Heart Disease & Endo-PAT

 

 

Let's Start by Watch a short video about Endo-PAT

 

History of Coronary Heart Disease

In 1918, a Spanish flu epidemic spread across the world. People trusted that medical scientists would find a way to prevent or cure the disease, as they had done for smallpox and other former killers. However, not much was known about the flu at that time, and all efforts to halt the disease failed miserably. Over 600,000 people died from the flu in the United States alone.

In 1998, heart disease was responsible for the deaths of over 700,000 Americans. What makes this fact even more tragic is that unlike those 1918 victims of the flu, today we know what risk factors contribute to coronary heart disease. Recent advances in medicine explain how to prevent and treat heart disease. Medical professionals have at their disposal numerous strategies to combat the disease. Much of this wealth of knowledge about heart disease comes from a medical study in Framingham, Massachusetts.

Major risk factors for heart disease

• smoking

• high total cholesterol

• diabetes

• hypertension (high blood pressure)

• peripheral vascular disease

• abdominal aortic aneurysm

• carotid artery disease

• family history of premature heart disease

• males 45 years and older

• females 55 years and older

• low HDL cholesterol

Framingham

In 1948, medical experts were becoming increasingly concerned about the "epidemic" spread of coronary heart disease. They persuaded over 5,000 healthy residents of the town of Framingham to participate in a unique study. Volunteers for the study received free complete physical exams every two years. They also answered numerous lifestyle questions about their diet, level of activity, smoking and drinking habits, and anything else that the researchers thought might be relevant to heart disease. Over the next 20 years, researchers collected data and noted which volunteers had developed heart disease. The researchers identified physical and lifestyle elements that were shared by those who developed heart disease. They called these "risk factors" - and for the first time, heart disease prevention became a real possibility.

Predict Heart Attack or Stroke Breakthrough: Endo-PAT device

Physicians and researchers now have access to a noninvasive fingertip test that can identify patients with the earliest stages of cardiovascular disease and replace testing that is done during angiography.

People with high blood pressure or cholesterol are at increased risk of heart attack, but doctors haven't been able to predict who among that group is most likely to have one. Now, a device that clips onto your finger can tell by sensing lack of elasticity of your blood vessel lining, a condition called endothelial dysfunction. "A poor score is a stronger warning than the usual risk factors because it indicates that cardiovascular disease has already begun—but at an early stage when you can more easily control your risks," says Amir Lerman, MD, a cardiologist at the Mayo Clinic in Rochester, MN.

The device, called the Endo-PAT, has been FDA approved since 2003, but a new 8-year study by Lerman and his colleagues shows that half of people whose scores indicate endothelial dysfunction go on to have a heart attack or stroke, proving the test to be a powerful forecaster of individual risk.. "It's an extremely important test," says Lerman, "especially for women, who are more prone to have endothelial dysfunction without other risk factors."

In addition to the Mayo Clinic, the Endo-PAT was evaluated in clinical research conducted at major medical centers such as, Harvard, New England Medical Center and Yale and published recently in the Journal of the American College of Cardiology.

Do You Know Your EndoScore?

"One of the top nine medical breakthroughs of 2009.  One of the most remarkable innovations that promise to revolutionize how doctors prevent, diagnose and treat common conditions and diseases."  Prevention December 2009.

Mayo Clinic study shows simple finger device may help predict future heart attacks and strokes.  Results presented at American College of Cardiology Annual Scientific Session show that a simple, noninvasive finger sensor test is "highly predictive" of a major cardiac event such as a heart attack or stroke for people who are considered at low or moderate risk. 

Over 50% of heart attacks in US occur in patients with normal cholesterol, so it is vital to have other more reliable methods of detecting early cardiovascular disease. Medical research has demonstrated that abnormal blood flow in your fingertip indicates impaired blood flow in your coronary arteries, which can be easily measured using a relatively new testing procedure known as EndoPAT.  The test is noninvasive and has been proven to be a useful screening tool for detection of those who are likely to have a heart attack or stroke within the next 5-7 years. 

EndoPAT is the only FDA approved device indicated for noninvasive assessment of endothelial dysfunction.  The endothelium is the innermost lining of the artery and is where cardiovascular disease starts and progresses.

"A poor score is a stronger warning than the usual risk factors because it indicates that cardiovascular disease has already begun-but an early stage where you can more easily control your risks," according to Amir Lerman, M.D. cardiologist had Mayo Clinic.

Research from the Mayo Clinic indicates that EndoPAT is able to spot coronary atherosclerosis. "The presence of endothelial dysfunction in coronary or peripheral vessels constitutes an independent predictor of cardiovascular events. EndoPAT is a noninvasive tool to identify patients during early stages of coronary artery disease". Journal of the American College of Cardiology, 2004.

EndoPAT testing has been available at this clinic for over two years.  Schedule an appointment today to know more about how healthy your heart and cardiovascular system are. 

