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Malhotra, et al has erroneously excluded LDL cholesterol and saturated fat [1] from the Inflammation and Heart Disease Theory [2], demonstrating a fatal flaw in their understanding of the various factors [2-4] that play a role in the inflammatory process itself. He and others have used Coronary Artery Calcium (CAC) scoring [5] to help justify their dietary preferences - further demonstrating a misunderstanding of the Inflammation and Heart Disease Theory [2] itself and a failure to understand that calcification need not be present for coronary artery disease (CAD) to exist and that CAC scoring itself is merely a semi-quantitative measure [6].
Evidence-based medicine (EBM) requires the ability to quantifiably measure outcomes which are accurate, consistent and reproducible; avoiding the use of qualitative or semi-quantitative methods, which misdiagnose the presence of disease (sensitivity) and reports the presence of disease (specificity) when absent [5-9].
EBM further requires a solid understanding of the pathophysiology of CAD [2-4], which is missing from the arguments declaring saturated fat is not a major issue [1] in the development and treatment of CAD [2,4,8]. EBM requires a full understanding of all the various factors involved in the development and treatment of CAD and the role they play [2-4], in addition to understanding how to measure the impact of dietary and drug treatments upon that inflammatory process [5-9].
Accordingly, we encourage those who do not believe saturated fat and LDL cholesterol are involved in CAD, to quantitatively measure the impact of their dietary and drug treatments upon actual CAD itself and not to merely look at weight loss or changes in blood tests - so they may provide better patient care using EBM [8].
References:
1. Malhotra A. Saturated fat is not the major issue. BMJ 2013;347:f6340.
2. Fleming RM. Chapter 64. The Pathogenesis of Vascular Disease. Textbook of Angiology. John C. Chang Editor, Springer-Verlag New York, NY. 1999, pp. 787-798.
3. Fleming RM. Chapter 29. Atherosclerosis: Understanding the relationship between coronary artery disease and stenosis flow reserve. Textbook of Angiology. John C. Chang Editor, Springer-Verlag, New York, NY. 1999. pp. 381-387.
4. Fleming RM. Chapter 30. Cholesterol, Triglycerides and the treatment of hyperlipidemias. Textbook of Angiology. John C. Chang Editor, Springer-Verlag, New York, NY. 1999, pp. 388-396.
5. Fleming RM, Fleming MR, Chaudhuri TK. Coronary Artery Calcium (CAC) Scoring and Treatment Decision Making. J Cardiovasc Med Cardiol 2019;6(4):92-93. DOI:10.17352/2455-2976.000200.
6. Fleming RM, Fleming MR, Dooley WC, Chaudhuri TK. Invited Editorial. The Importance of Differentiating Between Qualitative, Semi-Quantitative and Quantitative Imaging – Close Only Counts in Horseshoes. Eur J Nucl Med Mol Imaging. DOI:10.1007/s00259-019-04668-y. Published online 17 January 2020 https://link.springer.com/article/10.1007/s00259-019-04668-y
7. Fleming RM., Kirkeeide RL, Smalling RW, Gould KL. Patterns in Visual Interpretation of Coronary Arteriograms as Detected by Quantitative Coronary Arteriography. J Am Coll. Cardiol. 1991;18:945- 951.
8. Fleming RM, Harrington GM. What is the Relationship between Myocardial Perfusion Imaging and Coronary Artery Disease Risk Factors and Markers of Inflammation? Angiology 2008;59:16-25.
9. Fleming RM, Fleming MR, Chaudhuri TK. Are we prescribing the right diets and drugs for CAD, T2D, Cancer and Obesity? Int J Nuclear Med Radioactive Subs 2019;2(2):000115.
Competing interests:
FMTVDM issued to first author. The Inflammation and Heart Disease Theory was authored by the first author.
