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.

Let’s say you are a 50-year-old man 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 arteries of an average 65-year-old American man based on thickness of the endothelium lining of your arteries. If arterial age is 8 or more years greater than your actual age, you are increased risk for a heart attack or stroke.

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Let’s say the report also says you have soft plaque (plaque is “hardening of the arteries”). The presence of plaque also puts you at significant risk (even if your endothelium is not thickened), and soft (uncalcified) plaque is more worrisome than calcified plaque because it is less stable and more apt to rupture and block off an artery.

You and your medical provider need to figure out why you developed atherosclerosis, which is the cause of heart attacks and strokes and is also a huge risk factor for dementia. 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.

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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 — read 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: The aforementioned populations in the world 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,” 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% 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 two-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.

Next week’s column will be about cholesterol.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market, and cooking classes. Call 970-379-5718 for appointment, or email gfeinsinger@comcast.net.