Ep:385 REPLACE STATINS WITH THIS FDA-APPROVED PLAQUE STABILIZER
Summary
TLDRDr. Rob Cvis discusses the underutilized drug colchicine as a powerful anti-inflammatory for cardiovascular disease, which the FDA has approved to be more effective than statins in reducing risk. He emphasizes its benefits for secondary prevention, particularly in patients with high CRP levels, and suggests it as a safer and cost-effective alternative to statins, potentially in combination with low-dose aspirin, for reducing inflammation and vascular events.
Takeaways
- 👨⚕️ Dr. Rob is discussing the underutilization of colchicine compared to statins for cardiovascular disease, despite its proven effectiveness.
- 💊 Colchicine, known for treating gout, has been FDA-approved for its higher risk reduction in cardiovascular disease compared to statins.
- 🧬 Colchicine's history dates back to 1500 BC, originally used for joint inflammation and is derived from a plant.
- 🔍 The drug works as a powerful anti-inflammatory, which is crucial in addressing the root cause of cardiovascular issues rather than just the symptoms.
- 💡 Dr. David Nebert, an electrophysiology cardiologist, highlighted the benefits of colchicine for secondary prevention in patients with existing cardiovascular disease.
- 📉 High-sensitivity C-reactive protein (hsCRP) levels are a significant indicator of inflammation and cardiovascular risk, where colchicine can be beneficial.
- 💲 The low cost and less aggressive marketing of colchicine may contribute to its lesser-known status compared to statins.
- 🛑 For patients with a history of heart attack, stroke, or significant plaque burden, colchicine should be considered as a serious medication option.
- 🚫 The script suggests that colchicine might be a replacement for statins rather than used in conjunction due to its anti-inflammatory properties.
- 📚 A study published in the Journal of the American College of Cardiology emphasizes the predictive power of hsCRP over LDL cholesterol for cardiovascular events.
- 📉 FDA approval in June 2023 recognized colchicine's role in reducing the risk of major adverse cardiovascular events, including in patients with atrial fibrillation.
Q & A
Who is Dr. Rob Cvis and what is his area of expertise?
-Dr. Rob Cvis is a specialist in lipidology and cardiology, often referred to as the 'carb addiction Doc'. He focuses on the effects of carbohydrates on health and the role of various treatments in managing cardiovascular diseases.
What is the main point of the video regarding the use of Statins by cardiologists?
-The video suggests that cardiologists often insist on prescribing Statins for cardiovascular disease, despite the availability of other drugs like colchicine that may be more effective at reducing the risk of cardiovascular events.
What is colchicine and how is it typically used?
-Colchicine is a drug that has been used for centuries and is typically prescribed for conditions like gout and inflammation. It is derived from a plant and was known as early as 1500 BC.
Why does Dr. Cvis believe colchicine is more effective than Statins for certain cardiovascular conditions?
-Dr. Cvis believes colchicine is more effective because it is a powerful anti-inflammatory that significantly reduces vascular inflammation, which is a primary factor in cardiovascular diseases. The FDA has approved colchicine for reducing coronary artery disease risk at a level greater than Statins.
What is the role of inflammation in cardiovascular disease as discussed in the video?
-Inflammation is presented as a key factor in cardiovascular disease. It is suggested that by reducing inflammation, particularly in the blood vessels, the risk of cardiovascular events can be significantly lowered.
How does colchicine work in relation to atherosclerotic cardiovascular disease?
-Colchicine works by reducing the activation of white blood cells, decreasing their aggressive function, and reducing their adhesion to plaques, which are a major component of atherosclerosis.
What is the significance of C-reactive protein (CRP) in the context of the video?
-CRP is highlighted as a marker of inflammation that is more predictive of cardiovascular death than LDL cholesterol. Elevated CRP levels are an indication for considering colchicine as a treatment option.
What is the FDA's stance on the use of colchicine for cardiovascular disease?
-The FDA has approved the use of low-dose colchicine to reduce the risk of major adverse cardiovascular events, including heart attack, stroke, and cardiovascular death in patients with established atherosclerotic disease.
