Hello Dr Davis,

Interesting post about hard and soft plaque.  I recently had a discussion with my GP regarding my serious increase in scan score (Jan 2006 = 235, Nov 2007 = 419).  

After the first scan we started aggressively going after my LDL, HDL and Trig.. 196,59,221

And have them down to 103, 65, 92 - we still have a way to go to 60/60/60 -

So the increase is a suprise, but my doctor said that the increase could in part be cause some of the soft plaque had been converted to hard plaque and the scan would show that conversion.

Does hard plaque register more than soft?

Thanks for what you  are doing.

Hi, Dave--

I'm glad your doctor is working with you on gaining better control over your plaque growth.

However, there is no such thing as soft plaque converting to hard plaque to increase calcium scores.

Think of it this way: Calcium is a surrogate measure of TOTAL plaque, both soft and hard. In the majority of settings, there is little advantage to characterizing soft vs. hard.

To seize better control, don't neglect: 1) hidden lipoprotein patterns, 2) vitamin D. Also see  our report "10 steps to take if your heart scan score increases more than 10% per year" at http://trackyourplaque.com/library/fl_02-006tensteps-2.asp.

Good luck!

Dr Davis,

Thanks for the response.

  I wonder if you are seeing any trends that indicate a "flywheel" or momentum in the creation of plaque.  I notice you have some patients that take two years or more to stop the growth.  

Starting point Jan 06 - score=236
Quit smoking - Jan 06
Vitamin D - taking 1200
Lost 20 #'s (5'11)=195
Exercise 40min 4x
Fish Oil = 1600 DHA+EHA
Crestor = 10mg
baby aspirin
Basic good diet - no processed foods
Oatmeal and blueberries/raisins everyday.

This month = score=419

After last scan
just added Zetia
Just quit all wheat products
Considering quiting redwine - I tend to have 3-4 glasses versus the recommended 2
Doctor is still saying no to L-arginine (not enough studies)
Considering Niaspan

Any comments?

Thanks again - Dave K

P.S. One more question... maybe this should be a separate post.  Do we know the exact connection between smoking and plaque?  Does it lower LDL size, lower HDL - iritate the lining of the vessels? Is it just elevated blood pressure?  What did my thirty years of smoking do to my heart (versus lungs)?

Hi, Dave--

I'm afraid there's too much to cover in this Blog. You will need lipoprotein testing and almost certainly require more than a baby-dose of vitamin D to gain better control over plaque growth. This rate of growth, however, is very concerning.  

I would invite you to look at the hundreds of pages of discussion on the www.trackyourplaque.com website devote to just this question.

Thanks Again Dr Davis,

I have poured over your website and I'm still reading.  I plan to make your list of turn around "stars".

BTW - here is the comment from my GP - sounds exactly like the cardiologist you mentioned in the original post.

"Remember that although your coronary calcium score has gone up, this does not mean that you are at greater risk than you were a year ago.  Remember that the most dangerous plaque is the not-yet calcified soft plaque, which will not show up on an EBT.  It is only the safe, calcified plaque that can be measured with the EBT.   For your score to go up like it did, while your lipids came down so much, what had to happen was that lots of dangerous unstable plaque was converted to stable, calcified plaque.    There are no accepted guidelines for interpreting changes in calcium scores over time, because the scores tend to go up as treatment converts dangerous plaque to safer plaque.    We do know that aggressively lowering LDL reduces both unstable and stable plaque, and we know that risk can be further lowered by adjuvant therapy such as I listed above. "

Sigh . . .

It's amazing what a simple reading of the literature by your doctor would reveal to him/her.

In near future, I will be posting some blogs that summarize crucial studies in the heart scan literature in an effort to provide better weapons in your fight.

Dr Davis,

Thanks again for all you are doing and I look forward to whatever you can post.  I plan to challenge some of my GPs positions.  Your data certainly is of enormous value.

Dave K

P.S. I going to 2000 vit "D" tomorrow.

Also - have you thought about a "track-your-plaque" certification.  Something to indicate that our Drs are at least up to speed on the latest in *preventative* proceedures...?  I would switch.....

Hi, Dave--

Yes, excellent thought.

