Heart attack and stroke are the leading cause of death. South Asians suffer most of the heart attacks in the world, often younger than 40 years old. While bad cholesterol is high before the heart attack only 16% of the time, the carotid IMT warns over 95%. Most patients can reverse the disease, by guiding treatment with the IMT.
A higher lifetime tendency towards heart attack and stroke can often be measured on the IMT, in South Asians, by age 30, and in non-South Asians, by age 45, often much earlier. At the latest, I recommend that South Asians have an IMT at 30 years old, and all others at 45. If you have an abnormal IMT, I recommend checking annually, to determine whether your disease is worsening, over time.
The carotid IMT is simply a 10-min ultrasound of the artery in the neck, that measures the thickness of cholesterol and inflammation in the wall of the artery, that correlates strongly with later heart attack or stroke. A continued thickening over time indicates a higher risk of heart attack and stroke.
CIMT is used to diagnose and determine the extent of plaque buildup in the walls of the vessels supplying oxygenated blood to the head. Increased thickness in the intimal and media is associated with an increasingly diseased artery. Because there is a link between intimal medial thickness and cardiovascular events, CIMT is an important test for detecting disease in its earliest stage, when interventions such as diet, lifestyle, and medications can have the greatest impact.
I recommend that South Asians have an IMT at 30 years old, and all others at 45. If you have an abnormal IMT, I recommend checking annually, to determine whether your disease is worsening, over time.
Dr Sims is great and i'd definitely visit again! Checked into Doctor Sims's office very recently and was thoroughly impressed by my experience overall. After unsuccessfully trying to get an appointment with a number of doctors around the Sunnyvale area, I was very thrilled that Doctor Sims's office was still taking same day patients and was also accepting new patients as well.
I have been with Dr. Sims for many years.. I will highly recommend him.. He takes his time to make sure you get all the information you require and I never feel rushed. I deal with Doctors every day all day long due to my occupation. He is excellent at what he does.
Dr. Sims has been my primary care physician for at least 5 years and I could not be happier.
I recognize that many physicians are smart but Dr. Sims has almost encyclopedic knowledge on a wide variety of topics. He's well-read on the latest academic research and has incorporated many modern techniques in his practice. Unlike other physicians, Dr. Sims isn't over-reliant on prescribing medicine. He considers diet, vitamins and even lifestyle.
Dr. Sims is an amazing doctor. He is kind, intelligent, and seems to genuinely care about his patients well being. Unlike some Dr's who are more concerned with seeing as many billable patients per day as possible, Dr. Sims takes a real interest in not only treating his patients current issues but also in working to find ways to better address those concerns in the long run, putting the patient before the paycheck.
My quality of life has improved significantly since I became Dr. Sims' patient. He is the best primary care physician I have ever had.
For those of you concerned about Dr. Sims' prioritization of vitamin supplements as a key component to overall wellbeing, I encourage you to educate yourself with peer-reviewed studies on the matter. I would also like to add that being able to purchase supplements that I can trust are high quality and efficacious is a luxury, especially after the Dietary Supplement Health and Education Act of 1994.
I recommend Dr. Sims wholeheartedly.
Atherosclerosis is a disease in which plaque builds up inside your arteries. Arteries are blood vessels that carry oxygen-rich blood to your heart and other parts of your body.Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.Atherosclerosis can lead to serious problems, including heart attack, stroke, or even death.
Atherosclerosis can affect any artery in the body, including arteries in the heart, brain, arms, legs, pelvis, and kidneys. As a result, different diseases may develop based on which arteries are affected.
Ischemic heart disease happens when the arteries of the heart cannot deliver enough oxygen-rich blood to the tissues of the heart when it is needed during periods of stress or physical effort.Coronary heart disease, also called coronary artery disease, is a type of ischemic heart disease caused by the buildup of plaque in the coronary arteries that supply oxygen-rich blood to your heart.This buildup can partially or totally block blood flow in the large arteries of the heart. If blood flow to your heart muscle is reduced or blocked, you may have angina (chest pain or discomfort) or a heart attack.Coronary micro vascular disease is another type of ischemic heart disease. It occurs when the heart’s tiny arteries do not function normally.
Carotid (ka-ROT-id) artery disease occurs if plaque builds up in the arteries on each side of your neck (the carotid arteries). These arteries supply oxygen-rich blood to your brain. If blood flow to your brain is reduced or blocked, you may have a stroke.
Peripheral artery disease (P.A.D.) occurs if plaque builds up in the major arteries that supply oxygen-rich blood to your legs, arms, and pelvis.If blood flow to these parts of your body is reduced or blocked, you may have numbness, pain, and, sometimes, dangerous infections.
