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Cardiovascular Risk Reduction Program
What does Cardiovascular mean?
Cardiovascular refers to the entire body’s blood vessel circulation and the heart’s blood supply. A heart attack is caused by thickened blood vessels that harden and eventually crack. When the blood vessel cracks, it causes a blood clot that completely stops blood flow. The area of heart fed by that occluded blood vessel dies. This same phenomenon happens in the brain, but it is called a stroke. By reducing your cardiovascular risk, you improve your entire body’s circulation and thus extend the life of your heart, brain, kidneys, muscles, bones, and every other tissue in your body. Without proper blood supply, any and every organ will fail slowly over time.
Why do you emphasize Cardiovascular Risk Reduction so heavily?
The combination of strokes and heart attacks is the leading cause of death in America and there are no signs of this changing anytime soon! It is of utmost importance to prevent your blood vessels from thickening as this is a difficult phenomenon to reverse. With aggressive treatment, studies show that you can reduce plaque build-up by 9%. By doing an in-depth analysis of your cardiovascular health, we can determine how aggressive we need to be with medications, supplements, exercise, and nutrition. We utilize many different types of physical and blood work evaluations in order to get a complete picture on your overall cardiovascular health. These tests are state-of-the-art and are being done at most medical offices.
What are the differences between MICROscopic and MACROscopic blood vessels?
Microscopic blood vessels are the tiny capillaries that are responsible for bringing blood close enough for tissues to take in the nutrients that they need for optimal function. There are billions of these blood vessels throughout your body. On the other hand, the macroscopic blood vessels are responsible for delivering large amounts of blood to the tiny capillaries. When plaque develops and hardens, it is difficult to remove from these large blood vessels.
What types of tests do you use to evaluate Cardiovascular Risk and what exactly do they measure?
►Advanced Blood Work
The advanced blood work panel evaluates your hidden signs of cardiovascular disease. The blood work looks at cholesterol levels, cholesterol-associated proteins, and inflammatory markers that are known to contribute to heart attacks. The blood work also looks for early signs of insulin resistance and diabetes which is the leading cause of cardiovascular disease in America. The blood work assesses blood counts, electrolytes, thyroid function, liver function, vitamin levels, genetic mutations, and Omega-3 levels. Healthy amounts of omega-3, or fish oil, reduce inflammation and improve brain function.
►Max Pulse – Microscopic Blood Vessel Evaluation
This cutting edge technology is simple to do and performed in the office during your well visit or follow-up examinations. The test is performed by placing an advanced plethysmograph on your finger for 3 minutes. That’s it! The device looks similar to a pulse oximeter (oxygen meter), but it contains much more technology. It analyzes the elasticity, or stretching ability, of the capillaries (microscopic blood vessels) in your finger. Your results are categorized into a blood vessel type. Each type represents a different level of thickness. A Type 1 blood vessel is perfectly elastic while a Type 7 blood vessel is stiff and thick like a PVC or lead pipe. Any blood vessel reports beyond type 2 are considered abnormal and thickened. The advantage of this test is that you can identify microscopic disease earlier. Identifying disease earlier allows you to make lifestyle changes that may prevent the larger (macroscopic) blood vessels from being affected permanently.
►Carotid Intima-Media Thickness (Carotid IMT) – Macroscopic Blood Vessel Evaluation
The Carotid IMT test evaluates the thickness of your macrovascular circulation. An ultrasound is used to measure the size and thickness of the carotid artery (large artery in your neck that feeds blood to the brain). The thickness of the carotid artery is then plotted on a graph. Your level of thickness is compared to the average thickness of the remainder of the population. If your carotid artery is thicker than that of other people your age, you are given an adjusted blood vessel age. For instance, if you are 40 years old, but your carotid artery thickness matches a 65 year old person, your blood vessel age is 65 years old. This would put you at high cardiovascular risk and may change how aggressively we manage your risk factors. You are as old as your blood vessels are.
►Cardiopulmonary Metabolic Exercise Testing (CMET) – Stress Testing
This is a non-invasive test that assesses the cardiopulmonary (heart and lung) system as a whole. The CMET consists of a full array of pulmonary function tests (PFTs), gas exchange (oxygen consumption) analysis during exercise and electrocardiogram (ECG) monitoring. Compared to a traditional ECG stress test, the CMET is a more accurate test in detecting heart disease and provides more comprehensive clinical data that helps differentiate between heart and lung limitations, deconditioning, or a combination of these conditions. This stress test is used at the MayoClinic. Read more about why Cardiopulmonary Metabolic Exercise Testing is important, and how it is compares to regular exercise stress testing.
