The coronary risk factors have all been discovered and discussed in major medical journals by well-known experts in the field for a decade now, but a complete package of viable solutions (and manners of identification of heart disease) have seemed to fail to come to fruition in national consensus guidelines that would effectively improve care in primary and secondary cardiovascular disease prevention.
Beyond bandaid-statins and common coronary surgeries, which do little to correct underlying disease processes, what exists that actually works? Why is coronary artery disease still the #1 killer in America... and strokes #3? Why aren't these stats changing (and seem to get worse, especially for women)? Why is CAD not being broadly reversed with the huge resources and high-tech approaches currently available in our great country??
The use of a convenient, low-radiation diagnostic tool --- the EBT heart scans --- to guide and dictate therapy, the only plan and protocol for effective plaque reversal that has a true TRACK record of success.
Is seeing is not believing when plaque is present? Usually unfortunately... affirmative... (unless you're symptomatic with anginal pain or erectile dysfunction (future blog topic)).
These are subsequently quenched... For a lifetime…
Proatherogenic mechanisms and progression pattern
- Pahor M, Elam MB, Garrison RJ, Kritchevsky SB, Applegate WB. Emerging noninvasive biochemical measures to predict cardiovascular risk. Arch Intern Med. 1999 Feb 8;159(3):237-45. See diagram (above) and summary of CV risk factors (below)
- Oparil S, Oberman A. Nontraditional cardiovascular risk factors. Am J Med Sci. 1999 Mar;317(3):193-207.
- Frishman WH. Biologic markers as predictors of cardiovascular disease. Am J Med. 1998 Jun 22;104(6A):18S-27S.
- Harjai KJ. Potential new cardiovascular risk factors: left ventricular hypertrophy, homocysteine, lipoprotein(a), triglycerides, oxidative stress, and fibrinogen. Ann Intern Med. 1999 Sep 7;131(5):376-86.
- Gonzalez MA, Selwyn AP. Endothelial function, inflammation, and prognosis in cardiovascular disease. Am J Med. 2003 Dec 8;115 Suppl 8A:99S-106S.
The below publication from 2002 was produced from the AACE , the venerable group of brilliant forward-thinking experts which I mentioned earlier (updated recently in 2006 to take into account the Heart Protection Study and other landmark trials).
The first thing that blew me away about these guidelines was the demonstration of the utilization of CT scan scoring is on Table 16 on p.195 for an evaluation of a CAD patient case study (although I believe truly 'normal' is a zero score). Back in 2002 even CT scan results provided value to the AACE as a standard of practice for detecting high risk heart disease and the presence of plaque.
Isn’t that interesting? Back in 2002...
This is why I like the AACE…
Personally, in my opinion the pictures also are fantastic. Please see if you're into the pathogenesis of pro-atherogenic lipoproteins:
- Fig 1, 2, 3 on p.175
- Fig 4 on p.176
- Fig 5 on p.180
The AACE also identified the below Risk Factors for Coronary Artery Disease (Table S-1 on pg.166) which enumerate the same ones listed in the above medical journal articles.
Coronary Risk Factors
High total cholesterol or LDL-C
Small, dense LDL
Type 2 diabetes mellitus
Family history of CAD
Increased levels of Lp(a) lipoprotein
Factors related to blood clotting, including increased levels of fibrinogen and PAI-1
Certain markers of inflammation, including C-reactive protein
And… this is why I really REALLY like the AACE:
- Other risk factors for heart disease were additionally identified -- PCOS, hypothyroidism, SLE/lupus, Cushing's disease, etc (common theme: inflammation, insulin resistance)
- A moderate, lower-carb diet is favored over a typically AHA high-carb diet (on p.196; first 1-2 paragraphs) for a patient with elevated triglyerides (which is 50% of all Americans according to the NHANES data, although I'd predict that would probably be about 70% now)
- Can the AACE top their already prescient anti-atherogenesis guidelines?? Absolutely... A brief cost-benefit analysis (on p.196 Fig 6) of the resources conserved when cardiac events, surgeries and hospitalizations are successfully averted with lifestyle/medical/nutritional therapy.
The AACE are surprisingly one of the most progressive group of classic, systemic heart disease and prevention experts (btw they are not Cardiologists – wonder why is that?).
So who... can possibly... trump the AACE??
Strategies for control and reversal of vascular calcifications (HTN, carotid, peripheral, renal, coronary, ED, etc):
|Plaque-Builders||Food/Supp Strategy||Goals For Health|
|Blood pressure||L-Arginine, Vitamin D3, exercise, IBW, weight loss, carb restriction, cocoa extracts, etc||Normalization: BP = 110/70 Pulse 60|
|Vitamin D3 Deficiency||Supplementation of D3 (cholecalciferol in oil gel capsules)||Normalization: 25(OH)D3 = 60 ng/ml|
|Presence of Small LDL||Wheat elimination, carb restriction, Niacin, Vitamin D3, Oat bran, Intermittent Fasting, etc||Small LDL less than 10% (LDL less than 60 mg/dl)|
|Elevated TG||Wheat elimination, increased intake good oils/fats, high dose fish oil, Vitamin D3, Vitamin B3 (niacin), etc||TG << 60 mg/dl|
See above, strength training, carbohydrate restriction, dietary oils/fats, etc
|HDL 60 mg/dl or higher|
|Lipoprotein(a)||Niacin, Vitamin D3, high dose fish oil, Carb restriction, L-carnitine, coQ10, raw nuts, DHEA, Estrogen, Testosterone, adequate good oils/fat, etc|
Normalization: Lp(a) less than 30 mg/dl or large buoyant
|Homocysteine||Vitamins B6, B12, Folic acid, Wheat elimination, Estrogen, etc||Normalization: Homocysteine less than 8.0|
|Fibrinogen||Aspirin, fish oil, raw nuts, carb restriction, exercise, smoking cessation, etc||Normalization|
|Abnl Glucose, Hyperinsulinemia,Type 2 Diabetes, Type 1 Diabetes||Wheat elimination, Carb restriction, Exercise, IBW, Vitamin D3, high dose fish oil, raw nuts, Magnesium, Estrogen, etc||Normalization: Premeal glucose less than 85 mg/dl; Insulin < 4 uIU/L; A1C < 5.0%|
|Metabolic syndrome (including Central Obesity, NAFLD, Cardiac Steatosis, PCOS, Acanthosis Nigricans)||Same As Above||Normalization: ALT, AST < 20-40 (Normal Echo)|
|Estrogen Deficiency||Bio-identical HRT, Vitamin D3, etc||Normalization|
|Testosterone Deficiency||Replacement, Vitamin D3, etc||Normalization|
|Antioxidant Deficiencies||Diet/supplementation of Vitamin K2, C, E, A, D3, etc||Normalization|
|Thyroid Disorder||Replacement, Vitamin D3, Magnesium, Calcium, etc||Normalization: TSH 0.2 - 1.0 mIU/L|
|Oxidative Stress, Inflammation||Above strategies, exercise training, yoga, meditation, Natural Vitamins, improvement of sleep (quantity, quality), mental stress reduction, high dose Vitamin ‘O’, etc||Normalization: CRP less than 3.0|
|Chronic Kidney Disease||BP and glucose normalization, Vitamin D3, high dose fish oil, address Lp(a)/Homocysteine, etc||Normalization: Cr less than 0.8-1.0 Microalbuminuria less than 10- 20 ug/mg|
|Abdominal/Thoracic Aortic Aneurysm, Valvular Disease||All the above, BP normalization, Vitamin D3, etc||Normalization: Prevention of dissection and expansion|
|Other CAD Risk Factors||See above article||Normal|