Know Your Cardiovascular Risk With These Tests

Foreign. Talk to you about identifying diseases that could kill you in the future and be able to handle them now. And one of my big concerns is cardiovascular disease. Heart attacks, strokes, peripheral artery disease. And this is near and dear to me because my father became a cardiac cripple when he was very young, had bypass surgery in his 40s, stroke in his 40s, multiple stents, amount of dying of congestive heart failure and had severe angina. And I've got that risk, I've got the genetic risk. I've got what they call the, the heart of the heart attack gene. And you can be tested for that. But doesn't really predict who's gonna have a heart attack. Just means you have a higher risk. Cholesterol doesn't predict who's gonna have a heart attack. This means maybe you have a higher risk factor. It's almost useless in predicting heart attacks if you or your doctor say, I want to know if I'm gonna have heart disease, dear. Cholesterol pretty much very soft correlation, if any. And we're finding that there's certain blood work that can predict heart disease to some degree, but they're not really telling you if you're the one that's gonna get it or maybe you don't have that risk. Fact just fine. So I'm just going to talk briefly about the tests. The blood tests that show have a correlation to heart disease and a relative weight, the hemoglobin A1C, which is a measure of diabetes. The higher it is, the more likely you'll have atherosclerosis. And that's, that's the strongest link. There's something called homa, homi, which is kind of homi, which is kind of similar to A1C but it's basically your blood sugar. So higher blood sugar, pre diabetics, diabetics are going to get more heart attacks and non pre diabetics and non diabetics back to life. The oxidized apob. There's cholesterol, then there's ldl and there's something called apob, and then there's oxidized apob. Each one of these is a higher risk in correlation to heart attacks than cholesterol. So cholesterol, ldl, apob. Oxidized apob. Oxidized apob has a high correlation with cardiovascular disease. Uric acid, that's the thing we think about with gout. Higher uric acid tends to have more cardiovascular disease. Homocysteine typically elevated people with certain genetic mutations. I have one of them. There's A genetic mutation called mthfr. And if you had the mutation, your homocysteine might run high. And there's ways you can manage that after that. There's things like C reactive protein and LDL and apob, but those are all really weakly correlated cardiovascular disease. So that's one thing. But we can do some testing to see do you actually have it or not. Now, the three tests I'm going to talk about are pretty readily available. They're not covered by insurance in most cases and they're reasonably cost. So the lowest cost one and the most available one is a CT calcium score. That's a CAT scan calcium score. The study takes just seconds and you go into a CT machine, usually costs around a hundred dollars and it tells you to have calcium deposits in your arteries. That's very good screening test. I don't think it's useful for people that are higher risk. It's not useful to track disease and we'll talk about that. And it's not useful for people that are older or have more likely to have abnormal CT. So if you took people in their 40s, 30s and 40s that were concerned about developing of cardiovascular disease and they did a calcium score and it was zero, they're probably in good shape now. It's not a guaranteed, but it's better than checking the useless cholesterol. Okay, so I'm just going to say that. So that's a good test to do. If you do have an abnormal calcium score, then you really need to go further to see you have stuff that's worse than calcium, which is soft plaque. So atherosclerosis or hardening of the arteries as it's sometimes referred to, the worst artery is actually when it has soft plaque, which wouldn't be a hardened artery, it wouldn't be calcified. Calcium is repairing those arteries. So if you have a calcium score, it means you've had atherosclerosis for some time or lipid deposits in your vessel walls for some time and now it's hardening and be seen on an X ray, basically which the CAT scan is because calcium is impenetrable like bone. And if you have a calcium score that's abnormal, you'll want to know, well, I could have five times that amount of soft plaque. It's actively growing or is it just I had a little tiny, little tiny ditzel of a calcium calcification from minor injury to my arteries. You'd want to know that. We want to go further. The other thing that happens if you Have a calcium score that's high and let's say 50% of the atherosclerosis is soft plaque. And you aggressively manage your, say, lipids, which is that group of cholesterol products. The soft plaque turns a hard plaque. Your calcium score actually goes up while you're getting healthier. So it's very misleading. So this is a good screening tool. Okay, the second one, cimt, Crotid Intima Media Thickness Test. This is an ultrasound. This is one of my favorites because it's very easy to do, more expensive than the calcium scores, more like $300 and is a good way to track things along. And there's very clear standards based on sex and ethnicity of what your CIMT should look like. So cmp Carotid Intima Media Thickness. This is the carotid artery, which in here you can feel your pulse. And if you have disease in your heart, you'll also have in your carotid artery. They're kind of mirror each other. So it's good, good like say canary and coal mine to tell you if you have disease somewhere else. So we can do the carotid. That's the most common one checked. Because when you get atherosclerosis, there's certain areas where it grows first and it's areas of turbulence. And there's one right here. And there's one another artery here called the left anterior descending, which we call the widowmaker. When people have it, you know, plug up. So the CIMT is done with an ultrasound, takes more like 20 minutes, not a few seconds like a CAT scan, a little more sophistication to reading it. So there's clinics that, that offer this. It's not going to be done typically in a hospital be done in a setting where there's somebody that