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Cardiovascular Disease

Heart disease and stroke are the most common cardiovascular diseases. They are the first and third leading causes of death for both men and women in the United States, accounting for nearly 40% of all annual deaths. More than 910,000 Americans die of cardiovascular diseases each year, which is 1 death every 35 seconds. Although these largely preventable conditions are more common among people aged 65 or older, the number of sudden deaths from heart disease among people aged 15–34 has increased. In addition, more than 70 million Americans currently live with a cardiovascular disease. Coronary heart disease is a leading cause of premature, permanent disability in the U.S. workforce. Stroke alone accounts for disability among about 1 million Americans. More than 6 million hospitalizations each year are because of cardiovascular

diseases. The economic impact of cardiovascular diseases on our nation’s health care system continues to grow as the population ages. The cost of heart disease and stroke in the United States is projected to be $403 billion in 2006, including health care expenditures and lost productivity from death and disability.

(http://www.cdc.gov/nccdphp/ publications/aag/pdf/aag_cvh2006.pdf)

Definitions of Cardiovascular Disease Risk Factors

Total cholesterol: Cholesterol is a waxy fat like substance. Total cholesterol refers to the sum of the different sub-fractions of cholesterol that are measured in the blood. Total cholesterol is an independent risk factor for cardiovascular disease. The National Cholesterol Education Program says 240 is considered high. A person with this level has twice the risk of heart disease compared with someone whose cholesterol is 200 mg/dL. Total cholesterol 200- 239 is borderline high cholesterol. Any cholesterol level of 200 mg/dL or more increases your risk. (More than

half the adults in the United States have levels above 200 mg/dL)

LDL cholesterol: Low density lipoprotein (LDL): A subfraction of total cholesterol. (Like oil and vinegar, cholesterol and blood do not mix well. So, for cholesterol to travel through, it is coated with a layer of protein to make it a lipoprotein. Hence the name LDL-cholesterol) LDL is the ‘bad’ or athrogenic cholesterol fraction. More directly correlated with risk for CVD then total really. Excess LDL builds up in your arteries (simplistically). The higher the level of LDL, the

greater your risk for heart disease. Generally above 130 is considered high, but some high risk individuals should have that even lower.

HDL cholesterol: High density lipoprotein: a subfraction of total cholesterol. The ‘good’ or non arthrogenic cholesterol fraction. General thought that the higher the better as it appears to ‘pick up’ or remove athrogenic LDL from the bloodstream.

Triglycerides: Another type of fat carried in the blood. Most of the body’s fat tissue is in the form of triglycerides, stored for use as energy. High triglyceride levels also are associated with increased CVD risk. In fact the number one risk factor is your triglyceride to HDL ratio. Take your total number of triglycerides and divide that by your HDL cholesterol. If that number is >3.5 you have an increased risk of having a cardiovascular event. If it is <3.5, your cholesterol numbers a whole are not as significant. The Cholesterol/HDL Ratio (tChol/HDL-C) is not as well known, and is often not calculated in conventional medicine, but we know it is a good predictor of insulin resistance or Metabolic Syndrome, and has been used by some (importantly Gerald Reaven) as a surrogate marker for insulin resistance. But there’s even more to the story than that, and that’s the sub-fractionations of cholesterol which must be included in the overall findings to truly know if your bad cholesterol is really all the bad and if your good cholesterol is really all that good. These are “specialty” labs not offered by conventional medicine but can offer an abundance of clarity in the overall cholesterol “story” and are readily done at our office.

Fat Mass: % body fat is pretty self explanatory. Once a woman goes over about 30% fat, there is a dramatic correlation with illness and disease, which is why we test every new patient with a body composition test.

High sensitivity C-reactive protein (hs-CRP): A very sensitive marker of systemic inflammation in the body. It’s actually an inflammatory mediator produced in the liver. This sensitive test measures ‘sub acute’ inflammation. That is, someone with rheumatoid arthritis would have a very high level. That’s not sub acute. However, if this marker is used to measure inflammation in individuals who don’t have overt inflammatory conditions it can pick up sub acute ‘smoldering’ if you will. It could be anything smoldering, but there has been a lot of work done in the past 10 years that suggests that many people with no overt inflammatory condition and who have elevated levels (not as high as RA mind you) are at increased risk for CVD. Hence this is an independent risk factor for CVD and the general acceptance that CVD is an inflammatory mediated condition.

