755 South Perry, Suite 100
Castle Rock, CO 80104
303.688.8989 Office
303.688.3482 Fax

Strong Heart Institute - Health & Wellness

Who needs a cardiovascular evaluation?

-Anyone that has a family member (any of the grandparents, parents uncles, or aunts, brothers, or sisters) with a history of heart disease, stroke, heart attack, sudden death, high blood pressure.

-Anyone that has a personal history of atherosclerosis (plaque, angioplasty, stents, bypass grafting or unstable angina)


-Anyone with metabolic syndrome or diabetes
BMI (Body Mass Index) > 30
waist > 35 inches in women
waist > 40 inches in Men
Elevated Blood Pressure > 130/85 mm Hg
Triglycerides greater than 150mg/dl with HDL< 40 in Men and HDL < 50 in women

Current national guidelines are not aggressive enough to stop heart disease. The providers at the STRONG HEART INSTITUTE have addressed these guidelines and modified them to the corrected targets, achieving real reductions in cardiovascular events. We have also seen a terrific regression of cardiovascular disease with our aggressive risk reduction strategies over the past decade.

Why settle for “average” advice when you can get world class cardiovascular risk reduction at STRONG HEART INSTITUTE?

Blood pressure relationship to stroke and heart attack:

115/75mmHg = the lowest risk for cardiovascular events.
Every 20 points of elevation of the systolic (top number) doubles your risk.
Every 10 points of elevation of the diastolic (bottom number) doubles your risk.

135/85 mmHg 2 X risk
155/95 mmHg 4 X risk
175/105 mmHg 8 X risk
195/115 mmHg 16 X risk

What is a Cardiovascular Event (CVE)?

Stroke and Heart Attack are the same event in different locations.
A stroke is a heart attack in the Brain
A heart attack is a stoke in the Heart

Living “heart healthy” you can help to reduce your risk for stroke and heart attack.

Women and death risk

What is the number one killer of women in America? Most women fear breast cancer as the number one killer… Not even close. If you add together the top five cancers women get, it would not equal half of the number of strokes and heart attacks women suffer each year.

Are Statins Dangerous?

“Doctor Google” and the hobgoblins of the internet want you to believe that statins are poison only to be taken as a measure of last resort after your fourth or fifth stroke or heart attack…..this is absolutely not the case. The most prescribed medication in the world is a statin. If statins were even occasionally dangerous, we would see many problems with a medication this widely prescribed. Rarely problems do occur and in that unlikely instance, the problems may be easily addressed. If you take a statin to reduce your risk of a cardiovascular event, you should not feel any side effects from your treatment. If you feel any side effects whatsoever from any of your risk reduction medications, please alert your physician so a solution may be provided.

What is a CIMT? (Carotid Intima-Media Thickness test)

This is an ultrasound examination of the carotid arteries in the neck. It is a painless and completely non-invasive test that takes you about ten minutes. The analysis of the exam data usually takes another fifteen minutes. The data analysis will be completed at a time after your office visit is complete.

At the STRONG HEART INSTITUTE we perform the CIMT test for three reasons:

1. We can asses your vascular age and plaque status before deciding if treatment is necessary.
2. We can use the results of the CIMT to assist in designing a treatment plan for you.
3. We can use the results to do serial evaluations over the years to asses the progress and effectiveness of your therapy.

We pioneered the use of CIMT testing in the Front Range at the STRONG HEART INSTITUTE in 2001. Advanced cardiovascular clinical trials all over the world now use CIMT testing as a marker for cardiovascular disease and as a measure of treatment effectiveness…something we have been doing for the past decade.

Gender, age, blood pressure, and cholesterol level can all have an impact on your CIMT result. At the STRONG HEART INSTITUTE we will work with you to design a cardiovascular risk reduction plan to best modify your blood pressure and cholesterol.

Advanced/Expanded Lipid Testing

Most lipid (cholesterol) testing done in the world today utilizes an equation designed about fifty years ago to calculate your good (HDL) and bad (LDL) cholesterol numbers. This twentieth century test does a relatively poor job of estimating the actual HDL and LDL numbers especially as triglyceride values rise.

Fortunately in the twenty first century we have many types of expanded and advanced lipid testing available to help us obtain accurate values for HDL and LDL as well as a wealth of other important information related to lipid levels and cardiovascular risk. These advanced tests are often covered by insurance plans, and are often cost equivalent to the outdated lipid profile utilized in the last century.

Ask your Strong Heart Institute physician which advanced lipid profile meets your individual needs.

Cholesterol and Triglycerides Changes

There is good news and bad news…

Good News – you can probable reduce your LDL (the bad cholesterol) by ten percent, by making some lifestyle changes. You can also elevate your HDL (the good cholesterol) by increasing aerobic exercise.

Triglycerides go down as you decrease your sweets and alcohol intake and lose that abdominal fat.

Bad News – most of your circulating LDL is what your liver makes based on your parents and grandparents genes.

If your triglycerides stay high then your HDL will have a difficult time increasing.

If your HDL stays low your cardiovascular risk stays high.

Fewer than two percent of people achieve a fifty percent LDL reduction with diet changes alone.


Aerobic exercise gets you gains in HDL, lowers your triglycerides, and improves your heart rate, blood pressure, and heart wall function.

We need about thirty minutes per day of exercise strenuous enough to get sweaty. As we age our exercise requirement increases annually….so a sixty year old needs more daily exercise than a forty year old just to stay fit.