Why does Dr. Cvis suggest that colchicine could be a better alternative to Statins for some patients?
-Dr. Cvis suggests that colchicine could be a better alternative due to its anti-inflammatory properties, its effectiveness in reducing cardiovascular risk, and its lower cost compared to Statins.
What is the recommended dosage of colchicine according to Dr. David Nebert, as mentioned in the video?
-Dr. David Nebert recommends a low dose of 0.5 mg of colchicine for patients with elevated CRP levels and a history of cardiovascular disease, as part of a secondary prevention strategy.
How does Dr. Cvis view the combination of low-dose aspirin and colchicine for certain patients?
-Dr. Cvis sees the combination of low-dose aspirin and colchicine as a potentially healthier and more effective alternative to Statins, especially for patients with a history of cardiovascular events and ongoing inflammation.
Outlines
🤔 The Overlooked Superiority of Colchicine Over Statins
Dr. Rob Cvis discusses the puzzling preference of cardiologists for prescribing statins despite evidence suggesting that colchicine is more effective in reducing cardiovascular disease. He points out that colchicine, known for its use in treating gout, has been FDA-approved for its high risk reduction in atherosclerotic cardiovascular disease, a fact often overlooked. Dr. David Nebert, an electrophysiology cardiologist, is credited for bringing this to light. The video emphasizes the need to consider colchicine for its anti-inflammatory properties, especially in patients with a history of heart attack, stroke, or elevated C-reactive protein (CRP) levels, indicating inflammation.
🛡️ Colchicine as a Powerful Anti-Inflammatory for Secondary Prevention
This paragraph delves into the anti-inflammatory benefits of colchicine, highlighting its effectiveness in reducing vascular inflammation, which is superior to that of statins. Dr. Cvis suggests that colchicine should be considered for secondary prevention in patients with significant plaque burden or a history of cardiovascular events. The paragraph also touches on colchicine's role in reducing amyloid protein synthesis, associated with conditions like Alzheimer's disease, and its potential in managing atrial fibrillation by decreasing inflammation in heart cells. The importance of using the right dosage of colchicine to avoid toxicity is stressed, along with its historical use since 1500 BC for joint inflammation.
🧬 Colchicine's Mechanism of Action and Its Impact on Inflammation
The speaker explains the mechanism by which colchicine operates, focusing on its ability to reduce the activation and adhesion of white blood cells to plaque, a process fundamental to the development of atherosclerosis. Aspirin is mentioned as a complement to colchicine, with the dual therapy potentially offering significant benefits in managing cardiovascular disease by addressing both clot formation and inflammation. The paragraph also discusses the correlation between high uric acid levels, a risk factor for gout and kidney stones, and cardiovascular disease, suggesting that colchicine's benefits extend to these conditions as well.
💊 Dosage Considerations and the Role of Colchicine in Patient Management
Dr. Cvis shares insights on the dosing of colchicine, advocating for a low-dose approach to minimize toxicity risks while maximizing anti-inflammatory benefits. He discusses the cost-effectiveness of colchicine compared to statins and emphasizes the importance of patient knowledge in making informed decisions about their treatment. The video also presents a case study of a patient with a high calcium score and stroke history, suggesting that colchicine could have been a beneficial addition to the patient's regimen. Dr. David Nebert's dosing strategy for patients with elevated CRP is introduced, recommending an initial dose of 0.5 mg to 0.6 mg of colchicine.
📚 FDA Approval and the Future of Colchicine in Cardiovascular Disease Management
The final paragraph summarizes the FDA's approval of low-dose colchicine for reducing the risk of cardiovascular events in patients with established atherosclerotic disease or multiple risk factors. It contrasts the traditional focus on lipids and LDL cholesterol with the emerging understanding of inflammation as a key driver of cardiovascular disease. The paragraph cites a study from the Journal of the American College of Cardiology that positions high-sensitivity CRP as a stronger predictor of cardiovascular death than LDL cholesterol. It concludes with a strong personal endorsement from Dr. Cvis for considering colchicine as a replacement for statins in appropriate cases.
