I come from a family with some bad stories around food. My dad spent most of
his adult life between - from 250 pounds up to 350. So these right 2 categories.
A BMI of 35 to 40, and then higher. How did we get - how did he get there? He loved
sweets; but it wasn't just sweets, it was just piles and piles and piles of food.
My mother actually got up over 160 at one point. So, here's one of the - and I got
up over 190. I'm currently 155 and what does all that got to do with heart
attack and stroke health? Obviously, a lot and that's the battle that I routinely
fight. I have - over the - as an adult - well, as a young adult in college I got up to
190 then I decided I wanted - I needed to lose weight and I went on more of a low
low-fat, plant-based diet. Got down to about - have actually, for the most part of
my adult life, gone between 155 - 160. I have been over 160 a few times. A few
years ago got up to 170. Now, it's an interesting thing - what does that got to
do with CIMT? With my CIMT. it has to do with a lot and we'll go through that
over the next few minutes in this video. My arterial age tends to be driven to a
large extent by my BMI and I'm not alone. That's a - that's a key item. I get a lot
of grief for being so aggressive about BMI and body fat, as you may know, and if
you're saying "Well, BMI is not exactly body fat." I know that but if I
inserted RFM (relative fat) mass and every time I said BMI - nobody would - even
fewer people would understand what I'm trying to say. So I'm referring to body
- body fat mass or relative fat mass. Fat does cause some things that challenge
your insulin - your body's response to insulin and, therefore, your - your routine
sugar values - glucose values; therefore, also, some plaque values and that is
where the connections start to get made. There's a strong case that insulin
itself, drives a lot of this plaque as well and that's not what this video is
about. This video is just starting off making that connection between body mass
or relative fat mass and CIMT results. Now, as you start looking at my CIMT, my -
one of my early videos covered my early experience with CIMT and made a case
that despite having stayed around, actually, for the most part in my life as
I said, in the 150s - 160s, I had gained weight as I got older. I started getting
that middle-age spread. I was playing two hours of basketball
full court twice a week plus a half marathon once a week; so I was running
too much distance for a 50 year old and I also decided to bulk up a little bit
to be able to bump people around on the basketball court. It was after one of
those events, one of those two hour activities that I remember thinking
about it and praying and saying "You know what? If I get too fat and start having
some heart attack stroke risk maybe I can start sharing some of this with the
other folks that are gray Panthers or folks that are beginning to become gray
Panthers." I still expected though, during - after getting my first CIMT, to do a
victory lap because, again I was not eating unhealthy food,
again, plant-based; although, significant carbs. That was in February of 2015. I was
57 years old and I had an arterial age of 73.
At that point - and I also had some plaque by the way. At that point I just - it
motivated me. Here was the representation of that plaque - 1.49 millimeters
heterogeneous plaque in the right common carotid. I bit the bullet despite being
very anti medications, especially on the statins topic. I decided to go ahead and
start statins a couple of years earlier. I had developed high blood pressure, went
on - I've been on Losartan for a couple of years that's an ARB; switched
from the ARB to an ACE inhibitor Ramipril and started statins. I bumped
around from simbastatin, pravastatin - and then as the price continued to drop on
Crestor, I went to rosuvastatin or crestor. Now, over the - I got very deep. I
started a more of a concierge practice and started doing more of these CIMTs. I
was gettintg them - I was able to get them done every month because they'd come in
to be done for my patients and I'd say "Hey, while I'm here, let me hop up on the
table." I saw a very interesting and very nice pattern - linear pattern of a drop.
You can see that pattern here in the Nomagrams. In October of 2015, just what?
eight months later, I had dropped, wh-? 14 years? From 73 year old arteries to 59
year old arteries. In another, October to September of '16, another 11 months, I
dropped seven more years. These are Noma grams down here. These are
basically, how those numbers of years are calculated - the arterial age is
calculated. You see, there's population norms for
intima-media thickness testing, starting as early as age five. The pink
line is women and the blue line is men. Men tend to lay down a little bit more
oxidized LDL inside the artery walls. if you don't understand
IMT (intima-media thickness test) or LDL or oxidized LDL, that's probably - that's
- that would be too much of a digression for this video. So when I did that video,
it was - at one point, my "giving my devil his due" meaning actually
admitting that - Yes, lifestyle is very important but -
especially when for the first few years that you start statins, they can be very
impactful as well. Initially, if you go in and you look at the - the statistics,
statins can't do - have a pattern of decreasing plaque during those -
especially those first couple of years when plaque has just been laid down.
