Heart Health Hypertension

Approaching Hypertension

Western medicine refers to elevated blood as essential hypertension, which is a somewhat confusing term, but it means that a patient has a high blood pressure of unknown cause.

Approaching hypertension appropriately requires uncovering why a person has high blood pressure before assuming it’s due to an unknown cause. Here is our approach.

Essential Hypertension

The most common form of hypertension is idiopathic hypertension which Western Medicine calls essential hypertension.

This distinguishes it from secondary hypertension, which has various other causes:

  • kidney disease
  • hormone imbalances
  • pregnancy-induced

However, many clinicians will argue that most of this essential hypertension, in fact, has other known causes which aren’t addressed.

Approaching Hypertension

Our Heart Health Coaching addresses hypertension by reviewing its major risk factors. Both in terms of what can cause it and the major risks of living with elevated blood pressure.

Our goal is in the neighborhood of 120/80, depending on various risk factors and family history.

1. Obesity

Liposuction won’t solve obesity-induced hypertension. The lifestyle changes leading to weight loss seem to be the curative factors for bringing blood pressure back to normal.

2. Elevated Uric Acid

Diets high in fructose and meat tend to elevate uric acid. Even if there are no problems with gout, a lower uric acid is desirable.

Alcohol, especially regular alcohol use, tends to elevate uric acid levels as well.

Some experts recommend keeping this value under 6 mg/dl; others want it as low as 4.

3. Elevated Blood Sugars

It’s hard to know whether elevated blood sugars or elevated insulin levels are the main cause of elevated blood pressure. Either way, we recommend our clients have optimal levels before considering that the blood pressure problem is idiopathic.

4. Sleep Apnea

Sleep apnea goes undiagnosed quite frequently. Good home tests are available these days, but the treatment – sleep apnea device – often has a low compliance rate.

Sleep apnea can cause elevated blood pressure, fatigue, headaches, and difficulty focusing.

5. Fatty Liver

Visceral fat, in general, especially fat around the liver, seems to cause a disruption in the normal hormone cycles of the body.

Non-alcoholic fatty liver disease (NAFLD) is bidirectionally associated with other metabolic disorders. Therefore, we screen for NAFLD in our decision algorithm.

Measuring Improvements

In most, doing even some work towards improving the factors above is likely to yield good blood pressure improvements.

The obvious method is regularly checking blood pressure numbers, focusing on a daily average called ambulatory blood pressure.

A secondary method is to monitor kidney function levels, called glomerular filtration rate (GFR), which creatinine or cystatin C measures.

Heart Attacks Heart Health Hyperlipidemia Statins

apoB and Cardiovascular Disease

Most clients in our Heart Health practice show up with their lipid profile in hand, most concerned about their LDL and HDL numbers. In this article, we’ll share our viewpoint on apoB and cardiovascular disease risk.

Old, Discarded Viewpoints

Lipidologists and preventative cardiologists no longer rely on LDL-C as a way to risk stratify someone for heart disease.

In most laboratories, LDL-C is often calculated and rarely measured directly, making LDL-C an even less reliable marker for cardiovascular disease risk.

Once believed to be protective, HDL-C is no longer believed to serve much value when assessing a lipid profile.

Modern Lipid Profile Analysis

If you have one of your old lipid profiles lying around, you can calculate your non-HDL cholesterol, which, 97% of the time, corresponds to apoB levels.

(Total cholesterol) – (HDL cholesterol) = non-HDL cholesterol

You can also use an online calculator.

Triglyceride Levels

these days, we mostly use triglyceride levels to determine if somebody’s dietary intake of simple carbohydrates is excessive.

The higher triglycerides are, or the more insulin resistance somebody is, the more likely they will have excess cholesterol needing transportation by apoB lipoproteins.

apoB Targets

apoB can be cheaply measured ($20 – $60) in most laboratories. Insurance often covers it, but that’s hardly necessary for lab testing.

The way we determine apoB targets is to determine a person’s overall cardiovascular disease risk.

1. Very High Risk

Those at very high risk should have apoB levels below 60 mg/dl.

