Category: Preventive Cardio

In recent years, a vocal minority has promoted the idea that cholesterol does not cause heart disease. This is also known as the cholesterol myth. This narrative has gained traction on social media and in some alternative health circles. However, these claims are fundamentally flawed and contradict decades of robust scientific research, clinical trials, and real-world cardiovascular outcomes. Cholesterol and Heart Disease: Myth vs. Truth But is there any truth to this assertion? It depends on the terminology used to make the point. The key point is that atherosclerosis has multiple causes, and cholesterol is one of them. Instead, most advocates of this line of thinking are more interested in social media engagement, selling products, and telling people what they want to hear. The cholesterol myth advocates would be providing better information by mentioning that up to 50% of people with normal cholesterol can have heart attacks. In the primary care setting, often only cholesterol is treated, and there is no detailed preventive cardiovascular plan. It takes much more than just a cholesterol drug to prevent heart attacks and strokes. The role of cholesterol and atherosclerosis is complex, requiring in-depth knowledge, as is the case with many aspects of medicine....

Calcified plaque in the arteries is seen in some endurance athletes, especially runners. The type of plaque typically seen is dense and contains more calcium particles than those who do not exercise. If exercising is healthy, why would an endurance-type exerciser get more plaque than someone who does not exercise? Why Calcified Plaque Develops There are many reasons calcified plaque develops. Over 400 reasons have been elucidated, but a shorter list is more practical. The more risk factors a healthy person has, the higher the risk of developing coronary artery plaque. For example, a 55-year-old runner with a family history of coronary artery disease, moderately elevated LDL of 130, male gender, and a history of a high-stress job has more than enough risk factors to cause coronary artery disease. The additional stress of exercise increases the calcium deposits in plaque that have already occurred. There are ways that exercise impacts arterial health. Some researchers consider plaque development an adaptive response to the increased blood flow-induced shear stress through the artery during exercise. The Impact of Exercise on Arterial Health The ways that exercise impacts arterial health include oxidative stress from long endurance-type activities, mechanical strain on the artery wall from...

More data regarding the risks associated with artificial sweeteners and cardiovascular disease has been accumulating. I decided to review the literature and post answers to some of my patients' questions around this topic. What is the relationship between artificial sweetener consumption and cardiovascular disease risk? Recent studies suggest a potential link between higher artificial sweetener intake and an increased risk of cardiovascular diseases (CVD), particularly cerebrovascular diseases like stroke. This association was observed even after adjusting for factors like age, sex, physical activity, smoking, and dietary habits. How was artificial sweetener intake measured in these studies? Both studies utilized detailed dietary assessments. The NutriNet-Santé study in France used three non-consecutive days of 24-hour dietary records, repeated every six months. The UK Biobank study relied on repeated 24-hour diet recalls. What types of artificial sweeteners were investigated? The studies investigated a range of artificial sweeteners, including aspartame, acesulfame potassium, sucralose, cyclamates, saccharin, thaumatin, neohesperidine dihydrochalcone, xylitol and aspartame-acesulfame salt. Were specific artificial sweeteners linked to particular CVD risks? Yes, the research indicated that different artificial sweeteners might be associated with different CVD risks: Aspartame was linked to a heightened risk of cerebrovascular events Acesulfame potassium and sucralose were associated with an...

Cholesterol is probably the most controversial topic I discuss with my patients. This is because many of them have heard that cholesterol drugs (statins) cause cancer, damage the liver, deplete CoQ10, don’t work, or are a waste of money. For arterial plaque to occur there needs to be disruption of the endothelial layer (inner blood vessel wall). Then LDL particles find their way through the inner arterial wall and activate the immune system causing inflammation. The immune system ingests these particles and then the cells die. As this continues, a core of lipid develops and it can eventually rupture causing heart attack. [caption id="attachment_3358" align="aligncenter" width="966"] Figure 1[/caption] What is LDL Cholesterol? Low-density lipoprotein (LDL) is the “bad” cholesterol that most of us have heard about. While elevated LDL is a risk factor for heart attack, LDL alone is not a good predictor of an individual’s risk. Because of this problem, more sensitive cholesterol tests have been developed which look at cholesterol particle size, number, and density. Although cholesterol abnormalities contribute to atherosclerosis there is more to the story. For example, LDL particle number is the more important risk indicator. An issue that feeds the cholesterol controversy is the fact...

What is a Coronary Artery Calcium (CAC) score? A CAC score measures the amount of calcium in the walls of the coronary arteries, which are the blood vessels that supply blood to the heart. CAC is measured using a non-invasive CT scan. A higher CAC score indicates a greater buildup of calcium, which is a sign of atherosclerosis (plaque buildup in the arteries). Calcium gets deposited in the artery wall, which contributes to the formation of more complicated, older plaques as part of the healing and stabilization process. Atherosclerosis increases the risk of heart attack, stroke, and other cardiovascular events. How is CAC scoring used to assess cardiovascular risk? CAC scoring assesses cardiovascular risk by providing additional information about the presence and extent of atherosclerosis beyond traditional risk factors. While traditional risk factors like age, sex, cholesterol levels, and blood pressure can estimate the likelihood of developing cardiovascular disease, CAC scoring directly visualizes the presence of plaque in the arteries. A CAC score of 0 indicates the absence of detectable plaque, generally associated with a low risk of cardiovascular events in the near future. Conversely, a CAC score above 0 suggests the presence of plaque, and the higher the score,...