Chapter 6
Can I reduce my heart scan score?
If we can accurately measure coronary plaque, we should aim to
reduce it.
Like a weed in your garden, coronary plaque can grow rapidly.
With growth unchecked, plaque scores increase, on average, at a
rate of 30–35% per year (Janowitz 1991; Maher 1999; Budoff 2000;
Raggi 2005). A starting score of 100 will become 130, 169, 220, 286,
371, . . . kaboom!!!
Heart attack doesn’t necessarily occur once a specific value
heart scan value is exceeded, but the likelihood of heart attack
escalates along with the score. It’s like building a house of cards: the
more cards you stack, the shakier the structure, until you add that
final card and it all collapses. Growing plaque is unstable plaque.
If you know your heart scan score, your future is at a
crossroads. One path leads to life with a score that doesn’t increase
(or decreases) versus another path with your score increasing the
expected 30-35% per year. How different is your future between the
two paths? Even in the ensuing two years, an increasing score
means your heart attack risk skyrockets 20-fold. It means you’re
getting closer and closer to that day when catastrophe strikes. In
contrast, a stable or decreasing score means high likelihood of
remaining free of heart attack and major heart procedures. There is
tremendous benefit to stopping your score.
Can you reduce your score? Most people can, given the proper
tools, adherence to the program, and sufficient time.
What does it mean to reduce your score?
When a heart scan score is held stable or is reduced, this is
evidence that, not only is plaque no longer growing, it is being
inactivated. (Plaque activity cannot be directly measured in a live
human, so we need to rely on indirect methods.) You have
eabsorbed fatty tissue in the plaque, shrunk plaque size, turned off
nflammatory processes and enzymes, and extracted some of the
calcium. When plaque is inactivated, it is far less likely to rupture and
cause heart attack.
You and I can live happily with plaque. We just don’t want
plaque that is growing and potentially rupture-prone. A stable or
educed heart scan score can be viewed as indirect evidence of
plaque inactivation. Inactive plaque is far less likely to rupture, to
cause heart attack and other catastrophes.
How do I know if my score has increased or decreased?
How do you know what plaque is doing—shrinking or growing?
Simple: get another scan.
Many people ask: Doesn’t having a “perfect” cholesterol value
with treatment guarantee a reduction in score? Unfortunately, it does
not. How about a perfect lifestyle—strict adherence to diet, vigorous
exercise, adequate sleep, etc? This won’t guarantee that plaque
shrinks, either. Cholesterol values, even lipoproteins (discussed in
chapter 7) are only starting points to identify potential tools to shrink
your plaque. The only way to measure results in a specific individual
s to re-measure the quantity of plaque present: get another scan.
Reducing cholesterol, eating healthy, etc. are indeed helpful and
enhance the likelihood of stopping your score, but no specific
measure guarantees it.
In fact, there is nothing that truly tells you what your score is
doing except . . . another score. Tracking your plaque is therefore a
two-scan experience. There is no way to accurately and reliably
predict what your score has done without looking at the score again.
The Track Your Plaque 5 Stages of Reversal
I break the course of tracking plaque down into five distinct
phases, what I call “The Track Your Plaque 5 Stages of Reversal”:
Stage 1 Deceleration: Slowing plaque growth to ≤30% per year
It’s an unambitious goal, but a modest effort can slow growth to
below the “natural” rate of 30% annual growth. This is the rate of
growth experienced by many people who take statin cholesterol
drugs (Lipitor®, Zocor®, etc.) as a sole strategy for combating heart
disease.
Slowing growth to less than 30% per year is regarded as an
unsatisfactory result in the Track Your Plaque program, one that can
be improved substantially. While this represents an improvement over
natural or accelerated plaque growth, substantial risk for heart attack
persists with this level of growth.
Stage 2 Deceleration: Slowing plaque growth to ≤20% per year
A modest reduction in heart attack risk occurs when growth of
plaque is slowed to 20% or less per year, but remains above 10%.
Stage 2, like Stage 1, is also a typical result for someone who does
nothing but adds a statin cholesterol drug and follows a conventional
(e.g., American Heart Association low-fat) nutritional program.
While existing data suggests that achieving Stage 2
Deceleration modestly reduces the risk of heart attack and the
likelihood of heart procedures, there’s plenty of room for
improvement.
Stage 3 Deceleration: Slowing plaque growth to ≤10% per year
Now we’re starting to have a real impact. When plaque grows
at 10% or less per year, it hasn’t stopped, but has slowed
considerably from its “natural” rate of growth. Plaque growth rates of
10% or less per year are associated with a substantial reduction in
heart attack. Achieving this rate of growth should prompt the
question, “What could I do just a little bit better?”
Stage 4 Zero Growth: Zero percent plaque growth per year
This means that plaque growth has halted. Even though plaque
has not reversed, zero percent plaque growth is associated with a
dramatic reduction in the risk of a heart attack (Raggi 2005). This is
probably due to the fact that, while calcium has not changed, the
active elements in plaque, like inflammatory cells and fatty material,
have been reabsorbed, resulting in reduced potential for plaque
rupture. In my experience and in published experience, the likelihood
of a heart attack is virtually zero at this stage.
