Take Care of Your Heart: A Comprehensive Approach to Cardiovascular Care
Optimal wellness necessitates optimal function of all the systems and components of the human body. Breakdown in any one area can lead to illness and disease, so it is difficult to call any single body part more important than any other. If pressed, however, most would agree that your heart and overall cardiovascular system are a pretty vital piece of the puzzle.
Maintaining a healthy heart means having vessels clear of obstruction that allow the body to carry vital oxygen and nutrient rich blood to each and every cell. Dysfunction can quickly lead to devastating effects and cardiovascular damage can come in many forms. Indeed, cardiovascular disease is a broad category, encompassing a wide array of heart and vessel conditions, including coronary artery disease, atherosclerosis (hardening of the arteries), arteriosclerosis (narrowing of the arteries), hyperlipidemia (elevated cholesterol), high blood pressure, arrhythmias, congestive heart failure, heart attack and stroke.
Although there has been some improvement in recent years, cardiovascular disease is still the leading cause of death in the U.S., claiming more lives than all forms of cancer combined. About 630,000 Americans die from heart disease each year—that’s one in every four deaths. Coronary heart disease is the most common type of heart disease, killing about 366,000 people in 2015. In the U.S., someone has a heart attack every 40 seconds, and each minute, more than one person dies from a heart disease-related event.
Direct and indirect costs of heart disease total more than $300 billion—including health expenditures and lost productivity. The miracle of modern medicine has been the vast reduction of infectious disease, but as people are able to live longer, what is taking its place is cardiovascular disease. Clearly, this is something worthy of attention.
It’s also important to note that cardiovascular disease is not just a concern for men. While the classic stereotype of a severe heart attack is often portrayed as suffered by an overweight, overstressed man, women are equally at risk. One out of 31 female deaths in the U.S. is from breast cancer, as compared to one out of eight from heart disease. Approximately one woman dies from heart disease every minute, and the American Heart Association reports that 50 percent of men and 64 percent of women who died suddenly of coronary artery heart disease had no previous symptoms.
Cardiovascular Risk Factors
High blood pressure, unhealthy cholesterol levels (not just high cholesterol) and smoking are key risk factors for heart disease. About half of Americans have at least one of these three. Several other medical conditions and lifestyle choices can also put people at a higher risk for heart disease, including diabetes, obesity, hypertension, poor diet, physical inactivity and excessive alcohol use. It’s quite easy to lead a relatively sedentary life, make poor dietary choices and get overwhelmed with the stresses of everyday life. These, plus some unlucky genetics, are a recipe for progressive heart disease.
Although it gets all the attention, cholesterol is not the only, or even the best predictor of heart disease. In fact, our total cholesterol is an especially weak predictor—yet it seems to have become the be-all and end-all number in determining treatment. Further, the common explanation of “good” versus “bad” cholesterol misses the mark in a more comprehensive view of cardiovascular risk.
This is because 50 percent of individuals who suffer heart attacks have normal “bad cholesterol” (low density lipoprotein, or LDL). Far more important than total LDL are the particular sub-particle levels that are present. A higher total LDL level that is made up of mostly larger LDL particles is of less concern, while smaller, dense LDL particles have the capacity to do more damage within the vessels.
Size matters in terms of HDL (high density lipoprotein) as well, where larger particles are able to carry more cholesterol out of the vessels to be recycled within the liver, and thus are more protective. Particle size is not considered in a basic cholesterol panel, the standard that is drawn in most doctor offices. By not looking at these markers, vital information is missed in the assessment of an individual’s overall cardiovascular risk.
There is some important data to be derived from a basic panel, though. Elevated triglyceride levels are an independent predictor of heart disease, and higher triglycerides in the blood also increase the amount of the small dense LDL particles that are present. An important ratio to consider is the amount of triglyceride compared to HDL. A 2:1 ratio is optimal, where there is no more than twice the amount of triglyceride than HDL. Unfortunately, a standard American diet combined with a sedentary lifestyle tends to send triglyceride levels up and HDL down—a double hit that increases heart disease risk.
Blood sugar dysregulation is another important risk factor for cardiovascular disease. In fact, 68 percent of people over age 65 with diabetes will die not directly from that condition, but due to some form of heart disease. Sustained levels of elevated blood sugar cause significant damage within the vascular system due to its inflammatory effect. High blood sugar causes elevated levels of fasting insulin, which causes the body to store more fat, as well as creating additional inflammation.
Elevated blood sugar is also commonly associated with hypertension and excessive weight gain, which also increase cardiovascular risk. The take-home message here is that intake of sugar is far more damaging than fat in the diet—a fact that was lost and falsely turned on its head for the past half century, but is finally starting to gain traction and is being correctly conveyed today.
Chronic inflammation is getting more attention as an underlying cause of many common diseases, and for good reason. In the case of cardiovascular disease, inflammation is the main driver of the wrong kind of cholesterol ending up in the wrong place. This is the body’s way of trying to repair the damage, but over time these plaque accumulations within the vessels can lead to even more trouble, including heart attack or stroke.
One particular cholesterol particle is especially responsible for inflammatory changes within the blood vessel: a kind of especially small dense LDL molecule known as lipoprotein A, or LpA. Having an LpA level above 75 doubles our risk of cardiovascular disease, regardless of any other factors. This is one of the strongest predictors available. Unfortunately, LpA is a mostly hereditary trait, which is why it is high in individuals with very strong family histories of cardiovascular disease. It can be a hard number to budge (and it is not affected by statin medications), but there are some interventions that may reduce the level, or more importantly, mitigate that elevated risk. Again, it is vital to have this information so we can make the best-informed decisions in the quest for optimal health.
The Power of Prevention
The trouble with cardiovascular disease is that too often there are no noticeable signs at all until the sudden appearance of life-threatening symptoms. That’s why it so important to screen and assess for risk prior to a significant cardiovascular event. In no aspect of medicine is prevention as important as with heart health. Testing is readily available for assessing all the advanced cardiovascular risk markers mentioned here. Whether dealing with current cardiovascular issues or interested in prevention, obtaining this information is vital to our health. Based on these lab tests, naturopathic medicine has much to offer when it comes to keeping hearts healthy.
It should come as no surprise that the foundational basics of health are vital for a healthy cardiovascular system. A low carbohydrate, plant-based Mediterranean diet and regular cardiovascular exercise are crucial. Additionally, sufficient quality sleep, adequate stress management tools and plenty of emotional love and support cannot be underestimated. Add to that additional individualized naturopathic interventions to lower inflammation, strengthen cardiac function and improve lipid profiles, and there can be a comprehensive holistic plan to help keep our hearts healthy for years to come.