Cardiovascular Disease | Part 2

Screening for Heart Disease

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Dr. Aaron Hartman

May 17, 2022

Femal Doctor performing checking the BP of a female patient

Last week we started our discussion on cardiovascular disease, the number one killer in our country. We talked about many risk factors and the root causes of heart disease: inflammation, oxidative stress, and immune dysregulation.
Today, we’ll look at the traditional markers for heart disease and see why these screening tools are inadequate for preventing this silent killer. Then we’ll talk about some of the more advanced testing options that paint a better picture of a person’s real risk for heart disease.

Basic Screening Tests

Blood Pressure
First up is blood pressure. What’s normal blood pressure? You’ll hear 140 over 90 is normal. But what if I told you a blood pressure higher than 110 over 70 was associated with an increased risk for heart disease? Simply addressing an elevated blood pressure with medication and ignoring the root cause of the problem does not effectively promote better cardiovascular health.
Traditional recommendations set normal total cholesterol as less than 200 and LDL as less than 100 or 120. But current data shows that a cholesterol LDL of over 60 starts to lay down plaques in your arteries.
Blood Sugar
What is a normal fasting sugar level? We hear that normal fasting blood sugar is 100 or less. But actually, a normal fasting blood sugar, below which there’s no increased risk of heart disease is 75. For every one point, the fasting blood sugar is above 75, there’s a 1% increased risk for heart disease. So a fasting sugar of 100 has a 25% increased risk for heart disease. And you’re not even considered by the American Endocrinological Society as being close to being diabetic in these ranges.
As you can see, with these basic screening tools we’re currently using, we’re way underestimating heart disease risk.


Why Are We Underestimating Heart Disease Risk?

The reason is simple. If we use these more advanced numbers, we would see that half of our country is either diabetic or prediabetic. We’d also discover that 80% of Americans have insulin resistance. And we’d see that almost half of us have high blood pressure issues.
Our medical system simply can’t deal with these kinds of numbers.
In our current medical system, screening methods need to be feasible in a primary care office where physicians have 10 to 12 minutes to talk to patients. However, individualized, functional medicine or metabolic medicine uses a different model and gives more time, attention, and current data to bear. A functional medicine physician can use a more comprehensive approach to evaluate your risk factors and not just use a simple template when assessing your risk.

What Are Some More Advanced Screening Tools We Can Use?

Because inflammation is a risk factor for cardiovascular disease, there are other advanced tests we can use to assess inflammation and therefore get a better understanding of cardiovascular disease risk. For example, high-sensitivity C-reactive protein (hsCRP) is a measure of inflammation in your arteries related to liver function. We also might look at homocysteine, which is a metabolic measurement for inflammation. High homocysteine levels can also be associated with vitamin deficiencies.
We might look at cholesterol at a more granular level – by breaking it down into the more important risk factors like LDL particles and apolipoprotein B. There are over 20 Different breakdown products in cholesterol that can be used to assess risk factors through the Cleveland HeartLab. These cost about $200 and insurance doesn’t pay for them, so they are not often considered.
Tests for immune dysregulation get a little tricky. We might use tests like interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF alpha), interferon-beta, and others that measure cytokines related to the immune response. You might notice that these are similar factors related to a cytokine storm, and have been discussed in relation to COVID 19. You might also know that the dysfunction of small vessels was one of the pivotal causes of severe COVID. We’re now seeing a correlation between infection, inflammation, and heart disease.
Along these lines, we’re seeing that most people with heart disease have some degree of low-grade infection in their body, whether it’s in the gut, the mouth, or elsewhere. This is why even dental health can be important for preventing heart disease.
Then there is advanced testing that measures calcium buildup, like a coronary artery CT, which measures the calcium buildup in the arteries in the heart, a marker of late-stage heart disease. It is possible to have a stress test that’s normal, a catheterization that’s normal, yet still have a high calcium score; I see this all the time.
There are also other tests like carotid ultrasounds that measure the artery wall thickness and can actually pick up changes before calcium is laid down. EndoPAT, which assesses endothelial function, and Computerized Arterial Pulse Wave Analyzer (CAPWA) are examples of further tests used to assess heart disease risk. All these need to be done under the careful guidance of a metabolically-trained physician, typically through either the tutelage of Dr. Houston through the Institute for Functional Medicine (IFM), the American Academy of Anti-Aging Medicine (A4M), or some similar organization.

Next Week

In our third post on heart disease, we’ll discuss a personalized approach to cardiovascular disease and then I’ll talk about some of my favorite foods and nutritional supplements that reduce cardiovascular disease risk.
I hope this discussion of testing options for cardiovascular disease has been helpful. If you’d like to learn more, please check out our website. Also, sign up for our newsletter and follow us on Facebook and Instagram. We’ve created an entire educational platform to help you on your self-education journey. These are designed to support you as you are learning about yourself and give you resources on how to achieve greater health.
Take care and be well.
Since 2010, Richmond Integrative and Functional Medicine has been helping people to restore their health and hope with an integrative approach to conventional and alternative medicine that’s entirely science-backed. We at RIFM believe everyone is made for health. We offer a comprehensive, in-person patient membership program to ensure you get access to the care you need to thrive.


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