CARDIOVASCULAR DISEASE, Andrew Weil, M.D.

[Guest guest]

CARDIOVASCULAR DISEASE

 

Cardiovascular disease is a collection of illnesses that include

heart disease, high blood pressure, stroke and congestive heart

failure. It is the leading cause of death in the United States.

 

Here are some compelling statistics on Cardiovascular Disease from

the American Heart Association's " Heart Disease and Stroke

Statistics " – 2004 Update:

 

Cardiovascular Disease (CVD) has been the number one cause of death

in the U.S. since 1990.

 

More than 64 million Americans have one or more types of CVD; 50

million have high blood pressure.

 

More than 13 million Americans have coronary heart disease.

 

One in five Americans has some form of CVD.

 

One in three men develop CVD before the age of 60, versus one in 10

for women.

 

CVD alone has claimed more lives each year than the next seven

leading causes of death combined.

 

Each day, more than 3,850 Americans die of CVD, that's one death

every 8.64 seconds.

 

Heart disease or coronary artery disease

 

Heart disease or coronary artery disease is caused by

atherosclerosis. Atherosclerosis is a condition in which cholesterol-

rich plaque builds up along the arterial walls. High cholesterol

levels can play a part, though they do not always result in

atherosclerosis and atherosclerosis can exist with normal

cholesterol levels. But when the coronary arteries are affected, the

condition is called coronary artery disease.

 

How does atherosclerosis develop?

 

Atherosclerosis seems to begin with an injury to the endothelial

lining along the artery wall. Interestingly, this process actually

can begin at an early age. Once an injury occurs, white blood cells

such as monocytes and macrophages, along with lipids, begin to

accumulate along the inner layer of the artery as well as the muscle

layer. Smooth muscle cells begin to multiply from the irritation and

eventually form a plaque. Platelets and other blood clotting

factors stick to the rough surface of the artery wall, forming a

thrombus (clot).

 

A clot can continue to grow until it completely blocks an artery,

cutting off the oxygen supply to a vital organ. Or a clot can break

free from the vessel wall and become lodged somewhere else further

downstream. This could lead to a heart attack or stroke if the clot

completely blocks the blood and oxygen supply to a major artery

leading to the heart or brain.

 

Although initially there are no symptoms, once the arteries become

very constricted, one may experience pressure or tightening in the

chest due to a lack of oxygen being delivered to the heart

(angina). There may also be cramping in the lower extremities due

to blockage in the peripheral veins (peripheral vascular disease).

 

Factors associated with heart disease

 

Researchers now believe that many different problems can lead to

heart disease. And cholesterol can often play a key part.

 

Cholesterol is a waxy, fat-like substance made by the liver. It is

an essential component of cell membranes and used to produce

hormones and vitamin D.

 

Cholesterol is carried through the body attached to two different

compounds called lipoproteins: low-density lipoproteins (LDL) and

high-density lipoproteins (HDL). LDL is commonly known as the " bad

cholesterol " ; it carries cholesterol from the liver throughout the

body, making it available to be deposited in artery walls. HDL is

known as the " good cholesterol " ; it picks up cholesterol from the

arteries and delivers it to the liver to be recycled or eliminated

from the body.

 

The body needs cholesterol to function – but too much of it in the

blood, or too much of the wrong kind, add up to trouble. The factors

leading to heart disease are as follows:

 

High total cholesterol – especially high LDL levels – These two

factors combine to form a well known risk factor for heart disease

(though people can have heart disease without having high

cholesterol). Lifestyle may influence cholesterol levels but the

tendency appears to be genetic. Dietary and nutritional supplement

treatment of high cholesterol levels are moderately effective.

Medications to lower cholesterol are usually very effective.

 

Low HDL cholesterol and high triglyceride levels – This is a

different pattern than high total and LDL cholesterol although

someone may have both. This pattern, associated with insulin

resistance, is also genetically driven and appears to affect as much

as 30 percent of the population. It carries with it a high risk of

high blood pressure and diabetes as well as heart disease. Dietary

and nutritional supplement treatment for this pattern are different

from those for high total and LDL cholesterol levels. Here,

lifestyle changes are generally quite effective.

