Celebration of American Heart Month:
As we approach then end of February, this year is flying by even faster than 2008. It’s our last week to celebrate American Heart Month. Yes, February is the month of the Heart, the time to make a different kind of New Year’s resolution, one that is hopefully more focused and permanent than what we’ve all tried to implement in January. In celebration of Heart Month, I have decided to share an inspirational story about my cousin. His case is so compelling – and he is so kind – that he has permitted me to tell his tale.
The Call for Help
Toward the latter part of 2007, I received a desperate call from my cousin; his weight and blood pressure had reached new heights and he was beginning to panic. He was a fifty year old CEO of a major marketing firm, and his lifestyle did anything but promote health and well-being. Every week, he'd fly to one of his several offices that dot the US. While in his youth, he had been a superb athlete, but recently, exercise was no longer in his vocabulary. His diet was typical of well-to-do business travelers, rich in unhealthful meats, deserts, and copious quantities of wine. He had become a cardiac nightmare.
The Work Up
And so I invited him to visit me in Florida, where I arranged for comprehensive blood work, as well as a coronary CT angiogram (CCTA). For those of you unfamiliar with the recent light-speed evolution of the CCTA, let me take a moment to debrief you on what I consider to be the greatest single advance in cardiovascular technology in the past decade. In 1994, the first multislice CT scanner was created, with a dual detector array. This allowed two slices to be imaged simultaneously. Although this was certainly a substantive advance in imaging, it was not until the 64 slice CT was released in about 2005 when we finally could rapidly and accurately visualize the entire coronary tree (even with bypass grafts) during a single brief breath hold. Even more recent advances have enabled us to perform CCTA studies with a minimum of radiation exposure. My cousin’s CCTA revealed the presence of multi-vessel non-obstructive disease. (See images below) This meant that he had enough plaque to place him at risk for a life-threatening myocardial infarct, but not enough to warrant a bypass or stent. His Lab Results were even more frightening: low HDL, high Triglycerides, markedly elevated Lp (a), elevated fasting blood sugar, high LFTs, and low vitamin D. On Physical Exam abnormalities were legion. He was 5’10’’ and weighed 232 pounds. His waist circumference measured at the top of the iliac crests was 45 and ¾ inches. His BMI was 33.3 and his Framingham ten year risk (which often underestimates risk) was calculated to be 6%. He was already on a multitude of Medications for hypertension and dyslipidemia – Hyzaar, Metoprolol, and Vytorin.
Assessment: Not Good
Things did not look good. He was obese, had impaired glucose tolerance (or pre-diabetes), had a significant dyslipidemia, and already was showing evidence of non-alcoholic fatty liver disease. In short, my cousin had classic metabolic syndrome, a condition that in some trials has been found to predict a cardiovascular prognosis even worse than that of full-blown diabetes mellitus. He needed to change.
The Plan: A Health Makeover
Fortunately, my cousin was accompanied by his wife, a loving and solid partner who clearly did not want to see her husband die from what would otherwise have been a preventable disease. She was, therefore, a great ally in the implementation of Therapeutic Lifestyle Changes (TLC). He was placed on phase one of the South Beach Diet (low in simple sugars), and instructed to drink copious quantities of water. He was told to exercise for at least one hour daily, incorporating both resistance and aerobic modalities. Vitamin D3 was added, as was VitalOils1000, an omega-3 supplement I formulated in order to provide the AHA’s recommended 1 gram of combined EPA+DHA in a single soft gel. One year has elapsed and the result has been nothing short of phenomenal.
It Worked
My cousin now weighs in at 180 pounds, a loss of 52 pounds or about 22% of his body mass. His waist circumference is down to 36 inches, a reduction of 9 ¾ inches ! His previously abnormal laboratory values have all normalized. My cousin has altered his metabolism to such a great degree that he no longer has impaired glucose tolerance, fatty liver disease, or even a dyslipidemia. He is even off his medications for hypertension. Yes, he still has coronary artery disease, but through his own efforts he has dramatically lowered his risk of ever experiencing a cardiovascular event. Some subtle changes in his medications, in concert with his hard work and adherence to prescribed TLC, have metamorphosed him into a nearly unrecognizable man.
The Lesson
The bottom line is that we all are at risk for a whole host of disorders. All we can do is the best we can do to prevent them. We can not alter our genetic tapestry but we can change our behavior. We must acknowledge that the value of maintaining an ideal body weight, exercising frequently and keeping one’s lipids under control is now beyond reproach. Following the example of my cousin, by taking control of our lifestyles we can most certainly live longer, more vibrant and vital lives.
Please send your thoughts and comments to be published in our next RI edition of Letters to the Editor.
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