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| BaleDoneen method | |
|---|---|
| Specialty | Cardiology |
The BaleDoneen method is a risk assessment and treatment protocol aimed at preventing heart attack and stroke. The method also seeks to prevent or reduce the effects of type 2 diabetes. The method was developed by Bradley Field Bale and Amy Doneen.
Similar to other protocols, the method tests for cholesterol levels, blood pressure, and diabetes mellitus, as well as factors not included in other current protocols, including systemic inflammation, vitamin D deficiency, insulin resistance, elevated levels of lipoprotein(a), and genetic risks, to identify potential root causes of arterial plaque. [1] [2]
Testing for plaque includes a carotid intima-media thickness test, (CIMT), which measures blood flow through the arteries and the thickness of the arteries. [2] [3] Physician Dr. Jeff Emery wrote that the test "allows us to identify if you are at future risk for a heart attack or stroke." [4] The American Heart Association has recommended CIMT as "a safe, non-invasive and relatively inexpensive means of assessing subclinical atherosclerosis. The technique is valid and reliable." [5] The method also uses the coronary artery calcium score (CAC), [5] a measurement of the amount of calcium in the walls of the arteries that supply the heart muscle, using a coronary CT calcium scan of the heart. [6] [7] CAC has been shown to be an independent marker of risk for cardiac events, cardiac mortality, and all-cause mortality. [8]
The method uses urine and blood tests to check inflammatory markers, such as a high-sensitivity C-reactive protein test (CRP) measuring CRP, a protein in found in blood that indicates inflammation throughout the body. [9] In 2017, results of the CANTOS trial demonstrated that anti-inflammatory therapies reduce risk for heart attack, stroke, other cardiovascular events [10] and cancer by up to 50%.
The method ties results of this testing to considerations of lifestyle, diet, sleep disorders, stress levels, genetic factors, and dental care, and personalized treatment targets are set to reduce patients' cardiovascular risk. [9] [11] In some cases, these goals exceed those set by standard care. A common protocol for blood pressure indicates that an adult male with a reading of 130/85 is not at risk for a heart attack if the patient is being treated for high blood pressure. However the American Heart Association [12] and the BaleDoneen method define safe levels as being below 120/80.
| This section needs more reliable medical references for verification or relies too heavily on primary sources .(January 2019) |  |
In a retrospective study that analyzed data from patients who had received cardiovascular risk reduction treatments that included lipid-lowering medications, lifestyle modification, and additional therapies for those with insulin resistance, type 2 diabetes, hypertension, metabolic syndrome, and other cardiovascular risks. [13] The following outcomes were reported during the first year of treatment with the BaleDoneen method, compared to baseline: 50% decrease in the size of carotid artery plaque deposits, 30% drop in triglycerides, 25% drop in LDL cholesterol, and 6% rise in HDL cholesterol.
A retrospective study of patients treated with the BaleDoneen method, [14] reported statistically significant reductions in CIMT measurements, plaque burden, fasting blood sugar, LDL cholesterol and inflammation over an eight-year period. Limitations of the study include lack of diversity in the study subjects, nearly all of whom were Caucasian, and lack of a comparison group. Randomized controlled clinical trials are needed to compare the effect of the method with standard treatment protocols.
For the treatment of arterial disease, the method uses pharmaceuticals such as statins, baby aspirin (low dose aspirin), renin–angiotensin–aldosterone system inhibitors (RAAS inhibitors), and other drugs that are common tools for most physicians, as well as vitamins, [15] supplements, lifestyle modification, and a diet based on the patient's DNA. [7] The method also recommends significant attention to dental care [16] to improve heart and circulatory system health, including brushing and flossing teeth twice a day. [7]
Coronary artery disease (CAD), also called coronary heart disease (CHD), or ischemic heart disease (IHD), is a type of heart disease involving the reduction of blood flow to the cardiac muscle due to a build-up of atheromatous plaque in the arteries of the heart. It is the most common of the cardiovascular diseases. CAD can cause stable angina, unstable angina, myocardial ischemia, and myocardial infarction.
A transient ischemic attack (TIA), commonly known as a mini-stroke, is a temporary (transient) stroke with noticeable symptoms that end within 24 hours. A TIA causes the same symptoms associated with a stroke, such as weakness or numbness on one side of the body, sudden dimming or loss of vision, difficulty speaking or understanding language or slurred speech.
Angina, also known as angina pectoris, is chest pain or pressure, usually caused by insufficient blood flow to the heart muscle (myocardium). It is most commonly a symptom of coronary artery disease.
Atherosclerosis is a pattern of the disease arteriosclerosis, characterized by development of abnormalities called lesions in walls of arteries. This is a chronic inflammatory disease involving many different cell types and driven by elevated levels of cholesterol in the blood. These lesions may lead to narrowing of the arterial walls due to buildup of atheromatous plaques. At the onset there are usually no symptoms, but if they develop, symptoms generally begin around middle age. In severe cases, it can result in coronary artery disease, stroke, peripheral artery disease, or kidney disorders, depending on which body part(s) the affected arteries are located in the body.