 

Elevated homocysteine levels – This risk factor for heart disease is

unrelated to cholesterol levels.

Homocysteine is an amino acid that can accumulate in the blood when

a person does not get enough folic acid and vitamin B6. This

condition is also genetically driven. Folic acid requirements for

some individuals may be much greater than the RDA of 400 mcg.

 

Smoking – This habit alone can increase risk of heart disease.

Smoking increases oxidation in the body and is harmful to blood

vessels.

 

Family history – a family history of any type of cardiovascular

disease increases an individual's risk of developing the disease.

Genetic tendencies, however, can be countered by a healthy lifestyle

in most cases. If you have a family history of heart disease, we

recommend paying particular attention to diet, exercise, stress

reduction and supplements.

 

Nutritional supplements and family history of heart disease

 

Fish oil – The omega-3 fatty acids in fish and fish oil supplements

have been shown to be an effective preventive strategy against heart

disease. They can lower triglyceride levels, increase HDL

cholesterol, help minimize inflammation and blood clotting, and keep

blood vessels healthy.

 

Coenzyme Q10 – This antioxidant is thought to be one of the most

important antioxidant supplements for protection against many forms

of cardiovascular disease. It helps protect LDL cholesterol from

oxidation, maintains healthy blood vessels, protects against clots

and plaque rupture, and supports optimal functioning of the heart

muscle.

 

What you can do to lower your cholesterol

 

Reduce greatly the amount of saturated fat you eat.

 

The richest sources of saturated fat (fat that is usually solid at

room temperature) in the diet are dairy foods (except the fat-free

versions), especially whole milk, cheese, butter and cream. Red meat

is also high in saturated fat.

 

Avoid trans–fat.

 

If you find " partially hydrogenated oil " listed in the ingredient

list of food labels, find a healthier substitute. There are many

spreads available on the market today that are free from trans-fat.

Trans-fat is also found in snack foods like chips, crackers and

cookies. It is found in the oils used to cook fast-food french

fries, doughnuts and movie popcorn.

 

Substitute non-gmo soy protein for animal protein. The protein in

soy foods have been shown to lower cholesterol levels. Try to

incorporate two servings a day into your meals. Choose from tofu,

tempeh, soy milk, whole soy beans and roasted soy nuts.

 

Use fresh garlic regularly in your meals. Garlic has been shown to

lower both cholesterol levels and blood pressure, and it tastes

wonderful, too. Use one or two lightly cooked cloves a day.

 

Drink green tea daily. The antioxidants in green tea help lower

cholesterol and prevent the cholesterol in your blood from

oxidizing.

 

Eat plenty of soluble fiber. Soluble fiber has a powerful

cholesterol-lowering effect. The best sources of soluble fiber are

beans and lentils, apples, citrus fruit, oats, barley, peas, carrots

and ground flax seed.

 

Lose weight. Even a modest amount of weight loss can lower

cholesterol levels.

 

Nutritional supplements and cholesterol

 

Coenzyme Q10 (CoQ10) – CoQ10 is a powerful antioxidant that has been

shown to be beneficial for heart health by protecting LDL

cholesterol from oxidation and re-energizing the mitochondria in the

heart cells, which is where energy metabolism occurs. This nutrient

is very important for the heart cells of patients with heart

failure. CoQ10 may also help lower blood pressure.

 

Fish oil – Though omega-3 fatty acids in fish oil don't specifically

lower total or LDL cholesterol levels, they do seem to reduce the

risk of heart disease by reducing platelet stickiness, inflammation

and triglyceride levels.

 

Insulin Resistance (high triglycerides and low HDL cholesterol)

 

Insulin resistance is now being recognized as an important and

common condition associated with heart disease, as well as diabetes

and high blood pressure. It affects an estimated 25-30 percent of

the non-diabetic population. It is primarily characterized by high

triglyceride and low HDL cholesterol levels, although high total

cholesterol may also be seen. Genetic factors play a significant

role, but diet and lifestyle changes can make a big difference (an

even bigger difference than in the previously discussed condition

of high total and high LDL cholesterol).

