Best Books for After a Heart Attack

Since we have a few cardiologists and GPs with a lot of experience, are there any books you folks could recommend for my mother after her heart attack? Thank you I’m advance.

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Hi @DeStrider

Sorry to hear that this happened to Mom. I hope she is doing well.

A tangent to another discussion - interestingly for people with cardiac events, Dr. Ornish’s diet is a lifestyle intervention that standard insurance and Medicare covers in the U.S. Patients that participate in these programs have markedly lower short term healthcare costs - so insurance companies that only care about the next 12 months have self-interest in funding this.

His book on this is here: https://amzn.to/3vQLJP8

https://www.ornish.com/

I suspect he has other books - but this is the main one. Also the link to the program - which even if outside of the U.S. you can read about and there are multiple videos and interviews available.

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Here’s a rebuttal of Ornish, Esselstyn and Greger claims of ASCAD reversal by Avi Bitterman:

It’s good for other things, though, just not that claim.

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So we have a dermatologist - someone who doesn’t do medical research in cardiovascular disease, commenting on the work of people who (Greger doesn’t) but the other two do.

I spent just a few minutes listening to this fellow and it was not of a quality I’d spend time on. Do a pubmed search and look at the research. People who are front line researchers - such as my Father - a Cardiologist and Epidemiologist understand the science and the integrity with Ornish’s material. It’s not perfect, but it is pretty solid. Listen to the people who practice in that specialty and also conduct high level research, and hear their opinion and reviews of the research that supports his approach.

Why do insurance companies and Medicare cover his plan - including on patients who are given the option to get a CABG vs. enroll in the Ornish plan – with those that do Ornish’s approach having a better outcome than those who undergo surgery - with all the risks? Because there is high level evidence.

I appreciate this Dermatologist thinks he can take down other physicians who have been practicing in a specialty he doesn’t practice in for 3-4 times as long as he has even been a licensed physician. Let researchers and experts in vascular disease take down Ornish if they want to. However, the front line researchers don’t believe there is a reason to - as the science is reasonable.

Outcomes are important - and his work speaks for itself. Lifestyle and diet obviously makes a difference to CAD and anyone who thinks this isn’t the case, including stabilizing disease is trying to sell you something or has such a bias toward unhealthy life choices, that they cannot see the science past their biases.

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I had an MI last August. I’m 55m, 100% occlusion of LAD. 1 STEMI. I found the book by Bale and Doneen, Beat the Heart Attack gene to be the best of the post HA books I’ve read. Esseltyn’s research is very promising, but the diet is very restrictive, so I’ve decided to try a WFPB diet. My LDL and APO B are now very very low thanks to 20 mg Crestor.

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Hi Jeff,

I think best evidence is WFPB, no processed foods, no simple sugars. There is a need to either optimize Omega 3 index/B12 (and other things) via supplementation, or diet. There remains some debate on adding a bit of small (not high on the food chain) fatty fish that is wild caught and having a bit of fermented dairy.

Glad you survived your MI, and it is a real wakeup call to have a major event occur. If you have vascular disease in your heart you have it elsewhere - it’s a matter of making sure it doesn’t become symptomatic again.

Hopefully you’ve got a physician tightly managing your ApoB and have had a measure of your Lp(a). Other critical issues include diet - which you are focusing on, blood pressure and glycemic control. There are other factors … and so long as your doctor is clued in to all of these, you’ll hopefully avoid having anything else happen!

It sounds like you are on the right track - and fortunately didn’t die, and hopefully didn’t have any significant loss of cardiac or brain function as a result of this event.

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Please consider what I am about to say as coming from a person strongly committed to doing his own research and seeking the counsel of physicians, if anything, later and less frequently than might be wise.

With this in mind, I think the best course of action after suffering a major cardiac event is to have a thorough workup at one of the Mayo, Cleveland, or other well known locations where you will find the best and brightest among the conventionally minded clinicians and more than a few researchers. In retirement areas such as Phoenix where I live part of the year, many such clinics are in practice and their reputation can (and should) be assessed before making an appointment.

