Dr. McDougall's Online Discussion Board

Has anyone on the McD diet had a stent placed and come off plavix? Did you come off gradually or just stop? Any problems? What about discontinuing a beta blocker?

My husband was on Plavix for one month after his heart attack (right coronary artery 100 percent blocked, bare metal stent). He's off all his post heart attack meds using diet alone to manage his blood numbers.

Beth

didi wrote:Has anyone on the McD diet had a stent placed and come off plavix? Did you come off gradually or just stop? Any problems? What about discontinuing a beta blocker?

There is still a lot of controversy about when and if to stop plavix after stent placement.

The stent are fully covered with the regrowth or grow through of the arterial wall within 1-2 years or so. So logically once that happens, there is no risk of stent caused thrombosis. With this line of thinking the only question is when to discontinue. Most say 2 years maximum.

There is another school of thought that says after MI (AND stent,) plavix (Clopidogrel) should be forever to prevent:
1. vascular ischemic events in patients with symptomatic atherosclerosis,
2. Acute coronary syndrome without ST-segment elevation (NSTEMI),
3. ST elevation MI (STEMI)

I think in your case #1 applies to you also.

I guess a lot of one decision would rest on how compliant one is with this WOE, weight, exercise and other risk factors like diabetes, etc.

It is very difficult to get a good cardiologist to work with you on these problems.

I have the similar dilemma re plavix.

Beta Blockers:
(2012) Among patients enrolled in the international REACH registry, beta-blocker use was not associated with a lower event rate of cardiovascular events at 44-month follow-up, even among patients with prior history of MI. Further research is warranted to identify subgroups that benefit from beta-blocker therapy and the optimal duration of beta-blocker therapy,” the authors conclude.
( JAMA. 2012;308[13]:1340-1349)

Hope this helps. Please do not do anything without talking to YOUR Doctor first.

DiDi PM me if you have any other questions.

J

This sounds like it should be a Dr. McDougall question. Maybe send him an email.

AND of course consult with a cardiologist that knows your entire history as well as understands this WOE.

re: consult with a cardiologist who knows your history and understands this way of eating. I am sorry but I am only familiar with cardiologists who reside on this planet.

didi

didi wrote:re: consult with a cardiologist who knows your history and understands this way of eating. I am sorry but I am only familiar with cardiologists who reside on this planet.

didi

My husband's cardiologist is vegan and recommended the Dean Ornish WOE. While it's not completely McDougall, it's pretty close. His exact words - "You need to be on a low fat vegan diet."

Hubby is off all meds for diabetes, cholesterol, and blood pressure, He is following a McDougall diet, but he will be on Plavix for life....He had a quadruple bypass in 2011..his veins and arteries were very bad from all those years of smoking and eating badly....the plavix will ensure he gets no more blockages...we are comfortable with this.

didi wrote:Has anyone on the McD diet had a stent placed and come off plavix? Did you come off gradually or just stop? Any problems? What about discontinuing a beta blocker?

I discussed this with my Cardiologist recently as I learned that coming off of Plavix (I am on Effient as Plavix doesn't work for me) is partly a function of how long your stent is. I have two together making for almost 3.5 centimeters. Most are closer to 1 cm. He told me the general rule is to be on the med for 1 year for every 1 cm of stent length. So I will be on Effient for over 3 years. I believe you will be taken of suddenly.

If you are on a very good plant based diet and continue with aspirin you are probably OK. But you could try to include certain substances in your diet which reduce platelet aggregation and ensure you don't eat anything which increases aggregation. Garlic and ginger are good. Vitamin E as well, but I wouldn't take this while you are on meds.

But discuss coming off of Plavix with your Cardio doctor. This is not a question for Dr M or a GP. You can also have your blood checked for platelets and fibrinogen levels. you do not want fibrinogen to be towards high end.

The doctor never mentioned anything to me about the length of the stent and time on plavix.

What about baby aspirin? Is it necessary to continue this? Aspirin demineralizes bones and causes bleeding and probably a whole host of other things. I am 100% compliant with McD/Esselstyn diet.

I honestly do not think anyone knows about these drugs after surgery or stent placement as far as whole food plant based no fat eaters are concerned because there are so few of us. It seems if Esselstyn is prescribing statins and aspirin and any other drugs it is because he wants to be extra safe, not because there is evidence that they are necessary for this way of eating.

didi

didi wrote:The doctor never mentioned anything to me about the length of the stent and time on plavix.

What about baby aspirin? Is it necessary to continue this? Aspirin demineralizes bones and causes bleeding and probably a whole host of other things. I am 100% compliant with McD/Esselstyn diet.

I honestly do not think anyone knows about these drugs after surgery or stent placement as far as whole food plant based no fat eaters are concerned because there are so few of us. It seems if Esselstyn is prescribing statins and aspirin and any other drugs it is because he wants to be extra safe, not because there is evidence that they are necessary for this way of eating.

didi

I would not have known about the length of stent issue except that I found research about it on my own and brought the issue up with my cardiologist. This is typical - having to draw doctors out with questions. This may be a discretionary area and each cardiologist may have a different opinion. But there is evidence that tissue grows over the stents from the ends, so it makes sense to wait longer to come off antiplatelet meds like Plavix and Effient if your stent is longer. Suggest you ask.

I agree there is a lot of uncertainty, and if I could do it over again I would not have had the stents - they put them in while doing angioplasty 12 hours after my heart attack and I don't feel I was completely informed, but that's another story.

I wasn't aware that Dr E had a position on taking these drugs, but you are correct in that Drs are often conservative in areas which they are uncertain about.

