Feinsinger column: February is heart month — find out if you and your loved ones have healthy arteries
Doctor's Tip

Valentine’s Day is coming up; February is officially American Heart Month. Once again, Compass Peak Imaging in Glenwood is offering a special price during February for carotid IMT heart disease screening–a special, FDA-approved ultrasound study that assesses artery health. People can call 970-665-2194 to schedule this test, without a referral.
Heart attacks are the number one cause of death in American men and women year after year, in spite of being preventable. Here’s what Christiaan Barnard—the South African heart surgeon who performed the first heart transplant—had to say about heart attack prevention: “I have saved the lives of 150 people by heart transplants. If I had focused on preventive medicine earlier, I might have saved 150 million.”
Unfortunately, medical training and practice in the U.S. are geared towards managing chronic diseases such as heart disease with pills and procedures, instead of preventing them. Heart disease is looked at as a plumbing problem, with blockages that need to be fixed with stents and bypass procedures, rather than as a medical disease (atherosclerosis—a.k.a. hardening of the arteries) that can be prevented, treated, and reversed through simple lifestyle changes and, when necessary, non-invasive medical therapy. About 50 percent of men and 70 percent of women who die suddenly from heart disease had no prior symptoms, making screening for diseased arteries imperative.
Risk factors for atherosclerosis/heart attacks include the following: smoking; blood pressure above 120/80; high total cholesterol, low good cholesterol (HDL), high bad cholesterol (LDL), high triglycerides; obesity, particularly around the waistline; pre-diabetes and diabetes; sleep apnea; inflammation; sedentary lifestyle; stress including depression and anxiety; inadequate sleep; the standard American diet; age (men over 40, women over 50); family history of cardiovascular disease; gout; autoimmune disease; erectile dysfunction; and migraine headaches. Some doctors use risk calculators based on these risk factors, but as respected heart attack prevention experts Bale and Doneen point out in their 2022 book “Healthy Heart, Healthy Brain,” these risk calculators are dangerously inaccurate.
If arteries are stressed by bad genes; bad habits such as sedentary lifestyle, smoking or unhealthy eating; or by other aforementioned risk factors, the endothelium that lines arteries thickens, and eventually plaque (atherosclerosis) develops. If the plaque ruptures–often triggered by inflammation–a blood clot forms in the artery blocking the blood flow, causing death of part of the heart muscle (or brain in the case of a stroke). A significant number of heart attack victims die suddenly, but of those who make it to the hospital an interventional cardiologist can save lives by opening the blockage with a stent or sometimes surgery that bypasses the blockage. However, stents and bypass procedures don’t treat the underlying disease, and in non-heart attack settings they have not been shown to save lives or improve quality of life.
There are two commonly-used methods of determining arterial health. One is coronary calcium scoring, available at most imaging centers. This is a CT scan of your heart, which shows how much calcium (atherosclerosis) you have in your coronary arteries. It involves a small amount of radiation, and can result in false-negatives because it doesn’t pick up non-calcified plaque, which is the most dangerous kind. Repeat coronary calcium scoring is not useful in determining effectiveness of treatment, because a higher score—a bad thing—can be the result of calcification of dangerous uncalcified plaque—a good thing.
The second method is carotid IMT, which provides a soundwave picture of the carotid arteries, which are located just beneath the skin on both sides of the windpipe, and are therefore easily assessable. IMT measures the thickness of the endothelial lining, and picks up both calcified and uncalcified plaque. If abnormal, IMT should be repeated a year after starting treatment. Appropriate treatment should result in less thickening, a lower plaque burden, and calcification/stabilization of dangerous uncalcified plaque. The downside of IMT is that it looks at the carotid rather than the coronary arteries, but there is a 95 percent correlation between the two—i.e. if you have atherosclerosis in one area you almost certainly have it in arteries throughout your body.
The Bale-Doneen Method is one of the most successful heart attack prevention methods in the U.S. Dr. Doneen recently served on a Society of Atherosclerosis Imaging and Prevention expert committee, which developed guidelines for IMT screening. Bale and Doneen recommend carotid IMT screening on everyone at age 40, and younger if significant risk factors are present. Note that the carotid IMT is much more sensitive than the usual carotid ultrasound done at most imaging centers and by companies such as Lifeline Screening—which just pick up major blockages.
So, it you’re 40 or over, or younger with significant risk factors, be proactive with your health and take advantage of this special carotid IMT screening. Next week’s column will be about what to do if you study is abnormal.
Dr. Greg Feinsinger is a retired family physician who started the non-profit Center For Prevention and Treatment of Disease Through Nutrition. For questions or to schedule a free consultation about nutrition or heart attack prevention contact him at gfeinsinger@comcast.net or 970-379-5718.

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