I am not suggesting that you follow the exact guidance of the team that will evaluate you (the best places have a 3-5 person team dedicated to your assessment). In fact, I would make clear at the outset that your goal is to seek a comprehensive assessment and analysis with a range of options arrayed with their positive and (equally) negative considerations. Somewhere in the process, I would make sure that the person viewing him or herself as the leader knows you consider one-recommendation findings to be unscientific and possibly illogical, which they are. There are very few cases in which you have only one good option for moving forward, especially once your values and goals are integrated with the findings. Throughout the face-to-face (or virtual) briefing, I would ask questions in a way that forces the team to parse and qualify their recommendations. You might say, for example, what would your recommendation be if I were to do nothing other than change my lifestyle (or diet and exercise, etc.)?

Some of my friends include these kinds of physicians and they tend to recommend one path forward rather than carefully considered detailed options, even if it is not the path they would necessarily follow in your circumstances. In sum, you need access to the team’s advanced knowledge and experience but the team must be managed by you or an advocate that you involve in the process.

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Thanks for your comments. Very thoughtful. At the time of the MI I was very physically active, and in excellent shape, so the HA was a huge surprise. I’ve prioritized my health, including and especially heart care, since last August. I’m working with an integrative cardiologist, and following my own metrics very closely, including a recent Cleerly AI scan, which was quite insightful. My CRP has gone from 0.6 to 0.15, so that’s promising. I’m also researching and measuring all these markers:

  1. Blood Pressure Measurement: Essential for assessing overall cardiovascular health.
  2. Lipid Profile: Total Cholesterol, LDL, HDL, Triglycerides.
  3. Inflammatory Markers: hs-CRP, ESR, MPO.
  4. Blood Sugar and Diabetes Markers: Fasting Blood Glucose, HbA1c, OGTT
  5. Kidney Function Markers: Microalbuminuria, MACR.
  6. Advanced Lipid Testing: Apo B, LP(a), sd-LDL.
  7. Oxidative Stress Marker: F2-Isoprostanes.
  8. Genetic Markers: 9p21, KIF6, Apo E.
  9. Imaging Test: CIMT.
  10. Thrombophilia Testing: APCR, Prothrombin Gene Mutation, Factor V Leiden Mutation, ATIII Activity, Protein C and Protein S, Homocysteine, Fibrinogen.
  11. Additional Nutrient and Metabolic Markers: Omega-3 Fatty Acids, Magnesium, Uric Acid.
  12. Hematologic Markers: Hemoglobin, Hematocrit.
  13. Periodontal Health: Assessment of gum health and oral hygiene. Oral DNA Test
  14. Hormones: Cortisol, T3, T4, TSH, Testosterone (for men), Estrogen and Progesterone (for women), Insulin.
  15. Nutrients: Vitamin D, Vitamin B12, Folate, Magnesium, CoQ10. Regular monitoring of these markers, along with lifestyle modifications, can contribute to a holistic approach to cardiovascular well-being.
  16. CIMT,
  17. CT Angiography - Cleerly, and Coronory Artery Score (CAC Score)
  18. Sleep Apnea?
  19. Lifestyle factors: BMI, exercise, diet, smoking, drugs
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Certainly be guided by your specialist’s input. The issue isn’t usually how to best treat things going forward - it is generally quite straight forward. The issue is what wasn’t treated properly and for how long that led to you having symptomatic vascular disease at age 55.
I’m presuming that you don’t smoke tobacco or cannabis - if so - this adds overwhelming risk. Apart from this, generally it will be lipids, BP, glycemic control and Lp(a), potentially ApoE4’s.

I don’t know your history - but having treated literally 100’s of people who thought things were pretty good with their health, attend ER with a critical illness over 25+ years in the ER - is that many think things are managed - and they aren’t. It simply wasn’t identified and treated.

The tendency now to go wild and over investigate and overtreat is natural. Go with a sensible specialist’s advice. Maximal medical management is at least as good as most fancy treatment, and adding a huge number of imaging tests, fancy blood work - etc - typically adds nothing. It can result in even more investigation and procedures that haven’t been shown to benefit outcomes.

