Every day, people are told by their doctors that they are healthy. That their likelihood of having a heart attack is miniscule. That they’re safe because they are taking medication to lower their cholesterol. Unfortunately, these patients are often being misinformed. All strokes and heart attacks are potentially preventable. The key lies in correctly identifying and treating the root causes of cardiovascular disease (CVD). As founders of the Heart Attack & Stroke Prevention Center, we have devised a new model for detecting and preventing CVD, which empowers people to take charge of their medical destiny. We believe that people need to partner with their health care providers to create a personal care plan based on their unique risk factors.
This involves taking advantage of widely available, inexpensive tests that can reliably identify the early signs of cardiovascular disease up to 30 years before it becomes a silent killer. Unfortunately, many people do not understood what really causes heart disease. For example, contrary to popular understanding, most heart attacks don’t strike in severely blocked arteries (the ones that surgeons target for bypasses and stents). Instead, what is critical is inflammation of the arterial walls. This inflammation can destabilize plaque, causing it to rupture and tear the blood vessel lining, creating a clot. Therefore, unlike the current standard of care—which is largely concerned with blockages—we focus on detecting silent, asymptomatic plaque and inflammation.
When you go to your health care provider, you need to press for an in-depth examination of your health. Things that can signal the presence or greater likelihood of heart disease, but which are too often ignored are:
- Genetic predisposition More than 50% of Americans carry one or more gene variants that dramatically increase risk for heart attacks and strokes. Moreover, family history alone can be a poor predictor of heart attack risk. Therefore, talk to your health provider about genetic testing, particularly the 9P21, ApoE, KIF6, and IL-1 genotype tests. Cardiovascular events are not inevitable, even for people with high-risk genes. Knowing your DNA means that you can customize your treatment plan.
- Metabolic syndrome Although most people have never heard of it, metabolic syndrome, a dangerous cluster of abnormalities that greatly magnifies the threat of heart disease, stroke, or diabetes, affects more than 50 million Americans. However, because the syndrome’s cluster of disorders frequently don’t spark any obvious symptoms, it’s easy for people to go undiagnosed, especially if they don’t get regular physicals. The good news is that you can diagnose yourself by checking yourself for a large waist, high blood pressure, low HDL cholesterol, high triglycerides, and a high fasting blood sugar. If you have three or more of these five warning signs, you have metabolic syndrome.
- Plaque deposits We call plaque in your arteries, “kryptonite.” It can even bring down Superman. One very effective imaging test for finding out if you have kryptonite in your arteries is the Carotid intima-media thickness (cIMT) test, which directly examines the arterial wall. Painless and noninvasive, the cIMT scan can also be used to find out how “old” your arteries are. Inside the body of a healthy 40-something can hide the arteries of someone two or three decades older!
- Insulin resistance Most medical providers aren’t doing an adequate job of screening for insulin resistance (IR), even though it affects about 150 million Americans. IR delivers a devastating one-two punch because it’s the leading cause of vascular blockages and of chronic inflammation, the “fire” in arteries that ignites cardiovascular events. Make sure your doctor administers the oral glucose tolerance test, the gold standard of blood sugar testing, to be sure you are being most effectively evaluated. Don’t be fooled; you could have normal blood sugars and still have IR.
- Waist circumference This simple measurement (which most healthcare providers don’t check!) is a more accurate predictor of heart attack and stroke risk than your weight or body mass index (BMI). You can check your waist circumference by wrapping a tape measure around the top of your pelvic bones. There are ethnic differences in “failing” scores. A waist measurement above 35 inches for a woman, or above 40 inches for a man, is one “strike” for Caucasians, African Americans and Hispanics. However, for Asians, the abnormal numbers are 31 inches and 35 inches for women and men respectively, and for Japanese the numbers to watch for are 31 inches for women and 34 inches for men. Early detection is the big loser in our healthcare system, especially when it comes to heart disease. Go to your health care provider, and go armed with information about what kinds of tests you want, and why. Education is the key to wellness. It’s never too late to optimize your care and take control of your heart health, no matter what your symptoms or lack thereof.