Arterial Plaque Test, Inflammation and Cardiovascular Disease

Arterial Plaque Test, Inflammation and Cardiovascular Disease

Today I want to give you some basic
large look overview and what we’re talking about. David will tell you in a
few minutes or maybe he’s already told you. I don’t know about medical standards.
This is something that I learned from David. He taught me about how it was
200 years before a lime became the use of lime for a prevention of scurvy. To
became a standard, it took a hundred years for metformin. I looked him up,
checked him out on it, and he’s right. And at this point, it still takes 20
years or so… 15… 20 years even in the age of tech. Why is that the case? I’ve
been involved in medical standards when I was at Hopkins and ran the prevention
program. I had my students, my student doctors that I was teaching, did the
science reviews for the US Preventive Services Task Force. Those guys sit
around the table and have to argue with each other over who should have
discovered something, who hasn’t, why they haven’t. It’s a human political process
and they also have to prove that these things are right. So it takes time now.
There are three areas where the standards have not quite caught up to
the science and that’s what we’re going to talk about today. One of them has to
do with plaque, the next one has to do with insulin resistance (the most common
cause of plaque), and the third has to do with inflammation cardiovascular
inflammation and it’s proximal most urgent cause of heart attack and stroke.
Now it’s not gonna be missed. It’s not gonna be in that order. I’m gonna start
off with some discussion about inflammation then we’ll get we’ll jump
around a little bit. Please be patient with me as we do. If you look at Time
magazine wait back in 2004, they had a cover article on inflammation and its
cause of heart attacks, cancer, Alzheimer’s, and other critical diseases.
If you look at medical magazines, they’re still mentioning it. But as we just said,
the medical standards have not caught up yet. In fact, most cardiologists do know
that there’s something about cardiovascular inflammation and it
causing heart attack. But this study that came out two years ago still caught the
the world’s cardiology leadership flat-footed. The most common thing they
said was, “You know, I knew the cardiovascular inflammation had
something to do with it, but I didn’t know this.” And this what they’re talking to
is Paul Ridker, a very smart guy, cardiologist at Harvard who’s been
preaching this inflammation message for decades. Actually, was able to give a
very strong anti-inflammatory medicine used for inflammatory diseases which we
won’t go into but he gave that to people all over the world and actually decrease
their heart attack and stroke activities the rate of heart attack and stroke.
So I’m not gonna go any deeper in that. I’ll just show a picture of Paul Ridker
again, maybe the godfather of cardiovascular inflammation in terms of
this space. And the name of the trial was the CANTOS trial. You can see that in
Scientific American magazine as well as the New England Journal that I just
talked about. But again, let’s focus on what we’re here to learn today. First is,
“Do you have plaque?” Unfortunately, the standards of medicine are not that great
on helping you understand that, and that’s the most important first thing to
find out. That’s why we’re having the CIMT Tour. I’m gonna go quickly through these
items and talk about the pros and the cons. Framingham is basically where your
cardiologist or your primary care doctor will start. It’s not a measurement. It’s a
guess, and it’s a bad guess. Then usually, most people will say, “Well, I got a stress
test.” 5 million stress tests are being done each year. There are a huge number
of false positives, as in like 30%, depending on where you get them. And if
false positive leads you to the cath lab, they’re also an even worse a huge number
of false negatives. Again, you’ll see literature say up to 30%. Here the bottom
line is with a stress test. It’s not gonna be… it’s not going to show you a
positive unless you have over 50% blockage of your artery. Well guess what?
68% of heart attacks and strokes occur, and people that don’t have 50%
blockage of their arteries. Again, that’s why we’re here looking
CIMT… in getting a CIMT. PC angiogram, in other words “percutaneous,” going
through the skin. And welcome to the cat lab, that’s not where we want to go if we
can avoid it if we want to. Calcium score is a big improvement over these. It’s a
great first… it’s a great tool for screening. It’s not great for
following progress and there is radiation involved. So it’s available.
It’s just not as good as CIMT. CT angiogram is expensive. It’s coming out
of the blocks now as a very good test. Again, it’s expensive. And part of the
problem of the CT angiogram is you don’t know whether you’re… if you see plaque,
you don’t know whether it’s soft or stable.
Hence the CIMT again. I’ve mentioned it a couple of times, I’m not gonna cover it
any deeper today, Todd’s gonna cover that in his presentation and again you’ve
got David here to give you a little bit more detail. I just want to give you the
perspective from a physician in terms of the advantages and disadvantages. I did
an article a video recently on ABI ankle brachial index. It’s a great
do-it-yourself one except for the following problem. A negative is not gonna