 

A little background: Insulin is a hormone that facilitates the

transport of glucose from the blood into cells where it is used as

fuel. When blood sugar rises after a meal, the pancreas secretes

insulin into the bloodstream. With insulin resistance, the normal

amount of insulin secreted is not enough to move glucose into the

cells – thus the cells are " resistant " to the action of insulin. To

compensate, the pancreas secretes even more insulin in order to

maintain fairly normal blood sugar movement into cells and a normal

blood sugar level.

 

The resulting high levels of insulin, however, have several negative

effects -- on the enzymes in the liver that produce cholesterol,

and on the kidney leading to high blood pressure, as well as on the

enzymes in cells that regulate inflammation. Eventually, blood sugar

levels rise either because the pancreas stops producing insulin or

the cells become more and more resistant to the insulin that is

produced. The body's inability to adequately compensate leads to

diabetes.

 

Having diabetes, even in the early stages, significantly increases

the risk of heart disease. Early diabetes may be the first time

insulin resistance is recognized.

 

Warning signs and diagnosis of insulin resistance?

 

Individuals with insulin resistance are often overweight, with their

extra pounds accumulating in their abdomens, the classic " apple "

shape. They often have family history of diabetes, high blood

pressure or heart disease. Interestingly, although insulin

resistance is usually seen in people who are overweight, thin people

can also have the problem and be at the same risk for heart disease,

high blood pressure and diabetes.

 

The easiest way to diagnose the problem is to take a blood test that

looks for the following indicators: A low HDL cholesterol is almost

always seen, along with a high triglyceride level. You may also

check for a high fasting insulin level. A high uric acid level

sometimes accompanies these values.

 

What can you do about insulin resistance?

 

Watch your carbs – The classic low-fat, high carb diet that was the

standard recommendation for preventing or treating heart disease for

years can actually make insulin resistance worse. Carbohydrates

(starches and sugars) raise blood sugar levels and trigger the

release of insulin. A moderately low-carbohydrate diet (40-45

percent of calories) emphasizing low glycemic index sources of

carbohydrate (those that raise blood sugar levels slowly rather than

quickly) is recommended. In general, foods very rich in fiber are

healthy.

 

Cut saturated fats, but keep monosaturated fats --

 

Include moderate amounts of monounsaturated fat (30-35 percent of

calories, i.e. extra virgin olive oil, avocadoes) rather than

following a low-fat diet. However, in this condition, as with high

total and LDL cholesterol, saturated fat makes the situation worse.

 

Eat generous amounts (5 or more servings) of non-starchy vegetables

and one to two servings of low-glycemic index fruit every day.

 

Lose weight if you are overweight. Even small amounts of weight lost

can improve insulin resisitance.

 

Exercise – Vigorous aerobic exercise decreases the cells' resistance

to insulin.

 

Eat fish frequently – The best are cold-water fish like wild salmon

and sardines that are high in omega-3 fatty acids. This type of fat

seems to improve cells' response to insulin.

 

Eat small, frequent meals to keep blood sugar levels as stable as

possible.

 

Nutritional supplements and insulin resistance

 

Coenzyme Q10 (CoQ10) – CoQ10 is a powerful antioxidant that has been

shown to be beneficial for heart health by protecting LDL

cholesterol from oxidation and re-energizing the mitochondria in the

heart cells, which is where energy metabolism occurs. This nutrient

is very important for the heart cells of patients with heart

failure. CoQ10 may also help lower blood pressure.

 

Alpha-lipoic acid – This antioxidant nutrient improves the cells'

response to insulin and can reduce blood sugar levels.

 

Magnesium – Higher insulin and blood sugar levels are seen in people

with low plasma magnesium levels, and magnesium supplementation

improves insulin resistance in animal studies

 

Chromium – It improves glucose utilization in people with high blood

sugar levels and improves insulin resistance in animals.

 

High homocysteine – What is it?

 

Homocysteine is an amino acid that is produced in the body from

another amino acid called methionine. One of methionine's main

functions is to provide methyl groups for cellular reactions. A

methyl group is a small, simple chemical fragment consisting of one

carbon molecule and three hydrogen molecules.

 

When methionine donates a methyl group for a cellular reaction, it

becomes homocysteine.

