Beyond Cholesterol: Preventing heart disease and strokes

(December 2003) — It is important to start risk reduction for heart attacks and strokes at any age. Don’t wait for warning signs and symptoms. Checking the cholesterol panel during your yearly exam is only the first step in preventing damage in the vessels of your heart and brain. Other steps include more comprehensive lab tests, dietary changes, an aerobic exercise program and certain supplements. There are a number of tests that can be ordered to screen for vessel-damaging risk factors.

Homocysteine
Homocysteine is a biochemical highly irritating to blood vessels. Its lab value should be less than 10. You can bring it down with the correct combination of B vitamins, including folic acid, B12 and B6. Occasionally other nutrients are needed to bring it down, including trimethylglycine or a special folic acid called 5-methyl tetrahydrofolate.

Cholesterol values and antioxidants
It is best to keep your basic cholesterol fractions at certain levels and to prevent oxidation of cholesterol. There are certain standards for cholesterol and triglyceride values that relate to heart disease risk:

LDL <160 and <100-130 if possible
HDL >45 in men and >55 in women
Triglycerides <150
Total cholesterol <200

It is also important to measure lipoprotein(a), which is a harmful lipid related to LDL. Your lip(a) should be less than 30. A high value may be lowered with niacin taken under a doctor’s supervision. It can be helpful to know what subfraction and sizes your LDL and HDL are with a lipid subfraction study from a specialized lab.

Oxidized cholesterol from free radicals is most harmful. You can limit oxidation of cholesterol by including antioxidents in your diet. Augment your diet with antioxidents from flavonoids from darkly colored berries including blueberries and pomegranates. Consider a supplement mix of antioxidents including vitamin C, E, selenium, alpha lipoic acid and grape seed extract. You can also decrease your free radical exposure by decreasing toxic and chemical exposures.

Inflammation
Systemic or simply arterial inflammation can lead to inflammatory plaques that can rupture and abruptly close off an artery. Inflammation can make the smooth muscles stiff and make blood pressure rise.

According to a study of more than 50,000 nurses, the cardio CRP (C-Reactive Protein) test is the most specific indicator for an increased risk of heart disease due to inflammation. Your CRP should be less than 3, although less than 1 is ideal. Know your CRP score and have a holistic physician screen you for inflammation sources.

The most likely inflammation sites are your gums, arteries, sinuses and gastrointestinal tract. Highly purified fish oils can decrease inflammation and might stabilize inflamed plaque. Ocean salmon, sardines and small mackerel are good sources of the beneficial Omega 3 EPA oils. Due to the possibility of mercury in fish, though, it may be safer to take a purified fish oil; one gram per day is recommended.

Heart disease and women
Many women die from heart disease or have severe heart attacks and heart failure. Women are often told to not worry about higher LDL, triglyceride or total cholesterol figures because their HDL was high and their ratio was good. This might be improper reassurance if the beneficial subtraction of HDL is not a minimum value. Women need to heed warning signs. Doctors should comprehensively screen women with the above tests.

Insulin resistance
Insulin resistance and Syndrome X (obesity, hypertension and lipid abnormalities) can contribute to a risk for type 2 diabetes and heart disease. To reduce this risk factor, partake in regular aerobic exercise, limit starches and sugars, include chromium in your multiple vitamin and have your fasting glucose and hemoglobin A1C measured.

Diet, exercise and stress
Decrease saturated fats and eliminate partially hydrogenated fats. Eat a variety of organic fruits and vegetables. Eat organic whenever possible to decrease your exposure to pesticides and heavy metals. Try to exercise aerobically at least 30 minutes at your target heart range five to six days a week. Keep your stress well-managed and to a minimum. Support groups have been shown to decrease cardiovascular risk.

David Musnick, a holistic MD, is board certified in internal and sports medicine in Bellevue and is the author of Conditioning for Outdoor Fitness. He has special training in cardiovascular risk factor reduction. For more information, see www.drm.meta-ehealth.com or call 425-688-8818.