Stage 5 Reversal: Reducing your heart scan score
This is the "holy grail," the goal we seek. It’s the prize that has
tantalized the hopeful who’ve been misled into dead ends like low-fat
diets, chelation, and other blind alleys. When achieved in the Track
Your Plaque program, it is truly an enormous personal success that I
would equate with graduating college, getting married, or being cured
of cancer.
Reducing your heart scan score signifies that coronary
atherosclerotic plaque has reversed—it is smaller in volume. All the
components of plaque have diminished, including inflammatory cells,
fatty tissue, and calcium. It also means that plaque has been
essentially inactivated, its potential for rupture virtually shut down. It
also means that your risk for heart attack is zero. In other words, in all
practicality, heart disease risk has been eliminated. It also means
that, although plaque is still present, the fatty portion of plaque has
been replaced by solid structural tissues that allow plaque to exist
quietly without inflammation and without activity that triggers rupture.
A decreasing heart scan score provides powerful indirect evidence
that plaque is becoming stable and inactive.
In my experience, the majority of people who adhere to Track
Your Plaque can slow or completely stop the otherwise inevitable
increase in score, though the time required to do so may vary. In the
first year, if all the proper steps are taken, a very realistic goal is to
achieve an increase in score of no more than 10% (Stage 3
Deceleration). The existing data suggest that a score increase of
<10% represents low-risk, and heart attack becomes less and less
likely as your plaque is inactivated.
A zero-percent increase or decrease in score is more
commonly encountered after two years on this program. Obtaining a
reduction of score with present treatments is therefore a one to two
year long process for most participants.
It is important to point out that the lower your starting score, the
more easily it is reduced. Scores of 200 or less have a much greater
chance of being lowered in the first year than scores >200. In our
program, 70% of people with starting scores of <200 succeed in the
first year. This drops to 30% success in the first year if your score is
>200, 50% by end of year 2. The message here is clear: the earlier
you start to Track Your Plaque, the more control you will have over
your heart’s future. Nonetheless, if you start with a higher score, don’t
give up hope. You may have to work harder and be patient, since this
process requires at least two years for most people to enjoy
substantial score-reducing or slowing effects.
Certain groups of people can anticipate greater difficulty in
controlling their score. People with established diabetes will
encounter more of a struggle. Unfortunately, if you’ve already been
diagnosed with diabetes, reducing your score is less likely. The Track
Your Plaque principles still do represent the most powerful prevention
program you can follow, but it is more likely that you simply
“decelerate” your plaque growth with these efforts, rather than
achieve score reduction as long as you remain diabetic. (However,
we will discuss how diabetics can supercharge their plaque control
effort using our unique Track Your Plaque nutrition principles that
reduce the diabetic tendency, many times reverse it!)
People with the metabolic syndrome who have a combination of
low HDL, high triglycerides, high blood pressure, blood sugar levels
>110 mg/dl, and are overweight, will also struggle to control plaque.
The metabolic syndrome generally precedes the onset of full-blown
diabetes but has a similar, though lesser, impact on plaque. The most
powerful tool for control of plaque growth for many people like this is
weight-loss achieved through the strategies discussed later in our
Track Your Plaque Nutritional Principles. It is possible to control
plaque with uncorrected metabolic syndrome in the picture, but it can
be considerably more difficult.
Once score stabilization (zero change) or reduction is achieved,
the need for any future scans to detect additional change is really an
individual decision. Since the score has started to drop, the most
important goal has been achieved. It is worth considering another
scan, however, if there is some significant change in your program.
For instance, significant weight gain, reversal of diabetes, or a
prolonged period of treatment interruption are among reasons for
repeating a scan despite initial control of the score.
The Track Your Plaque Study
In 2008, along with nutrition scientist, Dr. Susie Rockway, and
statistician, Dr. Mary Kwasny, both of Rush University Medical
Center, we published a portion of the Track Your Plaque experience
(Davis 2008).
In this group of 45 participants, within 18 months 20 participants
achieved a reduction in heart scan score of 14.5% (mean), while 22
participants experienced zero change in score. Of the 45 participants,
only 3 experienced an increase in score. One participant, a 52-year
old woman, achieved an incredible 64% reduction in heart scan
score, our best outcome to date.
In other words, 42 of 45 participants, or 93%, for all practical
purposes eliminated risk for heart disease by halting or reducing their
heart scan scores.
Why such a small number of participants? Actually, prior to
publication of this study, we had enrolled several hundred people in
the program. But once vitamin D was added to the Track Your Plaque
program, we began to witness faster and larger reductions in heart
scan scores in a greater proportion of participants. So this small study
included only the modest number of participants who had been taking
vitamin D for the duration of the study, but did not report the several
hundred people who had participated “pre-vitamin D.” (There’s much
more on the crucial role of vitamin D in plaque control later in the
book.)
Copyright 2010 Track Your Plaque, LLC