👋 Closing Remarks and Call to Support
In the closing paragraph, Dr. Cvis invites viewers to support the channel financially if they have found the information valuable, suggesting a contribution to the PayPal account mentioned. This paragraph serves as a sign-off, indicating the end of the video content.
Mindmap
Keywords
💡Statin
💡Colchicine
💡Cardiologist
💡Inflammation
💡Atherosclerotic cardiovascular disease
💡CRP (C-reactive protein)
💡Secondary prevention
💡Uric acid
💡Aspirin
💡Atrial fibrillation
💡Alzheimer's disease
Highlights
Dr. Rob explains the common insistence on prescribing Statins by cardiologists despite their awareness of more effective alternatives for cardiovascular disease reduction.
Introduction of Colchicine, a drug known for its use in Gout but also recognized by the FDA for its higher risk reduction in cardiovascular disease compared to Statins.
Colchicine's history dating back to 1500 BC and its traditional use for joint inflammation.
The anti-inflammatory properties of Colchicine and its effectiveness in reducing vascular inflammation more than Statins.
The FDA's approval of Colchicine for reducing coronary artery vascular risk at a level greater than Statins.
The economic factors influencing the prescription of Statins over Colchicine, despite the latter's proven benefits.
Colchicine's mechanism of action in reducing inflammation and its dosage considerations to avoid toxicity.
The role of Colchicine in reducing Amalo protein synthesis, associated with Alzheimer's disease.
Colchicine's potential in reducing atrial fibrillation by decreasing inflammation in pulmonary veins.
The synergistic effect of combining low-dose aspirin with Colchicine for secondary prevention of cardiovascular events.
The importance of considering inflammation as the primary cause of cardiovascular disease rather than focusing solely on lipids and LDL cholesterol.
The benefits of Colchicine in reducing the risk of a second cardiovascular event, particularly in patients with a history of heart attack or stroke.
The paper from the Journal of the American College of Cardiology highlighting the predictive power of inflammation over LDL in cardiovascular mortality.
Dr. Rob's opinion on using Colchicine as a replacement for Statins in certain patient populations.
The FDA's approval in June 2023 for the use of low-dose Colchicine to reduce the risk of myocardial infarction, stroke, and cardiovascular death.
The potential of Colchicine to be a cost-effective and safer alternative to Statins for patients with established cardiovascular disease.
The strategy of adjusting Colchicine dosage based on CRP levels and the importance of patient compliance.
Transcripts
hi folks this is Dr Rob cvis and I am
the carb addiction Doc and is the final
in the series of lipidology Cardiology
Statin type uh drugs and Statin thinking
um one of this is the final video and
one of the things that perplexes me
always is when you see a cardiologist
before you even walk in the door you
might be a delivery person but they're
talking to you about you need to be on a
Statin and there's nothing that can
dissuade them from that narrative and
yet there are several things that they
know about that they absolutely know
about it's in their literature FDA
approved where the drugs are far more
effective at reducing cardiovascular
disease than statens and yet they will
insist on a stattin and most of them
have never ever mentioned this word so
there's a drug out there called culture
scene some of you may know it if you've
got Gout you've probably heard of
culture scene but most of you there's
nobody that's watching these videos that
doesn't know the word Staten and I bet
you very very few of you know the word
culture scene so uh the FDA a few years
ago proved culture
scene as a very powerful
drug with a much higher risk reduction
than
stattin for cardiovascular disease for
atherosclerotic cardiovascular disease
and um you've seen this guy on this
channel I've got a a friend and a
patient by the name of Dr David nebert
who is a electrophysiology cardiologist
he's a cardiologist and he brought this
to my attention I knew about and I use
culture scene for my Gout patients I use
it for inflammation but I haven't looked
at the association of culture scene and
risk reduction for cardiovascular
disease and yes the you want to reduce
the inflammatory response you want to
reduce the cause of the inflammation but
early on as you responding to that this
inflammation why not let's consider and
let's talk about culture scene and what
it does and what the risks and benefits
are so in patients on a standard
American diet in patients with a
significant you've had a CAC score now
you've got pla in your you know you've
got pla in your blood vessels or you've
had a heart attack you've had a stroke
you've had an event and we
call the intervention secondary
prevention so you've had an event now
