What tests are done at the CURE Center to measure arterial disease and its root causes?

The true progressing inflammatory nature of arterial disease (which causes heart attack, stroke and dementia) is not the model of mainstream medical care. New testing methods and technology enable the CURECenter to offer more individualized and effective treatments. We identify the root causes and eliminate or at least mitigate their effects. Like a sinking boat, we identify and patch the holes as completely as possible while preventing more damage for smooth and uninterrupted sailing.

We offer tests that are not generally offered in Standard Care:

• Discover Scan Carotid Ultrasound: This limited lower cost carotid ultrasound using point of care Butterfly iQ ultrasound probe and system is like a screening pap smear, mammogram or PSA to detect early cancer. If we find no disease, peace of mind is a benefit. If, however, even a little bit of arterial disease is found (like a little bit of cancer) the images can be sent for a CIMT report (see next paragraph) and then followed to make sure you are safer by following your CurePlan.

• Carotid Intima Media Thickness (CIMT) Ultrasound: CIMT measures arterial wall thickness/sickness/inflammation/swelling and documents atherosclerotic plaque stage and burden. A thicker artery wall is a more inflamed swollen sicker artery wall. This promotes formation of atherosclerotic plaque and related events such as heart attack and stroke caused by plaque rupture. Arterial wall thickness (inflammation/swelling) is more of a threat than luminal flow “blockage” in predicting new and unstable plaque formation. Unstable/soft/heterogeneous plaque rupture is the event we experience as a heart attack or stroke. This is more likely with new homogeneous unstable plaque. It becomes less likely as plaque becomes more homogeneous/healing and is minimal when plaque is calcified/healed/stable. Proactive optimal care can heal arterial disease and make your arteries healthier and younger with less risk of disability, death or need for rescue procedures.

• LpPLA2 (PLAC) Test: This enzyme rises when plaque and artery walls are inflamed or “hot.” You want your arteries to be “cool.” LpPLA2 drops with a less inflammatory diet, exercise, reduced insulin resistance, supplements (niacin, and bergamot and statins. It is a fire alarm or “arterial wall thermometer.”

• Myeloperoxidase (MPO): A rise in MPO should trigger a search for neutrophil mediated inflammation, especially from the dental abscess or periodontal inflammation. MPO indicates inflammation and erosion of the inner lining of the artery known as endothelium. A sudden rise should trigger a search for the driver of arterial inflammation, leading to heart attack or stroke. Think of a caustic chemical spill on your artery protective lining. Like a skin abrasion, blood clots form and can occlude flow.

• Microalbumin/Creatinine Ratio (MACR): MACR rises most commonly when blood pressure and blood glucose are poorly controlled.  This causes dysfunction and disruption of the arterial wall endothelium, allowing albumin to leak into the urine in greater amounts. A leaky endothelium fails to protect the intima from processes that lead to inflammation. Think of it as another fire alarm.

For more information about these and other tests, go to

https://www.knowyourrisk.com/

and other information from Cleveland Heart Lab, a major source of our testing

• Haptoglobin Genotype: Your Haptoglobin genotype determines if Vitamin E offers protection or increases risk of arterial disease. In addition, individuals with the Hp 2-2 genome are more sensitive to gluten, forming an inflammatory mediator called zonulin that makes your gut “leaky” and raises the risk of autoimmune disease. 

• Insulin ResistanceTesting: Optimally measured through an oral glucose tolerance test with insulin levels, insulin resistance (prediabetes) testing is important in identifying individuals who could be developing vascular complications before a Type 2 Diabetes diagnosis. The glucose tolerance test can identify insulin resistance long before the glucose starts to rise.

  • However, if there is other evidence of insulin resistance that does not require a visit to the lab, we can skip this step. Clues are seen in levels of nonoptimal HbA1c, glucose, triglycerides above 100, low HDL, and presence of small dense LDL (Pattern B).

  • The earliest indication for insulin resistance can be measured through body composition testing. We use the InBody 570, a device that can monitor insulin resistance response to changes in diet. Reducing insulin resistance is generally healthy for everyone, regardless of risk.

  • Continuous Glucose Monitoring (CGM) is now available without a prescription for an affordable $50 for each 2 week sensor. The feedback about individual glucose response to specific food intake provides immediate feedback for diet modification. www.stelo.com

  • Insulin levels: We rarely order these, mostly upon patient request. Normal fasting insulin misses early stage IR where lifestyle changes have the greatest long term return on investment and can provide a false sense of security. By the time fasting IR is elevated there are other indicators, like low A1c>5.0, fasting glucose >90, elevated triglycerides, low HDL, elevated visceral fat. More actionable data is obtained from CGM, showing the problem and solution in one $50 2 week learning experience and experiment.

