Doctor’s column: How to prevent a heart attack
Almost all heart attacks can be prevented but unfortunately many aren’t, resulting in unnecessary death and disability. Michael Gerber, M.D., on his very informative website nutritionfacts.org, likens the health care system in America to an overflowing sink, where instead of turning off the faucet (preventing the cause of disease) we spend our time, effort and a lot of money constantly mopping up the floor, with the pharmaceutical, hospital, and stent and bypass industries happily supplying the mops and the paper towels (at a large profit, of course).
People who are on a lifelong plant-based, whole (unprocessed) food, low-fat diet who also exercise regularly don’t have atherosclerosis and therefore are not at risk for a heart attack.
If you have not been on this diet or have not been exercising, and don’t know if you have plaque (atherosclerosis), you should have a carotid IMT, which is an inexpensive, non-invasive test done at GMA (not the carotid doppler done at hospitals, which is much less sensitive). Another option is a coronary calcium score, although this can be misleading if you are a man younger than 40 or a woman younger than 50, due to plaque that hasn’t become calcified yet. If you find that you do have atherosclerosis you are at risk for a heart attack, and here’s what you need to do to prevent one:
• Find a primary care doctor who has expertise in heart attack prevention who will look at your atherosclerosis as a medical disease that can be treated medically rather than as a plumbing problem that needs to be treated with stents or bypass (which have never been shown to prolong life or improve quality of life other than in the setting of an acute heart attack).
• Find a provider who will help you start a plant-based diet and exercise program, which have been shown to stabilize and even reverse atherosclerosis. At least find someone who will discuss this option with you.
• Don’t smoke.
• If you carry extra weight around your middle, insist on a two-hour glucose tolerance test to see if you have insulin resistance (aka prediabetes, the driver of 70 percent of heart disease). If the one-hour blood sugar is less than 125 or the 2-hour less than 120, you do have this condition, and it needs to be treated aggressively.
• Make sure your blood pressure is less than 120/80 (somewhat higher values are sometimes appropriate if you are in your 80s or 90s).
• Make sure your total cholesterol is less than 150 and your LDL (bad cholesterol) less than 70, with 30s to 40s being ideal. Especially if you don’t adopt the above lifestyle modification, a statin is indicated to lower your LDL and to decrease inflammation.
• Obtain a Cleveland Heart Lab inflammatory panel, because inflammation plays an important role in causing atherosclerosis, and of plaque rupture, the event that causes heart attacks. Elevated MPO or LpPLA2 means inflammation of the endothelial lining of your arteries, and needs to be treated aggressively.
• Have an advanced lipid panel done including an LDL particle number (Apo B is an equivalent test), which is much more accurate than the LDL level, and which also checks for particle size, small LDL particle size being more worrisome. An Lp(a), a particularly nasty type of LDL particle, should also be included because Lp(a) is responsible for a substantial percentage of heart disease.
• If you have atherosclerosis, take an 81 mg of aspirin daily, which will help prevent a blood clot from forming should you have plaque that ruptures.
• Consider taking Ramipril, a medication usually used to treat blood pressure that has been shown to stabilize plaque.
• Maintain good dental hygiene including brushing after meals, flossing and using a water pick. See your dentist for regularly cleaning, and on an urgent basis if any sign of gum disease or a tooth problem (dental disease is an important cause of inflammation that can lead to plaque rupture).
• If you snore, get checked for sleep apnea, and have it treated if you do have it (just losing weight and avoiding alcohol often helps).
• Get seven to eight hours of sleep a night.
• Consider a class in meditation or mindfulness to reduce stress, anxiety and depression.
• Read “Beat the Heart Attack Gene” by Brad Bale, M.D. and Amy Doneen.
• Read “Prevent and Reverse Heart Disease,” by Caldwell Esselstyn, M.D. or “My Beef with Meat” by Rip Esselstyn.
• Have your carotid IMT repeated in a year, to assess effectiveness of your treatment.
Dr. Feinsinger is a retired family physician who is available for free consultations about heart attack prevention, plant based nutrition, and other health issues. Call 379-5718 for an appointment.
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