If apoB isn’t available, their non-HDL-C should be < 90 mg/dl.

From the old LDL-C understanding, the goal would be an LDL-C below 70 mg/dl.

2. High Risk

Those at high risk should have the following numbers with a little more wiggle room compared to someone who is at very high risk:

  • apoB < 75 mg/dl
  • non-HDL-C < 120 mg/dl
  • LDL-C < 100 mg/dl

ApoB and Cardiovascular Disease

The biggest drivers of Atherosclerotic Cardiovascular disease (ASCVD), sometimes also referred to as cardiovascular disease (CVD) are the following:

  • tobacco use
  • hypertension
  • elevated apoB
  • elevated Lp(a)
  • elevated fasting insulin levels

How to Lower apoB

It’s hard to know who responds to what treatment. Some may not be able to tolerate statins even though their apoB drops drastically.

Others may see a massive drop in apoB by changing their diet, especially if they are hyperabsorbers of cholesterol.

Just as we have hyperabsorbers, those whose intestines squeeze every last bit of cholesterol from the food, we have hyperproducers.

The hyperproducers produce a lot of cholesterol from the liver, which finds its way into the circulation, causing elevation of apoB.

These changes partly explain why some will respond well to statins and even better when we add ezetimibe.

Repeat Testing of apoB Lipoproteins

In general, we advise our clients to check their apoB levels annually. As soon as it starts to get out of range, we discuss various interventions.

build a chance of a sudden rise in this lipoprotein level is low, regular monitoring will allow for immediate intervention.

apoB Lowering Through Exercise

When it comes to lowering certain risk factors, blood pressure is quite amenable to lifestyle changes.

It does not seem to be the same case with apoB levels. For those with a high elevation of this molecule, it is always advisable to start with lifestyle modifications first.

And certainly, there are certain dietary changes, such as a very low-fat diet, that can greatly improve someone’s apoB levels. Unfortunately, this is rarely reachable.

Heart Health Hyperlipidemia Statins Treatment

Reversing Atherosclerosis

Is it possible to reverse atherosclerosis in the coronary arteries or anywhere else in the body? This topic, often called plaque regression, deserves an overview for anyone considering any Heart Health intervention.

Atherosclerosis – The Approach

It’s fair to say that if you are past your teenage years, you will have some atherosclerosis. This is the plaque buildup inside the arteries of the body which causes health problems mostly when it affects the blood supply to the heart, brain, and limbs.

1. Main Approach – Prevention

The main approach to atherosclerosis is preventing it.

With our Heart Health Coaching, the goal is to live a lifestyle that:

  • decreases blood pressure
  • lowers circulating apoB levels
  • decreases inflammation
  • improves mitochondrial health

For many, lifestyle changes are adequate, and we can track serum biomarkers such as lipid levels, inflammatory markers, and serum insulin levels to track success.

For others, chemical interventions may be necessary, even for the prevention stage, such as statins, ezetimibe, or the PCSK9 inhibitor class of medications.

2. Secondary Approach – Treatment

Some clients will already have an atherosclerosis diagnosis. Perhaps a physician noted it on a knee X-ray, or the patient is experiencing symptoms of angina.

The secondary approach is to help prevent major cardiovascular events (heart attack, strokes, peripheral vascular disease) due to the buildup of this plaque.

Must we reverse atherosclerosis for this secondary approach to be successful?

Plaque Regression

Western Medicine states that not all plaque is equal. We have stable plaque and potentially unstable plaque. Though this is a rough categorization, it’s a helpful mental model to follow.

The goal is to minimize unstable plaque but encourage remodeling of existing unstable plaque and perhaps to encourage plaque regression.

In plaque regression, the amount of plaque actually decreases. Tiny intravascular ultrasound (IVUS) or a CT angiogram (CCTA) can confirm this.

Available studies show that high-intensity statin therapy decreases overall plaque volume by 10%, but that may not fully explain the decreased risk of cardiovascular events. So, perhaps stabilization is just as important.

