Health Column: Smart testing for heart health
Free Press Health Columnist
It’s always shocking when a person’s (usually male aged, 50-69) first symptom of heart disease is a fatal heart attack.
It was 150,000 Americans that befell this fate in 2001 and it has been rising steadily. Often these are men who are tracking their cholesterol, eating moderately well, on statin medications or even exercising extensively. The usual screening tools include total, HDL and LDL cholesterol levels, triglycerides and possibly the systemic inflammation indicators of a high sensitivity C-Reactive Protein (HS-CRP) or a homocysteine.
These are logical tests that unfortunately have not been accurate predictors for someone’s risk of a cardiac event. Remember that heart disease is still the leading cause of death in the U.S. for both adult men and women, more than all cancers combined. Many factors (some modifiable and some not) contribute to this process, but the worst appear to be poor diet, limited or excessive exercise, poor stress management skills, recent surgery, sleep apnea and chronic dental issues. Secondary factors appears to be conventional cigarette smoking, obesity, diabetes, hypertension, menopause and hormone replacement therapy. Most of these problems have to do with the promotion of chronic inflammation in the blood vessels.
Looking first at HDL, LDL, total cholesterol and HS-CRP levels, three studies uncover how poorly these blood tests correlate with a myocardial infarction (MI). First, a 2009 study in the American Heart Journal of 103,632 people with active heart disease revealed that 77 percent of individuals had an LDL less than 130 (often called “bad” cholesterol) and 45 percent had an HDL greater than 40 (often called “good” cholesterol). Those HDL and LDL levels are supposedly “ideal.”
Next, the 2008 New England Journal of Medicine MESA (Multi-Ethnic Study of Atherosclerosis) showed that the HS-CRP was the same among those who subsequently experienced myocardial infarctions as those who did not. As far as the other common studies, the cardiac stress test only appears positive at more than 70 percent of blood vessel blockage. Further, nuclear stress tests are normal in more than 80 percent of patients with advanced Coronary Artery Disease (CAD).
Finally, it is estimated by Bill Blanchette, M.D., a progressive internist in Boulder, that “86 percent of [myocardial infarctions] this year will occur in vessels that would be considered normal by stress testing or ‘non-obstructive’ by [cardiac] angiogram,” another common study. Simply put, these often-utilized tests demonstrate limited predictive value for heart disease and potentially demonize the cholesterol not only made in the body but needed by every cell membrane.
To this end, a 1991 Journal of the American Medical Association article suggested that if all of the adults in the U.S. were to go on a cholesterol-lowering diet for the rest of their lives, life expectancy would increase by only three months for women and four months for men.
HOW TO ACCURATELY PREDICT A HEART ATTACK
Currently the best indicator is the amount of calcium that has built up in the arteries, known as a calcium arterial score (CAC). It appears that this deposition is in response to vessel inflammation from which the body is seeking to heal; much like it would lay down calcium in reaction to a bone injury. The first step to revealing any calcium deposition is a carotid artery ultrasound.
Although this is a good screening tool, the risk is more clearly demonstrated when combined with Electron Beam Tomography (EBT). The EBT is like a CT scan of the heart arteries with the same radiation exposure as a mammogram. Although the regular 64-slice CT scan gives just as good information as the EBT, the degree of radiation exposure does not make this a practically repeatable exam.
Back in 2003, the American Journal of Radiology a study that directly correlated calcium deposition (or removal, in some cases) shown by EBTs with risk of cardiac events. In other words the more calcium present, the greater a risk of a myocardial infarction. The less calcium present, the smaller the risk. Most concerning, when the CAC progresses at a rate of 15 percent or greater yearly, it comes with a massive 17.2 fold increase risk of a myocardial infarction. This is clearly a very good risk indicator. Curiously, a mammogram itself will sometimes show the calcium deposition via the arteries displayed in the breast tissue.
Most heart attacks are the result of 30 or more years of a slowly progressive disease process. Because the first sign is irritation and injury to the (coronary) arterial wall, it’s a smart idea to begin with testing that tells you exactly how much inflammation is present. For men over 40 and women over 50, I recommend a carotid ultrasound and ideally, an EBT to get that important calcium score.
Christopher Lepisto, a GJ Free Press health columnist, graduated as a naturopathic doctor (N.D.) from Bastyr University in Seattle, Wash. He is a native of Grand Junction and opened his practice here in 2004. Previously, Lepisto lived and worked in New Zealand, where he developed a special interest in indigenous herbal medicines. For more information, visit http://www.grandjunctionnaturopath.com or call 970-250-4104.
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