THREE POWERFUL REASONS TO TRACK YOUR PLAQUE.
There's a 50% chance you already have hidden heart disease! Cholesterol values won't help you. Feeling good doesn't mean anything! Discover why Tracking Your Plaque is destined to become the new medical standard for preventing heart attack.
The Old Tests Were Wrong
If the means to turn off heart disease are already within our grasp, why don't most doctors tell you about it? Surely, if there were some medicine or health practice that could stop heart disease in its tracks, he/she would tell you about it! Think about that for a moment: Coronary disease is the number one cause of death in America, and most physicians do not know how to screen a seemingly well person for hidden heart disease. You may, in fact, know of friends or acquaintances who passed their annual physical exam from their family physician, only to die or have a heart attack shortly afterwards.
Old Habits Die Hard - You Don't Have to!
The fact is, the latest research and discoveries regarding the role of hidden plaque in heart attacks is so new that most practicing physicians and cardiologists have not yet been introduced to these revolutionary new concepts. They continue to rely on the test they know and are familiar with - the stress test. Contrary to popular opinion – including that held by many physicians – stress testing is not an effective means of screening people without symptoms for the presence of coronary heart disease. This is such an important issue that it bears repeating: Stress testing is not an effective method of uncovering hidden heart disease.
Then why are stress tests performed? Are they worthless? In truth, stress tests can be useful diagnostic tools, but only when used appropriately. People who go to the hospital with symptoms, particularly chest pain, can benefit by having a stress test to reproduce the symptoms. The physician needs to distinguish an impending heart attack from the pain of stomach ulcer, pleurisy (inflammation of the lining of the lungs from pneumonia), esophagitis (inflammation of the esophagus), gallstones, etc. If chest pain is provoked by walking on the treadmill during a stress test, this is suspicious for heart disease. The treadmill test (or a pharmacological equivalent) is often combined with a method of imaging blood flow to the heart muscle such as thallium, or methods to image heart muscle strength such as echocardiography (ultrasound). If there is poor blood flow to a specific segment of the heart's muscle, then a blockage in a coronary artery is present and your chest pain likely represents warning to a future heart attack.
But using a stress test to detect hidden coronary plaque in someone without symptoms is unlikely to uncover anything. This is because the majority of future heart attacks victims are walking around feeling just fine, yet have silent plaque in their coronary arteries. Heart attacks in these people are caused by "rupture" of a "minor" plaque, one that may be causing only 20 or 30% blockage, doesn't block blood flow, and is therefore undetectable by any stress test. Plaque rupture is a process that develops within minutes -- stress testing will not anticipate this event. What we really want to know is how much plaque is present in a well-appearing person.
Plaque is the Best Measure of Heart Disease
Perhaps you have early heart disease and danger is far in the future, say in 20 years. Or, you could have extensive coronary plaque with high probability of heart attack next week. Which one are you? Obviously, it's a crucial distinction, one that cholesterol values will not make. Average LDL cholesterol in the U.S.: 131 mg/dl. Average LDL cholesterol for people with heart attacks: 134 mg/dl. Will your LDL cause a heart attack? Heads or tails? The pitfalls of cholesterol are common to all statistical predictors of risk. It is little better than a coin toss for the vast majority of us.
A far superior measure of your risk for heart attack is to actually measure the amount of coronary plaque you have that results in heart attack. We therefore need a tool to measure the amount of atherosclerotic plaque lining your coronary arteries. And we need to do so along the entire length of all three coronary arteries, top to bottom. With a heart catheterization, you might be told, "You have a 30% blockage in the right coronary artery and a 50% blockage in the left anterior descending artery. But these blockages are just the tip of the iceberg. The process is really far more extensive. We require a more accurate means of quantifying all coronary plaque, both visible and hidden. The more extensive the plaque, the higher the risk for heart attack, even in the absence of "severe" blockage.
How do you measure plaque?
Imaging technologies are advancing at breakneck speed. The days of invasive procedures to diagnose heart disease are going the way of exploratory abdominal surgery and 8-track tapes.