Stabilization vs. Regression

This summary article determines which is better, stabilization vs. regression of plaque. Of course, in real life, we don’t have to choose one or the other – that’s the headache best left for the researchers.

1. Stabilizing Plaque

MIRACL, PACT, CURE, HOPE, and Lyon support the idea that plaque stabilization is effective.

We know from various studies that a lower-fat diet, increased activity, and managing stress/sleep can stabilize plaque, shifting more toward the preferred calcified plaque.

It’s important to mention that statins tend to change plaque composition toward:

  • fibrous volume
  • calcified plaque
  • reduction in fibrofatty volume
  • decreased a necrotic core

2. Reversing Plaque

ASTEROID, REVERSAL, and SATURN studies, on the other hand, focused on plaque reversal as a way to decrease the risk of cardiovascular disease.

We haven’t come across any convincing studies to demonstrate that plaque regression is necessary to help prevent major cardiovascular events.

However, if plaque regression is the goal, high-dose statin treatment should be the treatment of choice.

This answers the common questions our clients ask us about whether to repeat CT angiograms or CACs.

Heart Health Prevention

Autoimmune Disease and Heart Health

Many individuals live with autoimmune conditions where the body’s immune system engages in an inflammatory response. Autoimmune disease and heart health are related due to this underlying inflammation and the medications prescribed for such conditions.

In this article, we’ll discuss how we address cardiovascular health in our clients who experience autoimmune conditions.

Autoimmune Diseases in Western Medicine

Thanks to advances in lab testing and the development of biologics, many autoimmune conditions that previously were tragic can be managed quite well.

Lupus, Rheumatoid Arthritis (RA), Crohn’s, and Ulcerative Colitis are some medical conditions. Among the most common are Hashimoto’s Thyroiditis and RA, and Type 1 Diabetes Mellitus (T1DM).

Due to the nature of our healthcare system, it’s common to have multiple specialists involved who cannot properly communicate with each other.

The Gastroenterologist is working with the individual on the proper infusion regimen, and the Primary Care doctor is helping coordinate care.

Autoimmune Diseases Affecting Heart Health

This study offers a thorough overview of the increased risk of heart disease in certain autoimmune diseases. The increased risk is listed as a hazard ratio, a statistical lingo where 1 would indicate no increased risk, 2 would indicate double the risk, and 0.5 would be half the risk, and so on.

Inflammation may be at the heart of this relationship, and the goal at Heart Health is to measure and help decrease any potential inflammation in the body.

Since inflammation accelerates atherosclerosis, it’s an important lever to lean on. Always gentle, always wholistically, and always with the individual in mind.

Autoimmune diseases are taxing enough on the person, add to it the fear of heart disease, and only add to inflammation. That is not the point of this article.

Though the risk of heart disease is higher in autoimmune conditions, it’s certainly not a guarantee that any negative consequence will occur.

Improving Cardiovascular Health

Current goal lipid levels are debated constantly by different groups, from the ADA to AHA to CDC. What should your ideal lipid panel look like?

Education and empowerment have been our mantra at Heart Health Coaching since the beginning. We are good at compiling relevant information and empowering our clients to make their own best health decisions.

An individual with Rheumatoid Arthritis who rarely has any flares and is well-managed with a single agent may do well with a low ApoB. In contrast, someone with a more aggressive disease and other autoimmune diseases would benefit from a stricter Heart Health regimen.

We recommend clients measure their inflammatory markers, have lower fasting insulin levels, decrease their visceral fat, adopt a slightly higher-protein diet, and decrease their excess oil/fat intake.

Factors the Client Can Modify

The following factors, directly and indirectly, affect inflammation in the body. Not only does the cardiovascular risk decrease by modifying these factors but so does the autoimmune condition itself.

Adopted from the wonderful book of Integrative Rheumatology.