As for aspirin, I will have to review the literature again - my Cardiologist wants me on aspirin for life.

It is my understanding that Vitamin D3 supplementation will help with bone demineralization as well as have global positive health effects, including cardiovascular. But test your serum level first.

My hubby got 2 stents in oct 2010. we began mc dougall diet in dec 2010. he was on plavix, aspirin and coumadin [ for a-fib]. in feb of 2012 he had a nosebleed at 4:30 a.m. and we had to go to the ER. after that he got taken off plavix. so he was on plavix for about a year and a half. his recent heart follow up tests were all good. his blood sugars are controlled. he lost 40 pounds and is now off BP meds.

I got two bare metal stents (Rt. coronary artery) after an MI three years ago. Took plavix and aspirin (325 mg) for one year, but was also still taking my routine daily two grams of pure DHA/EPA at the same time. Got my arm jammed while working under the hood of my car, and ended up with one hell of a big hematoma & a huge, ugly bruise that lasted about 10 days. Went off the plavix after one year, and recently cut my aspirin dose in half (after communicating with Dr. McDougall), and also finally gave up the fish oil for a tbsp. or two of ground flaxseed instead. I may eventually reduce the aspirin to a single baby dose (or less, since it takes very little to produce the desired platelet effect), but I am able to tolerate it OK, so until I can discover the minimum dose that prevents carcinomas, I will stay at 160 mg.
My impression was that the people who are on plavix for life are mostly those with relatively clean arteries, but who still are prone to vascular occlusions. I also think one year on plavix is fairly standard for post MI patients (at least at the VA), with no gradual down-dosing needed. Been WFPB/no oil for two years, and will likely soon start weening myself from the beta-blocker & ACE inhibitor that are also standard post MI treatment, along with the low- dose statin I am still taking.
I am lucky to see the same cardiologist more than once (they come & go at the VA), and I wouldn't hold my breath waiting for any one of them to risk deviating from the standard VA treatment regimen. The fact that my BP was never above normal range before my MI, or the fact that my total cholesterol without taking any statins might now well be lower than 150 would not change their attitude. As far as cardiologists are concerned: You had an MI? Then you need a statin, a beta blocker, and an ACE inhibitor. End of story!

dynodan62 wrote:I got two bare metal stents (Rt. coronary artery) after an MI three years ago. Took plavix and aspirin (325 mg) for one year, but was also still taking my routine daily two grams of pure DHA/EPA at the same time. Got my arm jammed while working under the hood of my car, and ended up with one hell of a big hematoma & a huge, ugly bruise that lasted about 10 days. Went off the plavix after one year, and recently cut my aspirin dose in half (after communicating with Dr. McDougall), and also finally gave up the fish oil for a tbsp. or two of ground flaxseed instead. I may eventually reduce the aspirin to a single baby dose (or less, since it takes very little to produce the desired platelet effect), but I am able to tolerate it OK, so until I can discover the minimum dose that prevents carcinomas, I will stay at 160 mg.
My impression was that the people who are on plavix for life are mostly those with relatively clean arteries, but who still are prone to vascular occlusions. I also think one year on plavix is fairly standard for post MI patients (at least at the VA), with no gradual down-dosing needed. Been WFPB/no oil for two years, and will likely soon start weening myself from the beta-blocker & ACE inhibitor that are also standard post MI treatment, along with the low- dose statin I am still taking.
I am lucky to see the same cardiologist more than once (they come & go at the VA), and I wouldn't hold my breath waiting for any one of them to risk deviating from the standard VA treatment regimen. The fact that my BP was never above normal range before my MI, or the fact that my total cholesterol without taking any statins might now well be lower than 150 would not change their attitude. As far as cardiologists are concerned: You had an MI? Then you need a statin, a beta blocker, and an ACE inhibitor. End of story!

odd. I am a little surprised they put bare metal stents in your RCA instead of drug eluting stents like I have. The issue with endothelial cell regrowth is a much bigger problem with my kind of stent. You are well past the point of endothelial cell overgrowth blocking your stents though. It is possible that Plavix is used for MI purposes only, but from what I know (I had an MI as well) it was used for me solely to prevent platelet aggregation in the stents and is not intended to be long term MI therapy.

I was put on low dose Coreg (beta blocker) for my MI as well as a statin and the 325 aspirin. Doctor let me reduce to 81 mg aspirin. I switched cardiologist early on as the one who advised on the stenting and who I did my first follow-up turned out to be an A hole who I could not talk with. My current cardiologist takes time with me and will answer questions. I will be discussing coming off of my statin on next visit as I have had blood tests with and without stating therapy over the past 6 months and I can prove statins are not needed to keep LDL under 70 ( I did this on my own). I know that cardiologists say that statins have other benefits besides cholesterol lowering so I will be asking if those are benefits are different from those obtained from the very good plant based diet I am own - in other words, tell me why exactly I should stay on statins. If he is wishy washy with no convincing answer I will insist on coming off.

You should be aware that his local pharma rep has total access to, and likely keeps acutely abreast of his prescribing history. The doc's $ perks and free vacation junkets depend on how cooperative he is with the Rx pad.
When MY #s get into & stay under Dr. Esselstyn's 'heart attack proof' safe zone while off statins, I won't be looking for any cardiologist's approval re: leaving them behind for good. The anti-inflammatory effects of statin drugs are likely superfluous when someone is also taking ASA, and eating a diet with a proper balance of omega fats. The primitive WFPB populations who never knew heart disease seemed to get along fine without statins (or aspirin, for that matter), and never had to suffer the mental fuzziness & muscle ache side effects, or worry about their liver health and CoQ10 levels.