Cholesterol trumps heart scan?

28. August 2007 William Davis (4)
Lela's heart scan score: 449--very high for a 49-year old, peri-menopausal woman. Her score placed her flat in the 99th percentile, or the worst 1% of women her age.

Lela first consulted her primary care physician. Her doctor looked at the result puzzled. "Now wait a minute. Your cholesterol numbers have been great." After a pause, her doctor (a woman) declared the heart scan wrong. "Tests aren't perfect. The heart scan is simply wrong. I'm going to believe the cholesterol numbers and there's no way you have heart disease."

Is that right? Can cholesterol numbers trump your heart scan score? Can the heart scan simply be wrong?

The answer is simple: NO.

The heart scan is not wrong. The heart scan is right. What is wrong with this picture is that standard cholesterol testing commonly and frequently fails to identify people at risk for heart disease.

What if this woman smoked? That wouldn't be revealed in her cholesterol panel. Or had high blood pressure, increased inflammatory responses like C-reactive protein, had increased small LDL or lipoprotein(a), was severely deficient in vitamin D? None of that would be revealed by cholesterol numbers.

So, no, the heart scan is not wrong. The cholesterol numbers are not wrong. The doctor's interpretation of the data is wrong.

Please do not allow false reassurances offered by those who do not understand the technology steer you wrong.

This woman proved to have an entire panel of hidden causes of her coronary plaque uncovered. No surprise.
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Comments (4) -

  • Anonymous

    8/28/2007 5:15:00 PM |

    How would those of us who have had valve repair and bypass surgery track our plaque if blood tests don't provide the whole picture ?

  • Dr. Davis

    8/28/2007 6:34:00 PM |

    This is a problem area. One possibility is carotid ultrasound. Though less precise and an indirect measure of the body's burden of atherosclerotic plaque, it's the best that I am aware of once the heart's arteries have been changed or distorted by bypass.

  • Anonymous

    8/28/2007 10:40:00 PM |

    I've been wondering about heart scans and plaque burden.  I have a  vested interest in this as I have a strong family history of early CHD. (FWIW, my CCS is 29 at age 41; not dramatically bad, but I believe that places me somewhere around the 90th percentile for my age; or potentially with the plaque burden of a 54 year old).

    Once a person is old enough -- or has sufficient calcification of the plaques -- then there is a very good correlation between plaque burden and CCS.  That is my understanding as to why heart scans are not generally recommended for people under 40 and to some degree even for people in their early 40s.

    So, in my case I worry that my low score may actually be an under indication of my burden.  The only way to figure that out though would be angiography or maybe carotid IMT, right?

    Which leads me to my second questions: I think what you are doing here is fantastic, but have wondered, is the reduction in CCS a reduction in the plaque burden?  Or is it simply a reduction in the calcium in the plaques?  And how does that impact the stability versus the instability of the plaques?

  • Dr. Davis

    8/29/2007 1:58:00 AM |

    Whew!

    Unfortunately, too much to cover in a Blog. That's why we have an entire website devoted to this topic. You are invited to go to www.trackyourplaque.com to read further. You raise important issues that simply cannot be covered in a few sentences.

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How tough is the Track Your Plaque 60-60-60 target?

How tough is the Track Your Plaque 60-60-60 target?

9. August 2007 William Davis (3)
One of the basic requirements that stack the odds in your favor of stopping or dropping your CT heart scan score is to achieve basic lipid targets of 60-60-60.

In other words, we generally see best results when LDL is reduced to 60 mg/dl, HDL raised to 60 mg/dl, triglycerides reduced to 60 mg/dl. Now, these are not absolute requirements. Someone can have a spectacular drop in heart scan score even with an HDL of 56, LDL of 71. But the "Rule of 60" provides a useful target that is easy to remember, packs real power, and is clearly beyond that achieved with conventional approaches.

People often ask, "Just how tough is it to get to these targets?"

It's really not that tough. Interestingly, whenever I tell my cardiologist or primary care colleagues that I advocate these 60-60-60 targets, they declare that it's tough, perhaps impossible, except for the most highly motivated.

I agree that it requires motivation. A cigarette-smoking, TV-addicted, 70-lb overweight, chip- and pretzel-eating couch potato is not going to achieve them.

On the other hand, you don't have to be a marathon running vegetarian to do it, either.

Most people, in fact, engaged in the Track Your Plaque program achieve the 60-60-60 targets---or exceed them. It's not uncommon, for instance, for HDL to skyrocket to 80 or 90 mg/dl with many of our strategies. (Of course, if your starting HDL is 20 or 25 mg/dl, 80 or 90 is not possible with current technology.)

But it certainly does require more than the "Take Lipitor and stick to your low-fat diet" approach that is the mantra repeated in the vast majority of medical offices across the U.S. For instance, reducing LDL to 60 mg/dl when starting at 170 mg/dl will require addition of oat bran and other soluble or viscous fibers; raw almonds and walnuts; perhaps the use of Benecol butter substitute; reduction or elimination of wheat products if small LDL comprises a substantial proportion of LDL particles. Reducing triglycerides requires the generous use of omega-3 fatty acids from fish oil. Attention to vitamin D must be a part of the effort.

So, yes, it is not as simple as the conventional approach. But the results are far superior in reducing or eliminating heart attack and in dropping your heart scan score.

But it can be done. We do it every day.
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Comments (3) -

  • Anonymous

    8/11/2007 3:12:00 PM |

    Dear Dr. Davis,

    I am a 49-year-old woman. I have a 21-year-old mentally handicapped child and a son who is starting at GA TECH this Fall. I homeschooled both of them most of the way through school. I now help my husband run a home-based business. Needless to say, I spent many years pretty much ignoring my health needs. In February, 2007, I became very ill with strep from which I was not recovering well. My FP did blood work and discovered that my blood sugar was 477, my triglycerides 261, my HDL 42, and my LDL 129 (Total cholesterol: 223). He prescribed Metformin (2 extended release per day), and I embarked on a diet and exercise program. I have lost over 30 pounds, and my new lab results from 2 weeks ago were: blood sugar - 102, triglycerides - 119, HDL - 47, LDL - 150, and total cholesterol - 221. I have been taken off of Hydrochlorothiazide and am being switched slowly from Atenolol to Prinivil. My blood pressure is usually around 100/65 now.

    My doctor wants to put me on Simvastatin, but I prefer to try some natural means of normalizing my cholesterol before adding yet another med with another set of side effects.

    I have been eating very little bread, a little fruit (mostly berries or cantaloupe), lots of salad (very little dressing), green veggies, lean meat (mostly chicken or fish), and some beans (lima, garbanzo, pinto, or black).

    I would love further suggestions from you.

    Glenda Parkman

  • Dr. Davis

    8/11/2007 4:11:00 PM |

    Hi, Glenda--

    Those are spectacular results and testimony to what lifestyle changes alone can accomplish.

    Please note that this Blog accompanies the conversations on the Track Your Plaque website. It is not meant to be a source for the full discussion. Please refer to the website.

  • Dick Lyshek

    10/7/2010 4:39:10 AM |

    Dear Dr. Davis,

    I have relatives in Waukesha and Madison that are looking for a doctor that follows your protocols.  I would greatly appreciate any suggestions you could make.

    Sincerely

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