It is something we'd like to aim for, but over the long term, since right now there are too few to make a difference. One by one, they are declaring themselves and separating from the "pack."

Stay tuned for more on this issue. In the meantime, I continue to try and inform my colleagues about what is right, what is wrong, what is preferable for patient safety and yields truly empowering information, and try to impress on them that the practice of cardiology is not just about enriching their retirement accounts.

There is a show that I watch from time to time called Man vs Wild.  It is OK entertainment, and most importantly, my nephews enjoy the show.  It gives us something to talk about.  If you haven't seen it, the program is about a former British military specialist named Bear that goes out into different wild locations to show how to survive.  He eats gushy bugs and wild vegetables for food, builds forts to sleep in, etc.  

I happened to stumble onto an article about Bear a # of months ago.  It said that he has a condition that predisposes him to have high cholesterol.  His father died from a heart attack so as of last year he says he is now eating an all vegetable, whole grain, starchy, diet when at home.  He also mentions his new diet on his web sight in which he quotes from the World Health Organization for what that organization believes to be proper food to eat to be healthy.  http://www.beargrylls.com/health.html    

(I hope kids are not following his blog eating suggestions.)  

I mention this because my nephews and I have noticed that it looks like Bear has grown a little tube around the belly for this newer season.  I think Bear would be better off eating the Paleo diet that he does in the Man vs Wild show than his starchy WHO approved diet.  I wrote him a message to that effect and mentioned if he wanted to prevent heart disease, there was no better place to learn from than the TYP web sight.      

Talking about the good and the bad of corporations spreading the word about good nutrients, I heard a rumor that a larger German health food/ drug company is working on or coming out with a "unique" vitamin D.  I used to work in the health food industry several years ago and know the main researcher doing the work.  He seems like an honest guy.  When we worked together he was in charge of researching polycosanols.  The company had a patent on them and wanted to come out with a unique product.  I remember he tested the polys but he never found them to work at lowering cholesterol.  The company did not like the results, but he stuck with what he found and the company never did sell polycosanols. So when it comes to any new Ds hitting the market I doubt this company will be coming out with another no flush niacin.  It will be something that works is my guess, but will the newly marketed D be better than what is already about there......

Off topic, had lunch with the owner of one of the larger independent health food testing labs in US last week.  He lives in the same town as I.  I told him that I was now taking D3 and he said he was receiving many many orders for testing this.  D3 testing is popular this year.  He then volunteered that many companies are now testing for vitamin K2-7 also.  Good to see your word along with others on the importance of these nutrients is getting out.

We (my son & I) watched Man Vs. Wild just last night.  He ate raw yak liver, blood, & eyeballs in frigid Siberia, near the border of Mongolia, as well as blood sausage with the local people in their yurt.  His paleo nutrition is usually quite accurate.  I'm really surprised he fell for the WHO advice, since he sees how indigenous people often live quite well on traditional foods.  

On the other hand, we prefer the Survivorman series, which has a similar premise, but less "sensational".  Unlike Man vs. Wild, Survivorman goes it alone, without a camera crew.  He has to carry his own gear (minimal for himself) and set up his own camera shots and footage.  Unlike Bear, he downplays the "ugh, look what I have to eat to survive" attitude.

I am a dietitian that works with heart patients, and I do NOT recommend the AHA guidelines.  I actually have to spend a large amount of my time re-teaching them what their cardiologists and other health care professionals have been spouting off.  Just letting you know that not all dietitians are mindless AHA and ADA believers.

Dear dietitian--

That's great!

I am thrilled that you have the courage to speak out and express what you believe to be true, not what you're told to believe.

Keep it up!

Except Fanatic Cook lives on wheat and grains.  Little disconnect there.

Hi, Ivan--

Uh, oh. We should talk to her about that.

Yeah, I dropped Fanatic Cook from my reading list some time ago.  Little new or useful to learn there after she went a bit overboard on the "whole grains are good thing".  She moved into vegetarianism and veganism as an attempt to prevent cancer, and for the most part, provides some really weak support for that position.  I could say more, but I think I'll leave it at that.

Nice to hear she is seeing the AHA clearly, though.