 

Typically homocysteine then receives another methyl group from

either folic acid or vitamin B6 and is turned back into methionine.

Vitamin B12 acts as a cofactor for this reaction.

 

In short, if you don't have enough of certain critical B vitamins,

your homocysteine level rises.

 

A high homocysteine level is primarily a sign of an inadequate

intake of folic acid or vitamin B6.

 

Factors that control homocysteine levels:

 

Genetics – There are genetic variations in folic acid absorption and

utilization. Some individuals therefore need much more folic acid

than the RDA of 400 mcg.

 

Stress – Epinephrine and norephinephrine are stress induced

neurotransmitters. Their metabolism in the liver involves

methylation, a process that uses methyl groups, and can increase

need for methyl donors like folic acid.

 

Coffee consumption – As coffee consumption increases, homocysteine

levels increase.

 

The amount of folic acid, vitamin B6 or vitamin B12 in your diet and

supplements.

 

What is the relationship between homocysteine, heart disease and

strokes?

 

High homocysteine levels are associated with atherosclerosis.

Homocysteine is thought to be damaging to the lining of blood

vessels, leading to atherosclerosis. As homocysteine levels

increase, the risk of heart disease and stroke increase.

 

(High homocysteine levels are also associated with risk of cancer

and cervical dysplasia, as well as neural tube birth defects like

spina bifida.)

 

Diagnosing high homocysteine

 

Although the reference ranges for homocysteine from most labs show a

normal range up to 12, homocysteine researchers are suggesting that

any level over 8 should be treated.

 

Nutritional supplements and homocysteine

 

Folic acid, vitamin B6, vitamin B12 and betaine are all involved in

the process of adding a methyl group back to the homocysteine

molecule. Supplementation of these nutrients will bring high

homocysteine levels down. Although the B vitamins (the first three

in the list) are found in our multivitamin, we recommend higher

doses depending on your homocysteine level. If your homocysteine

level is high, we recommend re-testing it six months after you begin

taking supplements.

 

Angina Pectoris

Angina is chest pain that can occur when there is a dramatic

decrease in the blood supply to the heart, an increased demand for

oxygen by the heart, or a combination of both. It is a symptom of

heart disease or coronary artery disease. If the walls of the blood

vessels are hard and unable to relax (for example, as a result of

atherosclerosis), the vessels will not be able to dilate properly,

which slows down blood flow. Increasing physical or emotional

exertion increases the demand for oxygen. If the arteries are so

blocked that the heart cannot receive sufficient oxygen to meet its

needs, angina can result.

 

What are the factors that cause angina or an oxygen deficit to the

heart?

 

Most often, angina is caused by coronary artery disease. In some

cases angina can result from a narrowing of the aorta (a major

vessel leading to the heart) due to an aortic valve abnormality;

arterial spasms causing a temporary constriction in the artery; or

an enlarged heart, in which the blood supply is no longer adequate

to supply sufficient oxygen to the heart.

 

What are the symptoms?

Look for chest pain that is intermittent, brief and persistent. The

length of an attack and the severity can vary. The pain feels like

a tightness or pressure in the chest that may radiate to the neck,

along the left shoulder or down the left arm.

 

Some experience difficulty breathing and nausea.

 

What triggers an angina attack?

Angina can be triggered by emotional or physical stress, exerting

oneself after a meal, or extreme temperature changes. Cigarette

smoking can also bring on an angina attack.

 

What can I do to reduce my risk of angina?

Follow a heart-healthy diet.

 

Don't smoke

 

Nutritional supplements and angina

 

Coenzyme Q10 (CoQ10) – CoQ10 is a powerful antioxidant that has been

shown to be beneficial for heart health by protecting LDL

cholesterol from oxidation and re-energizing the mitochondria in the

heart cells, which is where energy metabolism occurs. This nutrient

is very important for the heart cells of patients with heart

failure. CoQ10 may also help lower blood pressure.

 

Hawthorne Berry - Hawthorne is another antioxidant with heart-

enhancing properties. Hawthorne may help improve coronary artery

blood flow and circulation to the extremities of the body, therefore

improving symptoms of angina.