A simple rule of thumb is:
(your age in years) – 18 = the number of minutes of daily exercise you need

Tobacco Use

There is NO healthy way to use tobacco. If you use tobacco in any way STOP now. If you need help stopping, please ask one of our physicians at the STRONG HEART INSTITUTE for help with a plan to get free from tobacco.

Every cigarette increases your systolic blood pressure twenty points for twenty minutes. Remember a twenty point increase in systolic blood pressure doubles your risk of stroke and heart attack.
20cigs X 20 minutes = 400 minutes (about 6.5 hours)

Four hundred minutes of electively increasing your blood pressure and doubling your risk of stroke and heart attack from just one pack per day of cigarettes……

Why would anyone elect to continue a habit that doubles the risk of heart attack and stroke???


Lipoprotein(a) is a dangerous form of LDL cholesterol with a protein bound to it. When Lp(a) levels exceed threshold values, the risk of heart attack and stroke doubles. Advanced lipid tests will measure and follow the concentration of Lp(a) in your blood so your STRONG HEART INSTITUTE physician can implement a treatment plan to manage this genetic risk factor.


This is one of the first blood tests for assessing arterial inflammation. Unfortunately it is affected by inflammation anywhere in the body.


This marker specifically for measuring arterial inflammation is not affected by inflammation elsewhere in the body. It can be used to help assess your treatment plan effectiveness.

Peripheral Artery Disease (PAD)

Plaque or obstruction of the arteries outside the body core is referred to as PAD. Patients with PAD have a markedly higher risk of a cardiovascular event.

If you have aching in your legs or arms after exertion of any kind please let one of us know, so that we may address this risk factor.

Hundreds of thousands of patient years experience have demonstrated that treatment with statins alone reduces cardiovascular events by 24 to 40%.

When used in combination with other cholesterol reducing medications we can reduce the risk of cardiovascular events by 80 – 95%.

Blood Pressure Treatment / Hypertension

Reducing weight, increasing aerobic exercise, stopping tobacco use, limiting alcohol intake and reducing salt intake may all help to lower blood pressure.

If these measures are inadequate to achieve your BP goals, then medication may also be prescribed to help achieve your blood pressure goal.

The typical hypertension patient in America uses three to four blood pressure medications to reach their BP goal. Occasionally one blood pressure medication is sufficient to get to goal, but do not be surprised if you require more than one.

Remember, as you lose weight and improve your other lifestyle blood pressure issues, we may be able to reduce or eliminate some or all of your blood pressure medications.


The most common type of diabetes in America is Type II Diabetes Mellitus.. This type of diabetes seems to result from our body “outgrowing” our ability to manage sugar effectively,. This is very often the result of abdominal obesity. Fat in our abdomen is the most dangerous fat - causing insulin resistance and arterial inflammation.

The diagnoses of diabetes doubles the risk of cardiovascular events for men and it quadruples the risk in women. Unfortunately as America gets fatter and fatter, the obesity epidemic has resulted in a diabetes epidemic. This can only mean a future with an increase in cardiovascular events for American men and women. Sounds pretty grim….the good news is that Type II Diabetes is preventable. Maintain a Body Mass Index (BMI) of nineteen to twenty-five and your risk of diabetes is low. A BMI above 30 increases your risk greatly. This is a case where you can elect to lose your diabetes by simply losing that abdominal fat.

Want to calculate you BMI??

Ideal = BMI of19 -25 (Lowest death risk)
Overweight = BMI of 25.1 – 30 (Intermediate death risk)
Obese = BMI >30 (Highest Death Risk)

This is INDEPENDENT of “big bones” or “muscular” body types. Having a BMI >30 increases your death risk from all causes.

When to take your cholesterol medications.

Take them whenever is most convenient for you. Do not worry about AM or PM…simply take them at the same time every day.

How Much Vitamin E?

Do not exceed 400 units of vitamin E per day, as doing so seems to interfere with HDL production.

Vitamin D and Heart Health?

We have long recognized the benefits of vitamin D for bone health. New studies are pointing toward an association between lower levels of vitamin D and increased risk of cardiovascular events.

At THE STRONG HEART INSTITUTE we would like you to have a daily vitamin D intake above the recommended 400IU. Ask your physician what dose of vitamin D is right for you.

Food Suggestions

If you have questions about taking food supplements, please talk to your STRONG HEART INSTITUTE physician.

Is Meat The Enemy?

Absolutely not. At THE STRONG HEART INSTITUTE we do not recommend consuming animal fat, but lean meats and oily fish are not a problem.

Better Red than Dead

Simcor, Advicor, and Niaspan Use

Ongoing Studies

STRONG HEART INSTITUTE is involved with lipid research and from time to time we are enrolling participants. If you are interested in being involved in a study let the Strong Heart Institute staff know.

Insurance Companies and your Health

Remember that what we pay for each month is NOT health insurance, but risk insurance. These insurance companies care little about achieving or monitoring health. They are concerned about keeping our premiums for profit.

At the STRONG HEART INSTITUTE your well-being is our reason for being.

We are not willing to blindly follow guidelines when evidence and logic demonstrate a different plan yields better results. As a consequence we will occasionally recommend a test or treatment that your insurance company balks at covering. Remember we plan to continue working with you in the years to come even after you have changed insurance companies five or six times. If you have any questions or concerns about a test or treatment plan we have ordered for you, please do not hesitate to discuss it with us.