Here at Optimal Wellness MD, we have integrated Coronary Artery CT Angiograms (CCTA) into our functional medicine practice in order to accurately assess whether our patients have plaque in their coronary arteries. Why? Because this test is the only way to know for sure whether you have plaque in your coronary arteries or not, regardless of what your blood cholesterol tests show. Did you know that Coronary artery disease is the top cause of premature death, causing 1 in 4 deaths in the US? Did you know that 50% of the time, the first sign of coronary artery disease is a sudden heart attack or sudden death? If you are serious about living a long and healthy life, you need to avoid dying prematurely from coronary artery disease. Unfortunately, the current standard of care is to check cholesterol and assess for risk factors such as obesity, diabetes, smoking, high blood pressure and family history and then assign you a risk score. However, while this may place you in a high or lower risk category, it does NOT accurately diagnose plaque in YOUR arteries. It is just an estimate of how likely you are to have plaque. The only way to know for sure if you have plaque in your arteries, how much plaque there is, and what kind of plaque (calcified, non-calcified, fragile and dangerous) is to directly visualize the plaque with a CT angiogram. A CCTA can not only see the plaque, but it creates a detailed picture of it and can measure the amount and shapes of the plaque in millimeters.
Many of my patients are in middle-age, but otherwise active, feel generally healthy, try to eat right, may be prescribed identical hormones such as testosterone or menopausal HRT in the case of women. Yet, I have been surprised at how many have significant plaque in their arteries when tested. Here is a picture of a recent 60 year old man's left anterior descending (LAD) coronary artery. He is active, has a low body fat, exercises, is using testosterone therapy, but like many patients, has an elevated level of small-dense LDL on testing. He was taking medication (Nexletol) to lower his LDL cholesterol. However, he turned out to have severe atherosclerosis, with no apparent symptoms.
What can be done about this situation? Well the good news is that there are many effective options for stabilizing the plaque and even reducing it. I use all the following options to treat my patients:
Diet: very low carb, lower fat, no "bad" fat, anti-inflammatory diet to reverse insulin resistance, lose body fat, especially visceral fat, and optimize metabolism away from the pre-diabetic state that causes plaque to be created. Recent data indicates that a high sugar/processed carbohydrate with toxic seed oil and processed food is driving insulin-resistance and the creation of plaque, not so much the red meat and saturated fat that has been demonized by conventional medicine. Chronic inflammation from eating unhealthy food is also a driver of arterial plaque.
Medications: low dose statins as an anti-inflammatory drug, with CoQ10 and GeranylGeraniol added to avoid statin toxicity, metformin, colchicine, aspirin, ACE-inhibitors such as ramipril at low dose, and GLP-1 weight loss medications, and new products such as Cavadex and PlaqueX to activate reverse cholesterol transport, which reduces fatty plaque. My goal in using medications is first to prevent a heart attack and then to reduce the amount of plaque by activating reverse cholesterol transport.
Supplements:Â Omega-3, Berberine, Nattokinase, Glycocalyx support, Nitric Oxide support, Garlic extract, polyphenol supplements.
We have our nutritionist work with our clients to get them to eat a truly heart-healthy diet.
We monitor labs such as the Cardio-IQ from Quest to see the important blood measures of cardiac risk such as LDL particle size and number, TMAO, ADMA, PLA2, ApoB, Apo A, etc. These are more important than just checking total cholesterol, LDL, HDL, and Triglycerides.
And finally, we repeat the CCTA testing every 1-2 years to document the effects our treatment plan is having on the plaque. Our goal is to stop the growth of plaque, stabilize it, and then to shrink it. CCTA testing indicates that with our approach, this is what happens.
