In my last post, I discussed what a heart scan score, or coronary calcium score, means.
You may recall that coronary calcium serves as an indirect gauge, a “dipstick,” for the amount of atherosclerotic plaque present in the three coronary arteries. Unlike “risk factors” like high LDL cholesterol, high blood pressure, or c-reactive protein, a heart scan score tells you that coronary atherosclerotic plaque, the stuff of heart attack and heart disease, is present and how much.
So, say you have a heart scan score. Perhaps it’s even a high value, such as 500. What now?
First of all, don’t panic. The vast majority of people who have heart scans are without symptoms. The score signifies that you have some amount of “silent” plaque not causing symptoms. (If you have symptoms of chest pressure, abnormal breathlessness, or similar symptoms, that changes the situation. This will need to be discussed with your doctor and a cause sought, including exploring whether heart disease is the cause underlying these symptoms. An evaluation typically begins with a stress test, a provocative test to relate the potential cause-plaque-with the potential effect-chest pain or other symptom, since symptoms can come from other sources, as well, such as acid reflux, stomach ulcers, or gall stones.)
Even if symptoms are not present, taking preventive action is important. Heart scan scores increase at the average rate of 30% per year if no preventive action is taken. If allowed to progress at that rate, potential for developing symptoms and potential for heart attack both escalate.
What having a heart scan score does NOT mean is that procedures like heart catheterization, stents, or bypass are necessary. There is only one reason to take a person who has no symptoms, even passes a stress test, into the hospital for a procedure: to make money. Heart procedures pay doctors and hospitals very richly; prevention does not. Just having silent plaque should never be the sole reason to justify a major heart procedure. Rarely, someone who has no symptoms yet has a major abnormality detected by stress testing might benefit from proceeding onward to big procedures. But the vast majority of people who have no symptoms of heart disease yet have a heart scan score should not be put through heart procedures, regardless of score.
Conventional guidelines, such as the Adult Treatment Panel-3 (ATP-3; viewable at the National Heart, Lung, and Blood Institute website,) the standard guidelines (supposedly) used by your doctor to treat cholesterol values, do not incorporate heart scan scores very neatly into their advice. ATP-3 acknowledges the power of heart scans to detect hidden coronary plaque and to clarify prediction of potential for heart attack, but the guidelines do not recommend widespread screening. (One of their reservations is the “high cost,” despite the fact that, in Milwaukee, Wisconsin, where I live, I can get a heart scan for $69 to $129. Because insurance doesn’t like to pay for screening tests, it is largely self-pay. But I would hardly call that a “high cost.”) The guidelines also fall short on recommending what course of action to take.
In short, there is little guidance on what to do with your heart scan score to be found in standard guidelines.
I’ve been applying heart scan scores in my heart disease prevention clinic for the past 14 years and I have found them invaluable tools to 1) detect and quantify the presence of coronary atherosclerotic plaque, and 2) track its progression or reversal. Having done this in thousands of patients, I can tell that I’ve learned several important lessons along the way:
Omega-3 fatty acids must be part of the prevention effort. Omega-3 fatty acids come from fish oil, not from flaxseed oil. (Flaxseed oil is a wonderful oil in its own right, but it cannot replace the cardiovascular effects of EPA and DHA from fish oil.) I buy my fish oil from the health food store or from the big retailers like Sam’s Club or Costco and have had uniformly excellent results. Omega-3 fatty acids reduce triglycerides, as well as reduce risk for heart attack and stroke.
Vitamin D normalization-Correcting vitamin D deficiency is a crucial step. I urge everyone in my heart disease reversal clinic to obtain a blood level of 25-hydroxy vitamin D and take vitamin D supplements and aim to achieve a level of 60-70 ng/ml. Most people require somewhere around 6000 units per day, preferably gelcaps, to achieve this level. Don’t be lulled into thinking that a suntan yields full restoration, since it usually does not in those of us over 40.
Thyroid normalization-Thyroid dysfunction, for a variety of reasons, is becoming incredibly common. First step: Be sure you are not iodine deficient. While iodized salt was hailed as a huge public health success story in the first half of the 20th century, everyone has forgotten the lessons we learned about iodine deficiency, thyroid dysfunction, and goiter. Now, the “official” agencies like the FDA urge us to cut out the salt but they’ve forgotten all about the iodine. Next, have thyroid assessed. Don’t accept the “normal” values cited by the lab. Ask your doctor what ideal values are, values associated with low risk for heart disease. (This is an entire topic of its own, a great future set of posts.)
Identify and correct hidden causes of plaque-There are a number of “unconventional” causes of heart disease not commonly discussed. The two most common ones I see are lipoprotein(a), a potent risk that is inherited, and small LDL particles, an exceptionally common abnormality, either inherited and/or caused by lifestyle.
Eliminate wheat products-As odd as it sounds, I credit elimination of wheat from the diet as among the most powerful anti-inflammatory, weight loss, blood pressure-reducing, and LDL cholesterol-reducing strategies I know of. It’s counterintuitive. It’s certainly against the “grain” of conventional advice, such as the advice to cut the fat in your diet. But it’s not the fat; it’s the wheat. Of course, this strategy should occur in the background of an otherwise healthy diet that includes lots of vegetables, raw nuts, lean meats, eggs, cheese, and some fruit.
Follow what I call the “Track Your Plaque Rule of 60”-My heart disease reversal program, the Track Your Plaque program, has had extremely good results achieving LDL cholesterol of 60 mg/dl or less, HDL cholesterol 60 mg/dl or greater, and triglycerides 60 mg/dl or less. As demanding as it sounds, following the vitamin D, omega-3 from fish oil, wheat elimination, and correction of hidden causes, reaching the “Rule of 60” is not as impossible as it sounds.
For anyone wanting to read about heart scans and how they fit into a broader program of heart disease prevention can download my 120-page book, What Does My Heart Scan Show?