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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!
Stress made him do it!
Ralph is lead engineer for an enormous highway reconstruction process
that posed considerable design challenges. It also landed him in the
center of a hot political controversy. One moment he’d field calls from
on-site engineers and contractors, and the next he’d be answering tough
questions from politicians, environmental groups, and concerned
citizens. Sometimes, the stress was almost unbearable.
With a project that was expected to last five years, Ralph really
started to worry about the effects of stress on his heart while living
through the maelstrom of controversy. Ralph’s family’s history also gave
him cause to worry: his father died without warning at age 43 of a heart
attack; his brother died the same way at age 49. Ralph was sure he was
walking a tightrope and that stress could topple him over anytime. His
only reassurance was that his mother was still alive and well at age 80.
We advised Ralph to get a CT heart scan. His score: 74—at age 54, this
placed him in the 53rd percentile compared to other men his age (heart
attack risk 2% per year)—not enough to pose a near-term danger and
probably very different from the scores his dad and brother might have
had at a similar age. However, all the plaque in Ralph’s coronary
arteries was located in the left main stem artery, the shared trunk of
two coronaries, the left anterior descending (LAD) and circumflex.
Though Ralph’s score was not impressively high, its location elevated it
to greater significance: heart attack originating from this location is
immediately fatal.
Through the Track Your Plaque approach, we identified the following
abnormalities that caused Ralph’s left main stem atherosclerotic plaque:
• HDL cholesterol 34 mg/dl (TYP target ≤60 mg/dl)
• Small LDL particles (TYP target <10% of total LDL)
• Triglycerides 123 mg/dl (TYP target ≤60 mg/dl)
• Excess VLDL (TYP target: 0 mg/dl)
• Vitamin D 23 ng/ml (TYP target >50 ng/ml)
Ralph also showed high blood pressure of 150/102 and borderline elevated
blood sugar of 108 mg/dl, consistent with features of the “metabolic
syndrome”, or pre-diabetes (even though Ralph didn’t meet the
conventional criterion of waist size of ≥50 inches).
With the new-found knowledge of his heart disease risk, Ralph felt
empowered and motivated to tackle his plaque. By converting to the Track
Your Plaque nutrition program (eliminating chips, breakfast cereals, and
minimizing snacks; using foods that help correct lipid and lipoprotein
patterns, etc.), along with a walking program six days a week, Ralph
dropped 30 lbs in weight over 18 months. Along with treatments to fully
correct his abnormal lipid/lipoprotein patterns, another heart scan
yielded a score of 69—a modest reduction from his original 74.
Ralph did it: Seized hold of a potentially life-threatening disease and
conquered it. Not only did Ralph reduce the amount of plaque in the
crucial left main stem artery, he acquired new piece of mind. Now, if
building a new highway was as easy!
When a heart scan is MORE than just a heart scan
CT heart scans provide exquisitely detailed images of
the coronary arteries. But there’s other information provided by images
of the chest that can yield insights into long-term health. Here’s a
list of a few common issues that arise.
Hiatal hernia
Heart scans provide images of the chest. However, if
the stomach—ordinarily in the abdominal cavity below the
diaphragm—migrates up into the chest, you can actually see the stomach
in the chest. If someone had a heart scan after breakfast or lunch,
you’ll even see their meal in the stomach nestled within the chest!
Hiatal hernias can vary in size from small to large. Though not
generally dangerous, they can be a substantial source of chest
discomfort (sometimes doing an awfully good imitation of a heart
attack), indigestion, gastresophageal reflux (stomach acid regurgitating
up into the esophagus), and other digestive problems. Though it presents
no real implications for your heart disease prevention program, if a
hiatal hernia is identified on your heart scan, it should be discussed
with your doctor, since it may be responsible for symptoms and digestive
disorders.
Enlarged Aorta
If the aorta measures more than 4.0 cm in diameter,
your heart scan report may contain a comment about “aortic enlargement”.
