10 steps to take if your heart scan score increases by more than 10% per year

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 the quantity of hidden plaque through your heart scan score. If after one year of effort your score increases >10%, then adjustments to your program should be considered by you and your doctor. 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.

There is no magic pill to add when this happens. Instead, a re-consideration of several issues will be required. Among the questions to consider:

1. Are you in the “60–60–60 Club?” Our goals are more stringent compared to the lax national cholesterol guidelines. For plaque regression, we aim for LDL cholesterol <60 mg/dl, HDL > 60 mg/dl, and triglycerides <60 mg/dl. If you are not at these targets, consult the Lipoprotein Guide in this Manual, or chapter 8 in the Track Your Plaque book.

2. 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 gain control over plaque. You and your doctor will know that you have the metabolic syndrome if you have 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. Any one of the above abnormalities qualifies you as having metabolic syndrome (in our strict definition); the more you have, the more the metabolic syndrome contributes to plaque growth. See Metabolic Syndrome: 7 Steps to Reduce or Eliminate It in this Manual.

3. 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 IDL are present, or whether there are other unrecognized issues like increased homocysteine or C-reactive protein. See chapter 8 of the Track Your Plaque book or the Lipoprotein Guide in this program Manual.

4. Have you included l-arginine in your supplement program? Because l-arginine can be somewhat cumbersome to take, some people will neglect this crucial supplement. That’s a mistake. L-arginine is a necessary ingredient in your plaque-regression program with a multitude of beneficial effects. Alternatively, if your dose is less than the recommended 6000 mg twice a day (on an empty stomach), consider increasing your dose. See chapter 11 of Track Your Plaque or the Quick Start to Nutritional Supplements in this Manual.

5. Do you take sufficient vitamin D? Vitamin D deficiency is rampant in the U.S., particularly in the 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. Consider taking vitamin D 1000 units per day. This strategy 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).

6. 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 vitamin D 1000 units per day; discuss the use of doxycycline with your doctor (see Putting Out the Fires of Inflammation in this Manual); 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); and ask your doctor to be certain the metabolic syndrome is not a persistent part of your profile. Also see Natural Ways to Lower Cholesterol and C-Reactive protein in this Manual.

7. Is homocysteine fully corrected? The best epidemiologic data suggest that a homocysteine level of 8.0 mmol/l is ideal. If your level is above this, discuss increasing your folic acid dose (which usually requires a prescription) with your doctor. Also consider an increase in your vitamin B6 dose to 50–100 mg and an increase in your B12 to 500–1000 mcg.

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 180/80 on a stress test. 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.

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 have 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. See Flavonoids and l-arginine: A Potent Combination for Arterial Health.

Copyright 2005, Track Your Plaque, LLC