we've got to reduce
the risk of a second intervention uh of
a second event and the FDA as I said has
approved C culture scene to reduce
coronary artery vascular risk CBD
risk at a level that is far greater than
Statin so if you have positive
cardiovascular disease and measurable
inflammation and this blood work that we
do high fertin or a highly selective CRP
C reactive protein above two now ideally
I want that below three which is an
anti-inflammatory thing but if youve got
ongoing
inflammation and we can measure that
with white cell count we can measure it
with um uh fertin CRP is the one that
the cardiologists use and I think it's a
valid valid number if that's elevated
and you have plaque culture scene should
be a seriously considered medication for
a while to reduce that
inflammation and we're talking about
something that is secret why because
culture scene doesn't cost very much
money doesn't make a lot of money for
the insurance companies it is ranked as
the
184th most commonly prescribed drug
stattin being right up there is number
one or two I think that one through cuz
money money and I know I'm not that jist
conspiracy theorist but that is a direct
correlation especially if you
consider a significantly increased risk
production versus stens so what is
culture scene culture scene actually
comes from a plant and we've known about
it since 1500
ad okay sorry uh 1500 BC I'm sorry BC
before
Christ okay 1500 years before Christ uh
folks ate this for joint inflammation
it's one of the crocus plants they used
to consume it for joint
inflammation so what culture scene does
is culture scene is a powerful
anti-inflammatory we go into the
mechanism and the most common use of
culture scene right now is for gout for
elevated uric acid so if you have an
attack of gout affects your fingers
affects your toes big toes is the most
common one or if you have kidney stones
a lot of doctors like myself will use a
short 2 or 3 Day course of of culture
scine to reduce the inflammation from
gut but uric acid uh which is a product
of fructose consumption a carbohydrate
um also results in a risk of gout and a
risk of kidney stones sodium Uric urate
Stones um and alopurinol is one of the
drugs that dumbs that down so alopurinol
is this is the preventive why do we use
culture scine that often as prevention
although I do because its drug range its
dosage range has to be very tight it can
have devastating effects when it's
overdosed so please the more is better
population out there the more is better
a little bit work going to take more
please do not do that if you're going to
consider culture scene because more can
be very toxic at a high level range but
if you're in the 0.5 to point6 range and
I'm going to at the end of this I'm
going to use Dr neighbor it's dosing uh
pattern uh to talk about it but what
culturein does is it prevents
inflammation of the joints and so
culture scine is a very powerful
anti-inflammatory primarily associated
with goat use uh with gout goat with
gout use however
vascular inflammation and a reduction in
vascular inflammation is its primary
effect so culture scene significantly
reduces the vascular inflammatory
response far better than Statin and it
it should be a go-to
drug for secondary prevention that is
the most important consideration so if
you've got a significant plaque burden
if you've had an event to stroke or a
heart attack culine should be a very
serious drug at the top of that list
until we get rid of the
inflammation maybe together with with an
aspirin and we have to shift our
thinking of cardiovascular disease away
from lipids and away from LDL and
cholesterol toward inflammation once you
consider inflammation as the cause of
this disease then culture seene Falls
very neatly into place and in my opinion
and I'm going to modify my management
the combination for certain patients
with high risk a combination of a lowd
dose aspirin as well as culture scine at
low dose is the healthiest combination
especially if you've had a stroke or
heart attack now one of the interesting
things is that ccine also reduces amalo
protein synthesis and for those of you
who don't know amalo amalo is a protein
replacement within organs when cells of
those organs die so we see amalo in the
pancreas and people with diabetes type 1
diabetes but the biggest biggest
biggest replacement tissue replacement
by amalloy
occurs in the brain and we call that
disease
Alzheimer's and so many experimental
companies are are are uh producing drugs
that block block protein synthesis that
block am that block amalo protein
synthesis and the FDA has even approved
some of these pathetically weak drugs
you've heard about them Alzheimer's
because they're going to make money but
they don't affect Alzheimer's because
Alzheimer's is an inflammatory
condition and the amalo is there to
replace the death of the brain cells and
