February is heart month. Almost all heart attacks are preventable, but in spite of that, in non-COVID-19 years they are the No. 1 cause of death in the U.S.

Heart attacks are caused by atherosclerosis (hardening of the arteries, also known as plaque). Last week’s column discussed the importance of screening for atherosclerosis, ideally starting at age 40 — age 30 if you have risk factors. The two studies most often used to assess arterial health — carotid IMT and coronary calcium scoring — were discussed, along with the pros and cons of each.

If you take advantage of the IMT special Compass Peak Imaging in Glenwood is offering during February, and find you have atherosclerosis on the basis of thickened endothelium — which lines your arteries — and/or plaque, you and your physician first need to determine why you developed it. Atherosclerosis is not inevitable as we age — there are groups of people in the world such as the Blue Zones whose arteries are as healthy at 90 as they are at 19, making these people heart attack-proof. What these societies have in common is that they eat primarily plant-based, unrefined foods; and they engage in frequent, low-level physical activity.

Following are measures you can take that can prevent, treat, and even reverse atherosclerosis:

DIET: Adopt a plant-based, whole food diet with no salt, sugar or added oil. Dr. Dean Ornish proved over 30 years ago that atherosclerosis can be reversed with this diet. Dr. Caldwell Esselstyn confirmed this subsequently — read his book, “Prevent and Reverse Heart Disease.”

EXERCISE: The Ornish program — which has been approved by Medicare and many insurance companies — includes regular aerobic exercise. If you’re sedentary, ease into a program of exercise such as walking for at least 30 minutes a day. If you have cardiac risk factors and/or severe atherosclerosis, talk to your provider to see if they recommend a stress test before starting vigorous exercise.

STRESS REDUCTION is also included in the Ornish program. Consider yoga or meditation. If you suffer from depression, anxiety or sleep problems, seek treatment.

BLOOD PRESSURE should be less than 120/80. For mild hypertension, weight loss, salt avoidance and exercise can help, but do whatever it takes to control it, including medication if necessary.

CHOLESTEROL: The aforementioned populations in the world who are heart attack proof have total cholesterols < 150, LDL (bad cholesterol) in the 30s and 40s, and triglycerides < 70. Plant-based, whole food nutrition lowers cholesterol, but if it doesn’t lower it enough, consider medication. In their book “Beat the Heart Attack Gene,” Bale and Doneen recommend a statin for anyone with plaque, no matter what their cholesterol is, due to the anti-inflammatory effect.

WEIGHT: Attain and maintain ideal body weight. If you look at your profile in the mirror and have even a small “belly,” lose it, because that almost always means you have insulin resistance (pre-diabetes), which leads to diabetes and cardiovascular disease. High triglycerides and low HDL (good cholesterol) are an indication of insulin resistance. Fasting blood sugar above the low 90s, and/or A1C above 5.6 (a measure of average blood sugar levels the previous three months) are also indicators of insulin resistance.

SLEEP APNEA: Anyone who has atherosclerosis should have an overnight oximetry to screen for sleep apnea. This inexpensive test involves wearing a monitor on your finger all night, that records oxygen level and pulse rate.

TOBACCO should be avoided in any form, including second hand smoke.

INFLAMMATION from conditions such as rheumatoid arthritis, ulcerative colitis and dental problems plays a large role in development of plaque, and in plaque rupture — the event that blocks a coronary artery resulting in a heart attack. Practice good dental hygiene, and if you have tooth or gum problems, see a dentist well-versed in the mouth-vascular connection.

Next week’s column will be about cholesterol.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment or email gfeinsinger@comcast.net.