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Understanding heart diseases, particularly the risk of heart attack, strokes, valvular diseases requiring stents or cardiac surgery, is a dynamic field. Heart diseases, particularly coronary heart disease (CHD), remain the #1 risk of disability and death in western countries in both men and women. The traditional risk factors for early CHD are smoking, diabetes mellitus, hypertension, elevated cholesterol, and a family history of early CHD. The standard lipid profile has served as a mainstay of CHD risk assessment for decades.

Lipoprotein(a) (Lp[a]) is a type of cholesterol particle that is not measured on standard lab panels. Measure Lp(a) can help refine strategies of CHD risk assessment. Lp(a) has huge importance as it is estimated to be elevated in approximately 20% of the world’s population and is genetically determined. It is a complex structure that has a low-density lipoprotein (LDL) particle with an added apolipoprotein(a) via a totally different hepatic pathway than LDL cholesterol. If inherited, the level of Lp(a) in the blood is elevated and has the potential to do harm by 1–2 years of age! Ongoing strategies to lower Lp(a) in patients at risk or with proven CHD are a recent focus of pharmaceutical companies but none are approved for use at this time. This case study indicates that “natural” approaches using diet and supplements may have a profound impact on the level of Lp(a). …


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Everyone has heard about LDL cholesterol, elevated blood pressure, diabetes mellitus and smoking in terms of heart disease risk. Unfortunately, most have not heard of Lipoprotein(a), also known as Lp(a) or the “sticky” cholesterol. Lp(a) is a low-density lipoprotein (LDL) cholesterol particle with an added tail called apolipoprotein(a) that makes it a unique and potentially dangerous for future heart attack, stroke, and valvular disease. An individual’s Lp(a) level is 80–90% genetically determined in an autosomal codominant inheritance pattern with full expression by 1–2 years of age and adult-like levels achieved by approximately 5 years of age. The Lp(a) level remains stable through an individual’s lifetime regardless of lifestyle. Approximately 1 out of every 4 person inherits the gene for Lp(a) and manifests an elevated level in the blood lifelong. Although most health care practitioners are not yet routinely ordering a simple blood test to assess the presence and level of Lp(a) in their practice, my preventive cardiology clinic is a referral center for those with Lp(a) and I see many patients. …


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In medical school nearly 40 years ago I was taught that heart disease is mainly due to smoking, hypertension, diabetes, cholesterol disorders, and a family history of early heart events (Framingham risk factors). Most patients are still evaluated by obtaining information regarding these 5 factors. Missing from this approach are major advances in understanding the development of coronary artery disease (CAD). One of the most important advances is the recognition that a type of lipid (cholesterol) particle that is inherited on a genetic basis is both common and causes a large number of tragic cardiac events, even deaths. This particle is called Lipoprotein(a) or Lp(a) and can be easily measured in a blood sample at most laboratories. …


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Making optimal decisions on your diet choices is one of the most important parameters of achieving and maintaining long-term health. Unfortunately, the media loves to twist poor quality data and a barrage of erroneous reports have claimed it is safe again to load your plates with meats, cheeses, butters, and eggs. Nothing could be further from the truth and a recent high-quality review identified the risks of these foods and the high saturated content they contain. Indeed, the last 2 months has seen a flood of new data and science indicating plant diets have benefits head to toe. …


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Hundreds of years ago, English physician Thomas Sydenham taught that “a man is as old as his arteries.” We usually don’t think about the health of our arteries until a problem arises (like an emergency room admission, a heart attack, erectile dysfunction or sudden death). It not routine to measure the “age” of arteries directly although I do this in my clinic with advanced equipment.

Fascinating data has emerged in the last few years suggesting that the flexibility of the spine and joints predicts the flexibility of arteries. Additional data indicates that yoga may help maintain our arteries in a youthful state. …


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Lipoprotein(a) is a still largely unknown LDL-cholesterol like molecule. It is, however, the most frequent inherited risk factor for heart attack, stroke, and calcific aortic valve disease. Lipoprotein(a), also known as Lp(a), is inherited in 20–30% of populations tested suggesting that it is elevated in over 1.5 billion people worldwide. Reports on Lp(a) are available in the research and lay press and a book has been published on the topic this year.

A unique feature of Lp(a) is that, in addition to its pro-atherosclerotic and pro-inflammatory potential, it also promotes blood clotting. Studies have evaluated if persons who inherit Lp(a) are at more risk of blood clots in the legs, lungs and other sites. An increased frequency of Lp(a) in persons suffering these serious conditions has been reported. …


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The advice on heart health tips is abundant in February, traditionally celebrated as Heart Month.

The constant reminders that cardiovascular disease is the #1 cause of death in the Western world are crucial. Educating the public on the research showing that up to 80% of heart deaths are preventable by not smoking, eating a plant heavy diet, and obtaining regular fitness is always of importance. Has we learned anything new to add to those health habits to further advance the prevention of heart disease? Although not a new concept, the link between oral care and heart care is stronger than ever. …


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This week a 59-year old woman traveled 2 hours to my office for a 2nd opinion. She was 5’3 and weighed 252 lbs., down from a peak of 320 lbs. a few years earlier. She had been diagnosed and treated for Type 2 diabetes mellitus since the year 2000 and had been treated for hypertension and hyperlipidemia for a decade. She had been treated once with laser for retinopathy and had mild peripheral neuropathy. She never smoked. Due to progressive kidney failure, she began hemodialysis in 2014 and had a kidney transplant in 2017. She had a carotid endarterectomy in 2016. She denied angina or dyspnea but underwent a chemical nuclear perfusion scan this year and had moderate to large reversible defects with an ejection fraction of 61%. She underwent right and left heart catheterization showing normal right heart pressures. Her left main was 10% narrowed, her vessels were large, her LAD after a septal branch was 70% narrowed, a first circumflex marginal was functionally occluded 100%, and her distal RCA to a dominant circulation was 80% narrowed.


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It is that time of year. Gifts are exchanged in many cultures. The ugly sweater? The spice mix? The newest online game? If you have to give a gift, how great would it be if it was actually healthy and helpful for the year ahead. Here are some ideas. I use and love every single item on this list and I often use all of them every day. Happy Holidays

  1. Pique Tea

These organic teas in crystalline form for cold or hot beverages are the best I have ever found and I have many glasses a day. Teas promote exceptional health and a gift basket of a selection of these beautifully packaged teas is a gift that will last for a long time. …


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What is a coronary artery calcium scan (CACS)?

It is a simple CT of the heart performed without injection of any contrast dyes that permits the easy identification of calcification (plaque) in the three major heart arteries. By good fortune, the density of arteries is different than the fat they sit in and the muscle and blood that are nearby in the heart. Calcium comprises about 20 percent of plaque in arteries but is such a different density than the rest of the heart that even small amounts show up like a beacon of aging and damage in by just holding your breath for 10 seconds.

A software program permits a score, called the Agatson score, to be calculated after the scan. If there is no calcium in the coronary arteries, the score is zero. Alternatively, even in persons with NO symptoms, the score can be the tens, hundreds and even thousands indicating small to huge amounts of calcified heart artery plaque that can lead to symptoms, sudden heart attacks, or sudden deaths. …

About

Joel Kahn

Professor of Cardiology, Summa cum Laude grad, Kahn Center for Longevity and GreenSpace Cafe. www.drjoelkahn.com @drjkahn. Author The Plant Based Solution NEW

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