I wanted to post a thread for the benefit of everyone who has found out that they have cardiovascular disease or has a family history of cardiovascular disease. I have done many hours of reading and research on this topic and want to share some tips and thoughts. Feel free to comment and add to what I have below. I am hoping this thread can help someone else out now or in the future.

Valuable First Line Screening
CT Calcium Scan/Score
Treadmill Test
Quest Cardio IQ Advanced Lipid Panel plus Inflammation

Necessary Reading
Beat the Heart Attack Gene - Bale/Doneen
Deep Nutrition - Shanahan

Here are some of my thoughts and opinions on this subject:

1.) Not *every* significant blockage needs surgery or a stent. COURAGE and ISCHEMIA proved that. I have a 90% mid LAD blockage and 4 others and I am now on "optimal medical therapy" as treatment (baby aspirin, statin, and 2 blood pressure medications) plus major diet and exercise changes. Not saying this applies to everyone, but it took me quite a bit of research and passing up 3 different cardiologists who wanted to cut me open, even though I passed a nuclear stress test, regular stress test, and had no angina or other symptoms to find one who suggested conservative management was best. He happened to be the most experienced of the 4 cardiologists I saw.

2.) Look into the significance of LP PLA2 and small particle LDL (Lipoprotein Fractionation, Ion Mobility - part of the blood panel I listed above). This seems to be a new research area, but, to me, the logic behind their significance makes sense and I am following guidelines to try and bring these markers back into range (mine were very elevated).

3.) Look into Lipoprotein(a) (part of the panel I listed above). This is a risk factor for cardiovascular disease.

4.) Look into insulin resistance. This is thought to play a role in cardiovascular disease. Insulin response cannot be properly assessed with A1C, fasting glucose etc. and that is all most doctors will run. The best assessment is from an insulin response to glucose test, where they measure your insulin levels over hours after drinking a glucose solution.

5.) Statins are not some sort of "devil medication". I am not sure why so many people are so against them. They reduce inflammation and stabilize arterial plaques in a addition to lowering LDL. I don't necessarily agree with the shotgun approach of driving LDL to extreme low numbers, but I take them for their other benefits. I did push back on my doctor on trying to raise mine to max/high doses, as published data, even on the manufacturer's websites, show you get only small incremental benefit on LDL lowering for each doubling of dosage.

6.) Look into APO E gene testing. Out of all the genetic markers that can be tested, this seems to be the one you can act on the most in terms of diet modifications which may help.

Appreciate the information!

How much did the advanced lipid profile cost you? I'm assuming insurance would not cover it. Did you request it from the lab yourself or did a doc order it for you?

Statins can be a real problem. The muscle pain and liver issues are well documented but there is growing concern over dementia as well.

Cholesterol Pills (Statins) are Probably Really Bad for Your Brain - Dr. Cate

What are you doing for your diet?

Here is a good detailed look at the data behind the Cardio IQ panel, I'm not done with it yet just watching between patients.

For both questions above, my first Cardio IQ panel was run by my first cardiologist and insurance did not cover it and the cost was about $300. However, this test can be ordered at the below link for under $200. I am actually using this same lab service to just test LDL particle size (Lipoprotein Fractionization, Ion Mobility) and LP PLA2 only for much cheaper every 6 months, since none of my other inflammation markers were elevated. Below is the lab service I am using. This is an online service that orders labs through Quest:

https://www.ultalabtests.com/test/cardio-iq-advanced-lipid-panel-with-inflammation

In regards to the diet question, I posted the below on another thread awhile back, but this basically sums it up. Diet basically follows the advise in "Deep Nutrition". The only other thing I can add to this is I have cut out *everything* with added sugar. Also, I am now using Ezekiel bread, a sprouted grain bread, which is very low glycemic index.

Quote:

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In a nutshell, I don't eat anything that couldn't have been eaten 100 years ago. No processed foods of any kind and limit carb intake to brown rice and potatoes and other natural sources (no pasta, no white rice, no bread/tortillas, etc.). We now only use avocado and olive oil (no "hateful 8" seed oils like canola, soybean, etc.). I still eat red meat and things with saturated fat in moderation. I think excess carbs are much more dangerous than saturated fat (contrary to the mainstream belief).

Basically, the "shop the edge of the grocery store" diet. This has been a radical change for me, as I was eating just about everything. I have also cut back my alcohol consumption to a couple of small glasses of red wine per week.

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Bonfire97 said:

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For both questions above, my first Cardio IQ panel was run by my first cardiologist and insurance did not cover it and the cost was about $300. However, this test can be ordered at the below link for under $200. I am actually using this same lab service to just test LDL particle size (Lipoprotein Fractionization, Ion Mobility) and LP PLA2 only for much cheaper every 6 months, since none of my other inflammation markers were elevated. Below is the lab service I am using. This is an online service that orders labs through Quest:

https://www.ultalabtests.com/test/cardio-iq-advanced-lipid-panel-with-inflammation

In regards to the diet question, I posted the below on another thread awhile back, but this basically sums it up. Diet basically follows the advise in "Deep Nutrition". The only other thing I can add to this is I have cut out *everything* with added sugar. Also, I am now using Ezekiel bread, a sprouted grain bread, which is very low glycemic index.

