If you were to ask a typical patient how old his heart is, he is likely to look at you baffled and say, “As old as I am.” He is correct, in the sense that his heart and arteries were born the same moment, but he is wrong in the sense that different parts of the body do age at different rates. You see this in the skin. Some people in their forties and fifties are saggy; others are not.
The same applies to the heart and arteries. So let’s see how we can find out what is happening on the inside of our arteries and heart.
I do this by checking for the presence and severity of each of the major risk factors. I use new and exciting noninvasive cardiovascular tests to determine the age of your arteries, as well as genetic tests called the telemeters, that look at your chromosome blanks to predict your biologic age, where I also do fascinating new genomic testing.
Here is my list of the top risk factors for heart disease.
This is easily measured in the office using an accurate, noninvasive, F.D.A.-approved machine. I measure endothelial dysfunction and vascular elasticity, as well as central blood pressure and aorta. These have a high predictive value for future cardiovascular disease, such as heart disease, heart attacks, stroke, and peripheral arterial disease. They also predict arterial age. These tests include utilizing the Caspro, carotid artery duplex and ankle brachial index monitoring.
Increased oxidative stress and lack of oxidative defenses.
Measured in the blood and urine are markers such as 8-Hydroxyguanosine, malondialdehyde (MDA), glutathione, catalase, SOD (superoxide dismutase) as well as the oxygen radical absorbtion capacity (ORAC).
These are measured using expanded lipid profiles that go far beyond the standard tests for cholesterol of LDL, HDL, and triglyercides. This expanded lipid profile includes LDL size and particle number, as well as HDL particle size. Several specialty laboratories are used. It sounds a lot, but it is all done with a simple blood test, just as if you were having your regular cholesterol. It is important to measure. It is important to know your serum prefatty acids, your mega-3 index, your trans fats, as well as your saturated fat levels.
Increased high-sensitivity CRP and inflammation.
I measure this using a high-sensitivity CRP, TNF alpha, interleukin-6, and others.
This is measured by a blood test indicating low levels of vitamin B6, B12, folic acid, and trimethylglycine. I also measure a genetic defect in MTHFR gene that codes for this.
There are several different types of hypertension, such as the dippers and non-dippers. Please note that a 10% fall during sleep is all right, but falling 10% indicates a problem. Morning surges of blood pressure are healthy, but more than a 20% increase suggests danger. I perform a pulse wave contour augmentation index with a pulse wave velocity test. Blood does not move through the arteries in a single block. Instead, it pulses through it–at times rapidly, and at times, slowly.
When the thrust generated by a single heartbeat nears the end of the vasculature, the energy of the wave is reflected back to the heart. The behavior of this pulse wave changes with age and certain disease states, including endothelial dysfunction. This predicts and gives a risk of heart attack and stroke by detecting increasing aortic stiffness, augmentation of the systolic pressure, and changes in the wave. It is extremely important.
Left ventricular hypertrophy and decreased diastolic relaxation–that is, the left ventricle which is the largest of the four heart chambers–is responsible for propelling freshly-oxygenated blood throughout the body. Hypertrophy or enlargement of the left ventricle may occur naturally as in aerobic training, or it may represent a diseased heart’s attempt to compensate for having to pump against increased blood pressure, an abnormal heart valve, or an intrinsic weakness by growing bigger.
Hypertension, for example, can cause the left ventricle to grow larger as it attempts to push the blood through the body against increased resistance. I measure this using echocardiography. Also measured is carotid intimal medial thickness, as well as coronary calcification.
This is determined using a telemere test to determine telemere length. Longer telemeres indicate a reduced risk of heart disease and predict slower vascular aging, and slower aging in general.
This can be detected using what is called SNP testing.
Gene alterations that can cause obvious and serous blood pressure and cardiac problems are found in many gene tests.
The SNP stands for single nucleotide polymorphism, which is a small genetic alteration in the DNA that occurs. There are some SNPs that increase the risk of coronary heart disease, as well as blood pressure, Alzheimer’s, and changes in cholesterol as well as inflammation and oxidative stress.
There is now gene testing to see several cardiac conditions. Your genes can contribute to blood pressure, cholesterol changes, and there are now genes to measure your response to medications, such as the benefits of using verapamil compared to Atenolol, or your blood pressure control on verapamil. New gene tests are available that compare the heart rate and blood pressure response to metoprolol. In addition, survival benefits of beta blockers and heart failure patients are now available.
The therapeutic benefits of ACE inhibitors in stable coronary artery disease, as well as verapamil-induced arrhythmias, are now available. Patients can also benefit from gene testing for statin-induced myopathy, such as from Lipitor or Crestor, Pravachol or Mevacor, as well as statin therapeutic benefits. There is testing now for Warfarin, which is Coumadin sensitivity, as well as Plavix. Other genetic testing will reveal underlying cardiac disease, diabetes, as well as genetic tendencies to increase cholesterol, myocardial infarction, and peripheral vascular disease. There is now gene testing in response to monounsaturated fats and response to polyunsaturated fats, and genes to find out what diet to eat or caffeine metabolism and lactose intolerance.
Genes involved with exercise, with Achilles tendinopathy or aerobic capacity, as well as blood pressure response to exercise, endurance training, muscle power and strength lifting are available.
Genetic gene testing for your body and weight, as well as obesity and metabolism, can now be ordered. Conditions such as macular degeneration, Alzheimer’s, cancers, as well as other health conditions, can also be obtained. Gene testing is the medicine of the future.
Calcifications seen on heart scans.
This is measured by electron beam tomography and/or MRI of the heart, and can detect early heart disease.
measured by blood, urine, or saliva testing, include tests for testosterone, sex hormone-binding globulin, estradiol, progesterone, growth hormone, as well as DHEA.
Diabetes mellitus by elevated blood sugar, increased insulin, hemoglobin A1c, and metabolic syndrome.
Hypothyroidism, including TSH, free T4, free T3, reverse T3, and thyroid antibodies.
Increased levels of heavy metals, such as mercury, lead, aluminum, arsenic, iron, and other measures, can be measured best through urine tests.
Low vitamin K and vitamin D levels are measured by standardized blood tests.
In summary, these tests should be performed in hopes of assessing functional heart age. These tests are checking the presence and severity of each of the major risk factors to determine the age of your arteries and heart. In addition to this, standardized cardiologic evaluation includes an EKG, cardiac echocardiography, carotid ultrasound, ultrasound of the arteries and veins of the legs, as well as stress echocardiography or nuclear stress testing.
After I assess the complete cardiac workup of the patient, I begin either medications or nutraceuticals and detoxification protocols, as well as natural hormones in hopes of correcting the abnormalities and prolonging the patient’s life.