Assessing Heart Health in 2023
A Functional Medicine Approach
by Mary E. Miller-Wilson
Heart disease, also known as atherosclerosis, accounts for one in seven deaths in the United States and is the leading cause of mortality in this country. Statins, prescribed to help lower cholesterol, are among the most commonly prescribed medications in the United States. Over 40 million Americans are currently taking them and they are fraught with side effects.
Over the years, cholesterol has been demonized by conventional medicine. With most cardiologists, the lower you can drive cholesterol levels with the use of statins and dietary management, the better. And yet, cholesterol is fat and is vitally important in the human body for the formation of cell membranes, various metabolic processes in the human body, the formation of hormones, and the creation of fat-soluble vitamins and bile acids (used to properly digest fats). When the total cholesterol is driven too low (<140), patients have difficulty concentrating, complain of brain fog, fatigue and muscle pain.
The traditional cholesterol panel that we are all familiar with was originally developed in the 1950s and has been revised multiple times since then, with the latest revision taking place in 2018. Every time a revision takes place, the parameters for the various types of cholesterol get tighter and tighter, thereby allowing traditional medicine to “cast a wider net” for statin use.
And yet, the central question remains, has this helped with our assessment of heart health and or eradication of heart disease?
In a Functional Medicine/Integrative Medicine environment, clinicians have moved on to more in-depth testing called Advanced Lipid Profiling, that provides a higher degree of insight into the dynamics of plaque formation in blood vessels. There are subclasses of both HDL and LDL cholesterol. The latest data shows that larger cholesterol particles are favorable to smaller ones when it comes to plaque formation.
Other aspects of Advanced Lipid Profiling typically include lipoprotein fractionation and insulin resistance score. Insulin resistance/metabolic syndrome is a bigger catalyst for the development of heart disease than abnormalities in the traditional cholesterol panel.
Other markers typically assessed in a Functional Medicine environment are hs-CRP and homocysteine, which again give a clinician more accurate insight into potential cardiac risk.
When a patient has a consistently skewed cholesterol panel in spite of clean eating and a healthy lifestyle, one needs to consider familial dyslipidemia, which means that you simply come from a long line of individuals that have high cholesterol levels, but it does not necessarily equate to an increased risk for heart disease.
However, this sub-set of the population is harassed when they go to their traditional physician about the need for a statin. Advanced lipid profiling is helpful in this instance, but another simple, inexpensive diagnostic test can be performed to delineate risk of heart disease for a patient, called CT Calcium Scoring.
CT calcium scoring is performed at both major hospitals and outpatient imaging centers. The cost is less than $100. Insurance will not pay for this test because it is still considered to be progressive. It is inexpensive, accurate and can be performed in less than 5 minutes. It assesses the lifetime burden of hard plaque in your coronary arteries. If there is the presence of plaque, it gives the location of the plaque. It is an excellent way to assess whether the abnormalities in the traditional cholesterol panel are translating into an increased risk for heart disease.
Assessing heart health and risk beyond the traditional cholesterol panel, which is outdated, has gotten easier and more comprehensive. Ask your doctor to order advanced lipid profiling and/or CT calcium scoring.
Mary E. Miller-Wilson is an Adult Nurse Practitioner with over 20 years’ experience and Institute of Functional Medicine Certified Practitioner. She practices in Rochester and Bloomfield Twp., MI at Hormones and Health. For more information call 248-315-2286 or visit her website: HormonesAndHealthDetroit.com.