Doctor’s Tip: What to do if you have plaque in your arteries
February 11, 2019
February is heart month.
In spite of almost all heart attacks being preventable, they remain the number one killer in America. Last week's column discussed the importance of screening for atherosclerosis — the cause of heart attacks and most strokes — ideally starting in your 30s. The two commonly-used screening methods are: (1) carotid IMT, done locally at Glenwood Medical Associates and at Compass Peak Imaging, and (2) coronary calcium scoring, done at most hospitals and imaging centers. The pros and cons of each were discussed.
If you have one of these imaging studies and find you have atherosclerosis, 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 whose arteries remain pristine as they age, making these people heart attack-proof. Here are the factors that often lead to atherosclerosis:
• diet: Dr. Esselstyn, author of "Prevent and Reverse Heart Disease," calls atherosclerosis a "food-borne illness," and notes that essentially everyone on the Standard American Diet (S.A.D.) has it. Doctor Esselstyn, and Dr. Ornish before him, proved that atherosclerosis can be prevented and reversed by a plant-based, whole food diet with no salt, sugar or added oil.
• insulin resistance (aka pre-diabetes): "Beat the Heart Attack Gene" authors Brad Bale, M.D. and Amy Doneen, R.N., PhD, point out that pre-diabetes is the root cause of 70 percent of heart disease in this country. It is common in people who carry extra pounds around the middle, and is often associated with elevated triglycerides and low good cholesterol (HDL). The gold standard for diagnosing insulin resistance is a two-hour glucose tolerance test. Pre-diabetes can be reversed by plant-based nutrition — medications are less effective.
• sleep apnea: Anyone with cardiovascular disease should be screened for this, with a simple overnight oximetry (a gadget is worn on the tip of your finger that records oxygen and pulse rate). If this test is abnormal, a formal sleep study is required. Treatments include weight loss, CPAP, and sometimes, dental appliances.
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• cholesterol: High total cholesterol, high LDL (bad cholesterol), high triglycerides, and/or low HDL all contribute to atherosclerosis. Plant-based nutrition and certain medications lower total cholesterol, LDL and triglycerides. Bale and Doneen, who developed the nationally and internationally recognized Bale-Doneen Method of heart attack prevention, recommend that everyone with atherosclerosis take a statin, no matter what their cholesterol numbers are — in part because of the anti-inflammatory effect.
• hypertension: Normal blood pressure is less than 120/80. Plant-based nutrition with avoidance of salt often resolves high blood pressure, but frequently medications are needed, at least initially.
• smoking, including second-hand smoke: Avoid both.
• inflammation: Inflammation — such as rheumatoid arthritis, ulcerative colitis and dental problems — plays a huge role in the development of atherosclerosis and in plaque rupture, which is the actual cause of heart attacks and most strokes. Practice excellent dental hygiene, and if you have atherosclerosis see a dentist well-versed in the mouth-vascular connection.
• depression, anxiety, stress, sleep problems: Consider mindful meditation and/or yoga. The Dean Ornish, M.D. program, which is covered by Medicare and some insurance plans, includes stress reduction.
• sedentary lifestyle: Exercise at least 30 minutes a day, such as brisk walking, which can be broken up into three 10-minute segments. Move about at least every 30 minutes while watching TV or working at a desk (a stand-up desk is another option).
Next week's column will discuss cholesterol in more depth and will also discuss the importance of advanced blood testing, such as that available through the Cleveland Heart Lab, for eliciting the cause of atherosclerosis and for determining appropriate treatment.
For more information, read the evidence-based book "Beat the Heart Attack Gene," and come to the power point presentation at 6:30 p.m. on February 28th at Compass Peak Imaging.
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and other medical issues. Call 970-379-5718 for an appointment. For questions about his columns, email him at firstname.lastname@example.org.
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