Heart disease is a major problem in men and is increasingly common in women, especially with advancing age. With changes in hormone levels, menopause appears to be associated with the start of a rise in cardiovascular disease in women. In women, angina is the most common initial symptom, whereas in men, myocardial infarction (heart attack) is the most frequent first sign of heart problems.
Cardiovascular disease – Signs & Symptoms
- Shortness of breath.
- Fatigue, exercise intolerance.
- Coughing, especially when waking.
- Chest pain/pressure which is worse during exercise.
- Intermittent claudication (cramp-like pain caused by poor circulation.
- Excessive night time urination.
- Insomnia.
- Unexplained nausea, vomiting, anorexia.
- Anxiety.
- Swelling (fluid retention) in extremities: ankles, fingers, etc.
- Earlobe creases – a unilateral crease is associated with a 33 per cent higher risk and bilateral ear creases indicate a 77 per cent higher risk.
We all know that cholesterol is among the risk factors for heart disease. However, 50 per cent of patients with heart disease do not have any of the traditional risk factors such as high cholesterol, especially when younger than 50 years of age. While it is important to check your triglyceride and cholesterol fractions regularly, there are other measures of heart risk that should be checked too, particularly if you have a family history of cardiovascular disease (especially at a younger age). We will look at the many factors that spell problems for your heart but we will begin with the latest on your old friend: cholesterol.
Risk factors for Heart Disease
- Hyperlipidaemia: lipoprotein(a), cholesterol.
- Chronic inflammation.
- Hypercoagulability (propensity to develop blood clots.
- Hyperhomocysteinaemia (where high levels of homocysteine damage the lining of the blood vessels).
- Chronic infection (from Chlamydia pneumoniae which causes pneumonia, or various bacteria and viruses).
- Hypertension.
- Insulin resistance (and diabetes).
- Iron overload(haemochromatosis).
Cholesterol update
Cholesterol is a vitally important substance in the body. It is found in all animal tissue and is manufactured in the tissues of the body that require it. It is critical in the liver for bile production, in the brain and nerve cells, in the skin for the production of vitamin D, in the ovaries and testes for production of oestrogen and testosterone, and in the adrenal glands for the manufacture of cortisol. In other words, if your cholesterol levels are too low, you can’t think properly, and you’re likely to lose your memory and have no libido.
Cholesterol levels can also be too high, however, and depending on the type of cholesterol that is elevated, can be a risk factor for heart disease. As you produce your own cholesterol, the amount you eat is inversely proportional to body synthesis: the less you eat, the more you make. Blood cholesterol does not reflect dietary cholesterol but it does reflect the cholesterol you have manufactured. For example, the higher the saturated fat in your diet, the more cholesterol you have to make to metabolise it. Remember that 70 per cent of the body’s cholesterol is produced by the body, independently of dietary sources. Be aware of the difference between high saturated fat and high cholesterol diets.
But your total cholesterol measurement doesn’t really tell you whether you are at risk for cardiovascular (heart) disease. For that you need to know the ratio of your cholesterol fractions. There are several different types of “cholesterol”: the so-called good cholesterol, the high density lipoproteins (HDLs); and the so-called bad type, the low density lipoproteins (LDLs).
When levels of HDLs (high density lipoproteins) are elevated, cardiovascular disease is reduced. HDLs protect against the development of atherosclerosis and ensuing heart disease, particularly in the early stages. The HDL cholesterol fraction collects fats that have deposited in the arteries and delivers them back to the liver to be made into bile so you can digest your next fatty meal.
The LDLs, on the other hand, deliver cholesterol to places in the body where it is needed and deposits it there. This is useful if you have the correct amounts but if you have excess cholesterol, it can potentially lead to a problem. This cholesterol fraction also carries (and deposits) oxidised cholesterol, free radicals, chemical and pesticide residues, and so on. The most common genetic problem is a reduced ability to break down LDLs – so they build up and prevent the formation of HDLs. There is also a genetic fraction that increases cardiovascular risk: lipoprotein(a).
Standard cholesterol tests miss 50 per cent of people at risk for heart attacks, due to their inability to detect abnormally small cholesterol particles. Both LDL pattern B and lipoprotein(a) increase the risk of heart attack threefold, but neither can be detected by standard cholesterol tests.
While other factors do have an impact on the risk of heart disease, atherosclerosis results ultimately from deposition of plaques of cholesterol esters (and foam cells), so cholesterol metabolism must be precisely regulated.
Lifestyle Risk Factors for High-LDL cholesterol
- Smoking.