Just managing the simple and obvious stuff very tightly yields almost all the benefits and - yes, you’ll need everything long term micromanaged, and will have some risk of symptomatic disease (on average - again - just speaking in generalities) occurring in the next 7-10 years - probably going down thereafter with tight ApoB management.

Hopefully your specialist takes a conservative approach. I’ve seen patients literally end up with 10+ cardiac stents for moderate obstructive disease that isn’t causing their symptoms - that with the data saying that stents for anything but STEMIs and some other rare case by case examples is no better than maximal medical management.

Hopefully this helps, and is general information that might guide your discussions with your specialist, and obviously isn’t advice for your specific situation.

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It’s too bad you’re not my doctor, and I say that with no disrespect to my current cardiologist who is quite proactive.

I don’t drink, smoke, or do cannabis. I exercise 2 hours a day. VO2 max is 43. BMI is 21.

Lp(a) is low. OGTT, recently done in January, is excellent. APO E is 2/3. LDL is 18. Apo B is 39. Fasting glucose is 90. A1C is 5.5. Ox LDL is low at 23. MPO is low. Omega 3 is 8.5%. Fibrinogen is 1.8 which is low. I could go on. The only thing I’ve found, from the many many tests I’ve done, is LDL Pattern is B and LDL Peak Size is 215 which is slightly low. LDL Small and Medium are good as is HDL large.

Net net … as you suggest, now that I’ve tested and marked all markers, I’m keeping a close eye on everything, especially Apo B and glucose spikes and control. I’ll do another Cleerly next spring to mark progression or regression of CVD.

I have no idea what’s behind my CVD, but I’m not stressing about it from this point forward.

And oh ya, I started Rapamycin last Thursday. We’ll see how that goes.

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You sound a lot like me. My heart attack in 2020 was a huge surprise because I had none of the risk factors typically associated with heart disease - cholesterol numbers were golden, not fat, didn’t smoke, physically active, no family history. The only thing that looms larger in retrospect than it did at the time was stress - marriage had been in trouble for three years and I got divorced in 2019. The bad news beyond the heart attack itself was there was not much “low hanging fruit” to do, or stop doing, to reduce risk in the future. I have been avoiding fast food (fried food) much more strictly than I did before 2020, when I basically thought “I’m in good shape and I’m not fat, I can get away with the occasional Chick Fil A.” Also I have been avoiding processed food and sugars as much as possible.

I’ve been following a lot of the same metrics as you. The ones I pay the most attention to are CRP, a1c, insulin and glucose, and the results of the NMR lipoprofile.

I wish I’d had a CAC scan before 2020 but at this point I’m not sure it would do anything for me. I already know I had lots of plaque in 2020. Even if a CAC told me at this point that things are “getting worse” I’m not sure what I’d do differently. Maybe that would induce me to try that damned vegan diet that is otherwise too demoralizing to contemplate, lmao.

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You still haven’t told us what your cholesterol levels actually were. “Golden” can mean anywhere from 10 to 129mg/dL depending on the incompetence of your doctor.

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What I find especially demoralizing with my “new” vegan, no alcohol lifestyle is having to explain to my friends why I don’t want a drink, why I’m not eating the Dairy Queen Blizzard, why I don’t want bread, and would rather get to bed at a reasonable hour. Although I was quite healthy before the HA, I did eat a lot of sweets, processed meats, and pastries. I also had a very stressful work life. I’m now retired living like my life depends on what I do each and every day. I’ve found that I’m also more appreciative of family, friends, laughter and love and am grateful be alive.

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I’m not interested precisely because it will only prompt a pointless and annoying discussion along the lines of “well that was low but not really low enough so that doesn’t count”.

I’m glad we are talking about this important topic! I’d love your viewpoint on WFPB with fat (evo, nuts… ) vs esselstyn’s recommendation of no fat. I keep hearing that new science is showing us fat is good for us… zero fat isn’t needed… but here we are?? I am at high risk (crazy calcium score) and am vegan for the animals but WFPB for my health. I never know if I should stop eating healthy fats? I am eating them currently because I”m wfpb, gf, and at a good weight, so I’m trying to avoid wanting die, but if there was a good case to give up more, i would ??

