The Heart of the Matter

Hospital waiting rooms are lonely places. Unfortunately for many people, the firstintroduction to cardiac disease involves waiting for physicians and nurses to deliver news about loved ones. By the same token, you might not have to look far up the family tree to find someone who has had a heart attack or stroke; it might even be you.

Cardiovascular disease consists of a variety of conditions that affect the heart, blood vessels and, ultimately, the organs and tissues they supply with blood. Some examples include hypertension, atherosclerosis, coronary artery disease, heart failure, arrhythmias, valvular disease, aneurysms and peripheral vascular disease. (see "Heart Disease Definitions" further in this article)

According to 1999 statistics, cardiovascular disease is Canada's leading cause of death, claiming 78,942 lives or producing 35.9 per cent of all deaths. Of these deaths, 39,808 were men and 39,134 were women. Six million Canadians, about one in five, are living with some form of cardiovascular illness today.

Cardiac disease and stroke are also major causes of illness and disability in Canada, exacting high personal, community and health-care costs. Heart disease accounts for about $7.3 billion, or 17 percent, of the direct costs of illness in Canada. The estimated indirect cost (lost wages and productivity) of heart disease is $12.4 billion annually.

Although cardiovascular disease is a devastating illness, you are not powerless against it. In fact, this condition is largely preventable. Let's take a look at the major risk factors and some things you may want to consider.

Age

Increased age is the dominant risk factor for heart disease and stroke. As our population ages, it is expected that the number of individuals with heart disease and stroke will increase. However, given the current emphasis on "anti-aging" it would seem baby boomers do not want to grow old. By incorporating a whole-body approach to health, accepting self-responsibility and applying common sense, many older people are able to delay or avert the likelihood of vascular disease.

Paradoxically, heart disease begins in childhood. It has long been known that babies, children and teenagers all have accumulation of cholesterol on the walls of their major arteries. By age 35, 75 percent of men and women have plaque covering 20 to 50 percent of the surface areas of certain arteries. So, prevention of cardiovascular disease must begin in youth.

Sex

At younger ages, men are at much higher risk of developing coronary artery disease (CAD) leading to angina or myocardial infarction (heart attack). There appears to be a 10-year lag for women in the development of CAD. The risk of stroke is also higher for men. If you are male, you should look at your risk factors early in life and reduce as many as possible. Women, your heart disease rates have steadily climbed over the last 30 years, so pay attention, too.

Family History

Heart disease and stroke run in families where lifestyle, cholesterol metabolism and vascular physiology are similar. You can't change the genes you were born with, but you can avoid the bad habits family members may possess. Learn from the mistakes of others.

Tobacco Smoking

Contrary to popular belief, smoking is responsible for more deaths due to heart disease and stroke than deaths due to cancer. Considering the negative effects this addiction has on the lungs, teeth, stamina, pocketbook and health of others, there is really nothing too positive one can say about this age-old habit. The risk is proportionate to the number of cigarettes smoked per day.

Whether one quits "cold turkey," uses nicotine replacement products, Zyban, homeopathic techniques, hypnosis, acupuncture or support groups, it requires intense willpower and behaviour modification. If one idiotically continues to smoke, replacement of antioxidants such as vitamin C, E and beta-carotene at higher doses is a must, as the body gobbles up these nutrients (especially vitamin C) in an attempt to combat the free radicals in smoke.

Physical Inactivity

Regular exercise can reduce body weight and improve cholesterol, blood pressure and diabetes, thereby reducing overall cardiovascular risk. Exercise has a beneficial effect on the heart, lungs, muscles, joints and bones and is a critical ingredient in a weight-loss program because calories are burned and the tendency to accumulate body fat is reduced.

Among the behaviours that can easily be self-monitored, exercise is at the top of the list. A well-balanced exercise program includes a stretching, strengthening and aerobic component lasting 45 to 90 minutes, three to five times weekly.

High Blood Pressure

See "High-Blood Presure--A Silent Epidemic" in this issue.

Dyslipidemia (high cholesterol)

See "The Truth About Cholesterol" in this issue.

Obesity

Becoming fat, especially if the fat tends to park on your belly, means a higher likelihood of developing heart disease and stroke. Being overweight ushers in other major risk factors for heart disease such as high cholesterol, diabetes and high blood pressure.

For individuals faced with what is often a lifelong battle to achieve a healthy weight, weight control is rarely an easy or pleasant issue. In addition to overeating, several causes have been identified and include genetic tendency and family history, lack of exercise, eating patterns, emotional issues and various medically related causes, including side-effects from certain drugs, endocrine disorders, specific brain diseases and abnormal body metabolism. Looking at all of these factors is crucial for any long-term success in this area.

Diabetes

This disorder affects the body's ability to use sugar, or glucose, properly, which causes it to become elevated in the blood. It can be caused by a deficiency of insulin or by cell insulin resistance. High blood sugar causes destructive changes in the blood vessels throughout the body, increasing the risk of cardiovascular disease by two to three times. Losing weight if overweight, getting regular exercise, eating adequate protein and few refined carbohydrates, and supplementing with chromium and B vitamins are just a few examples of blood sugar-lowering possibilities.

Excessive Alcohol Use

Drink alcohol moderately, if you drink. A drink or two per day may discourage heart disease, suggests dozens of studies. More alcohol is dangerous, and binge drinking is particularly harmful to your heart and general health. If you don't drink, do not take up drinking as a way to prevent cardiovascular disease.