- Obesity.
- Stress.
- Sedentary lifestyle (lack of exercise).
- Excessive alcohol, nicotine, caffeine and trans fatty acids .
- Dehydration (ensure sufficient drinking water).
- Dietary inadequacies.
- High-fat diets (especially oxidised fats).
- High-sugar (simple carbohydrate) diets.
- High sodium chloride (salt) in the diet.
- Low nutrient diets.
The cholesterol balance
To raise your HDL and lower your LDL, make sure that your diet is higher in vegetable than animal fats, i.e. higher in unsaturated than in saturated fats (although some animal fats are useful and some vegetable oils are overprocessed and contain trans fatty acids). Use extra virgin cold pressed olive oil for cooking and eating. Legumes (such as lentils) have a cholesterol-regulating effect. The blood of vegetarians shows markedly less cholesterol than that of meat-eaters. Avoid trans fatty acids, as these can be as damaging as saturated fats. (See the article on Trans Fats in WellBeing #109). High-fibre diets are important, so supplement with soluble and insoluble fibres such as psyllium, pectins, slippery elm and oat bran. Foods that have a regulatory effect that will improve cholesterol metabolism and are anti-inflammatory are fish, ginger, turmeric, garlic and onions.
Other factors that can balance cholesterol:
- Essential fatty acids from fish oils (omega-3) and evening primrose oil (with zinc, magnesium and vitamin B6) help reduce inflammation and thin the blood.
- Lactobacillus acidophilus and bifidobacteria both inhibit the synthesis of cholesterol in the liver.
- Lecithin helps transport and metabolise cholesterol and improves liver function.
- Increase your intake of B vitamins and Vitamin C (which increases the rate of conversion of cholesterol to bile acids).
- As for minerals, chromium is important to regulate sugar metabolism, manganese converts cholesterol into steroid hormones, and selenium reduces free radical damage.
- Calcium and magnesium in the correct proportion (2:1 ratio) are important for heart health.
- Sunlight uses cholesterol to manufacture Vitamin D.
C-Reactive Protein
C-reactive protein (CRP) is a marker of inflammation in the body and elevations in CRP are now regarded as the single strongest predictor of future vascular risk in both genders. The body releases CRP into the bloodstream when blood vessels leading to the heart are damaged, so it is a measure of the degree of inflammation in arterial linings, a biomarker of myocardial (heart muscle) damage and a marker of heart attack and stroke risk. People with high levels of CRP are three times more likely to die from a heart attack, and seven times more likely to die from a stroke, than people with low levels. When you get your next blood test, ask your doctor to test for C-Reactive Protein (high sensitivity).
C-Reactive Protein Levels are lowered by:
- Fish Oils (omega-3 fatty acids)
- Vitamin B6
- Vitamin C
- Vitamin E (1,200 mg per day for at least three months)
- Salicylates containing herbs (e.g. Filipendula ulmaria or Meadowsweet)
- Salix alba (White willow bark).
Fibrinogen
Fibrinogen has been identified as an independent risk factor for cardiovascular disease because it plays a role in thrombosis (blood clotting). Fibrinogen levels have been found to be significantly higher in people with cardiovascular disease and in people with other higher risk factors. As fibrinogen increases platelet aggregation, it can be used to identify individuals with increased risk of thrombosis.
To lower fibrinogen levels, take:
- Salicylates containing herbs (such as Meadowsweet and White willow bark).
- Aspirin .
- Camellia sinensis (Green tea).
- Ginkgo biloba.
- Garlic (clinical studies have shown that both raw and fried garlic cause a reduction of fibrinogen levels within six hours of their consumption) .
- Curcuma longa (Turmeric).
- Vitamins A, beta-carotene, C & E.
- Fish oils and olive oil.
Homocysteine
A growing body of evidence suggests that an elevated serum homocysteine level is a risk factor for heart disease, independent of other known risk factors. Homocysteine is an intermediary toxic substance produced in the metabolism of sulphur proteins in the liver. Levels of homocysteine are largely determined by nutritional status and lifestyle choices. High levels increase abnormal blood clotting and the deposition of cholesterol around the heart muscle and in the arteries. Approximately 40 per cent of all heart attacks and strokes are caused by elevated homocysteine levels.
Alcohol, tobacco smoking, coffee, ageing, stress, diabetes mellitus and hypothyroid patients exhibit elevated homocysteine levels. Nutritionally, low levels of folic acid and vitamins B12 and B6 increase homocysteine levels significantly, as a lack of these nutrients prevents homocysteine being metabolised correctly. Eating a diet high in fruits and vegetables (about 0.5 kg daily) lowers homocysteine levels by 11 per cent compared with those eating fewer fruits and vegetables.