19 February 2020
Richard M Fleming
Physicist-Cardiologist
Matthew R Fleming, BS, NRP (FHHI-OI-Camelot); Tapan K. Chaudhuri, MD (Eastern Virginia Medical School)
To err is human – to perseverate in that error can be harmful to patients. Re: Saturated fat is not the major issue
Malhotra, et al has erroneously excluded LDL cholesterol and saturated fat [1] from the Inflammation and Heart Disease Theory [2], demonstrating a fatal flaw in their understanding of the various factors [2-4] that play a role in the inflammatory process itself. He and others have used Coronary Artery Calcium (CAC) scoring [5] to help justify their dietary preferences - further demonstrating a misunderstanding of the Inflammation and Heart Disease Theory [2] itself and a failure to understand that calcification need not be present for coronary artery disease (CAD) to exist and that CAC scoring itself is merely a semi-quantitative measure [6].
Evidence-based medicine (EBM) requires the ability to quantifiably measure outcomes which are accurate, consistent and reproducible; avoiding the use of qualitative or semi-quantitative methods, which misdiagnose the presence of disease (sensitivity) and reports the presence of disease (specificity) when absent [5-9].
EBM further requires a solid understanding of the pathophysiology of CAD [2-4], which is missing from the arguments declaring saturated fat is not a major issue [1] in the development and treatment of CAD [2,4,8]. EBM requires a full understanding of all the various factors involved in the development and treatment of CAD and the role they play [2-4], in addition to understanding how to measure the impact of dietary and drug treatments upon that inflammatory process [5-9].
Accordingly, we encourage those who do not believe saturated fat and LDL cholesterol are involved in CAD, to quantitatively measure the impact of their dietary and drug treatments upon actual CAD itself and not to merely look at weight loss or changes in blood tests - so they may provide better patient care using EBM [8].
References:
1. Malhotra A. Saturated fat is not the major issue. BMJ 2013;347:f6340.
2. Fleming RM. Chapter 64. The Pathogenesis of Vascular Disease. Textbook of Angiology. John C. Chang Editor, Springer-Verlag New York, NY. 1999, pp. 787-798.
3. Fleming RM. Chapter 29. Atherosclerosis: Understanding the relationship between coronary artery disease and stenosis flow reserve. Textbook of Angiology. John C. Chang Editor, Springer-Verlag, New York, NY. 1999. pp. 381-387.
4. Fleming RM. Chapter 30. Cholesterol, Triglycerides and the treatment of hyperlipidemias. Textbook of Angiology. John C. Chang Editor, Springer-Verlag, New York, NY. 1999, pp. 388-396.
5. Fleming RM, Fleming MR, Chaudhuri TK. Coronary Artery Calcium (CAC) Scoring and Treatment Decision Making. J Cardiovasc Med Cardiol 2019;6(4):92-93. DOI:10.17352/2455-2976.000200.
6. Fleming RM, Fleming MR, Dooley WC, Chaudhuri TK. Invited Editorial. The Importance of Differentiating Between Qualitative, Semi-Quantitative and Quantitative Imaging – Close Only Counts in Horseshoes. Eur J Nucl Med Mol Imaging. DOI:10.1007/s00259-019-04668-y. Published online 17 January 2020 https://link.springer.com/article/10.1007/s00259-019-04668-y
7. Fleming RM., Kirkeeide RL, Smalling RW, Gould KL. Patterns in Visual Interpretation of Coronary Arteriograms as Detected by Quantitative Coronary Arteriography. J Am Coll. Cardiol. 1991;18:945- 951.
8. Fleming RM, Harrington GM. What is the Relationship between Myocardial Perfusion Imaging and Coronary Artery Disease Risk Factors and Markers of Inflammation? Angiology 2008;59:16-25.
9. Fleming RM, Fleming MR, Chaudhuri TK. Are we prescribing the right diets and drugs for CAD, T2D, Cancer and Obesity? Int J Nuclear Med Radioactive Subs 2019;2(2):000115.
Competing interests: FMTVDM issued to first author. The Inflammation and Heart Disease Theory was authored by the first author.