Are You Growing Plaque in Your Arteries? Three Key Measures You Should Know Right Now
Heart attacks and strokes remain the number one killer in America today. In fact, as rates of diabesity increase, the American Heart Association predicts that the incidence for cardiovascular disease (CVD) events will climb. The reality is that we cannot overcome heart disease with just drugs and surgery, we need a lifestyle-driven heart solution.
This solution needs to address the “cause” for cardiovascular disease, and our current paradigm of measuring cholesterol, blood sugar, and blood pressure measure has done more to feed the pharmaceutical and laboratory industries than reverse heart disease, itself.
My clinic has created a database that aims to assess the true cause of heart disease, namely growth of arterial plaque. Since Masley Optimal Health Center opened in 2004, I have collected comprehensive data on over 600 new patients who have come for our health assessments. These evaluations have included many standard markers for heart disease, and also include several functional markers such as: IMT testing, comprehensive nutritional intake, aerobic fitness measured with treadmill VO2max, body composition, and advanced laboratory studies (the biomarkers selected have been highly influenced by my twenty year involvement with Functional Medicine). From this database, we now know that some of the most commonly accepted risk factors for heart disease are really not that great. We have found several lifestyle choices that are much more powerful predictors of arterial plaque growth.
Likely the best measure of future heart attack and stroke risk is carotid intima media thickness (IMT) testing, which provides a precise and direct measure of arterial plaque growth for both the cerebral and coronary arteries. The 2012 American Heart Association Prevention task force has described carotid IMT testing as safe, strong, and a reliable predictor of heart attack risk. So the next question becomes, what predicts normal or advanced plaque growth? I am submitting a detailed scientific publication on this topic which should be in print in the next year, but let me share something to get you started.
The best predictors we found were not what we have used for decades, namely total and LDL cholesterol, blood sugar, and weight. Even advanced cholesterol profiles that include LDL size, particle count, and Lp(a) measures are not highly predictive of carotid IMT scores. Although weight and body fat initially appeared to be related to plaque growth, if you control for fitness when assessing weight and IMT scores, body composition became far less important.
In our study, out of hundreds of CVD biomarker measurements, the three most powerful predictors of arterial plaque growth as measured by carotid IMT testing were:
- Systolic blood pressure
- Fiber intake
- Aerobic fitness (your aerobic capacity)
Systolic blood pressure is easy to accept as a predictor for arterial plaque growth as blood pressure isn’t just a risk factor that predicts heart disease; rather it is much more, namely a direct measure of function of your cardiovascular system. If your arteries are sick, then they are stiff and your blood pressure goes up, and you grow plaque. In the study we are publishing, blood pressure is the best predictor of arterial plaque growth.
We looked at multiple aspects of nutrition intake, and high fiber intake was clearly the strongest predictor of decreased arterial plaque buildup. Fiber comes from vegetables, fruits, beans, nuts, and whole grains–all foods that nourish our arteries, so no surprise. You should aim to get 30-50 grams of fiber in your diet every day.
Fish and fish oil intake were also measures of reduced artery plaque, fish being stronger than fish oil itself. Saturated fat and several measures of single vitamin intake did not predict arterial plaque growth in our study. The advantage of fiber over single nutrients or a single vitamin is that it typically contains a full orchestra of nutrients and anti-aging compounds, and single nutrients can’t create the same music on their own.
Your arteries are muscular tubes, so perhaps no surprise that degree of aerobic fitness, as measured by running on a steep treadmill setting is an excellent predictor of arterial plaque growth. Of interest, minutes spent exercising didn’t matter. What did matter was if you were highly fit, you grew less plaque.
Other laboratory tests were associated with plaque growth rates, in particular the lower your total cholesterol/HDL ratio the better, and with the advanced lipid profile, the big fluffy HDL-2 should be in the high zone if you want to stop plaque growth.
So if you were to do just three things to stop arterial plaque growth, I’d say:
- Monitor your blood pressure and take measures to keep it less than 120/80 without needing medication. Eating more vegetables and fruits and daily exercising are the best tools to control blood pressure.
- Get your 30-50 grams of fiber daily. To raise your fiber intake, focus on eating more vegetables and fruits, beans, nuts, and whole unprocessed grains.
- Measure your aerobic fitness. Treadmill testing is the most fun part of our day assessing patients. Now it appears to be one of the most important parts of the day, too. A simple rule of thumb is that if you can make 15 minutes or more on the Bruce protocol treadmill stress test, you are very fit.
Out of over 600 evaluations to date, nobody at their first visit with us who exceeded 15 minutes on the Bruce protocol treadmill test and who ate 30+ grams of fiber daily has had an elevated carotid IMT test (score >0.8). That gives all of us a good goal to reach for 2013.
To Your Health!