How the Endo-PAT  test is done

• The test procedure takes about 20-25 minutes.
• Come to office 15-20 minutes early to acclimatize to the office temperature after being outside.
• Avoid tight clothing and sleeves.
• Leave cell phone in your car or turn it off including vibration mode.
• You will have to remove watches and rings.  Perhaps leave them at home or in your car to keep them safe.
• Do not wash your hands in cold or warm water 30 minutes prior to the test.
• During the procedure you will have biosensors placed the index finger of each hand.
• Your nondominant arm will have a blood pressure cup applied with sufficient pressure to temporarily occlude the circulation in your arm for five minutes.  This can be uncomfortable, but is harmless.  You might feel strange sensations during and right after the occlusion.  Slight bruising is possible.
• You will have to refrain from talking during the procedure when asked to be silent.
• You should be as relaxed as possible during the test. Most people fall asleep.

Results will be available right after procedure is completed.

Endothelial Dysfunction-How Insulin Resistance Progresses to Heart Disease

June 2009

Although there are several factors that influence the development of diabetes - genetics and autoimmunity for Type 1 diabetes, and lifestyle and genetics for Type 2 - the major goal for both types is the same: prevention of heart disease and complications. In the case of Type 2 diabetes, numerous lifestyle factors are known to be causative of insulin resistance - specifically, not living an active lifestyle and over-eating certain foods. Yet environmental factors also appear to contribute, including more recent observations that toxins in our environments, including diesel exhaust and pesticides, may contribute to the development of diabetes (Lee et al. Diabetologia, 2008). Yet, not everyone progresses from pre-diabetes to diabetes, and not everyone with diabetes develops heart disease. How can this be?

These conditions share certain characteristics, yet there still appears to be a continuum of severity, and, importantly, there appears to be an opportunity to shift the progression of diabetes, even once it develops. Is it possible that there is one common mechanism between diabetes & heart disease? And that this mechanism can be impacted therapeutically to help protect the delicate system of vessels that carry oxygen and nutrients throughout our bodies? This article, reviews current understanding of the importance of the inner lining of our blood vessels- called the endothelium - and the dysfunction that occurs at this inner lining that appear to be a common disruption throughout the continuum of insulin resistance through the development of diabetes, and on to heart disease.

The Endo-what?

The endothelium is the innermost lining of all of your arteries, large and small. The normal function of the endothelial lining is to produce a chemical called nitric oxide (NO), which causes the vessel to expand, or dilate, in response to either an increased need for oxygen, or in order to deliver more nutrients to the tissues of the body. Let me give a few specific examples, which will help this system become more familiar.

Insulin stimulates the production of NO [nitric oxide] by the endothelium so that blood flow is increased to the tissues, like your muscles, allowing the absorption of the nourishment from your meal. Often when people develop heart disease, especially later in the condition when chest pain occurs with even short bursts of activity, they are prescribed a drug called nitroglycerine. This drug is used because it is rapidly converted to NO in the body, causing the arteries to dilate, and thus more oxygen gets to the heart, and hopefully the pain stops. However, the vessels normally produce their own NO, in response to several stimuli, including exercise and also food intake.

Now think about the energy and oxygen your body needs during exercise- say when you go for a brisk walk or jog. In response to the demand for energy and oxygen, the heart increases its rate, and this increases the pressure applied to the inside of the vessels; the increase in pressure normally causes the endothelium to make more NO, and thus deliver more oxygen and fuel to the tissues in order to sustain exercise. Now, wouldn’t it also make sense that if the body wanted to deliver fuel to the muscles, even in the absence of exercise, that there would be a mechanism to do this as well- say after a meal? Surprise! The hormone insulin is the trigger that allows for this delivery to occur. Insulin stimulates the production of NO by the endothelium so that blood flow is increased to the tissues, like your muscles, allowing the absorption of the nourishment from your meal!

What Can Go Wrong?

Although the research is still emerging on the numerous causes of dysfunction of the endothelium, there is some convincing research that has demonstrated endothelial dysfunction, or the inability to produce NO normally, can be caused by several very common exposures - including exposures in our diet and exposures in our environment.

Regarding the dietary causes of endothelial dysfunction, we owe much of our understanding to researcher Antonio Ceriello, MD (Ceriello et al. Circulation, 2002; Ceriello et al. Diabetes. 2004). Dr. Ceriello and his team have performed numerous experiments investigating endothelial dysfunction following meals, or post-prandial. The basics of his experiments are as follows: he fed a group of people various standardized meals, and then measured the dilation of their blood vessels plus several markers of oxidation and inflammation for several hours following the feeding. The “meals” were either an oral glucose tolerance test, containing 75g of glucose, a high-fat shake consisting almost entirely of whipped cream, or a combination of the high-glucose and the high fat “meal”. The summary of his findings is that both high-glucose and high-fat meals disrupt the endothelium, however the glucose meal appears to do it very rapidly, i.e. within an hour; the high fat meal seems to do it later, but the effects last longer i.e., between 2-3 hours after the meal; and the combination does both, i.e. occurs rapidly and lasts a long time, from 1-3 hours following the meal. 

