DR. ROLLINS: Artery plaque alert – how an ultrasound can detect early warning signs of heart disease
October 31, 2013
About half of the people dying from the leading cause of death do not have the traditional risk factors to alert them. Heart disease is still the number one killer in America today and most people have no idea they are full of artery plaque until it is too late. But you can do better — you can scan for plaque.
HOW PLAQUE HAPPENS
Cholesterol is our friend. It is produced by the liver and is present in every cell membrane in the body. It is precursor to all our sex and adrenal hormones. It is converted by sunshine into vitamin D and aids the metabolism of the fat-soluble vitamins K, A, D and E. It insulates nerve sheaths and helps make up a large part of the brain.
It's normal that cholesterol moves through the body's artery walls. Cholesterol is only a problem when allowed to oxidize and that's when trouble starts. This oxidation triggers two things that ultimately lead to plaque.
First, chemicals are released that recruit white blood cells to "gobble" up the cholesterol. Second, enzymes are released that cause the surrounding tissue to breakdown and allow the cholesterol plaque to spread. The result is an inflamed, "soft," wet and foamy collection of cholesterol that resembles a boil streaking within the artery wall.
The idea that cholesterol slowly clogs the artery until it is completely blocked is somewhat misleading. Typically, an artery needs to be about 70-80% plugged in order to slow blood flow enough to give some warning symptoms, such as shortness of breath or chest pain with exertion.
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In fact, this is the exception.
As a rule, the inflamed cholesterol plaque that lies within the artery wall usually ruptures or "pops" long before the artery has narrowed enough to cause symptoms. Before clogging the artery, even 50% inflamed plaque tends to rupture and release the contents of the plaque into the bloodstream causing a complete and fairly immediate 100% blockage of the artery. This is why most people have no idea they have plaque until their first heart attack alerts them!
Over time, if left alone, calcium will accumulate around soft plaque as a response to the inflammation leading to "calcified" arteries. Soft plaque is active and when measures are taken to stop the process it settles down and becomes a hard residue, called "hard" plaque. Hard plaque is stable — it's not what kills. The calcium is not what kills. The soft plaque is what kills.
SCAN FOR PLAQUE
The standard major risk factors for heart disease include high "bad" LDL cholesterol, low "good" HDL cholesterol, high blood pressure, smoking and a family history of heart disease. Being male over age 45 and female over age 55 is another risk factor. The more risk factors you have, the higher your risk, but let me repeat, about half the people with heart disease have none or only one of these risk factors to alert them to danger.
So how do you really know if you are safe from artery disease or not? Simply look for plaque. The easiest way to do that is to look directly at one of the major arteries where plaque builds up, the carotid artery in the neck. And the best way to look for plaque in the carotid arteries is by using ultrasound technology.
Ultrasounds emit a harmless sound wave that will echo back to produce a very accurate picture of structures hidden below the surface. The ultrasound can "see" if any cholesterol plaque is present in the artery and more. It can also determine the characteristic of the plaque. Soft plaque is more dangerous because it is prone to rupture and cause a heart attack or stroke. Hard plaque is more stable, more mineralized/calcified, and much less likely to rupture.
The ultrasound can also measure the thickness of the artery wall. A thick artery wall means there is more plaque within the wall. This is called the "carotid intima media thickness" or CIMT and is shown in millimeters (mm). A CIMT of less than 0.6mm is considered healthy. You can determine your "arterial age" by comparing your CIMT to that of the general population.
We use a company called Vasolabs to do our carotid scans, for a few reasons. Most screening outfits, such as "Life-Screening," only measure if any plaque is present, with no analysis of plaque characteristics or CIMT. Hospitals simply don't do screening exams in asymptomatic people.
WHAT TO DO
First step… get scanned. If you are over 40, get scanned. If you have a scary family history with early heart disease or stroke, get scanned at any age. If you have no risk factors, so what, get scanned. If you have lots of risk factors, get scanned. If you know you have plaque, get scanned. Once you have the information, you now have a baseline to work from.
If you have no plaque, congratulations, scan again in a few years. If you do have plaque, then figure out why and stop it. First, address any obvious lifestyle factors. Eat a healthy diet rich in plant-based nutrients and low in sugar, low in fat, and low in red meat. Get regular exercise. Allow for plenty of restful sleep and manage your stress. If you smoke, quit. If you need help with any of these issues then consider a consult with a health coach to make it happen.
Second, get advanced blood testing to take a much broader and deeper look at all the known risk factors for plaque. Not just cholesterol, but sub-fractions of cholesterol, inflammatory markers, hormones, vitamins and more. There are about 20 items in the advanced risk profile that I like to run.
We offer carotid ultrasound scans at the IMC for $225. There are no special preparations and it only takes about 30 minutes. Call 970-245-6911 if you would like to schedule. If you find plaque then you can repeat scan every few months and watch your efforts reduce the plaque until it is either gone or stable. In this way, the scan could save your life.
Scott Rollins, M.D., is board certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call 970-245-6911 for appointments or more information.