Arteriosclerosis, literally meaning "hardening of the arteries", is an umbrella term for a vascular disorder characterized by abnormal thickening, hardening, and loss of elasticity of the walls of arteries; this process gradually restricts the blood flow to one's organs and tissues and can lead to severe health risks brought on by atherosclerosis, which is a specific form of arteriosclerosis caused by the buildup of fatty plaques, cholesterol, and some other substances in and on the artery walls.
Peripheral artery disease (PAD) is a vascular disorder that causes abnormal narrowing of arteries other than those that supply the heart or brain. PAD can happen in any blood vessel, but it is more common in the legs than the arms.
Hypercholesterolemia, also called high cholesterol, is the presence of high levels of cholesterol in the blood. It is a form of hyperlipidemia, hyperlipoproteinemia, and dyslipidemia.
Dyslipidemia is a metabolic disorder characterized by abnormally high or low amounts of any or all lipids or lipoproteins in the blood. Dyslipidemia is a risk factor for the development of atherosclerotic cardiovascular diseases, which include coronary artery disease, cerebrovascular disease, and peripheral artery disease. Although dyslipidemia is a risk factor for cardiovascular disease, abnormal levels do not mean that lipid lowering agents need to be started. Other factors, such as comorbid conditions and lifestyle in addition to dyslipidemia, is considered in a cardiovascular risk assessment. In developed countries, most dyslipidemias are hyperlipidemias; that is, an elevation of lipids in the blood. This is often due to diet and lifestyle. Prolonged elevation of insulin resistance can also lead to dyslipidemia.
An atheroma, or atheromatous plaque, is an abnormal accumulation of material in the inner layer of an arterial wall.
A vulnerable plaque is a kind of atheromatous plaque – a collection of white blood cells and lipids in the wall of an artery – that is particularly unstable and prone to produce sudden major problems such as a heart attack or stroke.
Carotid endarterectomy is a surgical procedure used to reduce the risk of stroke from carotid artery stenosis. In endarterectomy, the surgeon opens the artery and removes the plaque. The plaque forms and thickens the inner layer of the artery, or intima, hence the name of the procedure which simply means removal of part of the internal layers of the artery.
Carotid artery stenosis is a narrowing or constriction of any part of the carotid arteries, usually caused by atherosclerosis.
A Hollenhorst plaque is a cholesterol embolus that is seen in a blood vessel of the retina. It is usually found when a physician performs ophthalmoscopy, during which a plaque will appear as a small, bright crystal that is refractile and yellow. This is a medical exam finding, and is not a medical condition, though it may be related to cardiovascular conditions such as atherosclerosis of the internal carotid artery. It was first described by American ophthalmologist Robert Hollenhorst in 1961.
Computed tomography angiography is a computed tomography technique used for angiography—the visualization of arteries and veins—throughout the human body. Using contrast injected into the blood vessels, images are created to look for blockages, aneurysms, dissections, and stenosis. CTA can be used to visualize the vessels of the heart, the aorta and other large blood vessels, the lungs, the kidneys, the head and neck, and the arms and legs. CTA can also be used to localise arterial or venous bleed of the gastrointestinal system.
Intima–media thickness (IMT), also called intimal medial thickness, is a measurement of the thickness of tunica intima and tunica media, the innermost two layers of the wall of an artery. The measurement is usually made by external ultrasound and occasionally by internal, invasive ultrasound catheters. Measurements of the total wall thickness of blood vessels can also be done using other imaging modalities.
A coronary CT calcium scan is a computed tomography (CT) scan of the heart for the assessment of severity of coronary artery disease. Specifically, it looks for calcium deposits in atherosclerotic plaques in the coronary arteries that can narrow arteries and increase the risk of heart attack. These plaques are the cause of most heart attacks, and become calcified as they develop.
A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops in one of the coronary arteries of the heart, causing infarction to the heart muscle. The most common symptom is retrosternal chest pain or discomfort that classically radiates to the left shoulder, arm, or jaw. The pain may occasionally feel like heartburn. This is the dangerous type of Acute coronary syndrome.
Carotid ultrasonography is an ultrasound-based diagnostic imaging technique to evaluate structural details of the carotid arteries. Carotid ultrasound is used to diagnose carotid artery stenosis (CAS) and can assess atherosclerotic plaque morphology and characteristics. Carotid duplex and contrast-enhanced ultrasound are two of the most common imaging techniques used to evaluate carotid artery disease.
The Framingham Risk Score is a sex-specific algorithm used to estimate the 10-year cardiovascular risk of an individual. The Framingham Risk Score was first developed based on data obtained from the Framingham Heart Study, to estimate the 10-year risk of developing coronary heart disease. In order to assess the 10-year cardiovascular disease risk, cerebrovascular events, peripheral artery disease and heart failure were subsequently added as disease outcomes for the 2008 Framingham Risk Score, on top of coronary heart disease.
Amy Lynn Doneen is an American doctor of nursing practice (DNP) and co-founder of the BaleDoneen Method for the prevention and treatment of heart attack, stroke and type 2 diabetes, and for treatment after one of these medical events.
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