It’s that time of year again when we celebrate heart month. As Medical Advocates, you deserve to know all things cutting edge about your heart and cardiovascular system.

As an integrative cardiologist, I believe in going above and beyond the scope of traditional cardiology. It’s what I call “looking outside the box.’’ However, traditional, and integrative cardiology are not mutually exclusive. It’s the blending of the two that I consider essential.

Why must we review this yearly? Because heart disease remains the #1 cause of death in the United Stated and in the Western world. It’s an equal opportunity killer affecting both men and women, regardless of race. Remember these facts:

·   655,000 deaths occur annually in the Unites States. That’s 1.4 persons.
·   Someone in the US dies of heart disease every 38 seconds.

What about heart attacks?

·   850,000 Americans experience a heart attack annually.
·   605,000 of these heart attacks are an individual’s first cardiac event.
·   45% of these heart attacks are silent (more men than women)
·   Someone in the US sustains a heart attack every 40 seconds.

The enormity of this disease is obvious.

Rule # 1: KNOW YOUR RISK

Traditional cardiology and medicine often seem preoccupied with how low you can get your cholesterol down. I place much more importance on your actual risk.
There are both major and minor risk factors:

MAJOR RISK FACTORS

·   HYPERTENSION
·   SMOKING
·   ELEVATED CHOLESTEROL
·   DIABETES
·   OBESITY
·   PHYSICAL INACTIVITY

Some of the minor risk factors or secondary players are elevated triglycerides, Lp(a), elevated homocysteine, inflammation, environmental pollutants, genetic markers, and stress.

Let’s delve into testing because that’s where we often note the schism between traditional and integrative cardiology.

Rule # 2: TEST DON’T GUESS!

Take blood lipids for example. The average physician, including most cardiologists order the standard lipid panel, which includes total cholesterol, HDL or healthy cholesterol, LDL or lousy cholesterol and triglycerides.

As Medical Advocates you deserve to know more. What you want is an advanced lipid panel which includes the following:

·   LDL particle number
·   LDL particle size 

Why? Because the more information you have, the more effective you can assess your risk. LDL particle number measures the actual number of LDL particles. It is a better predictor of cardiac events than LDL, which is not actually measured, but calculated.

LDL particle size is clearly of prognostic importance. Large fluffy LDL particles are much more desirable than small dense LDL particles. Small particle size is up to 30% more likely to get oxidized and get trapped in the arterial wall where the plaque process begins.

LDL is not the culprit; oxidized LDL is the problem

Rule # 3: BIGGER IS BETTER

Other valuable tests used to assess one’s risk:

·   Lp(a): This is an inherited lipid abnormality. Lp(a) is a fragment of LDL which is sticky, inflammatory, and which clearly increases one’s risk
·   CRP (C-reactive protein): This is a non-specific marker for inflammation. Inflammation in the bane of our existence as it relates to aging. Heart disease is an inflammatory process. You need to know where you stand with this simple marker.
·   Hemoglobin A1C: This is a marker on the red blood cell that denotes how well your blood sugar has been controlled over the previous three months. Although not routinely ordered, it is essential that we all know our metabolic status. A normal value in < 5.4.  The prediabetic range is 5.5-6.4. Anything above 6.4 is frank diabetes.

Why is this so important? There are 30 million diabetics in the United States. That’s 10% of the population. Still worse, there are 88 million prediabetics. 84 million of these individuals are clueless about their situation. I see this all the time in the hospital setting when I evaluate cardiac patients. Most folks have no idea until they suffer a heart attack or stroke. So, without testing the A1C, most folks are in the dark about their metabolic standing.

·   Insulin level: This needs to be fasting. It’s extremely useful in detecting those who are metabolically unhealthy. This is no small deal when you consider that 88% of the population in this country is metabolically unhealthy.
·   Homocysteine level: This compound is a by-product pf protein metabolism. It is often genetically determined. Elevated levels can lead to inflammatory plaques in both the heart and the brain. Fortunately, the consumption of various B vitamins can help reduce levels
·   Vitamin D level: This more like a hormone than a vitamin. It is important in maintaining heart health as well as health in general. It is a known fact that people who do poorly with COVID 19 have low levels of Vit D. Medicare and PPO insurance do cover the cost of this test. It’s all about knowing what code to use!
·   Genetic markers: MTHFR and APOE

These are merely two genetic markers of interest, and it behooves us all to know our genetics.

MTHFR: No, it’s not what it looks like! The MTHFR gene provides instructions for making an enzyme called methylenetetrahydrofolate reductase. This enzyme plays a role in processing amino acids, the building blocks of proteins. One of these proteins is homocysteine which was noted above.
APO E: APO E carriers are prone to high cholesterol and Alzheimer’s disease. Moreover, APO E is more common in African Americans and Caucasians than in other ethnic groups. Such individuals tend to hyperabsorb cholesterol from the gut. This is in contradistinction to those who are hyperproducers of cholesterol Both dietary and pharmaceutical therapy may well differ in such folks.

To review, remember these 3 rules:

1)  Know your actual risk
2)  Test don’t guess
3)  Bigger is better when it comes to LDL cholesterol

There is additional useful testing available to help determine your actual risk, but these are the basic laboratory tests that I adhere to in assessing my patients. While exercising your right as a Medical Advocate, you are clearly putting yourself in the driver’s seat as it relates to your individual health. Whose body is it? It’s your body, so please do everything you can to control your health and wellness.

Happy Heart Month to all!

Howard K Elkin, MD FACC
THE MEDICAL ADVOCATE

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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, 2022.