Chronic kidney disease can occur if plaque builds up in the renal arteries. These arteries supply oxygen-rich blood to your kidneys.Over time, chronic kidney disease causes a slow loss of kidney function. The main function of the kidneys is to remove waste and extra water from the body.
Improved treatments have reduced the number of deaths from atherosclerosis-related diseases. These treatments also have improved the quality of life for people who have these diseases. However, atherosclerosis remains a common health problem.You may be able to prevent or delay atherosclerosis and the diseases it can cause. Making lifestyle changes and getting ongoing care can help you avoid the problems of atherosclerosis and live a long, healthy life.
Peripheral artery disease is a narrowing of the peripheral arteries serving the legs, stomach, arms and head. (“Peripheral” in this case means away from the heart, in the outer regions of the body.) PAD most commonly affects arteries in the legs.
Both PAD and coronary artery disease (CAD) are caused by atherosclerosis. Atherosclerosis narrows and blocks arteries in critical regions of the body.
The most common symptoms of PAD involving the lower extremities are cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs. Typically, this pain goes away with rest and returns when you walk again.
Be aware that:
Other factors can increase your chances for peripheral artery disease, including:
If you’re at risk for peripheral artery disease or have been diagnosed with PAD, it’s worth knowing that:
If you have atherosclerosis, that means that plaque has built up inside your artery walls. Plaque is made up of deposits of fats, cholesterol and other substances. Atherosclerosis in the peripheral arteries is the most common cause of PAD.
To see how plaque limits blood flow, view our interactive PAD library.
What happens is this: First, plaque builds up enough to narrow an artery, which chokes off blood flow. Next, if that plaque becomes brittle or inflamed, it may rupture, triggering a blood clot to form. A clot can further narrow the artery, or completely block it.
If that blockage remains in the peripheral arteries of the legs, it can cause pain, changes in skin color, difficulty walking and sores or ulcers. Total loss of circulation to the legs and feet can cause gangrene and the loss of a limb.
If the blockage occurs in a carotid artery, it can cause a stroke.
It’s important to learn the facts about PAD. As with any disease, the more you understand, the more you’ll be able to help your doctor make an early diagnosis. PAD has common symptoms, but many people with PAD never have any symptoms at all.
Learn the facts, talk to your doctor and take control of your cardiovascular health.
You have probably heard of plaque on your teeth, but your body also has another type of plaque. This is plaque that builds up in arteries - the blood vessels that carry oxygen and nutrient-rich blood from your heart to your body’s tissues.
Plaque in the arteries is a fatty, waxy substance that forms deposits in the artery wall. These deposits can narrow the artery and reduce blood flow. This is called atherosclerosis or “hardening of the arteries.” Plaques can also rupture and create a blood clot at the rupture site, as your body’s natural processes try to repair the “injury.” The blood clot can cut off blood flow through the artery and starve your body’s tissues of oxygen and nutrients. Therefore, a ruptured plaque can be serious: It is the most common cause of a heart attack or stroke.
Arterial plaque is made up of materials that enter the artery wall from the bloodstream. These include fat, cholesterol, calcium, waste products from cells and a clotting agent called fibrin. This is why your physician tests your cholesterol levels. High levels of “bad cholesterol” (low-density lipoprotein, or LDL cholesterol) can indicate a higher risk of plaque build-up.
Plaque build-up in arteries is, unfortunately, a natural part of living. Even children and adolescents have early evidence of the process.
However, diet and other lifestyle factors play an important role. High blood pressure, high LDL cholesterol and smoking can all worsen atherosclerosis. High blood pressure and the toxins in tobacco products damage the smooth inner lining of the artery, called the endothelium. These and other causes of inflammation of the artery lining contribute to cholesterol and other materials embedding in the artery wall to form plaques.
Additionally, some people are predisposed to having atherosclerosis. A genetic condition called familial hypercholesterolemia causes some people to have abnormally very high LDL cholesterol levels in the bloodstream.
Plaque builds up in arteries throughout the body, but not all plaques are equally dangerous. You might hear the term vulnerable plaque. This refers to a soft plaque that has a thin, fibrous cap. This plaque is more likely to rupture, causing a blood clot to form at the rupture site, cutting off or restricting blood flow, and potentially causing a heart attack or stroke
Plaque formation in arteries can be slowed. It may also be possible to reverse some of the damage, but mostly, it’s a process of controlling further damage. Unlike going to the dentist and having plaque removed from your teeth, this is not so easily done in the blood vessels. But improvements can be made. Work with your physician to identify if you are at risk of, or already have, heart disease from atherosclerosis. This may require a physical exam with personal and family medical histories, lab tests and other diagnostic tests. You may be recommended to take medications to control high blood pressure and to lower cholesterol levels. Eating a heart-healthy diet, quitting smoking and getting regular exercise will also help your arteries be their healthiest.
