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.

What is a Coronary Artery Calcium Score?

A coronary artery calcium scan reports your coronary artery calcium score. It is useful as a screening tool for those who are not known to have arterial disease. It should not be used to assess symptoms or monitor arterial disease in response to therapy. 

If you already know of the presence of arterial disease in your body (if you’ve had a stroke, heart attack, stent, or bypass surgery) or carotid artery ultrasound, determining this score is unnecessary. It may also lead to risky, costly/profitable stents or surgery with no benefit in the absence of symptoms like angina or heart failure.

What does the score mean?

A score of zero is generally reassuring that the risk of heart attack from silent arterial disease is low in studied populations. You want this score to be as low as possible. However, if you have other risk or evidence of arterial disease, you could have plaque that is not calcified, known as soft/homogeneous/vulnerable/or unstable plaque. This occurs in about 10% of those with zero calcium scores.

Non-calcified plaque is the most vulnerable to rupture (the event that leads to heart attack). Therefore, a score of zero does not guarantee that you will not have a heart attack. Plaque can still form after a reassuring test in response to a change in conditions that promote inflammation, such as a dental infection.

Coronary calcium scores rise as plaque heals and inflammation subsides. In our experience, scores rarely fall, which makes this scan inappropriate for measuring progress.

Instead, we recommend measuring trends of the thickness (sickness or inflammation) of your carotid arterial wall, which can be done with completely safe ultrasound. This is a much more meaningful measure of disease response to treatment. To find this option, click www.vasolabs.com/events.

Coronary artery calcium scans can lead to a slippery slope that can be dangerous to your health and your pocketbook. They can lead to unnecessary procedures, such as stents, that do not prevent heart attack or stroke in individuals with no symptoms. 

If there is no plaque seen on carotid ultrasound, an elevated Coronary Artery Calcium Score should provoke a search for root causes and efforts to eliminate them.  

The proper response to a positive screening/asymptomatic coronary artery calcium score should be to identify the root causes of arterial disease and eliminate them. This is what we do at the CureCenter.

If you have no history of heart attack, stroke, TIA, stent, bypass or other evidence of arterial disease, we suggest first getting a carotid ultrasound to screen for plaque as the first step. You can do this by scheduling your 15-minute CureScreen.

If you’re unsure what to do next, request a no cost/no obligation Discovery Call today.

Don’t let the cardiologist or coroner be the first to tell you about your disease.

by Dr. Craig Backs

I once met with a man in his 60’s who I cared for years ago. He was interested in reconnecting because his current physician had retired. After speaking with him, I offered to develop a custom CurePlan. He declined and stated, “I eat right, I exercise, and my doctor says my cholesterol is good.” I decided to not push the issue because it rarely if ever works to change beliefs. 

A few weeks later, I received a call from the hospital. It was this man’s wife, informing me that he had suffered cardiac arrest while exercising the prior morning. He had been successfully resuscitated and was recovering without apparent residual effects.

He now wanted to discuss a CurePlan because his catheterization had demonstrated three vessel coronary artery disease and he was recommended for coronary bypass surgery. He asked: “What should I do?”   

Sadly, I had little to offer him and urged him to follow the advice he had gotten for standard care. I had no influence on his hospital care other than as a “friend” that would only create friction with his surgeon and other doctors. 

I could have suggested he go home, come see me to discuss the details, and then decide if surgery, with all its risks, is the correct option. However, I didn’t believe it was worth the risk of him going into cardiac arrest again outside the hospital. I did not have all of the details of his diagnosis and he had previously declined my offer for a custom CurePlan and advice for proactive measures.

So, he and his family went through life altering operation on the heels of a life altering cardiac arrest and resuscitation. All of this would likely have been avoided if he had known of his arterial disease early and proactively treated the missed root causes proactively. 

I hope that someone who reads this story will act proactively in their own interest and for the benefit of their loved ones. Identify the disease that lurks within and could take you out in a moment without warning.