The aorta is the major artery of the body emerging from the top of the
heart and branches into all other arteries of the body like the carotid
arteries, the arteries to the arms and legs, abdominal organs, etc.
Heart scans show the aorta emerging upward from the heart (ascending
aorta) and the portion that curves and heads downward through the chest
towards the abdomen (descending thoracic aorta). If high blood pressure
is present for several years, the aorta may enlarge. A diameter >4.0 cm
suggests that forces causing it to enlarge have been at work for many
years.
Other causes of an enlarged aorta are factors that weaken the lining of
its wall and make plaque grow, just like the plaque in your coronary
arteries. These include high cholesterol, inflammation, lipoprotein(a),
and homocysteine. Occasionally, the aorta may enlarge due to inherited
disorders that weaken structural tissues of arteries (e.g., Marfan’s
syndrome).
Two consequences can arise from an enlarged aorta: aneurysm and stroke.
If the aorta reaches a diameter of ≥4.5 cm, it’s classified as an
aneurysm. Surgical replacement is often recommended when the aorta
reaches 5.5 cm, since the likelihood of rupture increases dramatically
at this diameter. Aortic enlargement is usually, though not always, is
accompanied by aortic plaque that increases stroke risk (see below).
Should your heart scan report mention an enlarged aorta, discuss this
with your doctor and ask how you can prevent it from getting any larger
and how risk of stroke can be reduced.
Aortic calcium
If calcium is seen in the aorta, your heart scan report
may contain a comment about “aortic calcification “ that can be mild,
moderate, or severe.
Just as calcium in the coronary arteries represents atherosclerotic
plaque, the same holds true in the aorta. Calcium, and therefore plaque,
often but not always occurs with aortic enlargement. Plaque in the aorta
has a tendency to rupture, though it doesn’t cause heart attack when
this happens, but causes stroke and “mini-stroke”: little bits of debris
or blood clot break free and travel “upstream”, usually to one of the
small arteries of the brain.
The steps you follow to control coronary plaque and heart attack risk
also reduce risk for stroke from aortic plaque. You should discuss how
aortic plaque impacts on your prevention program with your doctor. Many
authorities suggest that calcified plaque in the aorta trigger
prevention efforts just like calcified plaque in coronary arteries, and
that lipid treatment should be intensified to prevent further plaque
growth and diminish risk for stroke.
Aortic valve calcium
Controlling the flow of blood ejected from the heart
and into the aorta is an ingenious piece of natural engineering called
the aortic valve. Just like any valve in the plumbing of our home or
car, the aortic valve serves a similar function: to allow the flow of
blood in one direction and prevent it from flowing backward into the
heart. Viewed end-on, the aortic valve looks like a pie cut in three
pieces. The three slices, or leaflets, are anchored to the aorta,
allowing each leaflet to open and close with each beat of the heart.
The aortic valve is subject to wear and tear, just like brake pads in
your car and cartilage in your knees. As plaque material accumulates
along the aortic valve leaflets, they become stiff. Aortic valve calcium
seen on a CT heart scan may be described as mild, moderate, or severe.
Moderate and severe levels may lead to a need for echocardiography, an
easy ultrasound-based test that can precisely quantify severity of valve
dysfunction.
It’s been recently appreciated that the factors that create plaque in
coronaries and aorta may contribute to calcification of the aortic
valve, as well. (Please note that aortic valve calcium is distinct from
aortic calcium.) It is presently unclear, however, whether correction of
causes of coronary plaque also helps reduce aortic valve calcium.
Mitral valve calcium
There are two varieties here: calcification of the
mitral valve itself and calcification of the “frame” of the mitral
valve, often called the “annulus”. Your heart scan report may read
either “calcification of the mitral valve”, “mitral annular
calcification”, or both.
Mitral valve calcium is uncommon nowadays, though in the early 1900s it
was very common (though not uncovered by CT heart scans!) as a result of
childhood rheumatic fever which inflamed the valve, causing it to
stiffen and accumulate calcium over many years. If you have mitral valve
calcium, your doctor will likely order an echocardiogram to determine
how stiff or leaky the valve has become.
