February is heart month. Almost all heart attacks are preventable, but in spite of that they remain the number one cause of death in the U.S for both men and women. Last week’s column discussed one of the two best methods of determining the health of your arteries:  carotid IMT. (The other one is coronary calcium scoring, which is not useful for younger people).

 Let’s say you are a 50-year-old woman and take advantage of the special IMT screen for heart disease offered by Compass Peak Imaging in Glenwood during February, and your report comes back indicating that you have the arteries of an average 65-year-old American woman based on thickness of the endothelium lining. If arterial age is 8 or more years greater than actual age, you have early coronary artery disease—which is easily reversable with proper treatment. Or let’s say you’re a 55- year-old man and the report says you have plaque. This means you have hardening of the arteries and therefore are at risk for a heart attack or stroke, with soft (uncalcified) plaque being the most unstable and therefore the most dangerous kind.

If your IMT is abnormal, your medical provider needs to figure out why you developed diseased arteries, putting you at risk for heart attacks, strokes, dementia, as well as other conditions. Atherosclerosis is not inevitable as we age—there are groups of people in the world such as the Blue Zones whose arteries are as healthy at 90 as they are at 19, making these people heart attack-proof. What these societies have in common is that they eat primarily plant-based, unrefined foods including daily legumes; and they engage in frequent, low-level physical activity.

Following are measures you can take that can prevent, treat, and even reverse atherosclerosis:

• Diet: Adopt a plant-based, whole food diet with no salt, sugar, or added oil. Dr. Dean Ornish proved over 30 years ago that atherosclerosis can be reversed with this diet. Dr. Caldwell Esselstyn confirmed this subsequently as outlined in his book “Prevent and Reverse Heart Disease.”
• Exercise: The Ornish program—which has been approved by Medicare and many insurance companies–includes regular aerobic exercise. If you’re sedentary, ease into a program of exercise such as walking for at least 30 minutes a day. If you have cardiac risk factors and/or severe atherosclerosis, talk to your provider to see if they recommend a cardiac stress test before starting vigorous exercise.
• Stress reduction is also included in the Ornish program. Consider yoga or meditation. If you suffer from depression, anxiety, or sleep problems, seek treatment.
• Blood pressure should be less than 120/80. For mild hypertension, weight loss, salt avoidance,  and exercise can help, but do whatever it takes to control it, including medication if necessary.
• Cholesterol: Populations such as the Blue Zones who are heart attack proof have total cholesterols < 150, LDL (bad cholesterol) in the 30s and 40s, and triglycerides < 70. Plant-based, whole food nutrition lowers cholesterol, but if it doesn’t get your numbers to goal, consider medication. In their 2022 book “Healthy Heart, Healthy Brain,” reknown heart attack prevention experts Bale and Doneen recommend a statin for anyone with plaque, no matter what their cholesterol is.
• Weight: Attain and maintain ideal body weight. If you look at your profile in the mirror and have even a small “belly,” lose it, because that almost always means you have insulin resistance (pre-diabetes), the driver of 70 percent of heart disease. High triglycerides and low HDL (good cholesterol) are another indication of insulin resistance. Fasting blood sugar above the low 90s, and/or A1C above 5.6 (a measure of average blood sugar levels the previous 3 months) are also indicators of IR, but the gold standard is a 1 and 2-hour glucose tolerance test (1-hour sugar of > 125 and/or 2-hour sugar of < 120 indicate insulin resistance).
• Sleep apnea: Anyone who has atherosclerosis should have an overnight oximetry to screen for sleep apnea. This inexpensive test involves wearing a monitor on your finger all night, that records oxygen level and pulse rate.
• Tobacco should be avoided in any form, including second hand smoke.
• Inflammation from conditions such as rheumatoid arthritis, ulcerative colitis, and dental problems plays a large role in development of plaque, and in plaque rupture. Practice good dental hygiene, and if you have tooth or gum problems, see a dentist well-versed in the mouth-vascular connection.
• Repeat the IMT test in a year. With appropriate treatment, endothelial thickening should improve; soft plaque often disappears or at least calcifies, thereby becoming more stable; and the amount of calcified plaque doesn’t increase and often decreases

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.