American College of Preventive Medicine – Policy Resolution # 02-03

TITLE: The Abolition of Symptomatic Coronary Artery Disease

AUTHOR: H. Robert Silverstein, MD, FACPM, FACC

DATE: February 3, 2003 (Revised from 1-27-2003 submission.)

 

WHEREAS, Published evidence1,2,5-7 clearly documents that symptomatic Coronary Artery Disease can be abolished by maintaining total cholesterol levels of 150 mg/dl in those without coronary artery disease and 130 mg/dl in those with documented coronary atherosclerosis and/or diabetes mellitus; and

WHEREAS, Achieving and maintaining cholesterol levels in this range for the abolition of symptomatic coronary artery disease is feasible in all socioeconomic classes including the indigent and is accomplished by using a very high fiber diet along with statins/niacin/fibrates/thiazolidinediones/biguanides/ezetimibe, etc. when necessary (commonly). This dietary plan is much, much higher in fiber than is currently recommended by the American Dietetic and Heart Associations, but still is practical, commonly accepted, and consists of 75-100 grams per day of fiber from whole, unprocessed, and ideally organic foods with fish twice a week and anything once in a while,1-7 and

WHEREAS, thirty-five percent of coronary ischemic events occur between a total cholesterol of 150-200 mg/dl.1 In the Framingham study, Castelli has found in America that coronary artery disease essentially ceases to exist below a total cholesterol of 150 mg/dl;2 and

WHEREAS, the current National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) cholesterol Guidelines8,9 recommendations are limited to partially controlling coronary artery disease morbidity and mortality; and

WHEREAS, the National Cholesterol Education Program Adult Treatment Panel is now in the process of reconvening to revise their recommendations;

Therefore be it:

RESOLVED that the ACPM should recommend the absolute prevention (abolition) of symptomatic coronary artery disease as has been documented in the peer-reviewed, population-based studies.7-9

RESOLVED that the ACPM form a Coronary Artery Disease Task Force to do the following on behalf of ACPM:

  1. Petition NCEP to address the abolition of symptomatic Coronary Artery Disease in their upcoming recommendations (anticipated release, December 2003)
  2. Petition U.S. Preventive Services Task Force to address this issue.
  3. Petition both the CDC and NIH to increase research, programming and funding directed toward the abolition of symptomatic coronary artery disease
  4. On a continuing basis, advise the ACPM Policy Committee and Board of new research findings and policy recommendations relative to the abolition of symptomatic coronary artery disease.
  5. Submit articles to the ACPM print and electronic newsletters to educate ACPM members as to the feasibility of accomplishing the abolition of symptomatic coronary heart disease, and the means by which this can be done.

 

References:
  1. Castelli WP. The new pathophysiology of coronary artery disease. Am J Cardiology 1998;82:60T-65T
  2. Roberts W. Getting more people on statins. Am J Cardiology 2002;90:683-685
  3. Silverstein HR. Preventing heart disease. Lancet 1990;335:227
  4. Silverstein HR. Coronary artery disease virtually preventable. Med World News 1994;34:17
  5. Silverstein HR. NCEP ATP III Guidelines and the abolition of symptomatic coronary artery disease. Am J Cardiology 2003;81:March 15 in press
  6. Ornish D, Scherwitz LW, Billings JH, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeido RL, Hogeboom C, Brand RJ. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998;280:2001-2007
  7. Esselstyn CB. Updating a 12 year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology). Am J Cardiology 1999;84:339-341
  8. NCEP-ATP III Guidelines - See the attached 15 pages of excerpts from the 40 page Executive Summary.
  9. Whayne Jr. TF, Zielke JC. Problems With the New Adult Treatment Panel III Guidelines. Preventive Cardiology 2002;Spring:91-93

    10.  

    ACPM External and Internal Review Criteria Fulfillment:

    • By adopting this resolution and forming a task force to explore these issues (promoting the abolition of symptomatic coronary artery disease), the ACPM will be positioned as a leader for the specialty of Preventive Medicine, and many other specialties.
    • If this resolution is actuated, mortality, morbidity, and the economic burden on the American public would be vastly reduced.
    • The abolition of symptomatic coronary artery disease would have an extraordinarily favorable impact on the health and quality of life of the American population.
    • The scientific validity of this policy has wide, but not vocal, support.
    • Such an ACPM policy position will help to advance the mission and goals of the ACPM, allowing the ACPM to make a unique contribution to public wellness.
    • Such a policy will increase the visibility of the ACPM and the Preventive Medicine specialty.
    • Such a policy would likely promote ACPM membership recruitment, involvement, and professional interests.

     

    Notes:

    This resolution has been modified in response to comments received from Policy Committee members, as of 02-03-2003. Supplementary publications, which scientifically substantiate positions that were a concern, have been furnished to the Policy Committee members.

     

    Resolution submitted by:

    H. Robert Silverstein, MD, FACPM, FACC

    Medical Director, Preventive Medicine Center

    Clinical Assistant Professor of Medicine, University of Connecticut School of Medicine

    1000 Asylum Avenue, #2109, Hartford, CT 06105-1794

    (860) 549-3444, fax (860) 549-3569

    hrs@towellness.com