Heart Health, what are my risks?
We have all heard of the person who was seemingly healthy, perhaps a thin runner who had a heart attack mid run. Did you know that up to 50% of those who have heart attacks have normal cholesterol? So what is it?? While in medical school we learned about high blood pressure, obesity, high cholesterol, diabetes, smoking, family history, stress and a sedentary lifestyle as the risk factors of heart disease. But what about those skinny runners who keel over during a race?? I have one word...INFLAMMATION. I have some patients whom have limited risk factors on paper. They may be a non-smoker, no diabetes, they exercise and eat fairly healthy but they may have a family history. Their cholesterol may be normal. What do I do with THOSE patients??
There are four things I would look at in these patients in addition to the risk factors mentioned above:
Insulin resistance: you may not have diabetes BUT do you have insulin resistance? When we eat sugar/carbs our pancreas releases insulin which helps our cells take up the sugar from our blood, because we do not want sugar floating around our blood vessels. It causes inflammation and damage to the lining of our blood vessels which makes it easier for plaques to form. HOWEVER, our body can be insulin resistant where it does not listen to the insulin we have. This may not result in high sugar but high insulin levels and this is a precursor to diabetes and also a red flag that we have inflammation in our bodies
NMR LipoProfile: Nuclear magnetic resonance spectroscopy can tell us the sizes and number of cholesterol particles we have in our body. The more LDL (bad cholesterol) particles, especially small ones, the worse we are. We want a lot of large HDL (good cholesterol) particles. So a "normal" cholesterol panel can be broken down further to determine if it is indeed a risk factor even though our old way of thinking would tell us it is normal. Does that make sense??
High Sensitivity CRP: C-reactive proteins are made in the liver when our body is under stress such as infection. They are increased when we are sick or have an autoimmune disease that is flaring. When we have high levels of inflammation in our bodies it means the inside of our blood vessels are prone to injury which in turn allows plaques to form. We can use a high sensitivity CRP to tell us if we need to focus on decreasing someone's inflammation. We can do this through diet, exercise, supplements or detox, but preferably all of the above.
Calcium score or Heart scan: This is a special cat scan that measures the amount of calcium deposits in the arteries of your heart. These are the blood vessels that bring oxygen to your heart, if you have a blockage of one of these blood vessels it results in a heart attack. Plaques that form in these coronary arteries have calcium in them which the cat scan detects. There are broad ranges of scores that indicate risk of heart attack in the next 3-5 years. This is a great test for people with family history or a couple risk factors, but not many. It helps physicians determine how aggressive we need to be and help uncover hidden risks in patients.
Remember that each of these identified on their own are not very helpful. It is only in light of ALL risk factors and ALL testing that one can begin to quantify overall risk. It is important that you talk to your doctor about these issues if you have questions or if you have any of these risk factors.