American Heart Association WebsiteFebruary is Heart Month and I’d like to take this time to discuss the importance of practicing prevention. It’s a given that heart disease is an equal opportunity killer, affecting both men and woman in equal proportions. Incredibly enough, it continues to claim more lives than all forms of cancer combined. Heart disease is the number one cause of death in the Unites States--and in the world. Someone in the U.S. dies from heart disease every 90 seconds. I could go on and on with the grim statistics, but you heard all this before, haven’t you? 

In my role as the Medical Advocate, my wish is that all of you pull in the reins and remain in the driver’s seat when it comes to your health. Becoming your own best medical advocate will greatly contribute to positive outcomes with regard to your health and wellness! 

While writing my upcoming book depicting my own journey of medical advocacy during a personally challenging 19 month period, I kept thinking about a patient of mine. BM presented to me over twenty-five years ago because he wanted to avoid the heart disease which ran in his family. His friends chided him, “Why are you seeing a cardiologist? You don’t have a heart problem.” His response was, “Precisely! I’m going to a cardiologist to hopefully avoid a heart problem.” I’m happy to report that twenty some years later this gentleman, who is now eighty years of age, remains in robust health!

Now I don’t necessarily believe that you have to see a cardiologist to practice prevention, but I do believe that selecting a physician or health care practitioner who exemplifies vibrant health and who is keenly interested in diet, exercise and healthy living is a key to your success in preventative health. He or she must be able to look outside the box and perform appropriate and timely testing. One size does not fit all and I cringe whenever I hear that radio announcement from a well-known HMO who claims they have the best statistics in treating heart disease because upon discharge all their patients receive: an aspirin, a statin, and an ACE-inhibitor. REALLY?! First of all, wouldn’t it be nice to treat these patients BEFORE they experience a heart attack so that they never end up in the hospital in the first place? Secondly, is it really possible to lump all heart attack patients into one group so that we can make life simpler and prescribe the same trio of meds for all? I can truthfully tell you that during my 30 years of practicing cardiology, nothing can be further from the truth. 

Effective prevention consists of more than treating hypertension or high blood pressure, elevated cholesterol and quitting smoking. In fact 50% of those who experience a heart attack have normal cholesterol levels. While we can’t do much to alter our age or genetics, there is a lot we can all do to PREVENT heart disease. You are all familiar with the primary risk factors: 

* Hypertension 

* Smoking 

* Elevated cholesterol 

* Diabetes 

* Physical inactivity 

* Obesity 

Well, there are several other risk factors with which you should be cognizant. But first let me mention something about cholesterol. It’s not simply some villain within us that clogs up arteries and causes heart attacks and strokes. Firstly, it is essential for life, and it serves as a chemical precursor to sex hormones, vitamin D, bile acids and cell membranes in our brain. Without cholesterol we would all be dead. Inflammation is the true culprit which initiates the cascade that leads to plaque within our arteries. When Ldl cholesterol, otherwise known as the lousy cholesterol gets oxidized, we then have the perfect setup for vascular inflammation. But not all Ldl is bad. It depends on the particle size. Large particle size Ldl is much less troublesome than small dense particle size. Why? Because small particle size Ldl is 40% more likely to get oxidized than large particle size. If practicing prevention is important to you, you need to know your Ldl particle size and fortunately there is laboratory testing that is readily available. One hint; if you tend to be diabetic or pre-diabetic, have elevated triglycerides and a low Hdl , otherwise known as the healthy cholesterol, it’s a good chance you might have the small Ldl particle size. How prevalent is small pattern Ldl particle size? It’s pretty common! It’s been postulated that up to 35-40 % of the American population have this inherited pattern. Again, appropriate testing is confirmatory and important, because treatment is different, both diet-wise and with regard to medications. Statins which are more widely used than any other medication worldwide lower Ldl quite nicely , but they do nothing to increase the size of the Ldl particle. In essence, to truly practice prevention, you need to know more than what is obtained from a standard lipid panel. You need to know the size of your Ldl particle so that you can maximize the effects of diet and/or medication. Remember the goal is more than simply lowering the total Ldl, but hopefully increasing the size of the Ldl particle. 

Space disallows me from discussing in detail what I call the “minor players” in heart disease. That will be a subject of a future blog but they are as follows: 

* Elevated triglyceride levels 

* Elevated Lp(a) 

* Elevated homocysteine levels 

* Elevated C-reactive protein (CRP) 

* Periodontal disease 

* Inflammatory Markers (Lp- PLA2 and Myeloperoxidase) 

* Genetic markers (Apo E, KIF6 and 9p21) 

* Elevated fibrinogen levels 

* Environmental pollution 

* Stress/depression 

Elevation in C-reactive protein (CRP) deserves special mention. It is a non-specific marker for inflammation which we know not only plays an causative role in heart disease, but in other degenerative diseases of aging such as cancer and Alzheimer’s disease. Now during a cold, flu or acute illness we expect to see a rise in CRP as it signifies out bodies’ defense, or our ability to heal. However when seen 24/7 or chronically, it is surely a bad prognostic sign.At HeartWise Fitness and Longevity Center, I make it a point to measure CRP levels in all my patients on a regular basis. It’s that important to follow my patients’ inflammatory status. As your own medical advocate, you should expect your physician to do the same. 

Isn’t it amazing that there are so many risk factors that are rarely mentioned? Yet, if practicing prevention is one of your goals to achieve vibrant health, this information is vital. February is not only heart month, but it’s also, in my opinion, the beginning of a new year. Why not take this opportunity to make your health a priority by staying in the driver’s seat when it relates to your wellness.

VERY IMPORTANT NOTE / DISCLAIMER: I am offering—always—only general information and my own opinion on this blog. Always contact your physician or a health professional before starting any treatments, exercise programs or using supplements. ©Howard Elkin MD FACC, 2016.

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