10 Steps to Take if Your Heart Scan Score
Increases More Than 10% per Year

An Update: 2008

In 2006, we first released our Special Report, 10 Steps to Take if Your Heart Scan Score Increases More Than 10% per Year, to serve as a checklist to refer to and help polish your plaque-control program.

It’s time for an update. While much of the program circa 2006 remains intact, we’ve made some important improvements. As experience evolves, new scientific evidence emerges, and more of our Track Your Plaque Members help us learn about new strategies, we continue to review and improve our approach, always aiming to improve our ability to control and reverse coronary disease.

Although it remains an important supplement to achieve specific effects, we’ve removed l-arginine from the list of necessary ingredients. There is no doubt that L-arginine provides benefits such as blood pressure reduction, normalization of endothelial responses, and anti-inflammatory benefits (along with enhanced penile erections), but many people have achieved plaque score reduction without it. We therefore remove l-arginine from the “required” list and onto the “optional” list.

We’ve also added optimism to our list. This interesting observation has emerged since our last release of the 10 Steps: with rare exceptions, only people who maintain a spirit of optimism in life achieve a halt or reduction in heart scan score (though being optimistic is no guarantee that score will drop).

There are also a few strategies waiting for a place on the list, but we await further experience and data to make judgments. In this waiting list, for instance, is vitamin K. While scientifically plausible and emerging data suggest an effect, the Track Your Plaque experience remains too preliminary. We do remain excited about its prospects, however.

The 10 Steps

The principal goal of the Track Your Plaque program is to keep coronary plaque from growing, even reduce the amount of plaque you have. We track this through your heart scan score.

If, after one year of effort, you get another heart scan and your score increased >10%, then adjustments to your program should be considered by you and your doctor. (Recall that the expected rate of plaque growth is 30% per year.) Regardless of your starting score or percentile rank, a rate of plaque growth of more than 10% per year is a red flag for escalating risk. It should be taken seriously and a re-examination of your program is in order. Plaque can’t grow forever without resulting in trouble!

There is no magic pill to add when this happens. Instead, several issues should be considered. Among the issues to consider:

