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Category:
Published: July 2007
Modern medicine's traditional approach to heart disease is heavily weighted towards high-tech, high-cost treatment with coronary artery bypass surgery and arterial stents* rather than a lower tech, lower cost prevention strategy. However, a new preventive approach is available which uses high tech risk assessment to guide lower tech, lower cost targeted interventions with specific diet and lifestyle changes, medications, and select supplements to lower heart disease risk.
The traditional approach to assessing cardiovascular risk has relied on the assessment of risk factors, the measurement of blood pressure and cholesterol, and the calculation of a global risk score. While it is true that cholesterol deposited in the artery wall creates the underlying condition needed for a heart attack to occur, some folks with high cholesterol never develop such deposits, while others with relatively normal cholesterol levels do. The new approach uses, when appropriate, specialized x-ray imaging tests to identify deposits in the artery walls before a heart attack occurs. Two such imaging tests are the Coronary Artery Calcium score, or CAC, and the Coronary Computerized Tomography Angiogram or Coronary CTA.
The CAC looks for calcium in the walls of the heart arteries. Cholesterol deposits in the artery walls become calcified as they grow larger. The CAC score correlates to the amount of cholesterol deposited in the artery wall. In an individual of 48 years, for example, a CAC score of zero means no measurable calcium and suggests a very low cardiovascular risk. A CAC score of 400 or more suggests significant deposition of cholesterol in the coronary arteries and a high degree of risk.
The Coronary CTA actually images all of the heart's arteries, the location of cholesterol deposits, as well as the degree of narrowing of the artery caused by the deposits. With Coronary CTA, for the first time, there is a way to make such a determination without requiring a hospitalization and without the invasive placement of a catheter from a groin or arm artery into a heart artery for the purpose of injecting dye.
The new approach, however, does not offer simply the identification of cholesterol deposits. Once deposits are identified, new blood tests beyond the usual lipid profile help target treatment to stabilize cholesterol deposits and shrink them. While the presence of cholesterol deposits in the artery walls is a needed precondition for a heart attack, it is generally, by itself, not enough. In general, to cause a heart attack, cholesterol deposits additionally need to be made "unstable" by inflammation. Unstable, inflamed deposits are the substrate for heart attacks. The new approach therefore identifies such inflammation with two specialized blood tests: hs-CRP and Lp PLA-2, and targets these markers of inflammation with specific interventions. Such interventions may include medications and select supplements, but relies heavily on specific diet and lifestyle changes and, when appropriate, weight loss. Regardless of the means used to achieve a given blood test result- diet, lifestyle, exercise, medication, or supplements-the goals of treatment in the new approach are the same.
The new approach moves beyond simply lowering the LDL or bad cholesterol. It also measures and alters LDL particle size and number. Additionally, the level of HDL, or good cholesterol, and Triglycerides are used to refine risk prediction. Non-HDL cholesterol ( Total cholesterol-HDL= all cholesterol which can form deposits) is targeted for treatment using diet, exercise, weight loss when appropriate, select supplements, vitamins, and medication when needed. Measurement and re-measurement of lipid parameters after successive graded interventions assures medication is only used when needed and only in the amount required to achieve optimal risk reduction.
Finally, the new approach is practical and recognizes the challenges of implementing diet, exercise and lifestyle changes in the current America cultural and culinary milieu. The new approach does not rely simply on the enunciation of specific evidenced based goals and a general recommendation of how to accomplish those goals. Rather, it employs lifestyle change techniques using a group class format to teach diet, exercise, cooking and meal preparation efficiently and at low cost.
In summary, a new approach is now available to help prevent heart disease. This approach relies on new high tech tests to image arteries and establish the presence of cholesterol deposits, and then uses new high tech blood tests to measure response to treatment. The new approach utilizes a comprehensive treatment plan of diet, exercise, lifestyle change, medication and select supplements to optimize blood chemistry and reduce cardiovascular risk.
* stent - a metal lattice placed in an artery to hold open the segment previously narrowed by cholesterol deposit
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