Arterial Plaque Test, Inflammation and Cardiovascular Disease | Part 1


Today I want to give you some basic
large look overview. And what we’re talking about? David will tell you in a
few minutes or maybe he’s already told you. I don’t know about medical standards.
This is something that I learned from David. He’s he taught me about how it was
200 years before a lime became the use of lime for a prevention of scurvy. To
became a standard, it took a hundred years for metformin. I looked him up,
checked him out on it, and he’s right. And at this point, it still takes 20
years or so… 15, 20 years even in the age of internet. Why is that the case? I’ve
been involved in medical standards when I was at Hopkins and ran the prevention
program. I had my students, my student doctors that I was teaching, did the
science reviews for the US Preventive Services Task Force. Those guys sit
around the table and have to argue with each other over who should have
discovered something, who hasn’t, why they haven’t. It’s a human political
process and they also have to prove that these things are right. So it takes time.
Now there are three areas where the
standards have not quite caught up to the science and that’s what we’re going
to talk about today. One of them has to do with plaque. The next one has to do
with insulin resistance (the most common cause of plaque). And the third has to do
with inflammation (cardiovascular inflammation) and it’s proximal most
urgent cause of heart attack and stroke. Now it’s not gonna be missed. It’s not
gonna be in that order. I’m gonna start off with some discussion about
inflammation then we’ll give we’ll jump around a little bit. Please be patient
with me as we do. If you look at Time magazine way back in 2004, they had a
cover article on inflammation and its cause of heart attacks, cancer,
Alzheimer’s, and other critical diseases. If you look at medical magazines, they’re
still mentioning it. But as we just said, the medical standards have not caught up
yet. In fact, most cardiologists do know that there’s something about
cardiovascular inflammation in it causing heart attack. But this study that
came out two years ago still caught the the world’s cardiology leadership
flat-footed. The most common thing they said was, “You know, I knew that
cardiovascular inflammation had something to do with it, but I didn’t
know this.” And this what they’re talking to
is Paul Ridker, a very smart guy, cardiologist at Harvard who’s been
preaching this inflammation message for decades. Actually, was able to give a a
very strong anti-inflammatory medicine used for inflammatory diseases which we
won’t go into but he gave that to people all over the world and actually decrease
their heart attack and stroke activities the rate of heart attack and stroke.
So I’m not gonna go any deeper in that. I’ll just show a picture of Paul Ridker.
Again, maybe the godfather of cardiovascular inflammation in terms of
this space and the name of the trial was the CANTOS trial. You can see that in
Scientific American magazine as well as the New England Journal that I just
talked about. But again, let’s focus on what we’re here to learn today. First is,
“Do you have plaque?” Unfortunately, the standards of medicine
are not that great on helping you understand that, and that’s the most
important first thing to find out. That’s why we’re having the CIMT. I’m gonna
go quickly through these items and talk about the pros and the cons. Framingham
is basically where your cardiologist or your primary care doctor will start. It’s
not a measurement, it’s a guess, and it’s a bad guess. Then usually most people
will say, “Well, I got a stress test.” 5,000,000 stress tests are being done
each year. There are a huge number of false positives as in like 30% depending
on where you get them. And if false positive leads you to the cath lab,
they’re also an even worse a huge number of false negatives. Again, you’ll see
literature say up to 30% here. The bottom line is with a stress test, it’s not
gonna be… it’s not going to show you a positive unless you have over 50%
blockage of your artery. Well, guess what? 68% of heart attacks and strokes occur
in people that don’t have 50% blockage of their arteries. Again, that’s why we’re
here looking
CIMT and getting a CIMT. PC angiogram, in other words “percutaneous,” going
through the skin. And welcome to the cath lab, that’s not where we want to go if we
can avoid if we want to. Calcium score is a big improvement over these. It’s a
great first group. It’s a great think tool for screening. It’s not great for
following progress, and there is radiation involved. So it’s available.
It’s just not as good as CIMT. CT angiogram is expensive. It’s coming out
of the blocks now as a very good test. Again, it’s expensive and part of the
problem of the CT angiogram is you don’t know whether you’re… if you see plaque,
you don’t know whether it’s soft or stable.
Hence, the CIMT. Again, I’ve mentioned it a couple of times. I’m not going to cover
it any deeper today. Todd’s gonna cover that in his presentation. And again,
you’ve got David here to give you a little bit more detail. I just want to
give you the perspective from a physician in terms of the advantages and
disadvantages. I did an article a video recently on ABI (ankle brachial index).
It’s a great do-it-yourself one except for the following problem. A negative is
not going to tell you that much. And if you have a positive, most people already
know their results before they have this test. It’s an accurate test. It’s a
do-it-yourself. It’s very inexpensive, unfortunately. And it’s a great test. If
you haven’t done it for yourself, look it up on my video and do it. Unfortunately
again, it doesn’t you already know most of what you’re gonna find out from an ABI. I’m gonna skip over these questions because we have a lot that I’d
like to cover for you today and let’s go again a little bit more deeply into
cardiovascular information. First of all, this is where we’re going in deeper and
deeper in terms of scope or granular granularity in terms of what’s going on
and where we’re looking from the heart and
cardiovascular system to a single artery then getting into layers of the arteries
and then getting into glycocalyx. Now again, very minimal high level. Look the
heart and the arteries. We’re looking at the intima and media. The intima is the
lining. It says it’s a slick lining but it again it has that glycocalyx area. The
glycocalyx is sort of like the edge of a marshland that area where you have marsh
next to the river, that’s where the real metabolic activities occur both in our
body as well as in the marshland. And this is a picture under this is a
cross-section of the artery showing that hairy-looking glycocalyx.
Here’s a diagram of the glycocalyx, and here’s a healthy glycocalyx right
here. Now what happens with inflammation is this. Let’s say you are a smoker or
you have inflammatory disease like rheumatoid arthritis or most commonly
like over half of us as adults, you have insulin resistance. In other words, you
eat carbs and your body stays at a 180 or above for hour after hour in terms of
your blood glucose level. Look what happens. That tends to destroy that
glycocalyx. This is a healthy glycocalyx up here. And down here out here, these are
systemic effects occurring from inflammation. Once that happens, it
becomes much easier to understand how small dense LDL can make it through that
hairy glycocalyx and lodge into the cells of the intima and pass through
them and lodge into the artery wall. Once that happens, we get inflammation the
body’s immune system. It’s taking from you’re taking friendly fire the body’s
immune system recognizes this plaque and says, “This should not be here.”
It sends in immune cells: T-cells, monocytes, polymorph… and I’m not going to
name all the different types of cells. But we will talk about two of them a
little bit later because we can actually measure their activity. That’s part of
the inflammation test. All of that’s actually not bad because the immune
system is doing what it should do. It’s liquefying something that shouldn’t
be there so it can remove it. So this is the cross-section of an artery. This is
the media, the muscular layer. This is the intima, the lining with that
glycocalyx. And this is plaque that has gotten stuck between the intima and
media layers. But here’s the problem. Well one more thing, this little this is a
liquid area that’s why I sort of retracted away from the slide. Now this
hot liquid area that again all of that stood up until this point and here’s the
problem you go back to these cells these cells and what and some of the chemicals
that they release can cause a clot. If they touch blood (and that’s exactly what
happened here), this is another view of someone who died from a heart attack,
just like this one and this is a larger view. It’s a little bit different
preparation. This is the media of the artery wall out here. This is the intima
as you see. There are a couple of broken places. This black thing is not hot
plaque, it is the clot that the blood formed when that hot plaque touched the
blood. The larger part of this clot is what killed the patient. It floated on up
to the heart. And again this is not plaque. This is… pardon the image,
there are the mislabeling…. this is the clot that’s gone on up into the area
where that hot plaque was here. You see there’s another hot plaque pocket right
here. So that shows that this is a systemic issue. In other words, it’s
happening one place in the body. It’s happening all over in the body.
That’s why, we can look and tell whether you have hot plaque by looking at your
neck instead of your heart we’ve actually done studies so we haven’t done
them they’ve been done many many times.