The newest CT scanning technologies offer the best balance of precision, ease, cost, and availability. The perennial problem for imaging the heart has been its rapid motion. The most recent CT scanners have the advantage of being "ultra-fast" and provide crystal-clear still-frame images, even of millimeter sized coronary plaque. Two CT devices are the pre-eminent leaders in the race to provide mainstream coronary plaque detection: electron-beam tomography (EBT) and multi-detector CT (MDCT).
The process is simple. Time from lying down on the scan table to looking at your heart pictures: About two minutes. The quantity of plaque in your coronary arteries will be reported to you as a "score". Just as in golf, the lower your score, the better. The best score? Zero – no detectable plaque. The higher your score, the greater your potential for heart attack.
New Discoveries About Heart Attack
Cholesterol makes you blind!
Cholesterol won't, of course, literally make you go blind. But as an indicator of hidden heart disease, it can leave you in the dark. Can you have a heart attack with low cholesterol? Sure can. Can you drop dead of a "normal" cholesterol? It's an everyday phenomenon. (1,152 times per day nationwide, to be exact, according to the American Heart Association.) Can you survive to age 95, outlive all your neighbors and never have a heart attack with high cholesterol? Absolutely.
There are better ways! Coronary imaging technology is advancing at breakneck speed. Today, we can have our coronary arteries imaged in 30 seconds and find out with 98% confidence if we have silent heart disease. Cholesterol can be 92 or 192, it makes little difference.
The hospital with the most bypass surgeries wins!
We live in an age when hospitals measure success by the number of coronary bypass surgeries they perform. Incredibly, it is still easier to get a bypass operation than it is to get good information on heart disease prevention. There are even billboards on the highways advertising bypass surgery.
Cardiac care is big business. As a nation, we spend $59 billion on cardiovascular care per year (American Heart Association, 2002). Annual hospital revenues for bypass surgery total $25 billion. Thirty percent of hospital revenues and 50% of profits are from cardiac care. Heart care to a hospital is like the Accord is to Honda, or Windows is to Microsoft—it's a hot seller.
Heart attack is the failure of prevention
Times are changing. We should reject the notion that heart disease unpredictably results in dangerous events treated with hospital procedures. We should think of every heart attack, every angioplasty, every bypass surgery as a failure to identify potential catastrophe. If heart disease requires decades to develop and if methods to detect it are already available, can't we terminate the process years before trouble starts? Isn't it better to prevent a fire than to struggle to extinguish a blaze once it's enveloping your house? The same holds true for your heart.
Who cares if you have "silent" plaque?
If you have plaque in your arteries undetected by stress testing, so what? Is there any danger from 'silent plaque?
You bet there is. Study after study through the 1980s and 1990s demonstrated that—much to the surprise of cardiologists—the majority (>70%) of heart attacks originate from "mild" blockages of 20–50%. These plaques don't block blood flow and don't cause symptoms. They would not be ballooned, stented, or bypassed. Yet "mild" plaques pose the greatest risk and are undetectable by stress testing.
Having plaque is bad enough!
Having any quantity of plaque in your coronary arteries is sufficient reason to be concerned that heart attack might be in your future. Keep in mind that, once plaque is established, it grows—and it grows rapidly. We used to believe that plaque growth was a slow phenomenon requiring years for significant worsening. But new studies applying heart scans to track plaque show frightening rates of growth of 30% per year. The volume of plaque in your arteries can easily double in a year.
Heart disease "regression" is not new
The concept of regressing, or shrinking, coronary plaque is not new. For years, people have wondered whether plaque can be shrunk.
Earlier efforts at plaque regression date back to the 1970s when techniques for measurement of plaque and treatment were primitive. Back then, clinical trials like those conducted by Dr. Blankenhorn at the University of Southern California, required coronary angiograms (obtained via heart catheterization) to assess the extent of plaque. The treatments included medicines no longer in use. Remarkably, some patients did obtain some regression of their plaque. But these efforts lacked two crucial ingredients: Precise methods to measure plaque and effective methods to control it. The results that are now possible are far superior to early efforts because we now have the ability to precisely measure and track plaque, and the "tools" to reduce plaque are more effective—and they're getting better every day. That's where the Track Your Plaque program comes in.
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