 

L – arginine – L –arginine is a precursor to nitric oxide that

relaxes blood vessels in the heart and has been shown to help

angina.

 

High Blood Pressure (Hypertension)

 

Hypertension is the most common form of cardiovascular disease in

America, affecting approximately 50 million people. That's close to

one out of four adults. High blood pressure is defined as a reading

above 140/90mmHg (systolic/diastolic). (Systolic pressure - the

first number - measures the pressure in the arteries when the heart

contracts. Diastolic pressure - the second number - measures the

pressure in the arteries when the heart is relaxing and filling with

blood.)

 

What causes high blood pressure?

The heart pumps blood through your arteries (large blood vessels),

pushing the blood against the artery walls with a force that is

measured as " blood pressure. " Normal blood pressure is around 120/80

mmHg. High blood pressure occurs when the artery walls lose their

elasticity and cause the pressure of the blood moving through the

arteries to rise. This excessive pressure makes the heart work

harder, and can eventually lead to an enlarged heart (cardiomegaly),

as well as damage to blood vessels in the kidneys and brain.

Hypertension, therefore, increases the risk of heart attacks, stroke

and kidney disease.

 

Doctors cannot pinpoint the precise cause of 90 percent of high

blood pressure cases, also known as " essential hypertension. "

However, they do know that certain factors can increase the risk of

developing high blood pressure:

 

Stress can cause hypertension by activating the sympathetic nervous

system, causing the arteries to constrict.

 

Eating large amounts of sodium can cause excess water retention,

expand blood volume and ultimately increase blood pressure.

 

A diet low in calcium, magnesium and potassium can increase blood

pressure

 

Insulin resistance can increase blood pressure by causing the

kidneys to retain sodium.

 

Regular alcohol intake can increase blood pressure.

 

Being overweight increases blood pressure.

 

What can you do to lower your blood pressure?

Follow the DASH diet. This diet, developed by researchers at the

National Institutes of Health's National Heart, Lung, and Blood

Institute is based on a large-scale research study which identified

the foods that affect blood pressure. The most important parts of

the DASH are generous amounts of fruit and vegetables and lowfat or

fat-free dairy products providing an adequate calcium intake. The

diet is also relatively low in fat and sodium. DASH researchers have

shown that diets rich in potassium, calcium and magnesium, and low

in sodium, (2,400 mg or less) play an important role in maintaining

healthy blood pressure levels. These are the high points of the

DASH diet:

 

Eat 8-10 servings of fruit and vegetables per day.

 

Choose low- or non-fat dairy foods, consuming 2-3 servings per day.

 

Limit animal protein to 6 oz per day, emphasizing lean sources.

 

Consume 4-5 servings of nuts, seeds and dry beans per week (2 Tbsp

nuts or seeds, or 1/2 cup cooked dried beans).

 

Eat plenty of fish – Include at least three servings of fish a week,

emphasizing cold-water fish like wild salmon and sardines that are

rich in omega-3 fatty acids.

 

Limit your caffeine intake - The caffeine in coffee, tea and sodas

can contribute to high blood pressure.

 

Limit alcohol intake – Blood pressure increases as your body

metabolizes alcohol.

 

Avoid processed foods - These are the biggest sources of sodium in

today's diet.

 

Maintain optimal weight - Even a minimal weight loss can improve

blood pressure.

 

Exercise – As little as 30 minutes of moderate exercise a day, like

walking, can lower blood pressure.

 

Relax –Meditation, yoga, breathing exercises or biofeedback are all

relaxation techniques that can help lower blood pressure.

 

Don't smoke – Smoking contributes to all cardiovascular diseases and

many other life-threatening conditions as well.

 

Nutritional supplements and high blood pressure

 

Calcium and magnesium – Inadequate intake of both of these minerals

has been associated with high blood pressure.

 

Vitamin C – A supplement of this antioxidant vitamin has been shown

to lower blood pressure in people with mild to moderate

hypertension.

 

Stroke

 

Stroke is the third leading cause of death when considered

separately from other types of cardiovascular disease, accounting

for about one out of every 14.5 deaths in the U.S., according to the

American Heart Association. About three-fourths of stroke victims

are over the age of 65, but a person can have a stroke at any age.

