What tests are done at the CureCenter to measure arterial disease and its root causes?

The true inflammation nature of arterial disease (which causes heart attack, stroke and dementia) is not the basis of mainstream medical care. New testing methods and technology enable the CureCenter to offer more individualized and effective treatments. 

Tests we perform and recommend not generally available from standard care include (but are not limited to):

• Carotid Intima Media Thickness (CIMT) Testing: CIMT measures arterial wall thickness and documents atherosclerotic plaque stage and thickness. A thicker artery wall is an inflamed, older and sicker artery wall. This indicator of arterial inflammation predicts formation of atherosclerotic plaque and related events such as heart attack and stroke.

  Arterial wall thickness (inflammation) is more relevant than luminal flow “blockage” in predicting new and unstable plaque formation. Unstable plaque rupture is the event we experience as a heart attack or stroke. This is more likely with new homogeneous unstable plaque. It becomes less likely as plaque becomes more homogeneous/healing and is minimal when plaque is calcified/healed/stable. Proactive optimal care can heal arterial disease and make your arteries healthier and younger with less risk of disability, death or need for rescue procedures.

• Screening carotid ultrasound (CureScreen): This limited lower cost carotid ultrasound using point of care Butterfly iQ probe and system) is like a screening pap smear, mammogram or PSA to detect early cancer. If we find no disease, peace of mind is the benefit. If, however, even a little bit of arterial disease is found (like a little bit of cancer) the images can be sent for a CIMT report (see above) and then followed to make sure you are safer by following your CurePlan.

• LpPLA2 (PLAC) Test: This enzyme rises when plaque and artery walls are inflamed or “hot.” You want your arteries to be “cool.” LpPLA2 drops with a less inflammatory diet, exercise, reduced insulin resistance, supplements (niacin, and bergamot and statins. It is a fire alarm or “meat thermometer.”

• Myeloperoxidase (MPO): A rise in MPO should trigger a search for neutrophil involved inflammation, especially from the mouth. MPO indicates inflammation and erosion of the inner lining of the artery known as endothelium. A sudden rise should trigger a search for the inflammation that can cause arterial inflammation, leading to heart attack or stroke. Think of a caustic chemical spill inside your arteries. Like a skin abrasion, blood clots form and can occlude flow.

• Microalbumin/Creatinine Ratio (MACR): MACR rises most commonly when blood pressure and blood glucose are poorly controlled.  This causes dysfunction of the arterial wall endothelium, allowing albumin to leak into the urine in greater amounts. A leaky endothelium fails to protect the intima from processes that lead to inflammation. Think of it as another fire alarm.

For more information about these and other tests, go to

https://www.knowyourrisk.com/

and other information from Cleveland Heart Lab, a major source of our testing

• Haptoglobin Genotype: Your Haptoglobin genotype determines if Vitamin E offers protection or increases risk of arterial disease. In addition, individuals with the Hp 2-2 genome are more sensitive to gluten, forming an inflammatory mediator called zonulin that makes your gut “leaky” and raises the risk of autoimmune disease. 

• Insulin Resistance Testing: Optimally measured through an oral glucose tolerance test, insulin resistance (prediabetes) testing is important in identifying individuals who could be developing vascular complications before a Type 2 Diabetes diagnosis. The glucose tolerance test can identify insulin resistance long before the glucose starts to rise.

  • However, if there is other evidence of insulin resistance that does not require a visit to the lab, we can skip this step. Clues are seen in levels of nonoptimal HbA1c, glucose, triglycerides above 100, low HDL, and presence of small dense LDL (Pattern B).

    The earliest detection for insulin resistance can be measured through body composition testing. At the CureCenter, we use the InBody 570, a device that can monitor insulin resistance response to changes in diet. Reducing insulin resistance is generally healthy for everyone, regardless of risk.

• Homocysteine: Elevation increases risk of:

• Osteoporosis - bone thinning

• Atherosclerosis 

• Thrombosis (blood clotting)

• Heart Attack

• Stroke

• Dementia

• Kidney failure

• Neuropathy

Treatment is supplementation with methylated folic acid. Dietary sources of folic acid are leafy greens like spinach and kale.

This paper from the American Heart Association offers a good summary of Homocysteine.

• Coronary Artery Calcium Score (CACS): This CT scan detects mature calcified plaque in the coronary arteries. However, it can miss new noncalcified plaque. This test is not useful in monitoring therapy progress/benefit. We recommend CACS when CIMT does not reveal disease but there is still suspicion of coronary artery disease. If this test detects disease that would have otherwise been undetected, a more proactive approach to address root causes will be encouraged. Beware of the slippery slope to a stress test, stents or surgery. Coronary Calcium Score is a “loss leader”for interventional cardiology programs. Call us first before scheduling further tests.

• Home Sleep Testing and Auto Titrated CPAP: These tests have made diagnosis and management of sleep apnea more affordable and effective. Sleep apnea is a root cause of heart attack, stroke, atrial fibrillation, hypertension and heart failure. Treating it can lower your risk of these events, lower your blood pressure, and reduce arterial inflammation.

• Oral Microbiome Testing: Oral microbiome testing involves taking a sample of saliva, and analyzing it in a laboratory to identify the types of bacteria present. If high risk bacteria species are found, they can contribute to arterial inflammation. In some cases, this can affect management of periodontal disease, which contributes to heart attack and stroke risk. 

  Knowing the nature of your oral “neighborhood” can prompt a more proactive approach to your oral hygiene. If there are dangerous criminals in your neighborhood, you will be more careful to “lock your doors” and augment your security for protection. The chronic diseases affected by your oral microbiome include periodontal disease, cardiovascular disease, Type 2 Diabetes and prediabetes, and even some cancers and dementia.