Health Column: Advanced testing to prevent & reverse artery plaque
INTEGRATE YOUR HEALTH
Free Press Health Columnist
“Bioidentical Hormone Replacement for WOMEN”
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Cholesterol is our friend. It’s part of every cell membrane in the body; it’s in a good portion of brain material; it’s the precursor to our helpful steroid hormones; and it’s involved in the repair of artery wall defects. But, cholesterol is also what makes up the plaques that clog the arteries to the heart, leading to a heart attack; or it forms small plaques that break loose and float upstream to cause a stroke.
Yet confoundingly, half the people dying from the leading cause of death — heart disease — have fairly normal cholesterol. And many people with high cholesterol have clean arteries. How can this be? Because making plaque is not all about cholesterol.
Think of cholesterol and plaque like the woodpile and a fire. You need the woodpile for the fire, but you also need a “spark” and the right conditions for a fire. In a similar manner, cholesterol only leads to plaque under the right circumstances. There are “sparks” that drive cholesterol to make plaque and certain conditions that favor plaque.
Cholesterol is only bad after it oxidizes. Just like iron rusts, because we live on the oxygen-rich planet earth, we oxidize. Only the low-density lipoprotein, or LDL cholesterol, oxidizes to start the process of making plaque, first by expressing chemicals that attract white blood cells to the area, which fuels more inflammation and oxidation.
The second thing oxidized LDL cholesterol causes is the secretion of chemicals that break down tissue. This weakens the artery, eventually leading to a rupture of the lining that formed a “cap” over the inflamed plaque. When the plaque ruptures, it causes a sudden and complete clotting of the blood within the artery, leading to a clogged artery and a heart attack.
The cells that line the arteries are called “endothelial” cells, and they help control cholesterol oxidation as well as blood pressure. But with aging, unlucky genetics, unhealthy lifestyles, poor diet and environmental toxins, the endothelial cells take a hit and can’t do their job. Keeping these cells healthy is key to healthy arteries in general.
There is a misconception that plaque slowly accumulates until it clogs the artery. The coronary arteries, which supply blood to the heart muscle, need to be 70-80 percent clogged before the blood flow is restricted enough to cause symptoms such as chest pain. Truth is, most people having a heart attack don’t have even a 50-percent narrowing before the unstable, inflamed plaque ruptures causing a sudden artery clog. This is why most people get no warning before their first heart attack. It’s also why someone in apparent good health could go for a long run one day and keel over dead with a heart attack the next.
HEART ATTACK PREVENTION
How do you know if you have plaque, and, if so, whether it’s stable or unstable? First, look for plaque. We tend to make plaque in three main places: the carotid arteries, coronary arteries, and the big aorta as it goes through the abdomen to the legs. These are areas of high blood flow, near the heart, with lots of shear damage to delicate endothelial cells.
Screen for plaque in the carotids with an ultrasound study. Most hospital and traveling screening ultrasounds only show if you have plaque or not. A more advanced ultrasound can be done, which measures artery thickness, plaque thickness and whether plaque is soft and active or hard and inactive. It’s the wet, juicy, soft plaque that kills us. The ultrasound screening I recommend is affiliated with http://www.vasolabs.com.
Another great screening test is a cardiac CT scan, which is a three-dimensional x-ray that shows calcium build up in the artery wall. It takes just a few minutes and is available at Community Hospital. Both of these screening tests cost about $200 and are available with a physician’s order. Call our office if you’d like to get screened.
If you screen your arteries, and find absolutely no plaque, then maybe repeat test every two to three years to insure things are still OK. If you find any plaque, especially the soft and active type, then I recommend more advanced blood tests to analyze why you are making plaque.
ADVANCED BLOOD TESTS
Vertical aligned profile, or VAP cholesterol, is the first test I recommend, to determine three main things. One, do you have high levels of an especially bad type of LDL cholesterol called lipoprotein-little-a (Lp-a), which is known as the “heart attack marker” and puts you at three times the risk of a heart attack. Second, you need to determine the size of the LDL particles as having small, dense particles that tend to stick and oxidize; this raises risk of heart attack three times. The third piece of data is to determine if you have enough of the “good” HDL cholesterol by fractionating out the truly protective HDL-2 subfraction.
The PLAC Test measures the level of an enzyme in your blood that is produced inside the plaque when the arteries are inflamed. If the PLAC test is high, this may indicate that the plaque is more likely to rupture through the inside lining of your artery into your bloodstream where it may cause a clot.
Markers of inflammation — such as high-sensitivity or cardiac-CRP, lipid peroxidase, homocysteine, and omega-6 fatty acids — can all give one a warning that the conditions are ripe for plaque formation. I also check fibrinogen, which measures the tendency of blood to clot.
Low levels of vitamin D, vitamin K and testosterone are independent risk factors for the formation of artery plaque. Newer tests that predict advancing inflamed plaque, such as myeloperoxidase and F2-isoprostanes, are just recently available. Measuring the thickness of blood, or blood viscosity, is yet another marker that can be used to predict risk of plaque.
With advanced imaging studies we can determine who has plaque and how active it is. By using more detailed blood testing, one can more accurately determine exactly why they are making plaque, better target the cause, and then get busy reversing it starting with lifestyle adjustments, nutritional supplements, and finally medications.
Free Press health columnist Scott Rollins, M.D., is board certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call 970-245-6911 for appointments or more information.
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