Importantly, Dr. Ceriello has performed these experiments in people with both types 1 & 2 diabetes - and in people without diabetes at all - and the effects were very similar, except that people with diabetes started out with much higher measures of oxidation and inflammation that those without diabetes. Also measured was oxidized LDL cholesterol, and C-reactive protein, which appear to increase in parallel with elevated blood glucose and blood fat. Also tested were meals with high- and low-levels of advanced glycosylation end products, the tasty caramel like chemicals that get formed during browning, toasting, roasting and frying foods, which also disrupt endothelial function, resulting in reduced NO production, increased blood clotting, and higher levels of oxidation products forming in the vessels. These findings suggest that all of us- even those of us without diabetes - are susceptible to this phenomenon, and that the dietary choices we make can either cause this to happen very quickly and very often, or very rarely.

Why Does a Little Endothelial Dysfunction Matter?

It is true that the endothelium is like the skin inside our blood vessels, and like skin, it repairs and replaces itself rather quickly. And, also like skin, there is a very large area covered with this layer. So, who cares? We slough off our skin, and it gets replaced, no big deal, right? Not so fast. This belief may be true if the reaction stopped there, but it doesn’t. In fact the disruption in our endothelium continues, and involves other systems in the body, including the immune system. It turns out that our blood vessels have receptors for toxic chemicals too, including oxidized LDLs, C-reactive protein, and advanced glycosylation end products, and when these compounds bind their receptors, they trigger a whole cascade of events, including the activation of the immune system’s inflammatory response. Our blood vessels release messengers called cytokines, and these messengers cause our immune cells, called macrophages, to navigate through our blood vessels and swallow up, or engulf, these toxic compounds. What happens to them?

Well, probably not surprisingly, they get taken to the dump- and the closest dump happens to be the deeper, inner layers of our arteries, leading to plaque buildup, or atherosclerosis. Now you might be thinking, why in the world would our body respond by triggering our immune system and creating plaque buildup from drinking a milk shake? I think it is important to consider the intelligence of this approach. The human body is designed to compensate for injury in very select ways, and in the case of vascular injury, it compensates by trying to seal up the problem, i.e., create clots, and get the culprit as far away as possible from the delicate inner lining of the vessels. Before thinking of this as counter-productive, consider the alternative? If these toxins were not removed and stored, they would continue to impair the delivery of blood and nutrients, and in sensitive tissues this could rapidly cause low oxygen levels, leading to rapid tissue destruction and death. Our body is smart, it is up to us to treat it correctly.

Unfortunately, not only does the inflammatory response that accompanies endothelial dysfunction contribute to atherosclerosis, but the inflammation also impairs the function of numerous other receptors, including the receptors for insulin in the liver, kidneys and muscles, and the receptors for both insulin and glucose in the pancreas. Over time, these disruptions lead to the slow, but progressive, development of insulin resistance and compromise to the pancreas, limiting its ability to detect blood sugar and respond by releasing insulin. Of course, this is a vicious cycle, because the development of insulin resistance and insulin deficiency both lead to higher blood sugar and higher blood fat, perpetuating the dysfunction.

Can Endothelial Dysfunction be Fixed?

The first treatment recommendation will sound very familiar to you: dietary change. Given the above discussion about the contribution of fat, sugar, and advanced glycosylation end products to a dysfunctional endothelium, the elimination, or significant reduction, of foods high in these pro-inflammatory factors is the first step to returning normal function.

Improve Blood Glucose and Lipid Control

Although obvious, it is important than blood glucose be reduced down to normal, or near-normal levels, ideally through diet and lifestyle change, in order to reduce the continued oxidative stress that occurs due to high blood glucose. Admittedly, we’ve seen recently from large clinical trials, that aggressive blood glucose lowering using drugs does not clearly benefit most people with diabetes, in terms of their cardiovascular outcomes. However, healthy lifestyle clearly does make a difference in cardiovascular outcomes, and therefore achieving as much reduction as possible, using exercise and dietary change, is a sure bet for protection. Also, glucose is not the only culprit. Blood cholesterol, i.e. LDL, and blood fat, i.e., triglycerides, are also pro-inflammatory substances and they too, need optimal treatment to protect your endothelium.

Conclusion

Your endothelium is not to be taken for granted, and in fact, it serves as a vital protective layer that protects your larger vascular structures from more damage. Dietary factors clearly impact endothelial function, with high-fat, high-sugar content, and highly glycosylated foods being the most harmful. Nutritional supplements like L-arginine demonstrated the ability to reduce endothelial dysfunction, and in some cases, reduce blood pressure, however caution is warranted for using some supplements, such as L-arginine by itself, and dietary change should precede any supplementation. Finally, lowering LDL cholesterol, reducing its susceptibility to oxidation, whether through medications, supplements or dietary means, also appears critical to protecting your inner most layers!

The good news is, with good dietary choices, good blood glucose and lipids control, and appropriate supplementation, endothelial function does appear to improve, and substantial improvements in nitric oxide production, reductions in blood pressure, and medication use are achievable.