Stroke is a disease that affects the arteries leading to and within the brain. It is the No. 5 cause of death and a leading cause of disability in the United States.
A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it and brain cells die.
Stroke can be caused either by a clot obstructing the flow of blood to the brain (called an ischemic stroke) or by a blood vessel rupturing and preventing blood flow to the brain (called a hemorrhagic stroke). A TIA (transient ischemic attack), or "mini stroke", is caused by a temporary clot.
Types of Stroke:
Occurs when a blood vessel supplying blood to the brain is obstructed. It accounts for 87 percent of all strokes.
Occurs when a weakened blood vessel ruptures. The two types of weakened blood vessels that usually cause hemorrhagic stroke are aneurysms and arteriovenous malformations (AVMs). The most common cause of hemorrhagic stroke is uncontrolled high blood pressure.
Called a “mini stroke,” it’s caused by a serious temporary clot. This is a warning stroke and should be taken seriously.
In most cases, a stroke is caused by a blood clot that blocks the flow of blood to the brain. In some instances, despite testing, the cause of a stroke cannot be determined. A stroke of unknown cause is called a “cryptogenic stroke.”
When stroke occurs in the brain stem, it can affect both sides of the body and may leave someone in a ‘locked-in’ state. When a locked-in state occurs, the patient is generally unable to speak or move below the neck.
80 percent of strokes are preventable.
A heart attack occurs when the flow of blood to the heart is blocked. The blockage is most often a buildup of fat, cholesterol and other substances, which form a plaque in the arteries that feed the heart (coronary arteries).
The plaque eventually breaks away and forms a clot. The interrupted blood flow can damage or destroy part of the heart muscle.
A heart attack, also called a myocardial infarction, can be fatal, but treatment has improved dramatically over the years. It's crucial to call 911 or emergency medical help if you think you might be having a heart attack.
Common heart attack signs and symptoms include:
Not all people who have heart attacks have the same symptoms or have the same severity of symptoms. Some people have mild pain; others have more severe pain. Some people have no symptoms; for others, the first sign may be sudden cardiac arrest. However, the more signs and symptoms you have, the greater the likelihood you're having a heart attack.
Some heart attacks strike suddenly, but many people have warning signs and symptoms hours, days or weeks in advance. The earliest warning might be recurrent chest pain or pressure (angina) that's triggered by exertion and relieved by rest. Angina is caused by a temporary decrease in blood flow to the heart.
Act immediately. Some people wait too long because they don't recognize the important signs and symptoms. Take these steps:
If you see someone who's unconscious and you believe is having a heart attack, first call for emergency medical help. Then check if the person is breathing and has a pulse. If the person isn't breathing or you don't find a pulse, only then should you begin CPR to keep blood flowing.
Push hard and fast on the person's chest in a fairly rapid rhythm — about 100 to 120 compressions a minute.
If you haven't been trained in CPR, doctors recommend performing only chest compressions. If you have been trained in CPR, you can go on to opening the airway and rescue breathing.
A heart attack occurs when one or more of your coronary arteries become blocked. Over time, a coronary artery can narrow from the buildup of various substances, including cholesterol (atherosclerosis). This condition, known as coronary artery disease, causes most heart attacks.
During a heart attack, one of these plaques can rupture and spill cholesterol and other substances into the bloodstream. A blood clot forms at the site of the rupture. If large enough, the clot can block the flow of blood through the coronary artery, starving the heart muscle of oxygen and nutrients (ischemia).
You might have a complete blockage or partial. A complete blockage means you've had an ST elevation myocardial infarction (STEMI). A partial blockage means you've had a non-ST elevation myocardial infarction (NSTEMI). Diagnostic steps and treatment might be different depending on which you've had.
Another cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. Using tobacco and illicit drugs, such as cocaine, can cause a life-threatening spasm.
Certain factors contribute to the unwanted buildup of fatty deposits (atherosclerosis) that narrows arteries throughout your body. You can improve or eliminate many of these risk factors to reduce your chances of having a first or another heart attack.
Heart attack risk factors include:
Complications are often related to the damage done to your heart during an attack, which can lead to:
It's never too late to take steps to prevent a heart attack — even if you've already had one. Here are ways to prevent a heart attack.
