Wednesday, January 16, 2013

Cardiovascular Disease





Seth J. Baum, MD, FACC, FACPM, FAHA, FNLA

Dr. Baum is a medical advisor for Solstas Lab Partners® Cardiovascular Disease Program and the founder of the Foundation of Preventative and Integrative Medicine. He maintains a clinical practice in Boca Raton, Florida. Reach him 1-888-440-FPIM and follow on Twitter @SethJBaumMD. For more information about Solstas Lab Partners, visit www.solstas.com or call 1-888-664-7601.

In spite of the dramatic advances Cardiovascular Medicine has enjoyed over the last three decades, heart disease continues to reign as the king of killers in the western world. Nearly half of us die each year as a consequence of cardiovascular disease (CVD), and, in truth, more women die from CVD than men. (Astonishingly, eleven times as many women die from CVD as from breast cancer!)

How can we reduce these alarming CVD statistics? Prevention.

It is no exaggeration that we see publications of medical trials examining novel cardiovascular risk factors or biomarkers on an almost daily basis. This area of medical research is prolific because it is consequential. Identifying an earlier risk factor enables doctors to implement prevention strategies sooner in the course of cardiovascular disease. An optimal scenario would have doctors consistently identifying risk even before the slightest aberration in the patient’s endothelium. Unfortunately, it appears to be a dream with only distant possibilities. For now, we must rely upon utilizing a combination of established protocols along with cutting-edge tools.

The following hypothetical patient illustrates such an approach:

A 50-year-old woman presents with mild, well-managed hypertension and an LDL-C of 130. She also has a TG of 200 and an HDL-C of 54. You calculate her Framingham risk score (FRS) online. Although you consider her an at risk patient, it is surprising to learn her 10 year risk is only 2%. This exemplifies a flaw in FRS but does not negate its value. Relying upon the 2011 updated AHA guidelines for women, you order a few tests, including an assessment of LDL particles through LipoScience, biomarkers from Cleveland Heart Lab, a Carotid Intima Media Thickness (CIMT), and the most advanced form of cardiac CT scanning as to limit radiation to a single mSv.

What you find is revealing… and disturbing.

Your 50-year-old female patient has extraordinarily high LDL particles, and elevated LpPLA2 and MPO levels signifying inflammation in the vessel wall. She also has five small mixed plaques on Coronary CT and significant thickening of her carotid IM. Your jobs (as the doctor and the patient) have now become far more meaningful. You place her on a statin (which you would not have done without the advanced data you just acquired) and educate her about the importance of Therapeutic Lifestyle Changes (TLC). Now, actually seeing her vascular disease and abnormal biomarkers, she heeds your advice. She exercises daily, eats a balanced diet, and brings her weight down to an optimal level. In short, you have just changed – and probably saved - her life. By digging deeper, you uncovered a smoldering fire that would, ultimately, have become a conflagration and potentially ended her life prematurely. Following this approach you have stepped into the future and joined the evolving field of preventive cardiology. You have amplified your effectiveness, for which your patients will be most grateful.

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