tell you that much. And if you have a positive, most people already know their
results before they have this test. It’s an accurate test. It’s a do-it-yourself.
It’s very inexpensive, and it’s a great test. If you haven’t
done it for yourself, look it up on my video, and do it. Unfortunately again, it
doesn’t… you already know most of what you’re gonna find out from from an ABI.
um I’m gonna skip over these questions because we have a lot that I’d like to
cover for you today and let’s go again a little bit more deeply into
cardiovascular inflammation. First of all, this is where we’re going in deeper and
deeper in terms of scope or granular granularity, in terms of what’s going on
and where were looking from the heart and
cardiovascular system to a single artery then getting into layers of the arteries
and then getting into glycocalyx. Now again, very minimal high-level look the
heart and the arteries we’re looking at the intima and media. The intima is the
lining. It says it’s a slick lining but it again it has that glycocalyx area. The
glycocalyx is sort of like the edge of a marshland, that area where you have marsh
next to the river, that’s where the real metabolic activities occur both in our
body as well as in the marshland. And this is a picture. Under this is a cross-section of the artery showing that hairy-looking glycocalyx. Here’s a
diagram of the glycocalyx and here’s a healthy glycocalyx right here. Now
what happens with inflammation is this let’s say you are a smoker or you have
inflammatory disease like rheumatoid arthritis or most commonly like over
half of us as adults you have insulin resistance. In other words, you eat carbs
and your body stays at 180 or above for hour after hour in terms of your
blood glucose level. Look what happens. That tends to destroy that glycocalyx.
This is a healthy glycocalyx up here and down here but here these are systemic
effects occurring from inflammation once that happens. It becomes much easier to
understand how small dense LDL can make it through that hairy glycocalyx and
lodge into the cells of the intima and pass through them and lodge into the
artery wall. Once that happens, we get inflammation. The body’s immune system,
it’s taking from you’re taking friendly-fire the body’s immune system
recognizes this plaque and says, “This should not be here.”
It sends in immune cells… T-cells, monocytes, polymorph.. and I’m not going to
name all the different types of cells but we will talk about two of them a
little bit later because we can actually measure their activity. That’s part of
the inflammation test. All of that’s actually not bad because the immune
system is doing what it should do. It’s liquefying something that shouldn’t
be there so it can remove it. So this is the cross-section of an artery. This is
the media, the muscular layer. This is the intima, the lining with that
glycocalyx. And this is plaque that has gotten stuck between the intima and
media layers. But here’s the problem. Well, one more thing this is a liquid
area that’s why I sort of retracted away from the slide now. This hot liquid area
that again all of that stood up until this point. And here’s the problem you go
back to these cells and some of the chemicals that they
release can cause a clot if they touch blood and that’s exactly what happened
here. This is another view of someone who died from a heart attack. Just like this
one and this is a larger view. It’s a little bit different preparation. This
is the media of the artery wall out here. This is the intima as you see there are
a couple of broken places. This black thing is not hot plaque. It is the clot
that the blood formed when that hot plaque touched the blood. The larger part
of this clot is what killed the patient. It floated on up to the heart. And again
this is not plaque. This is… pardon the image there are the
mislabeling… this is the clot that’s gone on up into the area where that hot
plaque was. Here you see there’s another hot plaque pocket right here. So that
shows that this is a systemic issue. In other words, it’s happening one place in
the body, it’s happening all over in the body. That’s why we can look and
tell whether you have hot plaque by looking at your neck instead of your
heart. We’ve actually done studies so we haven’t done them they’ve been done many
many times. I wanted to remind you that if you’d like to get your C int the
first stop on the C IMT access tour is in Anaheim in LA on September 28th
that’s a half day of David minds talking about in person how would we do these of
what the advantages are a little bit more about lifestyle and its impact on
health Todd and I plan to come in remotely but the big thing here is
getting that see IMT all of this is like I think 245 yeah 245 bucks to get a half
day of this type of information but more importantly Aves your own C IMT done and
read to get there you go to cardio risk dot u s slash healthy life thank you

2 thoughts on “Arterial Plaque Test, Inflammation and Cardiovascular Disease”

  1. For those who know that cardiovascular inflammation contributes to heart attack and stroke, do they even try to encourage nutritionally superior eating habits before resorting to anti-inflammatory medication?

  2. Whoa! Did the video malfunction and just stop? I didn't feel like there was any closure and was left hanging waiting for additional information.

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