(It's More than Cholesterol)

It's a tragedy! We all know someone who has faithfully gotten an annual physical (including blood tests and EKG) from their doctor, and the doctor has happily reported that the results show no evidence of cardiovascular or other disease. Your friend feels secure, believing that his preventive measures of regular exercise and prudent diet seem to be working well.

Yet, that same person experiences a heart attack or stroke within weeks of seeing his doctor! How could someone be assured that he’s doing well and still get a heart attack or stroke? What went wrong?

This is a question that doctors have long agonized over—but are recently getting more satisfying
answers. Beginning in 1948, researchers began a comprehensive study of 5,000 Americans to try to identify and understand cardiovascular disease risk factors. What they found from this now famous Framingham Heart Study was that there is inconsistency between the results of our routine laboratory testing and the incidence of heart disease.

The Framingham study revealed that 80 percent of patients who had a cardiovascular event (heart attack or stroke) showed results from routine blood lipid profile tests for cholesterol, triglycerides, etc., similar to the normal population who did not have cardiovascular disease. This implied that the traditional lipid panel was not capable of being an accurate "key" to determining true risk. In a research study reported in The American Journal of Cardiology, it was demonstrated that the usual "cholesterol" panel was only 40 percent predictive for revealing coronary heart disease. Why?

We now have the answers to the lack of predictability based on annual cholesterol tests. It appears that heart disease has many risk factors other than cholesterol that have not been tested for previously. It also appears that we have not understood that a major culprit in cardiovascular disease is the "soft plaque" in the arteries and not the traditional calcified plaque that was thought to gradually build up and "clog" the artery.

A new laboratory test called the VAP Cholesterol Test analyzes fantastic new markers to help predict cardiovascular disease. Researchers have "cracked open" the lipid molecules in the bloodstream and found at least 10 new items critical to evaluate heart disease. These include Lp(a) (lipoprotein a), VLDL and VLDL-3 (very low density lipoproteins), Non-HDL (non-high-density lipoprotein), IDL (intermediate density lipoprotein), real LDL (real low density lipoprotein) and real-LDL-C size pattern, remnant lipoproteins, and HDL2 and HDL3 (high density lipoproteins 2 and 3). VAP Cholesterol Test markers, when abnormal, have been found to be "positive" indicators even when traditional markers like total cholesterol, LDL, and triglycerides are "normal."

Another accurate marker that can now be evaluated is the homocysteine level. When homocysteine is elevated, the risk of heart attack and stroke has been shown to be three times higher than with normal homocysteine levels.

C Reactive Protein (RS) is another blood marker that is elevated with any inflammation in the body, but also correlates with an increased risk of heart attack. Another is fibrinogen, a protein normally found in the blood that is key in helping us not bleed to death when we’re injured, but when excessive, increases the risk of clots forming in the bloodstream itself and causing heart attacks or strokes. Low testosterone levels in men, and low levels of the trace mineral selenium may increase the risk of coronary disease by 24 percent.

The ADMA (asymmetrical dimethyl arginic) test measures levels of a chemical that inhibits normal nitric oxide dilation of the blood vessels. When levels are high, researchers have found a 27-fold increase in the risk of heart attack. A high level can also reveal an increased risk of hypertension, erectile dysfunction, and insulin resistance.

Researchers have discovered that bacteria like Chlamydia, H. pylori and dental bacteria are associated with heart disease. Chlamydia has actually been found in the artery plaque and is suspected of increasing plaque formation. Cytomegalovirus and Coxsackie virus are thought to trigger plaque build-up through a complicated mechanism of "molecular mimicry.” Elevated antibody levels to these bacteria or viruses can indicate excessive levels of these harmful organisms and may be an indicator of risk.

Then there are nutrients that we need to help prevent plaque formation in the blood vessels. These include antioxidants and omega 3 fatty acids. Evaluating whether or not we have optimal levels of these nutrients can help us know how close we are to obtaining a truly heart-protective diet.

We can take a totally non-invasive look into the arteries and see if plaque is developing years before an EKG or stress test (nuclear or regular) can indicate a problem. This technology entails 64 heart scans taken through various cross-sections of the coronary arteries and analyzed with calcium scoring. It can visualize blockages better than ever before and provides a calcium (plaque) score between 1 and 400.

Carotid ultrasound of the carotid arteries can measure the thickness of blood vessel walls, and the thicker and more inflexible the vessel walls, the greater the risk of heart attack and stroke.

Not everyone needs all of these advanced cardiovascular tests, but it is wonderful to know that they are available to help us identify our individual risk factors and understand how to reduce them. These tests are especially important when a person has a family history of heart attacks, strokes, blood clots, dementia, and other increasingly preventable problems. Knowing where our genetic weaknesses may lie can be a great help in avoiding the family cardiovascular disease pattern.

If there are positive test results from any of these new tests, multiple strategies can be used to lower risks. At The Center for Occupational & Environmental Medicine, we use a comprehensive approach including diet changes, nutrient supplementation, intravenous chelation, and medication where necessary. Please see Healthy for Life Weight Loss for information about our very successful weight loss program.

For further information about our programs, please contact The Center at (843) 572-1600.

References:
Castelli WP. Lipids, risk factors and ischaemic heart disease. Atherosclerosis. 1996;124:S1–S9.

Castelli WP. Canadian Journal of Cardiology 1988:4A: 5A.

Frost; American Journal of Cardiology 1998: 81:26B.

Lamarch B, Tehernof A, Moorjani S, et al. Small, dense low density lipoprotein articles as a predictor of the risk of ischemic heart disease in man: prospective results from the Quebec Cardiovascular Study. Circulation. 1997 Jan 7; 95(1) 69-75.

Superko HR. Did grandma give you heart disease? The new battle against coronary artery disease. American Journal of Cardiology. 1998;82:34Q–46Q.

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