Heart failure, sometimes known as congestive heart failure, occurs when your heart muscle doesn't pump blood as well as it should. Certain conditions, such as narrowed arteries in your heart (coronary artery disease) or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently.
Not all conditions that lead to heart failure can be reversed, but treatments can improve the signs and symptoms of heart failure and help you live longer. Lifestyle changes — such as exercising, reducing sodium in your diet, managing stress and losing weight — can improve your quality of life.
One way to prevent heart failure is to prevent and control conditions that cause heart failure, such as coronary artery disease, high blood pressure, diabetes or obesity.
Heart failure can be ongoing (chronic), or your condition may start suddenly (acute).
Heart failure signs and symptoms may include:
See your doctor if you think you might be experiencing signs or symptoms of heart failure. Seek emergency treatment if you experience any of the following:
Although these signs and symptoms may be due to heart failure, there are many other possible causes, including other life-threatening heart and lung conditions. Don't try to diagnose yourself. Call 911 or your local emergency number for immediate help. Emergency room doctors will try to stabilize your condition and determine if your symptoms are due to heart failure or something else.
If you have a diagnosis of heart failure and if any of the symptoms suddenly become worse or you develop a new sign or symptom, it may mean that existing heart failure is getting worse or not responding to treatment. This may be also the case if you gain 5 pounds (2.3 kg) or more within a few days. Contact your doctor promptly.
Heart failure often develops after other conditions have damaged or weakened your heart. However, the heart doesn't need to be weakened to cause heart failure. It can also occur if the heart becomes too stiff.
In heart failure, the main pumping chambers of your heart (the ventricles) may become stiff and not fill properly between beats. In some cases of heart failure, your heart muscle may become damaged and weakened, and the ventricles stretch (dilate) to the point that the heart can't pump blood efficiently throughout your body.
Over time, the heart can no longer keep up with the normal demands placed on it to pump blood to the rest of your body.
An ejection fraction is an important measurement of how well your heart is pumping and is used to help classify heart failure and guide treatment. In a healthy heart, the ejection fraction is 50 percent or higher — meaning that more than half of the blood that fills the ventricle is pumped out with each beat.
But heart failure can occur even with a normal ejection fraction. This happens if the heart muscle becomes stiff from conditions such as high blood pressure.
Heart failure can involve the left side (left ventricle), right side (right ventricle) or both sides of your heart. Generally, heart failure begins with the left side, specifically the left ventricle — your heart's main pumping chamber.
Lef-sided heart failure
Right-sided heart failure
Systolic heart failure
Diastolic heart failure (also called heart failure with preserved ejection fraction)
A single risk factor may be enough to cause heart failure, but a combination of factors also increases your risk.
Risk factors include:
If you have heart failure, your outlook depends on the cause and the severity, your overall health, and other factors such as your age. Complications can include:
Some people's symptoms and heart function will improve with proper treatment. However, heart failure can be life-threatening. People with heart failure may have severe symptoms, and some may require heart transplantation or support with a ventricular assist device.
Any of the following conditions can damage or weaken your heart and can cause heart failure. Some of these can be present without your knowing it:
The key to preventing heart failure is to reduce your risk factors. You can control or eliminate many of the risk factors for heart disease — high blood pressure and coronary artery disease, for example — by making lifestyle changes along with the help of any needed medications.
Lifestyle changes you can make to help prevent heart failure include:
Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly. But having too much cholesterol in your blood raises your risk of coronary artery disease.
LDL and HDL are two types of lipoproteins. They are a combination of fat (lipid) and protein. The lipids need to be attached to the proteins so they can move through the blood. LDL and HDL have different purposes:
If you have a high LDL level, this means that you have too much LDL cholesterol in your blood. This extra LDL, along with other substances, forms plaque. The plaque builds up in your arteries; this is a condition called atherosclerosis.
Coronary artery disease happens when the plaque buildup is in the arteries of your heart. It causes the arteries to become hardened and narrowed, which slows down or blocks the blood flow to your heart. Since your blood carries oxygen to your heart, this means that your heart may not be able to get enough oxygen. This can cause angina (chest pain), or if the blood flow is completely blocked, a heart attack.
A blood test can measure your cholesterol levels, including LDL. When and how often you should get this test depends on your age, risk factors, and family history. The general recommendations are:
For people who are age 19 or younger:
For people who are age 20 or older:
Things that can affect your LDL level include
Copyright © 2019 Dr. Stephen Sims for Cogent Family Healthcare, A Division of BASS Medical Group.