takes patients that want to get healthier versus health insurance that want to treat disease. So somebody wants to get healthier, they're going to a different kind of doctor that has the ability to let patients pay for their own studies versus what your insurance cover, which is just called medical necessity. It's not considered medically necessary to know if you're going to have a heart attack 10 years from now. That's a reality. The medical necessity is treating a heart attack. Okay, so these are things that you have to pay for on your own. Not very expensive, about $300. And if you have an abnormal CIMT, we may go further, look at chart. I'll talk about that shortly. But for right now, if it's just, you know, let's say you're 50 and you have arteries of a 60 year old. You're not an impending death risk, but you're going to have a heart attack, most likely in your lifetime. So we want to change that risk. And we've over and over again seen people go from five years older or 10 years older than their cardiac age to five or 10 years younger. My own personal journey, I have a family history of heart disease and I've had a calcium score was negative. And about 10 years ago I got sick, I had a spinal issue, my cholesterol went high and my blood pressure went high. I laid a little atherosclerosis down in my arteries and my arteries are a little older than I was and now they're about 10 to 16 years younger than I am. So I've reversed that through some, through interventions. So we can reverse that and we can track it with cimt. Can't track with the calcium score, we can track with cimt. In other words, you can do the study again at six months a year and see if your arteries are getting older and younger. There's two things we look at on the cimt. One is the thickness of this intima media and there's tables that we can compare it to people your age. So if it's, let's say 0.7 millimeters and you're 50 or a woman that's thicker than it should be, should be maybe 0.55. And we know that the 0.7 is more like a 60 year old. If it's, if you're 55 and it's 0.4, you know your arteries are much younger. The second thing is plaque burden. So plaque is atherosclerosis. These are these hard and soft plaques. Are they hard or soft? Hard plaques don't hurt you, but it means you've had an issue in the past. Soft plaques are growing potentially, and those are ones that could potentially cause a stroke or a heart attack. So we want to turn soft plaque and hard plaque and then eventually get hard plaque to shrink. And in some cases it does go away. And that's not always a sure thing. Making plaques go away. Your goal really should make all your plaques hard. Secondary goal would be getting, getting rid of them, which is maybe more, more complex. But making soft plaques go hard is not easy. You've got to do interventions, medications, lifestyle, sometimes more aggressive medications. But the opposite of that is letting these things continue to grow until you have the first symptom, which is a stroke or the heart attack, which is what we want to obviously avo. And the last one is called a CT angiogram. Clery Y, C L E E R L Y. This is a artificial intelligence software that does a CAT scan with contrast. So it's kind of like doing a heart catheterization with the cannula that goes into your, your arm or your thigh. And it looks at the soft and hard plaque of the arteries of the heart, assuming there is some. And this is where the AI comes in, is able to calculate is it soft or hard plaque, how much of the artery is occluded and where it's at. So the Clery study, we typically don't do that as a first line. We do the cimt. If it's abnormal, consider Clery. If the CIMT is substantially abnormal, let's say it's, you know, your arteries are 10 or 20 years older than you are, then we definitely want to do a Clery study. See, are you getting an impending issue in your heart? And the Clery is something that can be, you know, follow along as well. There is ionizing radiation and there is contrast. So it's not, you know, like, let's say risk free, like an ultrasound is, but it's very, very low risk. People have had CAT scans, you know, for decades. We know they're, they're safe if not done excessively. Contrast only affects certain people with kidney disease or allergies to it. So that's some study that we don't go to first line. But that's something we do if you have an abnormal study. And then the next step is if you have disease, you know, see a functional medicine cardiologist or functional medicine doctor. We referred a couple doctors right here in the Detroit area. We have Clery in the area. You can actually get a CAT scan with angiogram anywhere and your doctor can mail the disc to Clery. I think they charge 750 to interpret that portion of it. It really can be done even at a, you know, rural hospital. This is, your doctor's got to put together the system with what the Clery company. We find that there's centers in Michigan, Ascension in Southfield has a Clery machine. I think it's roughly fifteen hundred dollars. I had one done two years ago. I'm doing again this year. I had a little bit of atherosclerosis, not much, but not what I want. And I'm reversing that. So I'm going to repeat that this year I did an intervention to improve all those numbers we talked about. And every single one of Them I'm working on even though there's different correlations with each one. When I talked about the blood work. So the Clery is probably the most precise one, but it's maybe not the first step. CIMT I think is the most practical for the broad population and calcium score, which is the CAT scan. The first one, the $99 one is more for screening younger people that have lower risk and get a low cost, very fast, very easy, widely available. Those are the three. And the real take home message is the conventional approach to cardiovascular disease is to deal with it when you have a problem. We've had patients that had a CIMP study in our office showing you 25 to 50%, you know, narrowing of their arteries and they will see the cardiologist like what do you want to do about this? It's not that bad. Well yeah, it's not that bad. You're not going to have a heart attack this year, but that's the direction you're going. So if you lost half the