  • Bottom Line: Insulin resistance is a feature, not a bug, in our software, regardless whether the program was a design or byproduct of natural selection. It gave the hunter gatherer to survive the food environment before agriculture. Grains and grazing are not a good fit. It is somewhat like using a word processing program when a spreadsheet would be a better choice. The “hack” is to revert our eating behavior away from grazing toward the feast/fast cycle of protein and fat based intake with more complex carbs as a fallback and rare high energy sugar treats like in season fruit and honey. We should all be considered guily and make changes according to the best of our ability and circumstances.

• Homocysteine: Elevation increases risk of:

• Osteoporosis - bone thinning

• Atherosclerosis

• Thrombosis (blood clotting)

• Heart Attack

• Stroke

• Dementia

• Kidney failure

• Neuropathy

Treatment is supplementation with methylated folic acid. Dietary sources of folic acid are leafy greens like spinach and kale. The needed amount of methylated folic acid and Vitamin B12 (and the blood levels) is dependent on the MTHFR gene variant. “Normal” blood levels of folate and B12 are not sufficient for those whose genetics require higher levels for homocysteine safe levels. Therefore, the test we rely upon is the homocysteine level, not the levels of folate or B12. Optimal homocysteine level is less than 8, which may require higher than population norms (yet safe) blood levels of folate and B12.

This paper from the American Heart Association offers a good summary of Homocysteine.

• Coronary Artery Calcium Score (CACS): This CT scan detects mature calcified plaque in the coronary arteries. However, it misses new noncalcified plaque. This test is not useful in monitoring therapy progress/benefit. We recommend CACS when CIMT does not reveal disease but there is still concern about coronary artery disease. If this test detects disease that would have otherwise been undetected, a more proactive approach to address root causes will be encouraged. Beware of the slippery slope to a stress test, stents or surgery. Coronary Calcium Score is a “loss leader”for interventional cardiology programs. Call us first before scheduling further tests, especially if you have no symptoms like chest discomfort and shortness of breath.

• Coronary CT Angiogram with AI Enhancement: This compelling advancement should and will eventually largely replace elective coronary angiography in the absence of acute symptoms. At a cost of $1500+ with radiation and IV contrast associated risk, it isn’t ideal as a screening process. Medicare and insurance coverage is increasing when the alternative is elective catheterization based angiography is the alternative for evaluation of symptoms or heart failure. If money is no object and there is nothing seen on carotid ultrasound focused on the wall (where the action is), it is an option for those who want to go “all in” looking under every rock and don’t mind the radiation and contrast risk and inconvenience. The tools don’t fit in a backpack or pocket, that is for sure. They tend to push toward stents and surgery, supporting the “oculostenotic reflex.” For more in depth info, click: https://patients.cleerly.com/education and https://vimeo.com/cleerlyhealth

• Home Sleep Testing and Auto Titrated CPAP: These tests have made diagnosis and management of sleep apnea more affordable and effective. Sleep apnea is a root cause of heart attack, stroke, atrial fibrillation, hypertension and heart failure. Treating it can lower your risk of these events, lower your blood pressure, and reduce arterial inflammation.

• Oral Microbiome Testing: Oral microbiome testing involves taking a sample of saliva to identify the types of bacteria present. If high risk bacteria are found, they likely contribute to periodontal and arterial inflammation. In some cases, this can affect management of periodontal disease and contribute to heart attack and stroke risk. 

  Knowing the occupants of your oral “neighborhood” can prompt a more proactive approach to your oral hygiene. If there are dangerous criminals in your neighborhood, you will be more careful to “lock your doors” and augment your protection. The progressing but reversible diseases affected by your oral microbiome include periodontal disease, cardiovascular disease, Type 2 Diabetes and prediabetes, and even some cancers and dementia. Options for intervention are best guided by a dentist and hygienist who understand this and the effective interventions. General steps include brushing, flossing, water flossing, antiseptic mouthwashes, oral focused probiotics and xylitol gum. More deeply established infections may require systemic antibiotics and debridement procedures like root planing and deep cleaning followed by maintenance routines.

What is a Coronary Artery Calcium Score?

A coronary artery calcium scan reports your coronary artery calcium score. It is useful as a screening tool for those who are not known to have arterial disease. It should not be used to assess symptoms or monitor response to therapy. 

If you already know of the presence of arterial disease in your body (if you’ve had a stroke, heart attack, stent, or bypass surgery) or carotid artery ultrasound, determining this score is unnecessary. It may also lead to risky, costly/profitable stents or surgery with no benefit in the absence of symptoms like angina or heart failure.

What does the score mean?