what culine does is it's associate with
a reduction in amalo but it doesn't
directly reduce amalo it reduces the
inflammation so there are lower levels
of amalo
but what they do the farmer companies
they directly treat the amalo block the
production of amalo but that's not
fixing the inflammation cine
does cine is also so we've talked about
it as inflammation in the blood vessels
the plumbing to reduce aerosis but
culture scene also works very
effectively and attention diabetics type
two diabetics culture works very
effectively to reduce inflammation
in the cells of your pulm
veins the blood vessel cells that over
time will modify and become electrified
those cells in your pulmonary veins can
become
electrified and have an electrical
signal when they shouldn't have a signal
that interferes with the normal
signaling of the electrical system of
the heart and we call that atrial
fibrillation and ccine also reduces
inflammation in those cells and reduces
the the abnormal electrification of the
heart and has an anti- atrial
fibrillation
effect so the combination and and to how
where exactly does culine
work well cusine specifically reduces
activation of white blood cells of
lucites decreases their activation
decreases their aggressive function and
decreases their adhesion
to plaque and if you remember plaque
starts out with a fibrin clot adding
platelets aspirin blocks that and then
the activated platelets bring white
cells in and the white cells bring
macrofagos in and The macras Bu bring
pla in or lipids so if you use an
aspirin to block platelets and you use
culturein to reduce that effective the
the inflam inflammation and the
activation of those white cells and the
adherence of those white cells you are
doing two massive things to reduce clot
propagation while not interfering with
the clot itself because there are things
like eloquest that are factor 10A
Inhibitors that prevent the clot well if
I cut myself I want a clot and yes
ideally I want activated plates I want
activated white cells but if there's a
balance between reducing a cut from a
clot uh from uh the clotting from a cut
and reducing pla formation if I'm at
risk for pla formation
this is where that balance Works where I
can still clot off a or at least create
an early clot for a a cut which is a
onetime event but I'm not having this
ongoing massive anti-inflammatory
response excessive anti-inflammatory
response occurring in my blood vessels
that is going to kill me of a heart
attack or a stroke there's no right
answer it's not absolute but that is
what we do with people that already have
inflammatory disease so the baby aspirin
shouldn't be taken by someone who's got
no risk or low risk same with the
culture scene but if your uric acid is
high if you're a PL inflammatory and
you've got plaa you've had an event the
combination of ASP and culture scene is
highly recommended particularly as a
weapon against Statin so stop the Statin
and take those two
meds just be very aware of the dosing
and low dosing is the way to
go so culture scene interferes with
white cell adhesion white cell function
and it also reduces the inflamm romes
that put out all these pro-inflammatory
cyto kindes so it reduces the
inflammatory uh risk and so many people
with cardiovascular disease aeroic
cardiovascular disease have high uric
acid
levels high uric acid levels and we see
that even our in our Alam HRS so there's
that double
benefit so I become very very gung-ho on
on culture scene albeit my primary focus
is to reduce inflammation so I don't
need any of those drugs but if you
already have the disease and you don't
want to see
propagation this may be a better added
strategy definitely in my opinion the
baby aspirin and then under certain
circumstances the addition of culture SE
so example I had a patient couple of
weeks ago taking his baby aspirin but he
has a huge burden I think it was 36 or
3,700 um C score and also a burden of
pluck in all of his vessels in the cored
in the ver
uh and he had a small stroke on
aspirin disease everywhere and developed
a small clot in the Basler artery of his
brain well
perhaps if he was on culture scene as
well as aspirin that may not have
happened now the good news is they got
to him early they removed that clot and
he's got very little residual effect of
that stroke but it could have been
catastrophic and if he wasn't on the
aspirin he probably would have
died or had death of his brain
but I'd like to put him or suggest to
him I never put anybody on suggest to
him that we add culture scene to the mix
now he's also doing a wonderful job of
reducing ongoing
inflammation reducing ongoing
inflammation through dietary changes
through Lifestyle Changes which is the
foundation but because he's got existing
disease because he had a
life-threatening event the risk or the
downside of culture scene any downside
which is really from toxicity is far