17 thoughts on “Arterial Plaque Test, Inflammation and Cardiovascular Disease | Part 1

  1. Ivor Cummins recently interviewed Dr. Malcolm Kendrick and I believe he said that plaques start in the coronary arteries first and secondly go to the carotid arteries. However, you state that when plaques form that they are systemic throughout all the arteries, especially areas of turbulent flow. Am I misunderstanding? Also Dr. Kendrick believes that the main benefit from statin drugs comes from its ability to increase nitric oxide. Which statin is the most effective for increasing nitric oxide?

  2. Great video. Just had my CIMT test results from Cardio Risk. I'm in the same situation you were in a few years ago. Although I'm 57 and Cardio Risk says I have the arteries of a 60 year old, my plaque burden is 7.8 and Early Event Risk at 3.1. The real kicker is that I'm NOT IR. I've been monitoring my blood glucose and ketones with a Keto Mojo. Fasting glucose is about 100. When I eat it might get up to 120, then back in the 90's 2 hours after a meal. I'm 5'11", 155lbs, low carb diet, daily workout routine, and overall no other health issues. I feel great. I guess it's time for statins!

  3. FYI, Your video intro volume is much louder than other videos I listen too and it often hurts my ears when clicking on your video after listening to other lower volume videos. The video intro is louder than your following audio, so it would be nice to have the intro volume reduced to match the lower following audio.

  4. Can anyone help me with this question. I would really like to know if the glycocalyx regenerates itself after being damaged or degraded from inflammatory processes that can occur to arteries. Dr. Brewer (who I must say is quite excellent) refers to the glycocalyx in his video presentations and the damage being likened to grass being cut very short. So if there has been damage is it permanent ?

  5. Great info Doc! Other than initial screenings with CIMT, what would be some medical reasons to perform follow up testing? How would a patient who had an MI & stent implants & has been on Statins for 5 yrs benefit from having a CIMT? Will follow up CIMT testing show plaque reduction? Just curious……………… Thanks for your videos

  6. Hi Doctor Brewer, could you make a video on niacin inducing insuline resistance? I would love to use it for Lp(a) & HDL but i am scared of insulin resistance

  7. Looking forward to parts 2 and… what’s good here is short and to the point which makes it easily shareable with our friends and family who are doubters or just in the dark. When I discuss this with others I see the shutdown, glassy eyes, disbelief in their faces. This is shareable in various formats others can learn from without all the deep deep science. They wont get it from me, or strongly disagree, or whatever. But they will listen to the doc!!!! I’ll be sharing!!! Thanks Dr Brewer for another great presentation!

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