Quote:

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In a nutshell, I don't eat anything that couldn't have been eaten 100 years ago. No processed foods of any kind and limit carb intake to brown rice and potatoes and other natural sources (no pasta, no white rice, no bread/tortillas, etc.). We now only use avocado and olive oil (no "hateful 8" seed oils like canola, soybean, etc.). I still eat red meat and things with saturated fat in moderation. I think excess carbs are much more dangerous than saturated fat (contrary to the mainstream belief).

Basically, the "shop the edge of the grocery store" diet. This has been a radical change for me, as I was eating just about everything. I have also cut back my alcohol consumption to a couple of small glasses of red wine per week.

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Thanks! Seems in line with what I have seen suggested. I've eaten the Ezekiel bread before (I'm type 1 diabetic) and it's decent. Sounds like mostly lean meats and veggies. Any fruit and/or dairy?

I do eat some dairy and fruits. Mostly yogurt and cheese on the dairy side in moderation. Also, some fruits like bananas, oranges, and apples. I would say that all of this is probably 25% of my diet.

I tend to agree that "excess carbs" can be a problem. As someone who lifts regularly, I recognize (or still believe) that carbs are the best source of energy. I know when I've tried restricting carbs, my workouts suffer. I'm also almost 50 and work at a computer all day, and I know my body doesn't need as much as it use to. I tend to eat fewer carbs on days I don't go to the gym.

The place I get stuck is what defines "excess"? If I am eating enough to have good workouts but I'm not gaining bad weight, am I in the right spot? Just a conundrum I think about...

jtraggie99 said:

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I tend to agree that "excess carbs" can be a problem. As someone who lifts regularly, I recognize (or still believe) that carbs are the best source of energy. I know when I've tried restricting carbs, my workouts suffer. I'm also almost 50 and work at a computer all day, and I know my body doesn't need as much as it use to. I tend to eat fewer carbs on days I don't go to the gym.

The place I get stuck is what defines "excess"? If I am eating enough to have good workouts but I'm not gaining bad weight, am I in the right spot? Just a conundrum I think about...

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Carbs are your ready to burn fuel. The problem is when you eat too many and then don't burn them and they are stored up as fat. Especially high fructose corn syrup which is strongly correlated to fatty liver.

If you eat carbs then jog/lift/etc they are helpful. The problem in USA is 90% of people eat a ton of carbs and sit on the couch.


-----------clip from AI query----------

High fructose corn syrup (HFCS) consumption has been linked to an increased risk of nonalcoholic fatty liver disease (NAFLD), a condition characterized by excessive fat accumulation in the liver12. Research suggests that consuming high amounts of fructose, especially in the form of HFCS, may contribute to the development and progression of NAFLD through several mechanisms:
Liver Fat Accumulation
Excessive fructose intake can promote lipogenesis (fat production) in the liver, leading to increased fat storage and potentially triggering NAFLD14. Fructose metabolism in the liver lacks hormonal regulation, making it more likely to contribute to fat accumulation compared to other sugars4.
Intestinal Barrier Damage
High fructose consumption may damage the intestinal barrier, allowing bacteria and toxins from the gut to enter the bloodstream and reach the liver12. This can lead to inflammation and further promote the conversion of fructose into fatty deposits in the liver1.
Inflammation and Oxidative Stress
Fructose intake can increase inflammation in the liver and alter glucose metabolism2. It may also upregulate the expression of proteins associated with oxidative stress and mitochondrial dysfunction5.
Ethnic Disparities
Research has shown that certain ethnic groups, such as Mexican Americans, may be at higher risk of developing NAFLD when consuming high amounts of fructose2. This partially explains racial and ethnic disparities observed in NAFLD prevalence.
Prevention and Management
To reduce the risk of developing NAFLD, it is recommended to limit the consumption of foods and beverages containing high fructose corn syrup26. However, moderate intake of whole fruits, which contain natural fructose along with fiber and other beneficial nutrients, is still encouraged as part of a balanced diet4.
It's important to note that while animal studies have shown clear links between high fructose intake and NAFLD, more research is needed to fully understand the effects in humans. Nonetheless, current evidence suggests that reducing HFCS consumption may be beneficial for liver health and overall well-being.
Citations:
[ol]

https://www.niddk.nih.gov/news/archive/2020/how-high-fructose-intake-trigger-fatty-liver-disease

https://www.medicalnewstoday.com/articles/high-fructose-corn-syrup-intake-linked-to-liver-disease

https://www.nature.com/articles/s41598-021-82208-1

https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2021.783393/full

https://hbsn.amegroups.org/article/view/5213/html

https://www.endocrine.org/news-and-advocacy/news-room/2022/people-who-consume-too-much-high-fructose-corn-syrup-could-be-at-risk-for-nafld

https://www.pennmedicine.org/news/news-releases/2020/june/the-gut-shields-the-liver-from-fructose-induced-damage

https://www.health.harvard.edu/heart-health/abundance-of-fructose-not-good-for-the-liver-heart

