Advanced Heart Attack and Stroke Prevention

Standard of care is not optimal care. This approach to heart attack and stroke prevention is taught by the founders of the Institute of Arteriology, Drs. Brad Bale and Amy Doneen. It incorporates all of the best current evidence-based medicine in the field of preventive cardiology. Advanced radiologic, endocrine, cholesterol, inflammatory marker, and genetic testing are used to develop a very personalized plan to optimally reduce your risk of heart attack and stroke. It is the foundation of our Health MAP.^TM

Details of the approach…

The Dilemma

An American suffers a heart attack every 26 seconds. A stroke occurs every 40 seconds. In 50% of people who experience sudden death due to heart disease, it is the first sign there is a problem. They die without warning.

Approximately 50% of those who suffer heart attacks only have low to moderately elevated cholesterol. About 20% don’t have any of the top 4 risk factors (high cholesterol, high blood pressure, smoking, or diabetes).

Plaque begins to form years or even decades before an event occurs. A study published in the Mayo Clinic Proceedings looked at 36-59 year olds with only one cardiovascular risk factor. It found that 34% had plaque!

Heart attacks and most strokes are caused by rupture of an arterial plaque. Sometimes an event occurs in the presence of very little plaque.   You may not be as healthy as you feel.

Once disease is discovered, our cardiology and surgical colleagues are doing a wonderful job prolonging survival through bypass surgery, stents, internal defibrillators, and other modern treatments.   They help people live longer, more productive lives.

Unfortunately, the incidence of heart attacks and strokes in the United States has actually increased despite improved treatments. Why?   We are failing in the area of disease prevention. We need to proactively improve our prevention of plaque buildup, heart attacks, and strokes.

The Hope

The approach we offer at RHS was developed by Drs. Brad Bale and Amy Doneen.

The method is evidence-based, set in a foundation of strong, peer-reviewed research and has been accepted on a national level. Ongoing research is gathered and described in The Institute of Arteriology.

How is the method different from traditional treatment?

The success of the method comes from developing a very detailed, methodical approach to identify early disease, search for the various root causes, and aggressively treat the culprits. The method far exceeds “standard of care” treatments that have proven to be inadequate. It strives to achieve “optimal care” for the individual.

Step 1- Look for Visible Evidence of Existing Disease

A stress test is not good enough. A vessel must be about 70% blocked to cause an abnormal stress test. 85% of heart attacks occur in plaques smaller than this.

Early, yet dangerous plaque can be difficult to find. We will search for arterial plaque in multiple locations and treat aggressively if any is present. When it comes to our health, we must assume that we are guilty until proven innocent.   If plaque is found in one location, we must assume it exists in the arteries of our heart and neck, placing us at increased risk of heart attack and stroke.

Some plaque contains calcium. Calcified plaque can sometimes be seen on a chest x-ray or mammogram. We can directly look for calcified plaque in the heart through a coronary calcium score. This will find plaque much sooner than a stress test.

Unfortunately, the most dangerous plaque is soft, meaning it does not contain calcium and won’t show up on these tests. One study published in the Mayo Clinic Proceedings showed that half of those with documented plaque had a calcium score of zero!

Carotid IMT Ultrasound is the newest screening test available and can pick up dangerous soft plaque. Until recently, it was only available as a research tool. It is now available to the public, but in very few places. Quality of the test is critical, so we send our scans to companies nationally recognized as best in class at reading these images. They are unsurpassed in both quality and quality control. Click here for more information about CIMT ultrasound. 

Step 2- Detailed Analysis of Root Causes

Once any disease if discovered, the root causes must be found and treated appropriately. Just looking at your blood pressure and a basic cholesterol panel is not good enough. You can’t blindly blame it on your smoking, obesity, or lack of exercise.

Root causes of disease

• Lipids- Total LDL (bad) cholesterol has never proven to be a risk factor for heart attack or stroke. A detailed Lipid analysis is performed.
• Inflammation- This section is critically important to understand. Think of inflammation as fire. Vessel linings on fire are porous to the flow of lipids into the artery wall where artery plaque forms. More importantly, vessels on fire are fragile and prone to rupture, causing heart attack and stroke.

