plants (esp. leafy greens)
• K2 (menaquinone) - found in animal products and synthesized in the GI tract (produced by micro-organisms)
• K3 - synthetic

Vitamin K1 is the predominant form of the vitamin in the diet and is primarily found in green vegetables, including spinach, broccoli, chard, kale, parsley, etc.

Deficiency is common:

• Many people don’t eat foods high in vitamin K regularly or in adequate quantities, and thus don’t get enough of the vitamin.
• With age, the GI tract tends to become less efficient at producing the K2 form of the vitamin.
• Antibiotic use can interfere with the production of vitamin K2 in the GI tract.

Bottom line:

Supplementation with vitamin K containing the K1 and K2 forms can help to fill the gap and may help to reduce the risk for blood vessel calcification associated with heart disease and stroke.

Two important notes:

Vitamin K is fat-soluble. It needs to be eaten with a meal containing fat for proper absorption.

Vitamin K also affects blood clotting. People taking blood thinning drugs need to talk with their physician before supplementing, as increasing vitamin K intake may change the necessary prescription.

A recent University of Michigan study projected the cost of strokes in the U.S. to be $2.2 trillion over the next 45 years. The study factored in everything from hospital care to medications to home health care.

And that’s a conservative estimate, as it’s based on the current rates of primary risk factors such as diabetes, heart disease , obesity, and high blood pressure. With rates of obesity and Type 2 diabetes rapidly increasing in younger populations, the eventual costs could be much greater.

Fortunately, these risk factor conditions are largely preventable, with nutrition playing a significant role.