more worth accepting for the massive
benefit so that's the way my brain works
and I'm not going to he says no I'm fine
with that it's a decision we make but in
order to say yes or no you need the
knowledge and you need the science not
the emotive thinking I'm not going to
scare him I'm just going to say hey this
is something we've learned this is
something you can add to it now this
from David neighbor so this is a
cardiologist's use of this medic a and
in his population he sees a lot of
people that are not willing to go on a
on a low carbohydrate diet my population
are all at least trying and if you're
trying but struggling or if you say
screw it well screw it doesn't is not
going to fix the problem but what David
talks about is when he sees a CRP and we
test CRP on everybody above two and you
have pre-existing cardiovascular disease
he uses A5 MGR dose now for gout we use
a 6 Mig dose a day and that that cost
you about $20 a month through something
like good
RX about $32 at CVS for a 90day supply
so it's not expensive just like baby
aspin is not expensive statins are far
more expensive although they may be
covered by insurance
so um if you have if you meet the
criteria secondary prevention
significant plaque burden elevated CRP
then adding culture scene to your
aspirin and ask me about it if you're a
patient of mine maybe a very effective
safe non-toxic non-harmful way to go
because of the stattin profile of harm
and less
Effectiveness and under these
conditions you can even go to lower
dosing so as your CRP improves you can
go down to taking half a tablet 2.5 migr
every day or maybe even doing it Monday
Wednesday Friday because the benefits
occur at a very low dose
so that's David's strategy I found that
half a tablet on weekend strategy works
pretty well in people who struggle with
compliance or people who uh um do not
have a very high CRP but have a high
plaque
burden so I think the the
value of preventing clot in a safe way
where we know it's
effective it has value in people with
pre-existing disease but if you've got a
zero CC score like me don't even go down
that pathway but work really hard on
preventing inflammation not smoking not
having insulin
resistance and that's where the gp1s and
some of the diabetic medications may
have greater Advantage but you need to
know about culture scene you need to
know about its effect you need to ask
those questions and the final thing I'll
tell you this is the paper the paper
published in the journal uh the Journal
of the American College of Cardiology
says lowd dose culture seen for
secondary prevention of carony artery
disease and I'll give you the
summary inflammation assessed by means
of Highly sensitivity CRP
hscp is a more powerful determinant of
cardiovascular Death and All cause
mortality than low density lipoprotein
ldlc
so hscrp a mark of inflammation is more
predictive of cardiovascular death than
LDL which is what every cardiologist is
measuring all the time that's their
starting point and these are
cardiologists several therapies that
Target residual
inflammation residual inflammatory risk
significantly reduce vascular event
rates for coron artery disease patients
already taking
other medications including statins lowd
dose culture scene and I'm going to
paraphrase here may be a very healthy
very effective and this is coming from
me Robert cus not them because they use
it on top of a Statin a very very
healthy alternative to a Statin and the
low dose is .5 Mig Orly and this has
been shown to safely lower major adverse
cardiovascular Risk by 31% % amongst
those with stable atherosclerotic
disease and
23% secondary reduction if you've had a
heart attack so if you've had a heart
attack your risk of a second heart
attack is lowered by 23% basically one
quarter reduction on culture scene
without any other changes you then
change your diet and you massively
reduce
that these magnitudes are magnitudes of
benefit are
larger than those seen with lipid
lowering
agents lipid lowering and inflammatory
Inhibitors are not in Conflict but are
synergistic and I disagree with that I
disagree with that
statement that's where they and I
disagree culture scene is a replacement
for stattin not to be used with a
stattin in my opinion but in June of
2023 exactly a year ago the US Food and
Drug Administration the FDA approved the
use of lowdose culture scene to reduce
the risk of myocard fuction stroke Cal
rasul and cardiovascular death in
patients with established atic disease
or multiple risk factors for
cardiovascular disease
including atrial
fibrillation
H it's in the College of Cardiology they
don't talk about
it because it doesn't fit their
narrative that inflammation is the
problem not lipids
if I've made you think if I've given you
new knowledge and I know I have I've
done my job leave a dollar in our PayPal
account till next time
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