A score of zero is generally reassuring that the risk of heart attack from silent arterial disease is low in studied populations. You want this score to be as low as possible. However, if you have other risk or evidence of arterial disease, you could have plaque that is not calcified, known as soft/homogeneous/vulnerable/or unstable plaque. This occurs in about 10% of those with zero calcium scores. On the other hand, a high or rising score can be good news if you are taking steps to control root causes leading to inflammation. Statin therapy RAISES CACS by HEALING/CALCIFYING existing plaque while preventing formation of new unstable higher risk plaque.

Non-calcified plaque is the most vulnerable to rupture (the event that leads to heart attack). Therefore, a score of zero does not guarantee that you will not have a heart attack. Plaque can still form after a reassuring test in response to a change in conditions that promote inflammation, such as a dental infection.

Coronary calcium scores rise as plaque heals and inflammation subsides. In our experience, scores rarely fall, which makes this scan inappropriate for measuring progress. Ultrasound measurement of intima media thickness and blood tests (LpPLA2, hsCRP, MACR) measuring inflammation/oxidative stress are more reliable indicators of risk of events. Any claims of reduction of coronary calcium score should be corroborated by these other measures. A rising or high score is actually more often good news, not bad.

Instead, we recommend measuring trends of the thickness/swelling (sickness or inflammation) of your carotid arterial wall, which can be done with completely safe ultrasound. This is a much more meaningful measure of disease response to treatment. To find this option, click www.vasolabs.com/events.

Coronary artery calcium scans can lead to a slippery slope that can be dangerous to your health and your pocketbook.They can lead to unnecessary procedures, such as stents, that do not prevent heart attack or stroke in individuals with no symptoms. 

If there is no plaque seen on carotid ultrasound, an elevated Coronary Artery Calcium Score should provoke a search for root causes and efforts to eliminate them. In the absence of symptoms, CACS should not lead to a stress test, stents or surgery. But, sadly, it often does for reasons related to risk and benefit for the system, not the patient.

The proper response to a positive screening/asymptomatic coronary artery calcium score should be to identify the root causes of arterial disease and eliminate them. This is what we do at the CureCenter.

If you have no history of heart attack, stroke, TIA, stent, bypass or other evidence of arterial disease, we suggest first getting a carotid ultrasound to screen for plaque as the first step. You can do this by scheduling your 15-minute Discover Scan.

If you’re unsure what to do next, request a no cost/no obligation Discover Zoom today.

Don’t delay! Don’t wait for the cardiologist or coroner to reveal your disease.

by Dr. Craig Backs

How much time do you have? Are you sure?
Recently, I learned that a current patient lost her husband to sudden death in his 50’s due to an apparent heart attack, dying right in front of her. Imagine trying to resuscitate a loved one and losing them this way. I’m certain that she tried to convince him to get a CureCenter evaluation, starting with an ultrasound and root cause lab assessment. But it never happened. Was it denial or ego?

Now it is too late, another casualty of the failure to know the truth about the Catastrophic Unseen Reversible Epidemic of Progressive Cardiometabolic Disease: Heart Attack, Stroke, Sudden Death, Dementia are all far more optional than you have been fooled into believing.

So many stories…….

I met with a man in his 60’s who I cared for years ago. He was interested in reconnecting because his current physician had retired. After speaking with him, I offered to develop a custom CURE Plan. He declined and stated, “I eat right, I exercise, and my doctor says my cholesterol is good.” I didn’t push the issue. It rarely changes deeply held beliefs, and even creates hostility. 

A few weeks later, I received a call from the hospital. It was his wife, informing me that he had suffered a cardiac arrest while exercising at the YMCA. Fortunately, beating the odds, he had been successfully resuscitated and was recovering without apparent residual effects.

He now wanted to discuss a CurePlan because his catheterization had demonstrated three vessel coronary artery disease and he was recommended for coronary bypass surgery. He asked: “What should I do?”   

Sadly, I had little to offer him and urged him to follow the advice he had gotten for standard care. I had no influence on his hospital care other than to create friction with his surgeon and other doctors. 

I could have suggested he go home, come see me to discuss the details, and then decide if surgery, with all its risks, is the correct option. However, I didn’t believe it was worth the risk of him going into cardiac arrest again outside the hospital. I did not have all of the details of his diagnosis and he had previously declined my offer for a custom CurePlan and advice for proactive measures.

So, he and his family went through life disrupting operation on the heels of a cardiac arrest and resuscitation. All of this could have been avoided if he had known of his arterial disease early and proactively treated the blind spot root causes proactively. 

I hope that anyone who reads this story will act proactively in their own interest and for the benefit of their loved ones. Identify the disease that lurks within, that could take you out in a moment without warning. Go to TheCureCenter.Life and click the boxes to get started.