I have heard Dr. John McDougall emphasize on several occasions that the “numbers” – cholesterol, triglycerides – don’t tell you everything. They don’t necessarily tell you exactly the condition of your arteries or your heart, for that matter. They are indicators.
And that even more important than “the numbers” is what is actually going on in your system paired with what you eat day-in-day-out that matters. And the best preventative we know for heart disease is a whole-foods, low fat plant-based diet.
When I spoke with Caldwell Esselstyn, M.D. while researching The Plant-Based Journey, I asked him in particular about “the numbers”. He too said the most important thing is “what’s going in every day.”
When Joel Kahn, M.D., aka America’s Holistic Health Doc and author of The Whole Heart Solution, graciously sat down to talk with me about Journey, plant-based eating, and heart disease, in addition to living a healthy plant-based lifestyle, he expressed enthusiasm about what he considers, as a cardiologist, to be the best measure of heart disease risk: the CACS scan.
And lucky us, he followed up by sending along an article to publish just for you.
Don’t Settle for Less than The Best: Early Detection of Heart Disease
Can you please solve this puzzle for me?
You turn 50 and and are asked to have a mammogram to directly examine your breasts.
You are also asked to have a colonoscopy to look directly at your colon.
For your heart you get a measurement of blood pressure and cholesterol and maybe an ECG.
Why is there no examinations of the heart (coronary) arteries where lethal blockages may form?
There is a better approach, one that has been promoted by the Society for Heart Attack Prevention and Eradication (SHAPE), the American College of Cardiology, and hundreds of peer reviewed research studies. It is a low-cost ($75-250) coronary artery calcium scan (CACS) using a fast multi-slice CT scanner.
With no contrast or IV injection, in under a minute a direct and painless examination of the coronary arteries is completed.
Who should not have the CACS?
If you already know you have coronary artery disease such by a previous cardiac catheterization showing blockage, a previous heart stent, or a previous heart bypass surgery, there would be no need for a screening test of this type. People who know that they have blockage in other parts of the body, like an artery of the brain called the carotid artery or the arteries of the leg, remain debatable candidates for the CT scan.
In my cardiology practice I find that if I can use the CACS results to really demonstrate to patients how their disease affects heart arteries, they get even more motivated to adhere to a prevention and reversal lifestyle. The American College of Cardiology has given a high endorsement (IIA) to the use of CACS in persons with known risk factors for silent coronary disease (like smoking, diabetes, a family history of early heart disease, high cholesterol and high blood pressure).
What about risks of the CACS?
Other than the cost averaging $100-200 out of pocket, the only other concerns are the possibility of creating undue stress, missing soft plaque without calcium, and radiation.
For decades cardiologists have relied on exercise nuclear testing using treadmill examinations.One measure of the dose of radiation is called a milliSievert or mSv. An exercise test with Cardiolite may expose a patient to 12 to 15 mSv of radiation. By comparison, a cardiac catheterization done in an efficient manner may expose a patient to about 10 mSv of radiation. In centers with the most advanced multislice scanners, that now are often 64 slice, 128 slice, 256 slice, and beyond, the imaging has gotten so fast that the radiation dose may be 1 mSv or less. Nearly 99% of dangerous heart plaques contain calcium detected by the CACS.
Why do a CACS?
A CACS may provide life-changing information.
For example, the European Society of Cardiology said that “there is overwhelming evidence that coronary calcification represents a strong marker of risk for future cardiovascular events in asymptomatic individuals and have prognostic power above and beyond traditional risk factors.”
The same position statement indicated that in asymptomatic individuals a calcium score of zero was associated with a very low risk of heart events over the next 3 to 5 years (less than 1 percent per year). Individuals with a coronary calcium score greater than 1000 have an eleven-fold increase in risk of major events even if they are without symptoms.
What can you do with the results?
A study group of 1005 patients with an abnormal CACS were treated with aspirin, and some received a statin to lower their cholesterol. After four years of follow-up, patients who received a statin had a seven percent rate of heart events like a heart attack versus 12 percent of those who received a placebo.
Other studies demonstrate that omega 3 fatty acids, aged garlic, and fruit and vegetable concentrates slow or reverse the calcification. The TACT trial published in 2013 demonstrated benefits from chelation therapy in a different patient population. We need more studies geared to determining how the risk can be lowered by specific treatments, to be sure. Yet these studies give a glimpse to the power of finding and treating silent heart disease at an early stage.
The “colonoscopy” for the heart?
Heart disease remains the number one killer for men and women alike in the US, and it is time to perform direct arterial examinations like CACS for at-risk persons as part of a routine wellness exam. In this regard, I think of CACS as the “colonoscopy” of the heart. Combining it with recent studies showing that lifestyle habits prevent 80-90 percent of heart attacks, celebrate this heart month with the knowledge that you are heart attack proof.
Have you had a CACS performed? What do you think? Looking forward to your thoughts in replies below.
What is a coronary calcium scan
I had never heard of this test before and found this article very interesting. I also had heard of Dr. Kahn and am glad to get a chance to read more about him.
Dr. Joel Kahn is an energetic, positive, and confident cardiologist who I am only lucky to be partnered with on advancing the plant-based cause. Thanks for pausing to put a thumbs up on his article contribution!
I know I am late to this article (about 4 years), but I just stumbled across this now. I am 35 years old, but because of family history, I started being proactive about checking things just over a year ago. I have had elevated levels of Cholesterol for a while now, and wasn’t doing my part to take care of it (diet/exercise). Just over a year ago, I saw a cardiologist who sent me for the Calcium Score, which at that time was a 43. I know that’s not in the dangerous level, but for 35, I believe that is bad. I had put off statins for a while, cause I really don’t want to be on medication. When I went for my yearly in November 2018, my numbers went up again (Total: 246, LDL: 196, HDL: 31, LPA: 317). As bummed as I was, I decided to finally agree to a low dose of Crestor to help things. I also have switched to a Whole Food Plant Based diet. My goal is to eventually get off of the medication, but my doctor (like most of them) thinks I need to take it forever, and said I will probably need to up the dosage too (currently on 10mg). His big reasoning for the medication is the calcium score. Is it possible to actually lower that score? I know it is the hardened/calcified plaque, but there are some that believe you can remove it. If I can lower that, then I would have some good ammunition to justify getting off the meds. Is it realistic to think that I can lower the score with a WFPB diet? I really appreciate any response to this. Thank you