#284 4 Best Ways to Lower Your CHADS-VASc Score (How to Safely Get Off Afib Blood Thinners)
Dr. John Day
Dr. Day is a cardiologist specializing in heart rhythm abnormalities at St. Mark’s Hospital in Salt Lake City, Utah. He graduated from Johns Hopkins Medical School and completed his residency and fellowships in cardiology and cardiac electrophysiology at Stanford University. He is the former president of the Heart Rhythm Society and the Utah chapter of the American College of Cardiology.
4 Best Ways to Lower Your CHADS-VASc Score (How to Safely Get Off Afib Blood Thinners)
No one wants to be on a blood thinner. By optimizing your lifestyle, it is possible to get off your atrial fibrillation blood thinner. In this article, I’ll share the four best ways to lower your CHADS-VASc score.
Strokes have to be one of the most devastating complications of atrial fibrillation. Even if you have optimized all aspects of your lifestyle, you will never get your stroke risk to zero. There is always a risk.
Stopping a blood thinner could cause a massive stroke. Taking blood thinners may lead to life-threatening bleeding.
Because the consequences are so high, you have to be in close communication with your physician. You can’t stop your blood thinner without discussing it first with your physician.
My Views of the CHADS-VASc Scoring System
One more disclaimer…I’m not a fan of the CHADS-VASc scoring system. I personally think it is flawed as I discussed in this article. However, if you want to “play by the rules,” here is the best way to “hack” the CHADS-VASc scoring system.
Brenda didn’t want a stroke. She also didn’t want to suffer the same brain bleed that her mother did on Coumadin. Brenda had a CHADS-VASc score of four which put her at high risk of a stroke.
“I’ll do anything to get off warfarin,” Brenda said.
“The only way we can safely avoid blood thinners is to get your CHADS-VASc score below two. To drop your score from a four to one will require that we reverse your heart failure, high blood pressure, and diabetes. I can’t stop your blood thinner now, but it may be possible over the next three to six months,” I said.
“I’m OK with taking a blood thinner for a few months as long as I know there is an end in sight,” she said.
What Are Your Odds of a Stroke? The CHADS-VASc Score
To lower your CHADS-VASc score, and safely get off blood thinners, you need to understand how this scoring system works. To put it simply, CHADS-VASc is an acronym. The lower your score, the lower your risk of a stroke. The goal is to keep your score below two.
Below is how you calculate your CHADS-VASc score:
C: Congestive heart failure (1 point)
H: Hypertension (1 point)
A: Age (65 and older gets you 1 point)
D: Diabetes (1 point)
S: Stroke/TIA history (2 points)
V: Vascular disease (prior heart attack, blockage in your heart, or blockage in any other artery gets you 1 point)
A: Age (75 and older gets you a total of 2 points for age)
S: Sex (female gender gets you 1 point)
According to the atrial fibrillation treatment guidelines, here is your annual stroke risk based on your CHADS-VASc score:
CHADS-VASc 0: 0%
CHADS-VASc 1: 1.3%
CHADS-VASc 2: 2.2%
CHADS-VASc 3: 3.2%
CHADS-VASc 4: 4.0%
CHADS-VASc 5: 6.7%
CHADS-VASc 6 or higher: ~10% up to as high as 15%
The Critical CHADS-VASc Score is 2
You don’t want a CHADS-VASc score of two or higher. A CHADS-VASc score of two or higher means that blood thinners are recommended for the rest of your life. While some aspects of the CHADS-VASc score can’t be reversed, others can. If your score is two or higher, it is possible to lower your score by up to four points.
How to Lower Your CHADS-VASc Score by 4 Points
If you want to get your score into the safe zone (below 2) where blood thinners are no longer required, here are four ways you can do it.
1. Reverse Heart Failure (minus 1 point)
Not every case of heart failure is reversible. However, you can drive many cases of acute heart failure into remission.
For example, heart failure caused by atrial fibrillation can usually be reversed by either maintaining sinus rhythm or by controlling the heart rate. Dramatic weight loss may reverse heart failure in obese patients. Correcting nutritional deficiencies, hormonal imbalances, or metabolic abnormalities may also reverse heart failure.
The key is to identify the cause of the heart failure. If the underlying problem can be addressed, then acute heart failure may resolve naturally.
2. Reverse Hypertension (minus 1 point)
Unless you have had hypertension for years, most cases are reversible by optimizing your lifestyle. For example, you usually don’t see high blood pressure in groups of people who have never been exposed to the modern diet or modern lifestyle. In contrast, 90% of Americans will get hypertension.
When it comes to hacking your CHADS-VASc score, you can’t just take a pill. Even if a drug controls your blood pressure, you still get one point for hypertension. The only way to drop a point is to reverse this condition. Basically, you optimize your lifestyle so that hypertension is no longer on your problem list.
If you want to get your blood pressure into the normal range fast, there are some simple things you can do. First, lose weight. Studies show that for every two pounds you lose your blood pressure will go down by about one point.
Second, eat a mostly plant-based real food diet. The more whole plants you can work into your diet, the lower your numbers will be. Also, get rid of all modern foods. Eliminate sugar, processed carbohydrates, and everything else processed, pre-prepared, or packaged.
You’ll notice that I left out salt. The reason is quite simple. If you eliminate anything processed, then your sodium intake will naturally be low.
Last, exercise daily. Physical activity lowers your blood pressure for up to 12 hours. If you want to keep it low throughout the day, you could even consider exercising in the morning and evening.
To learn more about how to reverse blood pressure naturally, you need to read this article I wrote.
3. Reverse Diabetes (minus 1 point)
Just like with hypertension, diabetes is another easily reversible condition. Even if your hemoglobin A1C score is in the normal range with medications, it still doesn’t count. The only way to drop your CHADS-VASc score by one is to get diabetes off your problem list.
