Cellular Medicine for Heart Health

It’s February, and that means it’s American Heart Month. Established in 1963, with the first observance in February 1964, an annual focus on heart disease as a primary cause of death in Americans has been going on for 60 years…and we continue to see cardiac disease as a leading cause of death.

Obviously, we have not come far enough in common medical practice. A visit to a primary care doctor for someone with poor cardiovascular health often ends in the same advice time after time – “lower your cholesterol.”

High Cholesterol Is Not the Issue

The usual glance at your lipid panel by your primary care provider is likely to go no further than either, “Your cholesterol looks good,” or, “Your cholesterol is too high.” Common practice suggests that if your total cholesterol is considered high risk, then statins should be prescribed. 

It is a dangerous belief that high cholesterol, specifically the LDL cholesterol type, is the only path to coronary events. Not all cholesterol of any kind is bad. The brain, muscle, and various aspects of the body and its processes rely on a healthy proportion of lipids, including HDL and LDL cholesterol. 

Statins are designed to block the process the liver uses to produce cholesterol. In turn, the liver begins filtering cholesterol from the body. Sending cholesterol levels shooting down in the name of lowering the “bad stuff” could put you at more risk than having high total cholesterol would have.

A study published in 2019 in the journal Scientific Reports showed that all-cause mortality rates are at their absolute lowest when total cholesterol is in the 220 – 250 range. Your doctor might look at your lipid panel, see you are above the sub-200 “in control” range, and prescribe a statin that plummets you out of the range shown as ideal by the study.

Total cholesterol is not a good tool for the prediction of cardiovascular risk. Yes, oxidized LDLs are troublesome but LDL numbers alone should not be the basis for taking the all-to-common simplistic approach toward cardiac care.

The Silent Problem

Every 1.7 seconds somebody dies from a cardiovascular event! And over 50% of those had no prior symptoms or identified risk factors! That means that this year alone around 650,000 Americans will die from heart disease—and many of them won’t ever see it coming. 70% of heart attack victims are considered low risk by traditional methods of assessing heart disease. 75% of lesions that are responsible for heart attacks only cause mild narrowing of the arteries and are missed by conventional stress testing.

What if we could know the true risk well ahead of time?? Think of the lives saved!  

For the past 60 years, cardiology has really been about “sick-care” with a focus on the symptoms of heart disease and not the real disease itself – atherosclerosis. Most people are diagnosed with reduced blood flow or blockage of an artery only when they have symptoms or a cardiovascular event. That is far too late.

Over 10 years of clinical trial data have shown that it isn’t plaque itself that is the concern, but it’s the type of atherosclerotic plaque build-up that matters.  So, what if we could accurately predict who is truly at risk? 

Enter ‘Cleerly”Cleerly Labs uses machine learning algorithms to non-invasively analyze atherosclerosis (plaque) and stenosis. Based on over 10 million images from over 40,000 patients gathered over a 15-year period in multi-center clinical trials, Cleerly’s AI algorithms generate a 3D model of the patient’s coronary arteries, can precisely identify the blood vessel walls and opening, and locate plaque.  But more importantly, Cleerly is the first technology that can quantify and categorize the type of plaque. 

There are two types of plaque; hard plaque and soft plaque. Hard plaque can build up in the arteries that supply blood to your heart and prevent enough oxygen from getting to the heart, but it is often very stable and not causing progressive risk.

A study published in 2019 showed the more narrow and more blocked a person’s arteries were, the more likely he or she would be to experience a heart attack.  But the results were actually quite surprising—it wasn’t the amount, but rather the type of plaque that was the biggest risk factor. Patients who experienced heart attacks were much more likely to have gunky, low-density plaque as opposed to hard calcifications. 

We are now understanding that most heart attacks are caused by soft or vulnerable plaque. A vulnerable plaque is an inflamed part of an artery that can burst. This can lead to the formation of a blood clot, which can lead to a heart attack. Traditional imaging such as a coronary calcium score or CT  scan cannot identify this risky pathology, so somebody could have a coronary calcium score of zero and yet 

still be at high risk based on their soft plaque burden. And vice-versa, somebody with a moderate coronary calcium score may actually be at a low risk.

