Lecture Notes: Dr. Rob CVIS and Dr. Phil AIA on Metabolic Health and Cardiovascular Disease

Introduction

• Dr. Rob CVIS: Addiction Specialist
• Dr. Phil AIA: Cardiovascular Surgeon
• Focus on shared interests despite different specializations.

Personal Journeys of Both Doctors

Dr. Phil AIA

• Formerly morbidly obese and pre-diabetic.
• Traditional healthcare advice (Eat less, move more) was ineffective for him and his patients.
• Attended a Society of Thoracic Surgeons meeting where Gary Taubes emphasized the significance of food types, not just amount.
• Adopted a low-carb diet leading to weight loss and improved insulin sensitivity.
• Belief: Understanding why surgery is needed is key to shifting the paradigm toward prevention.

The Role of Insulin Resistance

• Insulin resistance as a major problem in metabolic health leading to various health issues.
• Importance of educating colleagues in the medical field regarding insulin resistance over cholesterol issues.

Plaque and Vascular Health

Description of Plaque

• Plaque as a mushy, cheese-like substance found in arteries.
• When plaque is surgically removed, the underlying inflammation indicates damage to the vessel wall.
• Plaque does not evenly distribute; nearby areas can be healthy while other sections may show significant buildup.

Differences in Plaque Locations

• Varies between coronary arteries and peripheral arteries (e.g., carotid, femoral).
• Size of arteries and flow dynamics play a role in how and where plaque develops.

Diagnostic Tools

Coronary Artery Calcium Score (CAC)

• Indicates presence of calcified plaque; higher scores indicate higher risk for cardiovascular events.
• Not sensitive enough to pinpoint specific plaques or guarantee absence of soft plaques.
• A CAC score of zero is promising for low risk; might not indicate absence of some smaller amounts of soft plaque.

CT Angiogram (CTA)

• Offers detailed views of artery anatomy, blood flow, and plaque burden.
• More sensitive than CAC in detecting soft plaque and functional aspects of the vessels.

Catheterization (Cath)

• Invasive procedure to examine coronary arteries but does not give exact visualization of the plaque itself.
• Risks include possible debris release during the procedure.
• Important to use Cath judiciously only when necessary.

Medications and Strategies

Prevention Strategies

• Emphasis on lifestyle modifications, especially dietary changes (low-carb).
• Monitor and manage inflammation and insulin resistance proactively.
• Consider using GLP-1 inhibitors as adjuncts for managing insulin levels.
• Vitamin K2 and N-acetylcysteine (NAC) can assist in managing vascular health.

Reversal of Calcified Plaque

• While reductions in CAC scores can happen, maintaining stable scores may be more vital.
• Discusses emerging therapies like culture scene for inflammation reduction.

Key Thoughts

• Keeping patients off the operating table is a critical approach in both doctors’ practices.
• Need for comprehensive understanding and management of metabolic health issues to effectively prevent heart disease and related conditions.
• Discussing options with a clinician who understands metabolic health is crucial for effective risk management.

Conclusion

• Highlight of the importance of engagement in proactive health measures rather than reactive treatments.
• Encouragement to seek out proper medical advice and personnel experienced in metabolic health practices.