  • Mind
    • Breathing techniques
    • Reduce reactivity
    • Prayer
    • Creative outlets
    • Laughter and lightheartedness
  • Body
    • High fiber diet
    • High-quality proteins
    • Low-glycemic carbohydrates
    • Healthy fats
    • Supplements
  • Activity
    • Zone 2 training
    • Zone 5 training
    • Resistance training
    • Stretching
    • Meditation
    • Nature exposure
  • Spirit
    • Employment
    • Relationships
    • Purpose, hope, and meaning
  • Treatments
    • Physical manipulations
      • Massage
      • Acupuncture
      • Herbals
      • Topicals
      • Prescription medications
    • Psychotherapy
    • Guided Imagery
    • Eye Movement Desensitization and Reprocessing
Heart Attacks Heart Health

Understanding Atherosclerosis

Atherosclerosis, or plaque, is the process in which the arteries in the body become narrowed. Unstable plaque can sometimes rupture and lead to blood clots which cause a heart attack.

In nerd speak, atherosclerosis is referred to as atherosclerotic cardiovascular disease (ASCVD).

Understanding Plaque and Angina Symptoms

It’s normal for patients to have some plaque buildup in their coronary arteries as they age. Stable plaque rarely causes any medical problems.

The coronary arteries are under a lot of pressure, and their anatomy and blood supply make them a perfect target for plaque buildup.

Combine that with a person’s lack of exercise and stiffness of the arteries, and you can get a condition called angina, an overtreated diagnosis that we’ll discuss in future articles.


Angina is the medical term for heart-related pain. It’s when the heart doesn’t get enough oxygen temporarily when it has extra demand.

When the person stops exercising, or their anxiety level comes down, the heart’s oxygen demand goes down, and enough blood passes through the narrowed coronary arteries, stopping the chest pain.

A Heart Attack from Lack of Oxygen

A heart attack differs from angina in that the heart gets no oxygen whatsoever due to unstable plaque. It also remains starved of oxygen long enough that damage occurs.

If stable plaque is lining a coronary artery and it becomes unstable, it could break off. In its place is left a raw area on which clotting occurs.

This blood clot can grow and completely block off the artery. Without anything to break up the clot or manually open up the artery, that part of the heart muscle will die off.

That’s a heart attack.

Understanding Atherosclerosis & Cholesterol

Cholesterol is what we commonly measure in the blood. The total cholesterol value, for example, tells me how much total cholesterol is floating around in my bloodstream.

LDL cholesterol (LDL-C) tells me how much cholesterol my LDL particle carries.

Triglycerides (Tg) are a different lipoprotein altogether, not cholesterol; though they carry quite a bit of cholesterol. Tg isn’t as important when it comes to understanding atherosclerosis.

Other tests, such as HDL cholesterol and VLDL cholesterol, tell us how much cholesterol those particular proteins carry.

High cholesterol leads to atherosclerosis

The above statement is not fully accurate. Higher apolipoprotein B (apoB) directly increased atherosclerosis.

The cholesterol measurements are just surrogates for this ApoB molecule. For whatever reason, we aren’t accustomed to measuring this in the blood.

The Goal of Treating Atherosclerosis

To understand atherosclerosis, it’s important to realize that apoB is the main molecule that must be managed.

We aren’t trying to lower LDL-C or Triglyceride or raise HDL; none of that! It’s important to understand how those relate to the apoB molecules, but they don’t correlate in some individuals.

Some patients have high cholesterol, and they have no atherosclerosis. Others have low cholesterol and a lot of atherosclerosis.

This isn’t confusing. Remember that the vehicle is the lipoprotein – the apoB – while the passengers are the cholesterol molecules.

When we measure the LDL-C, then we are only told how many passengers exist on the bus. But the bus is what actually causes atherosclerosis.

Measuring Atherosclerosis

We can look for symptoms like angina or signs of limb ischemia which can tell us there is atherosclerosis.

X-rays of the body will sometimes show calcified vessels. This is the calcium deposit inside atherosclerotic arteries.

Coronary CT Angiogram

CT angiograms aren’t the most accurate studies for visualizing coronary arteries. But they have a place in certain populations.

Angiograms visualize the coronary arteries by injecting dye into the coronary artery directly.