thickness of your, if you've lost 20% of the thickness of your lumen, you're growing atherosclerosis. We taking this seriously yet? We have a knee jerk response to treat the cholesterol. We don't have a knee jerk response to screen the person. You actually have disease and somebody's cholesterol is sky high and they have no atherosclerosis at all. What are we really treating? We're treating a number. If somebody has a normal cholesterol and they have atherosclerosis, we should be dealing with that. Now we can argue over what treatment you should use. The reality is there's numerous treatments and we can see how people respond to it by reimaging them. We can even use more sophistication algorithms to figure out what's going to work best for the person. But the number one thing in my opinion we should doing is seeing if there's actual disease or not. Because we're still missing heart attacks at alarming rates. That's still the number one cause of death. I mean look at all the money we put into managing cardiovascular disease. It's almost a trillion a year which happened to death rate from heart attacks stay insane, hasn't gone down. Bypass surgery, angioplasties, angiograms, things like stress tests are not useful for detecting future heart disease. It might be stressful saying if your chest pain, having chest pain now, is it from your heart? That's helpful. Way more expensive than a cimt. Probably about the same Cost as a Clery study. I would just, you know, skip the middleman and go right, do a Clery study. And I think the world's moving that way. But until insurance covers it, which they're not now, people are reticent to do it. They. To spend their money on something that they maybe don't believe in. Well, my. What I've learned is that there are people that love their money more than their health. They're. They're going to do what's cheapest. I get that it has, it doesn't seem to be correlated to how much money they have has to do with what they value the most, their money or their health. And there's people that value their health more than their money. And if you value your health more than money, then you can spend $300 to get a CIMT test. Fifteen hundred dollars for Clery or about $100 for cats for the CAT scan. Any one of those tests would be a good first move. Better than the cholesterol test, which might be, you know, free under your insurance. And just a note on that. Why is insurance not cover it? Insurance was designed to manage catastrophes and disease. It was never meant to screen you for stuff. And the Affordable Health Care act, which came out in 2010, 2011, actually called Obamacare. Prior to that, there was no mandate for insurance companies to cover screening tests for cancer mammograms, PSA tests, and they mandated screening tests and some other things as well. And then we started assuming, well, if it's screening, our insurance would pay for it. Nope. Not unless Congress specifically identified the disease to screen for. They did not identify screening for cardiovascular disease. They identified screening for cancer. Okay. And even that setting, we still miss 75% of cancers with the screen that is paid for. So if you let your insurance company dictate your health, you're now thinking they're a health care company and they're not. They're a health insurance company, treats disease and some screening. So there's some healthy things to it. I'm not definitely not badmouth in the insurance system or healthcare system. You know, we treat blood pressure, diabetes. Those are great that we're doing that. And that's something. Those are considered diseases. But taking a step back from there, how do we identify something that's going to kill you? So hypertension and diabetes, what Those lead to heart attacks. You don't die of the hypertension, generally don't die of the diabetes or the hypertension. You die of the heart attack or the stroke or the cancer. Or the Alzheimer's disease. So we can identify all those things decades in advance. And I do mine. I hope you do yours as well. The CIMT study, we offer those at certain locations in Michigan. I'd like to expand that as it gets more popular. Fairly easy study to do and just get tested. Something that if you do it once and everything's great, probably do it again in five years. If you do it once and it's not so great, let's take some intervention, let's start doing this every six months or a year until you've gone backwards over a period of time. We've seen people go back really 10 years in thickness in a year. That really does happen. If we identify the steps, in some cases, they've got sleep apnea, they have untreated hypertension, they have some lipid issues, they have a lot of oxidized apob, they have high homocysteine. We can start managing those things individually and reversing and actually seeing if those efforts are taking place right now. You do cholesterol tests, it's high. Your doctor puts you on a statin, comes down, pat ourselves on the back. What are we really treating? We're treating a number. Let's treat the disease, let's look for it. And I think it's perfectly acceptable to work outside of your healthcare company and just, just do it on your own. There's these tests that are going around. I think it's called Life Screen, where they do the carotid ultrasound and the abdominal ultrasound. Inexpensive. Those are, those are good. I mean, I'm not saying not to do that, but it's not going to give you the cimt, it's not going to give you your cardiac age, it's going to tell you of a critical occlusion, which is still good to maybe screen for, but it's not the same thing I'm talking about. So I'm talking about people that don't have disease that they know of and they want to see if they're going to get it in the future. So we want to predict our future and sometimes we're not motivated to worry about the future. Well, the future comes sooner than, than you wanted to. And how many people you know that have had a heart attack and they didn't see it coming, they could have been screened 10 years earlier. That's our mission, help you look and feel better, less risk. And this is very low risk doing offshore. Essentially no risk other than the financial risk of paying for it and having nothing wrong with you. So thank you very much.