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It is a well-known fact that heart disease is the number one cause of death and disease in the US and has been for decades. Cardiovascular disease affects nearly half of American adults and is attributable to 1 in 4 deaths in the US every year. The old “an ounce of prevention” saying is never more appropriate than when it comes to cardiovascular disease because intervention early with lifestyle changes, early and regular screening with lipid testing and calcium scores, and early but appropriate use of lipid lower medications all dramatically change a patient’s course. A lesser-known fact about heart disease is that a little over half of all cardiac events in men and a little less than a third in women happen under the age of 65.

Atherosclerosis is a disease of your arteries which leads to a buildup of plaque and eventual artery narrowing. Unfortunately, many people do not realize they have atherosclerosis until their arteries have started to narrow, but at this point the disease is already quite advanced. Atherosclerosis begins with inflammation and plaque development within the vessel wall long before any artery narrowing takes place. An atheroma (collections of lipids, calcium, and inflammatory cells) is the abnormal accumulation of material in the inner layer of the artery – the true start to heart disease – and these are known to start forming in your twenties. 

Most people are familiar with procedures like angioplasty and coronary artery stent placements. These interventions happen when the artery narrows to a critical point and subsequently produces symptoms which prompt medical attention (or worse cause heart attacks). The narrowed artery gets stented open to allow blood to flow again. Interestingly enough, at least 12 randomized trials involving more than 5,000 patients have found angioplasty (in any form) has no reduction in future heart attack risk. It is imperative then to intervene long before any artery narrowing has occurred. 

How? Well, a few interventions are fairly simple: don’t smoke, eat a minimally processed whole food diet, limit saturated fats, and exercise regularly. See your doctor for regular physicals which should include a cardiovascular risk assessment that considers your medical history, family history, lifestyle habits, and lipid measurements. I also like to get a coronary artery calcium (CAC) scan in certain individuals depending on their risk level. The CAC scan is a strongly validated and relatively inexpensive indicator of more advanced stages of coronary heart disease. 

Lipid measurements have come a long way and we are able to pinpoint the specific levels of atherogenic (plaque forming) cholesterol particles in your blood by checking apoB and LDL-p. In contrast to the standard lipid panel that insurance deems “covered” at your annual physical, these numbers are a much better reflection of your blood lipid composition. Why don’t most physicians order these simple tests? Insurance does not cover them, and the patient is often stuck with an arbitrary bill of a few hundred bucks. What is the cash price for these labs at aspireMD? Less than $10. By knowing your risks, which includes your personal and family medical history, in conjunction with your labs an imaging, we can intervene early to help you live a longer, healthier life. 

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