Some studies show that a CTA can show high-risk plaque and help us identify those at the highest risk of plaque rupture.

Coronary Calcium Load

Another common test is the coronary artery calcium measurement; often referred to as the CAC score. This also utilizes a CT scan to calculate the amount of calcified plaque in the coronary arteries.

When understanding atherosclerosis, it’s important to point out that in most coronary vessels, calcified plaque makes up about 20% – or the tip of the iceberg – while fibrotic plaque and lipid-rich plaque make up the other 80%.

The most accurate measurement is intravascular ultrasound, but that’s not yet a viable option.

Developing Atherosclerotic Plaques

How do these “atheromatous plaques” develop?

There are many theories, but we know that something inflames the inner endothelial lining of the arteries, making it susceptible to fatty deposits.

The floating LDL particles (different from LDL-Cholesterol) can enter the endothelium. The cholesterol particle might then release and oxidize there, which starts the inflammatory cascade.

HDL particles can extract some of this cholesterol and return it back to the liver. But that process wouldn’t be enough on its own. Which is why raising HDL doesn’t help.

Heart Health

What’s Your ABI? Peripheral Vascular Disease

Knowing your Ankle-Brachial Index (ABI) can not only help you determine your risk of cardiovascular disease but helps you prevent major complications of peripheral vascular disease. What’s your ABI?

Measuring Your ABI

The easiest way to measure your ABI is with a manual blood pressure cuff and a handheld Doppler.

Not all clinics can do this, but any vascular office can do this for you. Many of our patients will perform this themselves if they are at risk for peripheral vascular disease.

Peripheral Vascular Disease

Cardiovascular disease often manifests with atherosclerosis which can lead to calcification and/or hardening of the arteries.

This stiffening of the vessels will often cause the ABI (ankle blood pressure divided by arm blood pressure) to be low and, in some instances, too high.

Stiffening of the arteries in the lower extremities, which is the hallmark of Peripheral Vascular Disease (PVD) can present with weakness in the legs, cramps, or pain.

ABI normal ranges for ankle-brachial index

The ideal ABI is in the 1.0 – 1.4 range. Any value of 1.4 could indicate stiffness of the arteries. If the value is below 0.8, it would indicate blockage of the arteries in the lower extremities.

ABI Testing at Home

The best way to test your ABI at home would be to purchase a manual blood pressure cuff and obtain a handheld Doppler, which measures fetal heart rate.

Both of these are quite inexpensive and you can purchase them online or at most medical supply stores.

Inflate the cuff to make the arterial sound disappear, and release pressure until the sound reappears. This is the systolic reading for both the arm and the leg.

Great ABI Video from Standford

The following video shows how to measure your ABI in the ambulatory (outpatient) setting to determine someone’s risk for PVD.

Blood Sugar Diet Heart Health

Stubborn Fasting Blood Sugars

You’ve lost weight, improved your activity level, changed your diet, and that stubborn fasting blood sugar won’t get below 110.

In this article, I’ll share how we approach such outcome discrepancies in our Heart Health Coaching practice. The most important caveat is that any improvement is a massive step in the right direction and that perfection is the enemy of progress.

In other words, a FBS of 110, if brought down even to 108 is a major step in the right direction.

Elevated Fasting Blood Sugar Troubleshooting

In this case presentation, we assume that you are actively involved in improving your blood sugars whether you are a non-diabetic, prediabetic, or type 1 or 2 diabetic.

For some reason, your actions have made a huge improvement in your A1C percentage and your postprandial sugars but the morning fasting sugars remain high.

1. Data Error

The CGM (continuous glucose monitor) our client is wearing might show elevated morning sugars, but is it accurate?

Confirming any values with a handheld glucometer and serum fasting blood sugars is best. As a bonus, we also recommend our clients check their fasting insulins.

2. Body Composition Issue

Some of our clients are underweight, and others are overweight. Is there excess visceral fat in the body?

Fat inside the muscle cells will decrease the cell’s ability to respond to insulin which would help clear excess serum glucose.

A DEXA scan will tell us if the client has too little muscle mass or too much visceral fat.