How to reduce homocysteine levels:
- B group vitamins lower homocysteine levels by up to 50 per cent
- Folic acid (500-1000 mcg per day) lowers elevated homocysteine levels by 25 per cent. Take with vitamins B12 and B6.
- Vitamin B6 (as P5P, 10-50 mg per day) inhibits formation of homocysteine.
- Vitamin B12 (400-1,000 mcg per day) facilitates the conversion of homocysteine back to methionine.
- Vitamin E inhibits the ability of homocysteine to stimulate the oxidation of LDL cholesterol.
High blood pressure
High blood pressure is characterised by blood pressure persistently exceeding 140/90 mmHg. Current research indicates that an optimal blood pressure is below 120/80 mmHg. Damage to the blood vessels can occur when the blood pressure is moderately but chronically elevated. However, the common symptoms of high blood pressure such as nosebleeds, tinnitus, dizziness, headaches, blurred vision and arrhythmias are not always present. Hypertension increases the risk of cardiovascular disease because the sustained elevation of blood pressure irritates the lining of blood vessel walls and they become thickened, inelastic and resistant to blood flow.
Excess insulin – Syndrome X
Hyperinsulinaemia (Syndrome X) is considered a cardiac risk factor, and may best explain why some individuals are not protected from heart disease even when blood pressure is treated. Excess insulin generates a stress response, resulting in the release of hormones that raise blood pressure by reducing blood vessel diameter. Hyperinsulinemia also encourages the retention of sodium and water, a process that increases blood volume and blood pressure. About 50 per cent of people with high blood pressure are insulin resistant. Syndrome X is closely related to diabetes.
In diabetes, atherosclerosis tends to develop early, progress rapidly and be more virulent. Data released from the Framingham Heart Study showed a 2.4-fold increase in congestive heart failure in diabetic men and a 5.1-fold increase in diabetic women during the 18-year study. Eighty per cent of people with diabetes die as a result of cardiovascular diseases, especially heart attacks. Diabetes also increases homocysteine levels.
Obesity
Obesity is a risk factor for most degenerative diseases, including heart disease, but the pattern of fat distribution is more important than weight alone. People with android obesity (apple-shaped bodies, i.e. abdominal obesity), have an increased risk of hypertension, diabetes, hyperinsulinism, cardiovascular disease and premature death. Conversely, fat distribution confined primarily to the hips, which is more common in women than in men, confers less risk. Obesity is a common denominator associated with excessive fibrinogen, elevated C-reactive protein, and insulin resistance and therefore increased cardiovascular risk. It is essential, in other words, to keep your weight under control.
Stress
Many heart symptoms, such as palpitations, arrhythmias and heart attacks, occur as a result of a stressful experience. Under stress, adrenaline increases, resulting in an increase in breathing, heartbeat and blood pressure. Anxiety and depression both have cardiovascular effects. A recent study of 2800 men and women over 55 years of age showed that even minor depression can increase cardiac mortality by 60 per cent, while major depression may actually triple the rate of cardiac-related deaths. Stress also raises cholesterol, changes food choices (usually by increasing sugar and salt consumption), alters insulin resistance and increases blood pressure, magnifying the risks imposed by a heart attack.
Stress management through meditation, yoga, Tai chi and regular moderate exercise can be an important component in the prevention and management of cardiovascular disease.
Loving your heart
There are many risk factors to your heart’s health but you can address them with sensible life choices. Heart-protective food choices include a diet high in fresh fruits and vegetables, and low in meat, as well as adequate calcium in foods like yoghurt; the major protein sources should be fish and vegetable proteins such as legumes. Foods that are high in fibre (especially soluble fibre) also help manage cholesterol. Decrease sodium in the diet; small amounts of Celtic sea salt can be used instead. Garlic, ginger, onions and turmeric all have a beneficial effect on circulation. It is also critical to ensure that you drink sufficient pure water to maintain good hydration.
High-fat meals reduce the function of the arterial system for four hours in healthy people. Very low fat diets are counterproductive, however, as adequate amounts of essential fatty acids (particularly omega-3 fatty acids) are necessary to regulate the prostaglandin pathways and manage inflammation. Low fat diets are commonly also low in the critical fat-soluble antioxidants such as vitamins A, D, E and K, and Coenzyme Q10. Be aware of your risk factors, make sensible changes to your lifestyle and your heart will love you for it.
