Most of you know that we celebrate Heart Month each February, and for good reason: Heart disease remains the #1 killer in the United States and in the Western World. It is an equal opportunity killer affecting both males and females alike.

CURRENT STATS:

· 697,000 deaths/year are attributable to heart disease. (1:4 deaths)

· 382,820 individuals/year die of Coronary Artery Disease (CAD)

· 805,000 heart attacks in the US annually

· 45% of all heart attacks are silent.

· Every 36 seconds someone dies of heart disease.

How does this compare to COVID 19? Even at the height of the pandemic in 2020, twice as many folks were dying of heart disease than dying of COVID.

Given the enormity of the problem, we must continue to honor Heart Month.

HERE ARE 5 HEART HEALTHY TIPS FOR ALL YOU MEDICAL ADVOCATES:

1). WHAT IS YOUR ACTUAL RISK?

Your actual risk is more important than your numbers, especially as it relates to your cholesterol. For the last several years, there has tended to be this knee jerk reaction to treat elevated cholesterol with statins. The problem with this strategy is that we are using the “one size fits all “principle which clearly has no role in the practice of precision medicine. Low risk individuals simply do not need to be treated with drugs. I always endeavor to maximize lifestyle measures.

How do you know you are high risk? Well, if you have a history of CAD, have ever experienced a heart attack or stroke, or have undergone balloon angioplasty/ stenting or bypass graft surgery, you are indeed considered high risk. I would extend this to individuals with carotid artery disease and peripheral artery disease (PAD), which affects blood flow to the brain and lower extremities respectively. I would also include the diabetic population, simply because 70%of diabetics will sustain a heart attack or stroke in their lifetime.

The six major risk factors include:

     * Hypertension

     * Smoking

     * Cholesterol issues

     *  Diabetes

     * Obesity

     * Physical Inactivity

2) WHAT TESTS DO YOU NEED TO ASSESS YOUR CARDIAC RISK?

    A). STRESS TESTING

Always consider stress testing if you have an inkling that your heart is in possible jeopardy. TEST DON’T GUESS

    B). ADVANCED CARDIAC LABORATORY TESTING

I tend to favor both BOSTON HEART DIAGNOSTICS and CLEVELAND HEART LAB. The following is what can be gleaned from such testing:

· LDL-particle number and APO-B-These are clearly more prognostically important than LDL-C

· LDL particle size -Just remember bigger is better)

· Lp(a)-A fragment of LDL-C that is strongly associated with premature CAD

· Homocysteine - Often related to the MTHFR genotype, accumulation of this amino acid can occur in both the heart and the brain.

· Inflammatory markers (e.g., C-reactive protein)

· Metabolic factors (e.g., Hemoglobin A1C, fasting insulin level)

· Genetic Markers (e.g., APO E and MTHFR)

OTHER RISK FACTORS include pollution, possibly heavy metals, and STRESS. A positive family history and advanced age are risk factors that are generally outside our control. However, it is believed that no more than 30% of our clinical outcomes are genetically determined. This means that 70% of our outcomes are related to lifestyle, hence the bourgeoning science of epigenetics.

     C). Coronary Artery Scan (CAC). This is a 5 minute CT scan that detects coronary artery calcifications. Any score above 100 is of concern. Scores between 100-300 are consistent with moderate plaque. A score greatest than 300 is consistent with severe disease and high risk. There is one important caveat; this scan only detects calcified or hard plaque. Soft plaque or vulnerable plaque which can break off and cause heart attacks and strokes is not picked up by this scan.

   D). SMART Vascular Dx (formerly known as the PULS test). This is the new kid on the block. It is a biochemical test, which determines biomarkers of endothelial damage. Your endothelium is one cell thick and lines all 60,000 miles of your vascular system. It is a semi-permeable barrier that keeps unwanted proteins from entering the vessel wall. An unhealthy endothelium loses its semipermeable nature, developing microscopic breaks within it. This allows oxidized LDL-C and other factors to migrate into the endothelium, initiating the inflammatory process that leads to coronary artery plaque. The higher the SMART score, the higher the risk.