3. Stress & Sleep

If there is undiagnosed sleep apnea or elevated stress levels, the fasting blood sugar will be hard to control.

Managing sleep and stress is just as important, if not more, than diet or exercise levels.

4. Dietary Extremes

A few clients, especially those in their 70s, seem chronically undernourished. A low dietary protein content combined with androgen deficiency leads to rapid loss of muscle mass, which is necessary for proper fasting blood sugar regulation.

5. Exercise Balance

Are you doing too much cardio and not enough resistance training?

We see too much cardio and not enough resistance training. It’s only been in the last decade that science has pointed toward the importance of weight lifting.

6. Excess Fasting

What does time-restricted eating do to your blood sugar long-term, not just short-term?

Some will do great with fasting, but many will experience glucose desensitizing during the fasting state and experience massive spikes upon waking, resulting in stubborn fasting blood sugars.

Improvement May be Enough

We remind clients that improving blood sugar profiles may be more than enough. Rarely do we recommend long-term use of blood sugar measurement via handheld glucometers or CGMs.

Even with some elevated values, health improvement is exponential as long as the changes are happening in the right direction.

Instead of obsessing over the last 10 mg/dl we encourage our patients to figure out their Heart Health Risk Score and aim to minimize other health risk factors.

Heart Health Metabolic

Ideal Body Composition by DEXA

A DEXA scan is traditionally used to measure bone mineral density (BMD) and body composition to delineate body fat content and muscle content.

In further detail, we look at how much of that fat is around vital organs and how much of it is centrally located, and a few other factors.

The critical takeaway of this article is that a DEXA report for body composition tells us if your skinny frame is healthy or harboring ominous fat around organs. And, vice versa, if your larger frame has most of its fat subcutaneously and not anywhere near visceral organs, which would be more protective.

Ideal Body Composition by DEXA Scans

The following report is that of a 29 yo female at 5’5″, 127 lbs.

Reports will vary from person to person and from different companies, but they will have all the data to make the necessary conclusions.

Another sample report can be found here. BodySpec, a favorite DEXA company of our clients at Heart Health Coach, provides this report.

1. Bone Mineral Density (BMD)

Your BMD is reported using a T-score and Z-score, depending on age, and compares you to others in your average age group.

If a compression fracture happens because of low bone density, it will happen in areas such as the hip or lumbar spine.

2. VAT

DEXA for body fat will report the total body fat that encapsulates the fat around the viscera and the fat found under the skin.

We pay close attention to visceral fat since this is the leading inflammatory cause of many metabolic diseases we encounter in practice. It’s this factor that we try to manipulate in our Heart Health practice.

If you are age 50, the ideal total body fat would be around 30%. If you are 25, 27% would be more ideal.

With the main goal of having a total body fat in the 50% percentile and below.

The VAT in grams should be 200 grams for the 50-year-old patient and around 0 for the 25-year-old.

3. Appendicular Lean Mass Index (ALMI)

Lean mass goes down with age, and preserving this is quite protective.

We use ALMI to accurately estimate the amount of lean muscle mass in your body. Each body part – arms, legs – has its own lean mass index.

4. Fat-free Mass Index (FFMI)

FFMI can be used the same as the ALMI, but when there is a discrepancy, we rely on the ALMI. That’s mostly because the FFMI includes the organs and bone and is factored into your height.

The goal would be to stay north of the 97th percentile, but not everyone can achieve this. Your genes may never allow you to reach a 97th percentile of muscle mass, so we approach your health individually.

Addressing Results from a DEXA Body Report

There is a lot of data, and it can feel overwhelming. The main questions to ask are:

  1. Am I overweight?
  2. Do I have excess fat around my viscera?
  3. Do I have enough muscle mass?
  4. Is my bone mineral density adequate?

The actionable items are:

  1. More resistance training
  2. More cardiovascular training
  3. Increasing protein consumption
  4. Decreasing insulin resistance

We can manipulate these last 4 levels at Heart Health Coaching, always with the person in mind, aiming to manipulate factors that will result in the biggest gains.

