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Track Your Plaque is the revolutionary approach
that shows you how heart scans and the latest medical and natural
treatments can be combined to create the most powerful heart attack
prevention program available!
In this issue:
Another Track Your Plaque
success story!
John was truly terrified by the results of his heart scan.
A nervous personality to begin with, John dealt with much of his anxiety
by smoking—up to a pack and a half a day in his younger years, but still
a pack a day at age 55.
John’s mother survived a heart attack in her 60s only to die during
bypass surgery. But the event that triggered John’s concern for his own
health occurred when several coworkers at the plant where John worked
died or underwent major heart procedures over a period of just a few
weeks.
So John got a heart scan. His score: 479. The report said this was a
severe quantity of plaque and that he should talk to his doctor right
away. John’s call was followed by a prescription for a statin
cholesterol drug (Vytorin®) and a stress test. John passed the stress
test, though the doctor said that he was more breathless than he should
have been, likely due to emphysema from smoking.
Terrified and confused, John came to us for some further answers. We
started out by urging John to quit smoking. Although he’d given it
thought, he hadn’t been certain just how important smoking was since
he’d passed his stress test. We stressed to John that, if he continued
smoking, success was virtually impossible. Plaque growth would continue
relentlessly at a rate greater than that seen in non-smokers. Smoking
would ensure failure: heart attack, bypass surgery or other major
procedures.
This was all John had to hear. Within days, he managed to “cold turkey”
his way to being a non-smoker.
We then measured John’s lipoprotein patterns. Despite his very slender
build (5 ft 6 inches, 151 lbs), he had a very severe small LDL pattern
(85% of all LDL particles were abnormally small) and an excess of
dietary fats in the blood after eating (excess intermediate-density
lipoprotein, IDL).
John was advised to add fish oil, 6000 mg per day (a higher dose for the
IDL abnormality), along with niacin, increased over four weeks to 1000
mg.
After a year, John was unable to wait any longer to find out whether
he’d succeeded or not. We gave him the go-ahead for another heart scan.
His score: 323—a reduction of 32%.
John could barely contain his excitement. “You know. Until I saw my
score drop, I was actually considering whether stopping smoking was
worth it. But seeing my score drop that much makes me feel real good
about what I’ve done. I’m going to stick to it.”
What better story of success could there be?.
When should you get another heart scan?
You’ve made substantial changes in your lifestyle patterns, added
fish oil, vitamin D, magnesium, etc. Have you succeeded in stopping
plaque growth? Has it been reversed?
There’s only one way to find out: Get another heart scan!
After 14 months of effort, Gary’s HDL cholesterol seemed “locked” at 52
mg/dl, a few points below the Track Your Plaque target of ≥60 mg/dl.
Gary had begun the program with a heart scan score of 224.
He weighed in 14 lbs. lighter by extending his exercise sessions, doing
his own yard work, and slashing his intake of processed carbohydrates.
He was taking fish oil, 6000 (higher dose because of a high starting
triglyceride level) and niacin, 1000 mg (Slo-Niacin®). Gary’s HDL at the
start of the program was 37 mg and was accompanied by several other
abnormal lipoprotein patterns, most notably small LDL.
We suggested that he try adding 4–6 oz of red wine per day, shed a few
more pounds (since much of the 20 lbs or so of remaining excess weight
was clearly in his abdomen, the sort that can depress HDL), and add 1
tsp of cinnamon to his breakfast choices.
Two more months and Gary’s HDL was still stuck at 52 mg. Gary was
clearly getting a little frustrated. After all, he had really put a lot
of time and effort into his lifestyle changes.
All other measures had been corrected, including an elevated C-reactive
protein, blood pressure, and his LDL cholesterol. We advised Gary to
consider another heart scan.
Gary’s score: 231, a mere 7 points above his starting level, essentially
unchanged, given the expected rate of increase of 30% without these
efforts. (This would have put Gary’s score at 291—60 points higher.)
When is the right time to get another heart scan?
When is it a good time to consider another heart scan score? We believe
there are several factors to consider:
- How long has it been since your previous scan? In general,
it’s unusual to benefit from having a scan at an interval of less than
one year. We’ve found that one year is a period of time that allows you
to make whatever changes are necessary based on lipid/lipoprotein
patterns, yet provide meaningful feedback. Most people do not succeed in
correcting all the causes of their plaque for at least six months and
often up to a year or more. Wait much more than a year and you tend to
lose momentum. Most people, being human, find it hard to adhere
long-term to multiple treatment efforts unless they know whether or not
they’re working. A year has worked best in our experience.
- Is your treatment program adequate? In most situations,
another scan provides valuable feedback that is very likely to trigger a
number of changes. For instance, if your score increased 18% in a year’s
time, you’ll want to make a number of important modifications to further
slow plaque growth. But if your score decreased 6%, no further
intensification is required. If your score dropped 35%, hallelujah!
Maybe you even have the luxury of backing off on some of your efforts.
- Has there been a significant change in your health? Say
you’re just starting out with your score of 425. You and your doctor
work together to correct several lipid/lipoprotein abnormalities
following Track Your Plaque principles. Then, you break your leg
downhill skiing. You’re confined to bed, then weighed down by a cast for
many weeks. The result: a pause in your program, a change in nutrition
and exercise for up to several months. When you’re back on two feet, you
resume your program. But then your mother falls ill and you’ve got to
travel several hundred miles to help her recover. . . You get the idea.
Sometimes, life gets in the way of your best efforts. This might be the
occasional extraordinary situation where a repeat scan might be a good
place to resume, so that you really know what your starting point is.