Although stroke seems to affect as many men as women, more women die

of a stroke than men in all age groups.

 

What is a stroke?

A stroke, also known as a cerebrovascular accident, is the death of

brain tissue caused from a lack of blood flow and insufficient

oxygen to the brain. The brain receives about 25 percent of the

body's oxygen supply from a continuous blood flow through two main

arteries, the carotid arteries (that come up through both sides of

the front of the neck) and the basilar artery (which forms at the

base of the skull from the vertebrae arteries). Strokes (like heart

attacks) can often result from a blockage in a blood vessel that

reduces or cuts off oxygen supply to the cells, resulting in the

death of the tissue. It only takes a short period of time without

oxygen to cause damage to the brain.

 

There are two main classifications of strokes:

 

Ischemic – The blood supply is cut off to part of the brain, either

due to atherosclerosis or a blood clot. Infections, inflammation or

certain medications can all contribute to ischemic strokes. These

strokes are the most common type, causing about 80 percent of all

stroke cases.

 

Hemorrhagic – These strokes comprise the remaining 20 percent of

cases. Hemorrhagic strokes are caused from a ruptured blood vessel,

preventing normal blood flow and causing bleeding into an area of

the brain. They can be the result of hypertension, which causes

excessive pressure on the arterial walls that may already be damaged

by arteriosclerosis. A ruptured aneurysm (the rupture of a weakened

area in the blood vessel wall), can also cause a hemorrhagic stroke.

 

What can I do to prevent a stroke?

Focus on your diet. Follow a diet designed for those with high blood

pressure and heart disease – it may be helpful in preventing

strokes.

 

Control your blood pressure either through lifestyle changes or

medication.

 

If you smoke, quit.

 

Exercise. People who exercise consistently have a lower risk for

having a stroke.

 

Limit alcohol. If you drink alcohol, do so only in moderation.

Moderate alcohol intake is defined as no more than one drink per day

for women and two drinks a day for men.

 

Take calcium and magnesium. These minerals are helpful in

controlling high blood pressure, one of the strongest risk factors

for stroke.

 

Manage diabetes and keep tight control of blood sugar levels.

 

Lower cholesterol into a healthy range.

 

 

Nutritional supplements and strokes

 

Calcium and magnesium – These minerals are helpful in controlling

high blood pressure, one of the strongest risk factors for stroke.

 

Congestive Heart Failure

 

Congestive heart failure (CHF) is a very serious heart condition in

which the heart cannot pump sufficient blood to keep up with the

body's oxygen demand. Even though the condition typically gets

worse over time, people are able to live with the disease for many

years.

 

What causes congestive heart failure?

CHF can stem from any disease that causes impairment in the heart's

ability to contract and pump blood, such as coronary heart disease.

Other factors include diabetes, an overactive thyroid gland, a viral

or bacterial infection to the heart muscle, or morbid obesity. When

the heart is constantly overworked, it first becomes larger – as

will any muscle in the body that you consistently exercise and push

hard. However, over time, the heart eventually tires out, resulting

in a decreased ability to pump an adequate blood supply.

 

What are the symptoms?

Fatigue and weakness, particularly when performing physical

activities, which stems from a lack of sufficient oxygen to the

muscles.

 

Swelling in the lower extremities. If the right side of the heart is

affected, fluid builds up in the feet, ankles, abdomen, liver and

legs. Left-sided heart failure can cause fluid retention in the

lungs, leading to shortness of breath.

 

Wheezing or coughing up pinkish phlegm.

 

Dizzy spells.

 

Rapid weight gain from fluid retention

 

Nutritional supplements and congestive heart failure

 

Coenzyme Q10 (CoQ10) – CoQ10 is a powerful antioxidant that has been

shown to be beneficial for heart health by re-energizing the

mitochondria in the heart cells, which is where energy metabolism

occurs. This nutrient is very important for the heart cells of

patients with heart failure. CoQ10 may also help lower blood

pressure.

 

Carnitine – This amino acid that is essential for energy metabolism

of the heart muscle.

 

Cordyceps – This medicinal mushroom is a good energy booster and can

improve the workload of the heart.

 

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