Homocysteine: Another metabolite measured in the blood. Homocysteine is actually a by product of certain normal metabolic amino acid breakdown and processing. However, if it is elevated it suggests a ‘sluggish’ conversion or reconversion from one amino acid to another. (This conversion is controlled by enzymes and these enzymes are driven in part, by certain vitamins that act as cofactors. Hence you can often drive or quicken this process with folic acid, B6, B12

etc.) The problem here is that homocysteine, akin to LDL cholesterol, appears to be athrogenic, i.e. it damages the vessel wall. Thus high levels are independently associated with CVD. Additionally high levels appear to be independently associated with strokes and dementia as well as other things. Homocysteine is a simple blood test that I often recommend in my office.

Hemoglobin A1C (HbA1C): This is a measure of long term blood sugar control. It is actually measuring changes in the hemoglobin molecule brought about by bouncing against glucose in the blood stream. Essentially glucose in the blood is bumping up against red blood cells (which contain hemoglobin). The more glucose ‘bumps’ against RBC’s the more ‘pock marks’

it makes on that molecule. You can measure these marks as HbA1C. So you can see the higher the number, the higher glucose is overall in the blood. Since RBC’s stay around for 120 days, you can get a good assessment of long term blood sugar control. It is generally used in diabetics; however, it is now very clear that even modestly elevated HbA1C-within the normal range-is actually an increased risk for CVD.

Fasting insulin: Insulin is a hormone secreted by the pancreas in response to glucose levels in the blood. Insulin’s main action is to open up, or unlock the cellular ‘door’ to allow glucose to get into cells. Glucose needs insulin to get into a cell. In Insulin resistance (Metabolic Syndrome) insulin is not working efficiency and so the pancreas pours out more insulin. This is good, because then in many people their blood sugar remains in the normal range. However

it is also bad as insulin has various other metabolic effects-it causes, increased triglycerides, decreased HDL, increased blood pressure etc. So higher levels of insulin are associated with Metabolic Syndrome and CVD.

Blood Pressure: Pressure exerted by the blood upon the walls of the blood vessels, measured by means of a sphygmomanometer (BP cuff), and expressed in millimeters of mercury. The numerator is the maximum pressure that follows systole (pumping) of the left ventricle of the heart and the denominator the minimum pressure (that accompanies cardiac diastole). (Adult) blood pressure is considered normal at 120/80 where the first number is the systolic pressure and

the second is the diastolic pressure. Hypertension (there are different stages) starts at greater then 140/90.

Fasting glucose: The level of glucose or ‘blood sugar.’ Fasting, anything below 100 mg/dl is considered normal, 100-125 is considered ‘impaired glucose tolerance’ (IGT) and 126 or greater is considered diabetic. IGT just means, as with many things, there is a continuum, and this is in the danger zone. Some people consider this ‘prediabetic.’. Therapeutic Lifestyle Changes (TLC)

Therapeutic Lifestyle Changes (TLC) are recommended as a first line treatment for a variety of common health problems by many national health organizations, including: National Institutes of Health (NIH), National Cholesterol Education Program (ATP III Guidelines), American Diabetes Association, North American Menopause Society, American Heart Association, American Association of Clinical Endocrinologists, among many others, therefore this should be prescribed and implemented FIRST for a minimum of 3 months before any drugs are considered. Even when drug are necessary for the management of symptoms, the underlying cause must still be addressed through therapeutic lifestyle changes.


Naturopathic Approach

A naturopathic approach to treating someone with cardiovascular disease or risk would therefore include the implementation of a low glycemic, anti-inflammatory meal plan based specifically on your body composition results, so it would be an individualize, unique to you plan. Personal training may be recommended if being sedentary is part of the underlying cause of your cardiovascular risk. Clinical nutrition, and or botanical medicine may be prescribed in addition to the lifestyle changes, to enhance and support a speedy return to health in your cardiovascular system.

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