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(HealthNewsDigest.com) – Despite the fact that heart attacks are #1 cause of death for Americans,many people still do not understand how to prevent one or how to work with their doctors to identify coronary artery disease or atherosclerosis early in life before it becomes dangerous.
Atherosclerosis is an inflammatory condition of the artery wall. It affects
the arteries of heart. We call this his coronary artery disease (CAD). If
one of these coronary artery plaques breaks apart or ruptures, a blood clot
may ensue, blocking blood flow to the heart muscle.
High cholesterol is not the main cause of heart attacks. Just treating
cholesterol prevents at best 30-40% of heart attacks. This is why it’s very
important to know more about risk factors and what you can do to stop plaque
building or even reverse it.
Most Americans think that if they don’t have symptoms they are fine. People
typically say they went through their yearly physical and got a clean bill
of health. They may have had an EKG or exercise treadmill test and since
they passed that, they think they are good to go.
This is a problem because an EKG only shows electrical abnormalities in the
heart and may indicate a past heart attack, changes in heart size or
arrhythmia, but cannot tell the doctor anything about the level of plaque in
the arteries of the heart. It’s plaque that causes heart attacks most of the
time. A person can have advanced atherosclerosis and have a normal EKG. Even
worse, an exercise treadmill test can give a false sense of security.
If a person fails the treadmill test, obstructive coronary artery disease is
likely present. This may lead to surgical procedure which could very well
save a person’s life. On the other hand, if a person passes, they’re told
that everything is fine. This may not be true.
Often during the process of atherosclerosis, the outside diameter of an
artery will enlarge to accommodate the increased amount of plaque within its
muscle layers, leaving the inside diameter where the blood flows largely
unchanged. The heart muscle will still get plenty of blood during the
exercise treadmill test leading to a normal EKG and a lack of chest pain
during exercise.
Another reason why someone may pass the exercise treadmill test is if they
have a long history of cardiovascular fitness (runners, swimmers, cyclists,
rowers), the arteries of the heart may form what’s called collateral
circulation or collateral branches. This is an adaptive change the heart
makes to gain the blood supply it needs in the face of compromised blood
flow.
Most of us have heard that hypertension is a silent killer. It’s called that
because a person can be completely unaware they have it until it gets really
bad. Usually, when hypertension is severe symptoms such as headaches or
ringing in the ears will result.
Well, there is one more silent killer. It’s atherosclerosis. Often a person
will have absolutely no symptoms until their first major heart attack. This
is why I am a big fan of 2 particular screening tests. The heart scan and
the carotid intima media thickness test. Ideally, these tests should be done
together. The first checks for plaque in the heart the second checks for
plaque in the major arteries of the neck. It’s important to note that not
everyone is a candidate these tests. People at extremely low risk for heart
disease don’t need to run out and get a heart scan and people with many risk
factors also do not necessarily need one because the test will almost always
show plaque.
I’ll give an example. A 33-year-old female runner with a total cholesterol
of 180, triglycerides of 80 an LDL of 101 and HDL of 65 with no history of
smoking or first tier relative dying of a heart attack before age 50. In a
heart scan in a patient like this, we expose her to radiation, but almost
always she will score of zero plaque.
Another example: A 58-year-old man with a 30 pack year history of smoking,
moderate abdominal obesity, rheumatoid arthritis, triglycerides of 168, LDL
of 150 and HDL of 35. Additional risk factor analysis and aggressive
treatment would be indicated immediately regardless of heart scan results. A
heart scan and carotid artery test could be used however to monitor
effectiveness of treatment. I might send someone like this to a cardiologist
for an exercise treadmill right away because it would be concerned there
could be narrowing of an artery.
Another issue is hormones. The estrogen present in a premenopausal woman
appears to have a cardioprotective effects and this is one reason why
premenopausal women aren’t a lower risk of heart attack. After menopause
women catch up fairly quickly to men with plaque buildup and are more likely
to die from a heart attack. Even though men have more heart attacks women
are more likely to actually die from one.
Another protective factor for women might be the loss of iron during
menstruation during premenopausal years. Iron is pro-oxidative and is linked
with inflammation in the arterial wall. Since men don’t lose iron every
month through blood loss they typically have much higher iron stores and
women.
Additionally, low testosterone (also known as hypogonadism) may be
experienced in men as they get older. A natural decrease in testosterone as
a man gets older age is called andropause. Not all men experience this at
the same degree. Typically I recommend getting a baseline testosterone level
at age 40 and checking it every year if it’s borderline low. Low
testosterone levels are associated with increased risk of heart attack as
well as atherosclerosis, high triglycerides, metabolic syndrome and
abdominal obesity.
Regarding cholesterol, there are different risk levels associated with the
size and number of the cholesterol particles themselves. This is why I
sometimes say “it’s lipoproteins that need to be watched not cholesterol.”
This is because the lipoprotein is what carries the cholesterol.
Lipoproteins are the little balls (particles) cholesterol travels in. If
these balls are small they can get into the arterial wall and increase
inflammatory atherosclerosis and heart attack risk. HDL, the good
cholesterol, also travels in little balls and bigger HDL particles indicate
improved cholesterol transport away from the artery wall to the liver for
reprocessing.
People should be doing a lot more to assess their heart attack risk in this
country. The standard of care, as it is called, is really not adequate to
prevent heart attacks currently. Detailed personal and family history and
assessment of traditional heart attack risk factors in addition to advanced
testing and possibly a heart scan and carotid intima media thickness test is
indicated in everyone 40 years or older. Men may want to look at these
things at age 30. A female with a first degree relative who experienced a
heart attack before age 50 may also want to consider a preventive cardiology
visit earlier than age 40.
Steven W. Parcell is a doctor specializing in the field of preventive
cardiology. Parcell currently has a naturopathic clinic in Boulder, CO.
He is a member of the American College for the Advancement of Medicine, the
Colorado Association of Naturopathic Physicians, the American Association of
Naturopathic Physicians, and the National Lipid Association.
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