Understanding the Three-Legged Stool Concept

Understanding the Three-Legged Stool Concept to Winning the War on Cardiovascular Disease

By Ronald Grisanti, DC, DABCO, DACBN, MS, CFMP

In my clinical experience and pursuit to clearly understand the key mechanisms of progressive cardiovascular disease (CVD), I have come across three schools of thought that I hope to bring to light in today’s article.

I commonly visualize a three-legged stool exemplifying the full understanding of developing atherosclerosis. The three areas of cardiovascular disease include:

1. Lipid dysregulation (Leg #1)

2. Endothelial dysfunction and inflammation (Leg #2)

3. Insulin resistance (Leg #3)

Lipid Dysregulation

The role of abnormal lipid markers (Leg #1) is essential in any phase of the atherosclerotic process and has been well established in peer-reviewed literature to be integral when establishing cardiovascular treatment protocol to reverse the elevated risk of atherosclerosis.

Endothelial Dysfunction

Another school of thought (Leg #2) is the issue of endothelial dysfunction. The endothelium is a thin membrane that lines the inside of the heart and blood vessels. Endothelial cells release substances that control vascular relaxation and contraction, as well as enzymes that control blood clotting, immune function, and platelet (a colorless substance in the blood) adhesion.

Endothelial dysfunction has been shown to be significant in predicting stroke and heart attacks because of the inability of the arteries to dilate fully. The dysfunction may be a result of high blood pressure, diabetes, high cholesterol, and smoking. Studies have shown that endothelial dysfunction precedes the development of atherosclerosis, a chronic disease characterized by abnormal thickening and hardening of the arterial walls with resulting loss of elasticity.

Watch the following video from Cleveland Heart Lab:

https://www.knowyourrisk.com/

Insulin Resistance

Insulin resistance (Leg #3), also known as impaired insulin sensitivity, happens when cells in your muscles, fat, and liver don’t respond as they should to insulin, a hormone your pancreas makes that’s essential for life and regulating blood glucose (sugar) levels.

The differing camps of thought in the world of cardiovascular progression are all simultaneously correct and wrong. The battle among different camps about what causes atherosclerosis should not be isolated to one or two legs of the stool.

Some thought leaders claim focus needs to be exclusively directed to insulin resistance, while others claim it is all about arterial inflammation/endothelial dysfunction. Of course, the traditional cardiovascular medical community with their myopic position are ordering only the basic lipid panel (total cholesterol, LDL cholesterol, triglycerides, and HDL).

I have reviewed hundreds and even thousands of medical records, and it is rare to ever see more than the basic lipid panel ordered to establish a cardiovascular risk level. Based on this limited cardiovascular assessment, the treatment of choice is almost always statins. This article is in no way denying the benefits of addressing lipid dysregulation via diet, lifestyle interventions, and, in many cases, the use of statins. 

That camp of health professionals assumes all levels of atherosclerosis are directly associated with lipid dysregulation. My point is quite clear: atherosclerosis is a multifactorial process regulated by a complex interplay among all three legs of the stool discussed earlier.

To obtain the best clinical outcome in stopping and even reversing atherosclerosis, it is imperative to carefully evaluate and treat all three legs of the stool. 

Innovative and advanced testing, as shown above with the three legs of the cardiovascular stool analogy, is necessary for providing the absolute best opportunity to aggressively and effectively manage atherosclerosis. Anything less than the labs mentioned above for all three legs of the stool is bad medicine that is bound to result in poor or even deadly clinical outcomes.

I have to wonder why the most prestigious and most well-respected medical institutions, such as Boston Heart Diagnostics and Cleveland Heart Lab, do exactly what I have discussed in this important article. As you will clearly see, these outstanding forward-thinking medical establishments have it right and realize that to be a leader in cardiovascular management and excel in reversing CVD, then you should do nothing short of addressing all three legs of the stool.

https://bostonheartdiagnostics.com/

https://www.clevelandheartlab.com/test-menu/