Hyperhomocysteinemia

Elevations of the naturally occurring, sulphur-containing amino acid homocysteine are associated with early CAD, stroke and vein blood clots. Experts report that high homocysteine can boost heart disease deaths six fold. A deficiency in the B vitamins, specifically B₆, B₁₂ and folic acid allows homocysteine to build up in the body. Supplementing with these nutrients makes good sense.

Oxidation

Oxidative stress is increasingly recognized as a component of the atherosclerotic process. Oxidation is linked to the presence of free radicals, which are unstable, destructive molecules that cause damage to the body. Antioxidants are substances that prevent free radicals from doing their damage. Examples include vitamins C and E, beta-carotene, selenium, coenzyme Q₁₀, soy isoflavones, green tea polyphenols and bioflavonoids.

Exertion in the Cold

About half of heart attacks occur in the winter, when temperatures are lowest. Snow shovelling is associated with angina and with infarction. Stay warm and buy a snow blower.

Infectious and Inflammatory Agents

The role of infectious agents in atherosclerosis is presently being investigated. Certain bacteria, viruses and fungi, such as Chlamydia pneumoniae and cytomegalovirus, could be more than casual bystanders in this heart disease epidemic. Studies show that gum disease (periodontal disease) is clearly associated with heart disease.

The hypothesis that inflammation contributes to atherosclerosis is supported by studies that associate markers of inflammation, such as C-reactive protein, with increased cardiovascular risks. These facts point to the need to consider antimicrobial and anti-inflammatory therapies.

Atrial Fibrillation

A type of arrhythmia, atrial fibrillation is a risk factor for stroke. Conventionally treated with Coumadin, a blood thinner, or anti-arrhythmic drugs, a variety of natural compounds such as magnesium, coenzyme Q₁₀, hawthorn and fish oils may be beneficial.

Platelets and Blood Clotting

Platelets are tiny blood cells that stimulate the clotting cascade, which includes a protein called fibrinogen. If platelets are too efficient and higher than normal, levels of fibrinogen accumulate and the risk of cardiovascular diseases increases dramatically. This is why Aspirin, which impairs the efficiency of platelets, is so commonly prescribed.

Smoking is the number-one elevator of fibrinogen levels, followed by obesity, high cholesterol, stress, lack of exercise and diabetes. A diet high in fish oils, vegetables, garlic and moderate amounts of alcohol lowers fibrinogen levels.

Iron and Heavy Metals

Too much iron can contribute to heart disease and aging by fostering free-radical attacks on cells. An iron overload condition called hemochromatosis is not uncommon, but is often under-diagnosed.

Don't routinely take iron supplements unless needed. Reduce meats and donate blood two to three times a year to deplete unwanted iron stores. In addition, some research has found the accumulation of toxic metals, such as mercury, arsenic, cadmium and lead, in the arteries of patients with heart disease. Unfortunately, we are all exposed to these metals and others via food, environment, dental fillings and so on. Chelation therapy, which involves the use of intravenous chelating agents and is done by qualified naturopathic physicians and other health-care professionals, may be used to remove these toxins over time.

Mental Stress

Stress encompasses unpleasant or painful emotions, such as anxiety, worry, frustration, hostility, anger and the like, leading to exhaustion or unrelenting pressure. The type A personality (driven and aggressive) is often challenged to effectively manage his/her stress.

There is scientific evidence that stress raises blood pressure, changes blood fat profiles and, when excessive or mishandled, contributes to cardiovascular disease.

The mind, body and spirit must be in balance to prevent heart disease. Focus attention on strengthening and enriching your relationships, consider relaxation techniques, adapt, accept and let go.

Conclusion

As we have seen, there are many risk factors that are not amenable to a single intervention. While diet is of great importance, you must consider an overall lifestyle plan. Natural supplements, herbs and therapies are available to complement or substitute the need for pharmaceuticals. Stronger, more invasive interventions such as ozone therapy, photo-oxidation, hyperbaric oxygen, neural therapy and intravenous modalities, may be used if appropriate. While drugs and allopathic cardiac procedures such as bypass surgery, angioplasty and heart valve replacement can be lifesaving, they do not take the place of prevention.

Remember, the plan you create is meant to unravel your risk factors and lead you to greater health.

Heart Disease Definitions

Angina: pain produced by the heart muscle in response to insufficient blood flow.

Aneurysm: ballooning or weakening in the wall of an artery.

Atherosclerosis: the progressive accumulation of cholesterol, calcium and blood clots on the wall of an artery.

Arrhythmia: irregular heartbeat that may be too fast or too slow.

Cholesterol: a steroid made in the liver and obtained in the diet that is essential to a variety of human functions.

Congestive heart failure: when the heart muscle becomes weak and unable to efficiently pump blood throughout the body.

Coronary artery disease: atherosclerotic blockage of blood flow in the arteries of the heart.

Hypertension: high blood pressure (see High-Blood Presure--A Silent Epidemic).

Infarction: the death of living tissue resulting from blood flow interrupting, for example, after a heart attack.

Peripheral vascular disease: atherosclerotic blockage of blood flow in the arteries supplying the extremities.

Stroke: injury or damage to the brain as a result of insufficient blood supply or blood clots, also called "cerebrovascular accident."