►Electrocardiogram (EKG or ECG) – Electrical Conduction of the Heart
The EKG is a test that has been used for decades for the assessment of heart disease. However, the limitations of the EKG are that it does not detect early signs of heart disease. The EKG can detect active heart attacks and old heart attacks, but we want to prevent these events from occurring by using the more advanced tests discussed below. The EKG’s primary use is to evaluate you for abnormal heart rhythms or abnormal electrical conduction through the heart that could cause death or injury. It can also show signs of an enlarged heart, electrical disease, and inflammation of the heart’s protective pouch (pericarditis).
►Echocardiogram – Heart Shape, Function, and Valve Evaluation
An echocardiogram is a painless assessment of your heart. An ultrasound is used to take pictures and videos of your heart as it beats in your chest. It is used to detect problems with heart valves, abnormal shaped chambers, strength of the heart beat, and the heart’s ability to relax. The procedure has no major risks associated with it as only sound waves are used in image generation.
►Abdominal Aorta Aneurysm Scan (AAA) – Enlarged Aorta Testing
The AAA scan is an ultrasound test that evaluates the size of the largest artery in the body: the aorta. The aorta spans from your heart down to your pelvis, and it provides blood to the most vital organs of the body, including your lungs, heart, kidneys, bowels, spleen, liver, etc. If your aorta is enlarged, dilated, or thickened, it is an ominous sign of hidden heart disease. Contrary to logic, as the aorta enlarges, the pressure gets higher, and it will eventually rupture. If the aorta ruptures, it is fatal more than 50% of the time as most people have lost too much blood by the time they arrive to the hospital. An enlarged aorta usually does not have any symptoms which is why periodic evaluation is important.
►Nitric Oxide Testing – The Miracle Molecule
Nitric oxide is a gas that is produced in every tissue and organ of your body, from your muscles to your brain. This chemical tells arteries to relax which allows more oxygen into tissues by increasing blood flow. Because it opens arteries, it also lowers blood pressure. Although Nitric oxide is abundant in the body, it is unstable and short-lived. Thus, it must be renewed continuously. A large and growing body of research points to Nitric oxide’s broad impact on health on all bodily systems. This is a simple test performed by placing your saliva on the test strip. Within seconds, you will know your Nitric oxide levels. Low or depleted levels need to be replaced in order to maintain optimal cardiovascular health. Supplements for improving nitric oxide levels are found in our office.
►Pulmonary Function Test (PFT) – Breathing / Lung Testing
This is a series of breathing tests that evaluates lung function. Pulmonary function testing measures how well air can move in and out of the lungs. It also measures the amount and speed of air that is moving. The additional use of bronchodilator (albuterol) medication or exercise with a pulmonary function test allows for analysis of the effects and severity of asthma.
Arterial Duplex and Ankle Brachial Index (ABI) — Arterial Blood Supply Testing
►Arterial duplex is performed with an ultrasound device. It assesses the blood vessel circulation that is bringing fresh oxygen to the furthest parts of your body (fingers and toes). If these blood vessels are narrowed or stiffened, it can cause significant discomfort and pain with exercise. It is also considered equivalent to heart disease if you have disease in limb’s blood vessels.
►Ankle Brachial Index (ABI) is another way to assess the blood vessels of the extremities. This test is similar to the arterial duplex because it measures the arterial blood supply (fresh blood being delivered to the tissues). The test involves a series of blood pressure measurements with blood pressure cuffs throughout the arms and legs. If any of your limb’s blood vessels are stiff, the ratio between your arm and ankle will be different, hence the name ankle versus brachial (arm) index.
Who should be tested and what are the criteria?
Anyone with risk factors should be evaluated for cardiovascular risk. There are multiple risk factors for having cardiovascular disease. If you have multiple risk factors, then it is extremely important to be vigilant about assessing your cardiovascular risk. Here are important risk factors:
|•Diabetes||•High Blood Pressure||•High Cholesterol||•Any Tobacco Use||•Inflammation|
|•Age Over 45||•Overweigh (BMI > 25)||•Family History of Heart Disease||•Poor Diet|
|•Vitamin Deficiencies||•Low Nitric Oxide||•Chest Pain||•Lung Disease|
How can I improve my cardiovascular risk? What is my treatment plan?
After performing your in-depth cardiovascular risk assessment, your healthcare provider will decide which types of treatment are necessary. It will usually involve dietary changes of low fat diet, decreasing sugar intake, and increasing protein consumption. Cardio or Fat-Burning Exercise is always important in reducing cardiovascular risk and extending your life expectancy. Supplementation with fish oil, niacin, Vitamin D3, nitric oxide, and any other supplements that are needed will be recommended. If your risk is high, prescription medications will be discussed. Common prescriptions include statins (Crestor, Lipitor), metformin, and Vascepa.