Cholesterol values, blood pressure, the presence or absence of symptoms,
stress testing—none of these can serve as a precise tool to gauge
progress. Never before have we had access to a tool like heart scanning
that tracks the growth or reduction of coronary plaque so easily,
safely, and inexpensively.
Can carotid plaque be reversed?
Rose, a 64-year old woman, just had a 70% carotid blockage identified by
a screening ultrasound. When the result was given to her doctor, he
prescribed Lipitor® and advised Rose that an ultrasound would be
required in another year. She would need carotid surgery, an "endarterectomy",
if the blockage worsened.
"Can't I reduce the amount of blockage I have?" asked Rose.
"No. Once you've got it, it doesn't get any better."
Is this true? Once you've got carotid plaque, you can only expect it to
get worse and it can't be reduced?
This is absolutely not true. In fact, in our experience, compared to
coronary plaque, carotid plaque is easier to reduce!
Experience elsewhere has demonstrated that carotid plaque is reversible.
In clinical trials, numerous agents have been shown to reduce carotid
plaque: statin drugs, niacin, fish oil, the anti-diabetic "TZD" drugs (Actos®,
Avandia®), several anti-hypertensive drugs, vitamin E, pomegranate
juice, and several others.
All of these published trials were designed to test the effectiveness of
a single agent, occasionally two, on carotid plaque compared to placebo.
All showed regression of carotid plaque of a few percentage points.
Unfortunately, there’s no trial that has set out from the beginning to
achieve carotid plaque regression using an array of strategies. Most of
these trials, for instance, did not include correction of hidden causes
of atherosclerotic plaque, nor did they include rational changes in
diet, exercise, etc. In other words, despite limited therapies, carotid
plaque still regressed.
Of course, the Track Your Plaque program is designed to help you control
or reduce coronary plaque. But, in our experience, people who have both
coronary and carotid plaque will show greater and faster reduction of
carotid plaque. Dramatic reductions are sometimes seen. We’ve witnessed
many 50-70% blockages reduced to <30%.*
The requirements to achieve reduction of carotid plaque are very similar
to the approach we use to reduce coronary plaque. One difference is that
hypertension may play a more important role with carotid plaque and
needs to be reduced confidently to the normal range (<130/70) before
carotid plaque is controlled.
The carotid arteries (left and right) are easily imaged using
ultrasound. (Large heart structures can be seen with ultrasound, but not
the coronary arteries.) In fact, carotid arteries are more easily imaged
than the coronary arteries: they don’t move, they’re near the surface of
the body, and they’re three times bigger. Using high-frequency sound,
clear images are available for most people.
One drawback to carotid ultrasound: it is a non-quantitative test. It is
a qualitative test. In other words, you may find out that there's a 30%
blockage ("stenosis"), at the far end of the common carotid artery on
the right side. Unfortunately, this gives you an isolated measure of
diameter of the plaque compared to the artery. What it does not tell you
is what the volume of the entire plaque is. That's a far more accurate
measure (and one that is incorporated into your heart scan score, by the
way). The figures quoted, e.g., 30% blockage, are also estimates, not
precise measurements. Many times, the percent blockage is derived from
blood flow velocities, a crude method of measuring plaque.
Despite its shortcomings, carotid ultrasound is easy, very safe, and
available in most hospitals and many clinics. Be aware that most
insurance companies will not allow you to go through a carotid
ultrasound scan as a "screening" procedure, i.e., a test just to see if
you have a carotid plaque. They will generally pay if you're having
symptoms of a stroke or "mini-stroke" (transient ischemic attack, or "TIA"),
have an abnormal sound in your carotid ultrasound detected by your
doctor with a stethoscope (a carotid "bruit"), or some other unusual
indications. Sometimes, a resourceful physician will muster up a
diagnosis based on something in your history (e.g., left arm numbness, a
common and often benign complaint that can also signal stroke).
Another option are the mobile scanners or some hospital services that
offer carotid screening, usually for a very modest out-of-pocket cost
(usually $100–200).
Don't accept flip dismissals or an over-enthusiastic referral for
carotid procedures. Insist on a conversation about plaque regression. If
you don’t get it, get another opinion. But even if you get a lukewarm
endorsement of the idea of reversing carotid plaque, rest assured that
your efforts to achieve reversal of coronary plaque, like that in the
Track Your Plaque program, will in most cases control carotid plaque, as
well.
* Although we are vigorous advocates of atherosclerotic plaque
regression, if you have a severe (≥70%) blockage or greater, or if there
are symptoms from your carotid disease, then you may at near-term risk
for stroke. You should seriously consider the advice of your doctor in
this situation..
Coming Soon to the
Track Your
Plaque Member Website
An update on homocysteine
Hundreds of studies have demonstrated that elevated homocysteine blood
levels are associated with increased risk of heart attack, stroke, and
aneurysms. Yet two recent trials comparing treatment of homocysteine to
placebo showed no benefits.
What should you believe? Is it time to discard the whole idea?
Should you consider testosterone?
In men, testosterone improves mood, increases physical energy, increases
muscle mass, and helps shed excess fat. It can also be an important
treatment for lipid and lipoprotein patterns.
Here's our guide to how and why you might consider testosterone for your
program.
Using fibers to accelerate weight loss
Choose one fiber and it makes your bowels regular. Choose other fibers
and you can reduce LDL cholesterol, reduce blood sugar, improve the
glycemic index of other foods, increase satiety—and lose weight.
Know which fibers are the right ones that provide benefits beyond bowel
health.
Copyright 2006, Track Your Plaque
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