Recently, now - let's fast-forward to another couple of years - April 2018
so actually that was what? I know there are six months after Sept - No,
actually, what? 16 months after September 2016, I was continuing to do these CIMTs
because of the practice at that point but I just did not save any of my
values. I did an event at the Kois Center in April of 2018, with my friend Doug
Thompson. By that point, I had started - actually, at that point, I was starting to
work full-time in the Medicare Advantage space. It's the - it's very exciting for me
because it's - it's an area where Medicare is actually beginning to adopt
preventive techniques so I became chief science officer for a group of Docs,
about 700 - 800 Docs who are focused on prevention in the
Medicare world. If you think Medicare Advantage is for
poor populations, it's cheap - it doesn't give you a selection. You need to be
thinking - again, all of the other insurance types - private insurance,
Medicaid, all - all of them - of the major insurance groups are headed much more in
that Medicare Advantage route and you shouldn't - you shouldn't see that as a
bad thing. Anyway, that's a digression, I'll stop that. Let's go back to my own
scan results and what happened with me and my scan and my plaque. Now, this one
is 28. I still had maintained my weight. I had not started into that full time
travel and weight gain, so I was still like 155; still about the same. A right
common carotid plaque in the - or a plaque in the right common carotid artery.
Plaque, for these terms - Discrete plaque is labeled as anything over 1.3
millimeters. So you see I have several other numbers in here: Right common
carotid artery - 0.8, left common carotid artery - 1.0, but they don't have a
letter next to them. The reason they don't have the letter is that, again, it's
not 1.3 millimeters or higher. Where did we get that number? Again, from the
research. If you go through the research, the - it's those discreet plaques that are
1.3 millimeters or Peaks that are 1.3 millimeters or higher, that contribute
to your overall cardiac event risk - Cardiac and stroke event risk. Now, so
heterogeneous, the - that's the next question. There's no question, as you
watch the progression of these things. Soft - you can see them and that's the
soft inflamed hot plaque; echogenic is the calcified plaque and, despite what
you may hear about calcification in arteries, calcification, overall, is a
marker that this plaque process has been going on and you've been going
through the cycles of laying - of getting inflamed,
laying down soft plaque, and then stabilizing it and maybe going - getting
inflamed again; softening that plaque again; but there's no question, echogenic
plaque is stable and that's what you want to have. Now, what is heterogeneous
or H - it's in between the two. So, if you look at my discrete plaque peak values,
that's what they - where they are in at the Kois Center in April of 2018.
Now, in comes working for full-time in that Medicare Advantage environment,
traveling every week, and I gained 10 pounds. I went from 155 up to 165 and I - I
had an increase in my arterial age. It went from - this is March 2019 at the
healthy life summit in Orlando, and I went from an arterial age of 52 - 53 up to
58, so that's an increase of five years. I didn't go back to the 73 year-old number
that I had back five years ago, but I have to watch my weight. If you look at
the actual peak values - those discrete plaque numbers, they really did not
change that much. This was really a risk that was driven more by common ar-
common carotid artery mean or arterial age. If you go back and you look at these
discrete plaques, the right common carotid artery still had a 0.8.
The bulb still had a 1.6, it was still heterogeneous. The internal
carotid was still 1.1; On the left common carotid was 0.9. It
was .1 before - I mean 1.0 before; 1.0 - 1.1, again, not significant changes. If you
look at total plaque burden or average CCA max region, or mean max, those really
did not change significantly. what changed? My arterial age. Why did it
change? You know, some of this - there's, I have no question, some of this could have
been variation from the - the technique of the - the ultrasound tech - what we call the
interrogation. Because I've done other videos to show you how just a tiny a few
degrees difference in the orientation of the - of the ultrasound wand can result in
significant changes, but that's for another video. These cardio risks were
done by Todd Eldridge's group, and Todd does about the best job I've seen in the
country on being able to filter out all of that noise and give us reliable
numbers. So I got focused on full-time work, travel every week, eating too much, I
gained 10 pounds and my arterial age went up. I've lost most of that, I'm back
to - have it back to about 155 again. We'll see over the next few months what the
impact is on my CIMT and my arterial age. If you've made it through this far,
thank you again for your interests.