1. Are you in the “60–60–60 Club?” Our goals are far tougher than lax national cholesterol (ATP-III) guidelines. For plaque regression, we aim for LDL cholesterol ≤60 mg/dl, HDL ≥ 60 mg/dl, and triglycerides ≤60 mg/dl. This goal is so powerful that few hidden lipoprotein abnormalities can persist in the face of 60–60–60. (The only common hidden lipoprotein abnormalities that might persist are lipoprotein(a) and small LDL.).
2. Do you have unrecognized or uncorrected lipoprotein abnormalities? If you and your doctor have chosen to rely on conventional lipids but your score continues to increase, give serious consideration to a full lipoprotein analysis. This may uncover whether hidden patterns such as small LDL, lipoprotein(a), and intermediate-density lipoprotein (IDL) are present and contributing to plaque growth. In particular, if you have lipoprotein(a), see Lipoprotein(a): What it is, why it's important, and why you need to know if you've got it! and Unique strategies for lipoprotein(a) reduction.
3. Do you have too much small LDL? Most people have plenty of small LDL at the start of their program and it’s a rare person with coronary plaque who doesn’t. Getting rid of small LDL is crucial for control of plaque. The target value for small LDL is not entirely clear, however, and differs depending on the lipoprotein testing method used. However, a useful starting goal is to get small LDL <30% of total by NMR lipoprotein testing(a revised target compared to our more stringent <10% advised in past); <15% by electropheresis (Berkeley) or VAP (Atherotech). Small LDL is both a genetic pattern as well as an abnormality caused by being overweight, over-reliance on processed carbohydrates, particularly foods made with wheat and corn.  If you’re unable to get small LDL measured, raising HDL to >60 mg/dl is reasonable assurance that small LDL is effectively suppressed. (See Lipoprotein Checklist: Small LDL)
4. Do you have metabolic syndrome? Cholesterol may be perfect, but if the metabolic syndrome continues to be a part of the picture, it is unlikely you will gain control over plaque. You probably have metabolic syndrome if one or more of the follow are present: HDL <50 mg/dl, small LDL, triglycerides >150 mg/dl, high blood pressure, excess abdominal fat, blood sugar of >110 mg/dl. Having this syndrome is a matter of degree. The more of these patterns you have, the more severe is the syndrome, and the more it contributes to plaque growth.
5. Do you take sufficient vitamin D? Vitamin D deficiency is rampant in the U.S., particularly in northern climates where sun exposure is infrequent for prolonged periods. The higher your heart scan score, the more likely you are deficient in vitamin D. Ask your doctor to check a blood 25(OH) vitamin D3 level (not a 1,25-dihydroxy-vitamin D3, a related measure but a reflection of kidney function, not vitamin D status).  Your vitamin D dose can be determined judging by your starting levels. In northern climates, most women require 4000 units per day, most men 5000–6000 units per day to achieve the desirable blood level of 50–60 ng/ml; occasionally, doses of 10,000 units per day or more are required, but should always be guided by blood levels every few months. Normalizing blood vitamin D levels is proving, in preliminary studies, to be a potent anti-inflammatory strategy, as well, with profound reductions in C-reactive protein and other inflammatory measures (e.g., matrix metalloproteinase). (See An interview with Dr. John Cannell: The importance of vitamin D)
6. Are you optimistic? For unclear reasons, an optimistic attitude towards life is essential to achieve control over coronary plaque. Pessimists—dominated by a complaining, nothing-ever-goes-right-for-me kind of attitude—rarely succeed at reducing coronary plaque. Awareness of this adverse effect is the first step in making the necessary changes in attitude. (See Optimism, pessimism and coronary plaque at)
7. Is inflammation corrected? If you’ve taken advantage of weight loss to achieve a BMI of 25 or less, have adopted the Track Your Plaque nutrition principles, incorporated fish oil into your program, and achieved the 60–60–60 goals for cholesterol numbers, yet you still have a high C-reactive protein (>1 mg/l), then consider normalizing vitamin D blood levels (above); consider an increase in your fish oil dose if you’re taking the minimum dose of 4000 mg per day (e.g., increase to 6000 mg per day or more); and ask your doctor to be certain the metabolic syndrome is not a persistent part of your profile.
8. Do you have unrecognized or underestimated hypertension? This is a common problem. People or physicians will often hem and haw around high blood pressure and delay or avoid treatment. An increasing heart scan score tells you that your “borderline” hypertension may not be truly borderline. You and your doctor might consider blood pressure a contributor if resting blood pressure consistently measures above 130/70. Also consider hypertension a potential contributor if your blood pressure exceeds 170/80 on a stress test—very important. Prescription agents may be required. Alternatively, consider use of coenzyme Q10 (a dose of 50 mg twice a day lowers systolic pressure around 15 points; diastolic pressure around 8 points). If you haven’t done so already, strongly consider including l-arginine in your program, or increasing to the full effective dose of 6000 mg twice a day. Normalizing blood vitamin D levels is important, too.
9. Have you fully eliminated bad habits? Smoking any amount and overindulging in alcoholic beverages (more than two glasses of wine, two beers, or one hard drink per day) will erase many of the benefits in your program and can be responsible for continued plaque growth despite everything else being excellent. Sorry, but there’s no way around this. You’ve simply got to completely address these vices.
10. Is your nutritional program flavonoid-rich? The effects of the healthful flavonoids are broad and powerful and include blood pressure, lipoprotein, and anti-inflammatory benefits, as well as magnifying the effects of l-arginine on correcting endothelial dysfunction (abnormal artery constriction). Consider adding more deeply colored foods to your day, especially blueberries, pomegranates, plums, black grapes, spinach, green peppers, and red wine. Drink green tea whenever possible. Use cocoa powder (unsweetened) in your protein shakes. Add capers, fresh basil and other herbs to your salads and dinner dishes.

No one thing can guarantee that you stop your heart scan score from increasing or reduce it. It’s really the combination of efforts that can yield success.

Strategies to help you achieve these goals are all discussed in detail on Special Reports on the www.trackyourplaque.com website. If you’re interested in stopping coronary plaque growth and slashing your risk of heart attack as much as humanly possible, you are invited to join our community of members on the www.trackyourplaque.com website.

Copyright 2008, Track Your Plaque.