Using its intricate AI analysis,  Cleerly’s comprehensive coronary analysis goes beyond any other technology giving a detailed vessel-by-vessel evaluation of stenoses and atherosclerosis. For every artery and its branches, the technology accurately and precisely quantifies the type of atherosclerotic plaque and vascular morphology. A rating of risk from mild to severe can then be determined so we have a better idea of who we need to be concerned about and what the best intervention might be. Cleerly’s technologies can also evaluate changes in plaque burden through longitudinal disease tracking over time to see if our intervention is working. Finally, we can take a proactive approach to this rampant disease!

Addressing Reality

As is the case with improving health, longevity, and healthspan, we are best served to follow areas of inflammation as sources of true cardiovascular health threats. 

A high triglyceride to HDL ratio indicates an inflammatory process may be becoming chronic. Ideally, the ratio should be less than 1.2:1 triglycerides to HDL. If the ratio is high, we can optimize insulin production, watch carbohydrate intake (which impacts triglyceride numbers more than fat consumption), or use Niacin to try to lower triglycerides. Raising HDLs is also possible, even by simply introducing HIIT training into your exercise portfolio.

Considering the B:A ratio of apolipoproteins is one of the most important indicators to ensure cholesterol is truly a problem. Apolipoprotein A (typically measured as Lp(a)) particles are considered “healthy” as large, buoyant particles. Apolipoprotein B (ApoB) are smaller and more dense. If the ratio is over 0.6, we can consider ways to convert the smaller particles to the healthier buoyant type by increasing fiber and lowering carbohydrates.

If you remember nothing else, it is vital to understand that inflammation is the root cause of the vast majority of acute coronary events like heart attack and stroke. The typical cardiac response by a primary care physician ignores this truth.

The positive side of this reality is that we have tools at our disposal that can shift the paradigm of our approach to cardiovascular issues:

Looking at Foundational Biomarkers of cardiac health, such as Lp(a) or ApoB can illuminate risks or concerns that may otherwise go unchecked. Check out the BLI Assessment to learn more about our comprehensive baseline health analysis. A discerning view of your labs goes beyond a glance at cholesterol numbers and looks for often overlooked biomarkers indicating inflammatory processes or potential areas for improvement.

With results from our assessments, we can move forward with novel ways to reverse damage and improve cardiac health. Simple interventions including medically managed peptides, hormones, and supplements can have huge impact. 

Semaglutide, a GLP-1 receptor agonist originally patented as a diabetes medication known for going viral as a weight loss drug, has been shown to reduce the risk of adverse cardiovascular outcomes. 

Plasmalogens, are specialized phospholipids found in all human tissue with concentrations in the brain, heart, lungs, eyes, and kidneys. Plasmalogens have an impact on reducing inappropriate inflammatory processes, while studies have shown that plasmalogen levels were reduced in a variety of cardiac disease settings.

Colchicine, an alkaloid that comes from the flower Colchicum autumnale, has been shown to have therapeutic potential in the management of atherosclerosis and its complications.

Hormones must be optimized to ensure cardiac health. Nearly every hormone present in our bodies plays a role in keeping the cardiovascular system functioning properly.

At Boulder Longevity Institute, we often mention shifting the paradigm in how we approach healthcare. We are fortunate to have experts who understand that medicine involves a constantly evolving landscape, and are committed to hours of research, collaboration with others in the field, and finding the best options and protocols to fit clients’ personal needs and goals.

Don’t get duped by the longstanding myths – Heart health is not an issue with “high cholesterol.” Rather the conversation should be focused on the intricate balance of cholesterol types and the presence of inflammation. With the common protocol of placing people on statins, which may do more harm than good, we continue to have to observe Heart Month every February. It is past time to change our approach to cardiovascular health and look deeper than the first numbers on your lipid panel.

Curious about the science behind cholesterol and how your lipids influence health? Head over to BLI’s Academy and tune in to the #BLIBackstage Lunch & Learn with the team, as Dr. Yurth deep dives into the intricacies of cholesterol well beyond just “good” and “bad”.

Check out the video here: Understanding & Optimizing Cholesterol

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Published February 14, 2024

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