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It is important to not implement changes that decrease your quality of life, that have no clear evidence of benefit.
A bunch of things you list are reasonable - but others aren’t evidence based. You can still have some fun without increasing risk.
Retirement is something I never plan to do - I’m glad you have the finances to have this as an option - but working is something where stressors need to be managed, but is something I’d encourage for most people to at least do some work. Other people I’ve worked with who have the finances to allow this mentor younger individuals and give back - but stay very active, which can be rewarding. I suspect you are doing some of these activities.

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There is no compelling evidence for low fat in the setting of a WFPD diet - so long as saturated fat is kept under 10%. Even looking at the macros (fat/protein/carbs) on a WFPB diet has no evidence of benefit. It is the quality of the diet that is critical.

We personally add no fats to anything. As much EVOO is better than butter or lard or coconut oil … it isn’t better than simply not having it and having those calories from WFPB actual whole foods that aren’t a processed food. EVOO is certainly the choice of added fat, but only for non-high temperature foods as beyond a certain temperature it degrades (and it is a low temperature) and you now have toxic oxidized fats.

Every food or compound has to be considered in the context of “instead of what?” So EVOO is a good substitution if you were going to take some butter instead. It isn’t a good substitution for having some olives, nuts, and yams for example.

The only macro I’d recommend people follow, especially as they get older, on a WFPB diet is to make sure they are getting adequate protein which is very easy to accomplish.

There is very little evidence going beyond 1.2 grams/kg/day even if working out heavily does anything. Going with current guidelines in the range of 0.8 grams/kg/day is probably the better longevity approach - however this needs individualization as there is some evidence with advanced age and high risk of sarcopenia, going higher might be helpful.

The other item that usually is automatically good - but should be intermittently tracked - is to make sure dietary fiber is preferably well above 40 grams/day. We usually get 70 grams/day. Dietary fiber is what gut bacteria feed on, and contributes substantially to gut health. It is possible, if not having legumes and bean to craft a low fiber WFPB diet - but that isn’t a goal of this dietary pattern, and one should be going for high fiber. However, for people transitioning, my wife’s advice, who gives the nutrition advice and has certifications in nutrition, among other things, is a very gradual increase in fiber by no more than 5 g/day increased no more often than weekly. You have to give your microbiome time to change, and will get lots of GI distress and likely inflammation if you don’t allow the transition to higher dietary fiber to be done slowly.

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If you don’t want to engage with the arguments then there is not much to discuss, which is fine.
Does the Ornish lifestyle reverse ASCAD (which is the reason for why I posted this)?

I truly have better uses for my time. I’m satisfied by the analysis of true experts in this area. I also don’t have a horse in this race - apart from saying that individuals who know this space are comfortable that Ornish’s plan does what it claims. Simply suggesting a very sensible book that has met criteria for multiple insurers to pay for a lifestyle change and have demonstrated cost effectiveness and outcome data sufficient to make funding a lifestyle change - for the first time in the U.S. The business decision makers at the insurance companies needed high level evidence financially to support such a program. I’m comfortable that after multiple years and looking at the financial evidence that the MBAs have concluded this costs them less $$. It will never cost them less $$ if the patients are having worse outcomes and requiring interventions as a result of this.
I believe the figures quoted for patients avoiding CABG is along the line of 25% of health costs as compared to those who had a CABG in the next 12 months and with better health outcomes.
But no - not going to spend 90 minutes listening to this … so not going to engage - any more than I would on listening to a flat earth supporter and spending hours dispelling their claims and rationale.

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Dr. Avi is specifically refuting the claim of ASCAD reversal (of the plaque built up in the arteries), nothing else. You can have an improvement in outcomes, symptoms, without such a reversal. I would guess that if you asked any expert cardiologist if the Ornish plan reverses plaque built up in the arteries as defined in the literature, they would say no.

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