Heart attacks continue to be the number one killer in American men and women, in spite of Dr. Dean Ornish proving over 30 years ago that heart disease can be prevented and reversed through plant-based, unprocessed food nutrition (Dr. Caldwell Esselstyn confirmed this subsequently).

Although 20% of heart attacks result in sudden death and are occurring more frequently in young people, not everyone is willing to change their diet significantly. Last week’s column was about the very effective Bale-Doneen Method of heart attack prevention, which also applies to other arterial diseases including most strokes, dementia, peripheral vascular disease, chronic kidney disease, and erectile dysfunction. Following is the BDM “proven six-step prevention plan,” taken from their 2022 book “Healthy Heart, Healthy Brain,” and their most recent annual preceptorship.

1) PATIENT EDUCATION: Heart attacks occur when plaque in the walls of coronary arteries ruptures, resulting in a blood clot that blocks flow of blood to the heart muscle (myocardium). The formation of plaque begins when lipoprotein-containing cholesterol becomes trapped in the intima — the layer that lines the inside of arteries. Entrapped lipoproteins become oxidized, which activates the immune system, which in turn causes inflammation. When this inflammation — which the BDM calls “fire in the arteries” — becomes chronic, plaque (hardening of the arteries, a.k.a. atherosclerosis) develops.

Our current disease management system (versus healthcare system) looks as atherosclerosis as a plumbing problem: if plaque causes arterial blockages of 70% or greater, invasive and expensive stents and bypass procedures are used to open or bypass the blockages, which can save lives in the setting of an acute heart attack. However, 99% of plaque is in the walls of arteries, not causing a blockage, and 86% of heart attacks occur when this non-obstructive plaque ruptures.

2) DISEASE DETECTION: To assess risk for heart attack, the current national guidelines recommend the Framingham Risk Score, based on the number of traditional risk factors for heart disease a patient has. Bale and Doneen cite evidence that this approach misses too many people at high risk. Instead, the BDM “considers all patients to be ‘guilty’ of harboring silent, potentially lethal plaque in their arteries unless they are proven innocent through laboratory and imaging tests that directly check for arterial disease.” In particular, they recommend carotid IMT to detect disease with repeat a year later to assess effectiveness of treatment (IMT is available at Compass Peak Imaging in Glenwood). In some cases they recommend coronary calcium scoring.

3) DETECTION OF FIRE IN THE ARTERIES: Two landmark studies in The Lancet medical journal in 2012 were the first to show that chronic inflammation (fire in the arteries) causes cardiovascular disease, and contributes to many other diseases such as dementia, diabetes, and cancer. Bale and Doneen “use a ‘fire panel’ of inexpensive blood and urine tests to check for inflammation.” These tests can be ordered through companies such as the Cleveland Heart Lab and will be discussed individually in next week’s column.

4) ROOT CAUSES OF OXIDATIVE STRESS AND FIRE IN THE ARTERIES: Traditional root causes are age; family history; smoking; obesity; hypertension; high cholesterol; sedentary lifestyle; inflammatory

diseases including asthma; autoimmune diseases; unhealthy diet; insulin resistance/prediabetes/diabetes; sleep apnea; and psychosocial issues. Bale and Doneen have come up with the following additional root causes: low vitamin D; abnormal gut microbiome; infectious diseases; endodontic disease (cavities, root canal infections); periodontal diseases; high risk mouth bacteria; high Lp(a)—a particularly harmful type of bad cholesterol; dysfunctional HDL (good cholesterol); elevated MPO (myeloperoxidase); gout; erectile dysfunction; and migraine headaches.

OPTIMAL GOALS: Weight and BMI should be at goal (go online to see tables based on height and weight). Waist circumference at point of greatest circumference should be less than 40 inches in men and 35 inches in women for Caucasians, with lower cutoffs for Asians and East Indians. For most people, blood pressure should be 120/80 or less. Fasting blood sugar should ideally be in the low 90s or less. Cholesterol, HDL, LDL, triglycerides, and non-HDL cholesterol and most important ApoB should be at goal (more about this in a later column).

GENETICS: The BDM is an individualized method of disease prevention in which several non-expensive genetic tests play an important role (more about this in a future column).