Several reliable biomarkers are now available that give a picture of whether your arteries are on fire. Medication and lifestyle changes can put out the fire. The markers can be followed to observe whether treatment interventions have been successful.

You are not adequately treated until your fire is out. Suboptimal treatment of inflammation is a critical reason we are not adequately preventing vascular disease.

There are many causes of inflammation. We will continue to search for and treat causes of your inflammation. Once inflammation is gone (the fire is cold) existing plaque will stabilize and possibly even shrink.

• Endothelial function- The endothelium is the inner lining of a vessel. A dysfunctional endothelium also leads to excessive flow of lipids into the vessel wall and increases the chance of rupture.
• High blood pressure- True normal blood pressure is less than 120/70. Almost always, there are root causes to this root cause. We will search for them, not just hand out medication.
• Insulin resistance- Insulin resistance is the abnormality that leads to diabetes. Insulin resistance usually begins 15-20 years before diabetes is formally diagnosed. During that dangerously asymptomatic time, high levels of insulin circulate. Insulin is highly inflammatory, causes endothelial dysfunction, raises blood pressure, and worsens the quality of both the HDL and LDL particle mix. 70% of people with identified plaque have insulin resistance.
• Disease causing oral bacteria- There is an undeniable link between periodontal infection (perio) and vascular disease. Several bacteria from our mouth have actually been found inside surgically removed vascular plaque. Up to 50% of heart attacks are triggered by infection from our mouth. 70% of the US population is thought to have at least mild perio. We are now able to test your saliva for the presence of those disease causing bacteria. If found, you will need aggressive home dental care and treatment by a dentist equipped to treat and follow up the perio.
• Sleep apnea- Sleep apnea can cause or worsen insulin resistance, blood presure, and vascular inflammation. Its treatment can reverse all three within 2 weeks.

Genetics

Your genetic makeup will help prioritize what lifestyle recommendations are important to adopt, help decide which medications and supplements to use, how soon to start a treatment such as a statin, how aggressively to treat insulin resistance, and whether aspirin may be needed, even in a young person.

Step 3- Optimally Treat Existing Problems

After reviewing your results, a completely personalized treatment plan will be suggested based on your specific abnormalities and genetics. Recommendations will include medications, supplements, and lifestyle changes. Many lifestyle changes are easy, some are difficult; all are important. Together we will develop an individualized plan for success that works best for you. Your personality and lifestyle will be considered.

After treatment is initiated, your biomarkers will be followed closely and treatment adjusted as needed. The endpoint of treatment is when all fire is out and existing risk is optimally treated. CIMT will be followed to look for plaque stabilization and improvement of wall thickness.

This method is data driven. It will “right size” treatment, which avoids under or overtreatment with medication and supplements. Once damage is present, drugs may be necessary to prevent heart attacks and stroke. We can objectively follow whether lifestyle changes being implemented are working.

When it comes to your vascular health, we will err on the side of caution. Many people have had a heart attack or stroke waiting for lifestyle changes to be effective. In this method, we will first put your fire out and get your risk factors controlled. We may then discontinue treatment once lifestyle changes have proven to be effective.

Summary

Cardiovascular disease prevention is best accomplished in the office of a family physician, internist, or even pediatrician. Vascular disease occurs in all organ systems and is closely linked to dementia, inflammatory diseases, type 2 diabetes/insulin resistance, periodontal disease, and sleep apnea. Optimal treatment involves considering other existing conditions like osteopenia, kidney disease, GI disease, and others.

Our goal is to prevent you from ever needing to see a cardiologist. However, if significant disease is found, we will refer you to a specialist. If you currently see a cardiologist, you still need them and any recommendations we have will be coordinated with them.

This program is the ultimate in proactive care. The cutting edge method of preventing heart attacks and strokes is proven successful, scientifically solid, nationally recognized, and we are absolutely convinced it works!