Fortunately, the same things that reverse hypertension are the same things that reverse diabetes. Indeed, at least 80% of my patients can reverse diabetes by losing every extra pound, eliminating all sugar and processed carbohydrates, and exercising daily.
4. Reverse Vascular Disease (minus 1 point)
Of the four ways to lower your CHADS-VASc score, this one is the most challenging and controversial. Most cardiologists don’t think this is possible. However, not all cardiologists feel this way.
For example, President Bill Clinton’s cardiologist, Dr. Dean Ornish, thinks it is possible. Based on his seminal 1990 publication, he showed it was possible without drugs or procedures.
Another believer is the Cleveland Clinic’s Caldwell Esselstyn. He has also published studies showing that heart blockages are reversible.
The secret to Doctors Ornish and Esselstyn’s approach is a 100% low-fat plant-based diet, daily exercise, social interaction, and optimization of stress levels. While I also believe it is possible to reverse vascular disease, I don’t buy the “low-fat” component. For example, healthy fats, like nuts, seeds, and avocados have all been proven to be helpful in countless studies.
Brenda’s Story Revisited
In the end, Brenda was committed. She lost 46 pounds, adopted a real food diet, and went to the gym every day. Yoga, meditation, and regular social gatherings with friends and family members also became a habit.
Within six months, she got off her diabetes and high blood pressure medications. And a follow-up echocardiogram showed that her ejection fraction had normalized with sinus rhythm. With her optimized lifestyle, her CHADS-VASc score went from a four to a one, and she was also able to get off her blood thinner.
An Ablation Won’t Get You Off Blood Thinners
Contrary to popular belief, an ablation won’t get you off blood thinners. Even if your a catheter ablation procedure eliminates your atrial fibrillation, according to the guidelines, you are still at risk. Thus, the only safe way off blood thinners for atrial fibrillation is to lower your CHADS-VASc score.
The Big Picture
The key takeaway is that it is often possible to lower your CHADS-VASc score. Acute heart failure, high blood pressure, diabetes, and vascular disease are all potentially reversible with an optimized lifestyle. In our book, The Longevity Plan, we’ll show you how to eliminate most chronic medical conditions.
In the Longevity Plan, we uncover and deconstruct the secrets of China’s Longevity Village. This village has the highest percentage of centenarians in the world. It is also a place where people rarely, if ever, get atrial fibrillation, heart disease, or cancer.
Disclaimer Policy: This website is intended to give general information and does not provide medical advice. This website does not create a doctor-patient relationship between you and Dr. John Day. If you have a medical problem, immediately contact your healthcare provider. Information on this website is not intended to diagnose or treat any condition. Dr. John Day is not responsible for any losses, damages or claims that may result from your medical decisions.
Once a woman reaches 65 she will be at a 2 so all woman would need to be on blood thinners. Is that correct.
Sadly this is the case according to the official guidelines. I am in the process of updating this article with my personal views of the CHADS-VASc scoring system. Basically, I don’t agree with 3 aspects of the CHADS-VASc scoring system:
1. I don’t think female gender should be counted as a risk factor. Yes, there are some studies that suggest women might be at higher risk of a stroke. However, there are also studies which show this isn’t the case.
2. There is no credit given for having an ablation. Many studies have now shown that your stroke risk is significantly reduced if you have had a successful ablation.
3. The current scoring system with the guidelines (CHADS-VASc) stipulates that nearly everyone should be on a blood thinner. The previous scoring system (CHADS), which was used in the US until 2014, only required the highest risk patients to be on a blood thinner. I personally haven’t seen any clear evidence that this new scoring system is any better than the old system.
Hope this helps!
Just saw that Mary asked the same question.
While CHADS-VASc is still the yardstick most doctors use there are other calculators that produce quite different results.
ATRIA developed by DR Singer, judged to be far more accurate than CHADS-VASc and yes more complicated to use, reduced my score from a moderate of 2 to a low risk score of 4, < 1% risk.
I have been reading that Intermountain has developed a new calculator combining CHADS-VASc and IMRS that doubles the accuracy of stroke prediction and also moves many people from moderate to low risk.
Could you comment on these newer and apparently more effective risk calculators, perhaps it is time to move on from CHADS-VASc
I agree, the CHADS-VASc system is flawed. No scoring system is perfect and the CHADS-VASc system isn’t even close!
Based on the studies I have seen, newer scoring systems also have their pluses and minuses. Currently, no one is using the alternative scoring systems (it is only for research purposes). For the time being, we are stuck with the CHADS-VASc system. It is going to take some very compelling studies to change the guidelines…
It is for this reason that people should discuss with their doctor whether or not the CHADS-VASc scoring system is right for them.
Hope this helps!
So what you are telling me is that because I am 70 years old and a female, I’m doomed to be more likely to have a atrial stroke than others.
I have no way to change my sex or age and that adds up to 2.
Why did I even read this article?
Thanks for reading! Unfortunately, you are correct in that there are some atrial fibrillation stroke risk factors that can’t be changed according to the CHADS-VASc scoring system.
Please note that the CHADS-VASc scoring system is not perfect. And many aspects of the scoring system are controversial like the part on gender. For example, some studies have shown that gender is not a risk factor for stroke.
Also, even though some aspects of the CHADS-VASc scoring system can’t be changed, you can dramatically lower your overall stroke risk by lifestyle optimization. This is something that I covered in a different blog post: https://drjohnday.com/9-things-i-would-do-to-prevent-atrial-fibrillation-strokes/
Hopefully, with new research, the CHADS-VASc scoring system will be updated or changed in time.
All the best,