Here is the handout from the February 2nd, 2013 lecture.
What is Cardiovascular Disease?
This is traditionally thought of as a blockage of the vessels supplying the heart. This results in a decreased blood flow to the heart. When the blockage is moderate, the symptoms are highly variable but include fatigue, chest pressure and shortness of breath.
When a vessel is completely blocked, part of the heart muscle beyond the blockage dies and this is called a heart attack. This can occasionally be silent, but in many cases the symptoms are severe chest pain, nausea, sweating and fainting.
There are two common misconceptions about heart disease. The first is that heart disease is confined to the heart. Actually, the entire vascular system is at risk of plaque development. Blockage of the arteries supplying the brain can result in a stroke and blockage of arteries supplying the legs and cause crippling pain with walking.
The second misconception is that plaque builds up slowly over time, eventually causing an obstruction. The development of plaque is gradual, but there is often a sudden event that causes a part of the plaque to break off and cause a blockage. Clearly plaque development is important, but it is also important to study what causes plaque to fracture and block the vessel.
We now understand that cardiovascular disease is not just clogged pipes. The factors that start the development of plaque are inflammatory and many of the factors that cause fracture of the plaque are also inflammatory. This chronic low grade inflammation is best measured using a test called a high sensitivity C-reactive protein (hs-CRP). This should be a part of the cholesterol panel. Additional tests can give more meaning to the cholesterol results. The most useful in my experience is the cholesterol particle count. Your cholesterol results are expressed as a volume measure-a familiar example would be "one cup". You do not know if that cup is full of lentils or lima beans. The actual number of beans in the cup is what you want to know. Small particles (lentils) are more likely to cause inflammation and plaque and than large particles (limas).
When should I worry?
There are established levels of concern for cholesterol and hsCRP results. These are good guidelines, but many people have heart disease with low cholesterol and many others have no heart disease with high cholesterol. We can calculate your risk based on your cholesterol result, but this is still imprecise. An additional useful tool is the Coronary Calcium Score. This is a 5 minute CT Scan of the heart that will detect calcified, but not soft, plaque. This is not covered by insurance because it is considered experimental, but it actually is an established part of cardiovascular care. Fortunately, this test is available locally for as little as $149.00.
What treatment?
The Diet-There are vast numbers of popular books discussing diet for prevention and treatment of heart disease. Right now the American Heart Association is revising its recommendations. On balance, the Mediterranean diet is the easiest to follow and gives good results in combination with exercise. The medical world was rocked in the early 1980's when Dean Ornish showed that a very low fat vegetarian diet, exercise and meditation, actually reversed heart disease. All three components of the Ornish program are necessary for optimum results. Further information is available at Preventive Medicine Research Institute, www.pmri.org.
The Exercise- Humans are designed to move. A highly effective and easy approach is a brisk thirty minute walk every day. Brisk means 3.5 miles per hour (or 1.75 miles in 30 minutes). Tai Chi is an exercise that is used both as a treatment in cardiac rehabilitation and as a preventive exercise. It is gentle enough for general use and combines the elements of a moving meditation.
Stress Management- Chronic stress increases the levels of chemicals that increase cardiovascular risk. Research shows that stress increases hormones that contribute to small particle size, increases blood sugar, and increases spasm of the vessels. "Stress" is a vague term, but if you think of it as being trapped in a situation over which you have no control, that would sum up most of the causes of chronic stress. Since you cannot always move away from the stressful situation, developing tools to manage stress is very helpful. One tool is meditation. I would define this very broadly as any reflective state of mind. That can mean sitting meditation to some and moving meditation to others. "Meditation is not something you do for twenty minutes twice a day. It's an approach to living-living with awareness by paying attention to what you are experiencing". Dean Ornish, 1993.
Biofeedback-Sometimes it is difficult to know what emotion you are experiencing, and here biofeedback can help. The Institute of HeartMath in Boulder Creek has published some very advanced research. They have also developed inexpensive biofeedback devices for home use. Their early research showed that heart rate variability was closely linked to cardiovascular wellness. Variability is defined as the variation in the interval between heart beats. The more regularly variable the heart rate (coherent) is, the greater the cardiac resilience. This can be trained using their biofeedback systems. Further information is available at: www.heartmath.org. Personal training available locally from Dr. Taylor.
Supplements- Fish oil and Flax oil contain essential fatty acids that are not always available in the diet in sufficient quantity. They are anti-inflammatory and also help shift cholesterol particles to a larger size and lower number. Good quality fish oil is essential, since this can be contaminated with heavy metals and industrial chemicals. CoQ10 (100-200 mg) is essential if you are on a statin drug, including red rice yeast. Some people need the activated form of CoQ10 which is UBQH. There are many other supplements that are appropriate for special situations. Even though we are in one of the richest countries, Americans often have nutritional deficiencies. We are stuffed, but starved.
Prevention and treatment of heart disease is multidisciplinary and best outcomes are obtained with a fully integrated program of conventional and complementary approaches yielding a truly integrated healthcare system. To your health!
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