This test not only determines endothelial damage, but also has prognostic value in presaging one’s risk of developing an acute coronary syndrome within the next five years.

Utilizing these various tests in the appropriate patient helps me to best stratify an individual’s cardiac risk.

3)  ARE MEN REALLY FROM MARS AND WOMEN FROM VENUS?

This was originally coined by author John Grey, Ph.D. The answer is a resounding YES, as it relates to the heart. Here are some of the differences:

· Different biology- Women tend to have smaller hearts and smaller arteries.

· Different cholesterol buildup in the two genders-Men tend to develop plaque in larger arteries, and women in smaller arteries (microcirculation).

· Different symptoms- Chest pain can be seen in both, but women tend to have more atypical symptoms such as nausea, sweating, vomiting, and pain in the neck, jaw, throat, and teeth. Basically, if it’s above the belly button in a woman, it’s heart until proven otherwise.

· Different heart attack physiology- Women may experience a heart attack in the absence of significant plaque in a major coronary artery. (e.g., coronary artery spasm, spontaneous coronary dissection, and/or Takotsubo cardiomyopathy). The latter is an acute inflammatory response when the heart enlarges and malfunctions after an emotional event, known as the “broken heart” syndrome.

· Different risk factors- We now know that gestational diabetes and preeclampsia are powerful predictors of future cardiac risk. Furthermore, women aged 40 or younger with endometriosis are three times more likely to have a heart attack, than age-matched controls.

· Differences in diagnostic tests-Troponin is the protein measured at the time of a heart attack. Women tend to secrete less troponin when compared to men. Currently in the works is establishing sex-specific thresholds.

4)  WHAT IS THE IDEAL CARDIAC DIET?

In a nutshell, there is no single diet. Why? Because we are all different and there are too many variables involved; risk factors, lifestyle, medical history, food allergies and sensitivities and personal taste all come into play.

Low cholesterol, low fat, especially saturated fat has been unnecessarily vilified for decades. The American Heart Association still supports this thinking which truly undermines current science. I, for one, do not subscribe to extreme, all or none type diets such as vegan and carnivorous diets. Such extremes can certainly lead to micronutrient deficiencies.

WHAT IS IDEAL? I am somewhere between the Mediterranean and paleo diets. We’ve known from the PREDIMED study conducted from 2003-2010 that the Mediterranean diet has a role in preventing heart disease. No other diet shares this claim. Basically, we are talking about fresh, unprocessed food low in sugar and starchy carbs. Sugar is truly the villain as it relates to our diet. Nothing is more inflammatory than sugar. Why it’s akin to throwing gasoline over a fire! Remember, all starchy carbs break down into sugar!

5) WHAT TO DO IF YOU THINK IT’S YOUR HEART?

My strong suggestion: GET CHECKED OUT!  If you are experiencing something foreign to you, or a feeling of extreme discomfort and anxiety, don’t second guess yourself. It’s always better to learn that it’s not your heart, than to suffer the consequences of a heart attack.

Being that this is Heart Month, I’ve read several posts in both Instagram and Facebook that describe detailed descriptions of what one might expect.

FORGET ABOUT IT! I’ve been in the field for over 35 years, and I’ve heard just about every scenario possible. Those descriptions only add mass confusion as far as I am concerned. Follow your intuition. Get checked out.

Remember, time equals muscle. The quicker you are evaluated in the emergency room, the better chance you have of minimizing the size and sequalae of a heart attack.

There are countless ways to protect the health of your heart. What I have outlined for you above is the integrative approach that we favor in functional medicine. As medical advocates you deserve the best. I encourage you to seek out physicians who are truly integrative in their approach.

After all, whose body is it? It’s your body, so let’s take this timeout and create the health and wellness you deserve.

Happy Heart Month to all,

Howard

PS! Please check out my recently launched book, FROM BOTH SIDES OF THE TABLE: WHEN DOCTOR BECOMES PATIENT… Become You Own Medical Advocate

    www.beyourownmedicaladvocate.com