[/ol]
Answer from Perplexity: pplx.ai/share

In general, I agree that HFCS should probably be avoided. But at the same time, HFCS is likely not the culprit we think it is. HFCS is somewhere between 42-55% fructose. Table sugar is 50% fructose. I think the issue with HFCS likely stems from the fact that you're just eating more sugar in general, and it has become a replacement for sugar in many processed foods - which are probably not good foods to eat a lot of to begin with. And while true that fructose can only be processed in the liver, I'm not sure a potential 5% difference in fructose can really be blamed for NAFLD

There's a "physician fitness and biohacking" on facebook, if you're interested in joining. Still new and small, but you might be interested.

I heard a microbiologist say if a dr says heart disease is hereditary ask what gene it is? He says 85% of diagnosis they can't find a cause and say hereditary. Believe it was Gary Brecka that stated this. Thought that was an interesting point of view.

Agreed. This is like saying "height is largely hereditary" and the person answering "oh yeah, which gene?"

Yeah, I think in regards to the gene thing, they have only scratched the surface with APO E and 9P21 etc.

Good stuff. Thanks for posting.


I agree on statins. I take them, but I only take it two days a week rather than every day and my numbers are great. I don't know why they over-dose that medicine.

KidDoc said:

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GeorgiAg said:

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Good stuff. Thanks for posting.


I agree on statins. I take them, but I only take it two days a week rather than every day and my numbers are great. I don't know why they over-dose that medicine.

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Because dosing it like you are has not been studied so a doc would just be making it up as he went along. Nothing wrong with YOU deciding to do this but if a doc went against FDA guidelines and you ended up with a heart attack or stroke you could sue him for making stuff up with no evidence.

ETA: Just like my doc would not advise me to stop my statin, we always have to be thinking about liability when we give professional advice to established patients.

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Damn lawyers.

(just settled a case against a neurosurgeon yesterday - don't worry bro REALLY needs to stop operating on people. He was peer reviewed and fired. Of course I don't know the results of the peer review but he was fired and tried to sue them in federal court for racial discrimination - most of it under seal so I couldn't get it. He lost the discrimination suit as well.) .

KidDoc said:

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AgShaun00 said:

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I heard a microbiologist say if a dr says heart disease is hereditary ask what gene it is? He says 85% of diagnosis they can't find a cause and say hereditary. Believe it was Gary Brecka that stated this. Thought that was an interesting point of view.

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That is a very narrow minded view as genetics is rarely limited to a single gene. It is very clear that some families particularly with familial hypercholesterolemia are prone to very early coronary artery disease.
From an AI query:

summarize family risk of cad

A family history of coronary artery disease (CAD) significantly increases an individual's risk of developing the condition. Key findings include:

- **First-degree relatives**: Having a first-degree relative (parent, sibling) with CAD raises the risk, especially if the relative developed CAD at an early age (premature CAD, typically before 50 years)[2][4].
- **Parental history**:
- If one parent had a myocardial infarction (MI), the odds ratio (OR) for CAD is 1.67; if both parents had MI, the OR rises to 2.90.
- Early-onset parental MI (before age 50) increases the risk further, with an OR of 6.56 if both parents are affected[1].
- **Sibling history**: The risk increases by up to 40% if a sibling has CAD, with even higher risks in identical twins[1].
- **Younger individuals**: Family history has a stronger impact on younger populations, with higher odds of CAD compared to older age groups[4].
- **Multifactorial influence**: Family history often interacts with modifiable risk factors like diabetes or poor cardiovascular health, compounding the overall risk[3][4].

Family history is a critical factor in cardiovascular risk assessment and highlights the importance of early prevention and lifestyle interventions.

Citations:
[1] Family history of cardiovascular disease - PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC4229162/
[2] Coronary Artery Disease, Family History, and Screening Perspectives https://pmc.ncbi.nlm.nih.gov/articles/PMC11477357/
[3] Family History of Modifiable Risk Factors and Association With ... https://www.ahajournals.org/doi/10.1161/JAHA.122.027881
[4] Prevalence and Cardiovascular Health Impact of Family History of ... https://www.ahajournals.org/doi/10.1161/JAHA.119.012364
[5] Family Health History and Heart Disease - CDC https://www.cdc.gov/heart-disease-family-history/risk-factors/index.html
[6] Expanding the definition of a positive family history for early-onset ... https://www.sciencedirect.com/science/article/pii/S1098360021032639
[7] Family history of heart and circulatory diseases - BHF https://www.bhf.org.uk/informationsupport/risk-factors/family-history
[8] Coronary Artery Disease - American Heart Association https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/coronary-artery-disease

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thought that was interesting take also and thank you for the explanation.