There isn’t a perfect but perhaps ideal body composition by DEXA which should be a second goal. The primary goal is to feel better and lower the Heart Health Risk Score.

Heart Health Prevention

The Heart Health Risk Score

I don’t know of any other health coach who creates a Heart Health risk score for their clients. I came up with this because most of us understand risk and know how to work with percentages.

Perhaps the most important point is that prevention is the most powerful tool against cardiovascular disease.

The objective is to push a heart attack, heart failure, peripheral vascular disease, valvular disease, or a stroke as far into the future as possible.

Heart Health Risk Score Criteria

In a previous article, I discussed the overview of risk stratification. In this article, I want to dive deeper into the anatomy of this score.

I have broken the risk score up into the following categories. It’s a constantly evolving tool that must be revisited often.

1. Age

You might think age isn’t much of a lever, but I disagree. If you are reading this article and taking action now, you have decided to prevent heart disease earlier than your future self.

In fact, age is the number one risk factor for cardiovascular disease. The older we get, the higher the risk.

2. Family History

A parent who suffered a heart attack at 49 is a powerful risk contributor to the heart risk score. While an uncle who suffered heart disease at 79 may not tell us much about this risk.

Your mother’s health and the environment in which she carried the pregnancy portend future risk.

3. Comorbidities

Comorbidities include conditions and diseases which accelerate atherosclerosis or elevate the coagulation response in case of an unstable plaque.

Sleep apnea, hypertension, diabetes mellitus, obesity, elevated lipid profile, systemic inflammation, and certain lifestyle factors.

Getting more granular, hypogonadism, and severe menopausal symptoms negatively impact the Heart Health Risk Score.

4. Exercise Capacity

While some variables increase the risk of heart disease, others are protective and lower the overall cardiovascular risk score.

A healthy VO2 Max and a higher than average HRV are indicators and may be protective. In fact, exercise improves these metrics and is independently protective against cardiovascular disease.

5. Mental Health

Living in an area with high pollution, loud noise, or being under constant stress negatively impacts heart health. More so in those who don’t have compensatory coping mechanisms.

Ongoing financial stress, poor sleep, childhood adversities, and relationship stress also elevate the risk score.

6. Imaging Studies

Another category worth considering is imaging studies such as the Coronary Artery Calcium score (CAC) and a CT Angiogram (CTA).

These are often done preemptively but when they are part of a comprehensive heart risk assessment plan, they can be quite powerful.

Heart Health

Mental Health and Heart Health

With enough medications and interventions, achieving perfect blood pressure, blood sugar, cardiac output, and vascular health is possible. But that’s not a sustainable way of managing Heart Health. For many, their mental health has to be addressed.

Mental health includes stress, anxiety, depression, and sleep. These things are related to our careers, relationships, and childhood events.

With a healthy psychological state, the autonomic nervous system is more balanced. Even the AHA has directed its marketing on the topic of emotional health.

Resistant Hypertension

My blood pressure is quite sensitive to my stress levels. This is likely related to my adrenalin levels in the sympathetic nervous system (SNS). We use epinephrine or forms of norepinephrine as a way to bring up the blood pressure of patients in the ICU.

With longer-lasting stress or constant low-level stress with which I can’t cope well, my hypothalamic-pituitary-adrenal (HPA) system is activated. The hormone cortisol causes changes in certain cell channels, which increase blood pressure.

Despite several medications, a patient’s blood pressure can remain elevated if their stress level doesn’t normalize.

Heart Health and Mental Health

Those who deal with a lot of depression and anxiety or face other major societal pressure tend to have much worse cardiovascular outcomes than less-stressed peers.

We can’t change job security, income security, or our upbringing. But how a person can cope with some of these mental health factors can help improve Heart Health outcomes.

Meditation, psychological intervention, breathing techniques, certain body movements, and dietary changes can help improve mental health.

My goal as a Heart Health Coach is to help identify the factors which require more immediate attention. Sometimes, it’s our psychiatric state which needs to be addressed first.