Calcium on the mitral valve annulus is an entirely different story. It
is a common and generally harmless abnormality that rarely interferes
with valve function. Many people in their 70s and 80s develop annular
calcium without consequence. Some physicians feel that annular
calcification increases risk of valve infection whenever germs enter the
bloodstream, e.g., during dental work. This is rare but should be
discussed with your doctor. Beyond this, mitral annular calcium is a
generally benign phenomenon.
Lipids are snapshots in time; heart scans are
cumulative
(Reprinted from The Heart Scan Blog. The full Blog
content is accessible at
heartscanblog.blogspot.com.)
Let’s paint a picture. It's fictional, though a very real portrait of
how things truly happen in life.
Michael is an unsuspecting 40-year old man. He has not undergone any
testing: no heart scan, no lipids, no lipoproteins. But we have x-ray
vision, and we can see what's going on inside of him. (We can't, of
course, but we're just pretending.) Average build, average lifestyle
habits, nothing extraordinary about him. His lipids/lipoproteins at age
40:
• LDL cholesterol 150 mg/dl
• HDL cholesterol 38 mg/dl
• Triglycerides 160 mg/dl
• Small LDL 70% of all LDL
With this panel at age 40, Michael’s heart scan score is 100. That's
high for a 40-year old male.
Fast forward 10 years. Michael is now 50 years old. He prides himself on
the fact that, over the past 10 years, he's felt fine, hasn't gained a
single pound, and remains as active at 50 as he did in 40. In other
words, nothing has changed except that he's 10 years older. His lipids
and lipoproteins now show:
• LDL cholesterol 150 mg/dl
• HDL cholesterol 38 mg/dl
• Triglycerides 160 mg/dl
• Small LDL 70% of all LDL
Lipids and lipoproteins are, therefore, unchanged. (Some of you might
correctly point out that simple aging causes some deterioration in
lipids and lipoproteins, but we're going to ignore these relatively
modest issues for now.) Michael's heart scan score: 1380, or an
approximate 30% annual increase in score. Since Michael didn't know
about his score, he took no corrective/preventive action.
The point: If we were to make our judgment about Michael's heart disease
risk by looking at lipids or lipoproteins, they wouldn't tell us where
he stood with regards to heart disease risk. His lipids and lipoproteins
were, in fact, the same at age 50 as they were at age 40. That's because
measures of risk like this are snapshots in time.
In contrast, the heart scan score reflects the cumulative effects of
life and lipids/lipoproteins up until the day you got your scan.
Which measure do you think is a better gauge of heart attack risk?
Interested in becoming a Track Your Plaque Member?
If you’re interested in finding out more about becoming
a Member of Track Your Plaque, go to
www.trackyourplaque.com. See why more and more people are finding
out that there are alternatives to the conventional answers for heart
disease.
. .
Coming Soon to the
Track Your
Plaque Member Website
DHEA: What role in your program?
The arguments for and against DHEA replacement have zig-zagged from
fountain of youth to dangerous. Here, we cut through the hype and hone
in on the issues important to your plaque-control program.
New Track Your Plaque Apprentice
Let us introduce you to Dave, our 2nd Track Your Plaque Apprentice. The
Track Your Plaque Apprentice provides Members with an opportunity to
follow a real individual along the program from the start—their starting
heart scan score, how lipids and lipoproteins are used, how the
nutritional program unfolds, along with all the ups and downs of a
real-life person. Dave is also the first Apprentice to chronicle his
progress on his Blog, a frank and real log of his day-to-day progress in
the Track Your Plaque program.
Online Chat
Also, watch for an upcoming Track Your Plaque on-line live Chat with
cardiologist, Dr. William Davis, coming in September. Time to be
announced.
.
Copyright 2006, Track Your Plaque
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