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Protocols: Cardiovascular Self-Care

According to the American Heart Association there is overwhelming evidence that dietary and lifestyle factors influence risk of coronary heart disease (CHD) both favorably and unfavorably, the three most atherogenic dietary risk factors are saturated fat, cholesterol, homocysteine and obesity. There is also emerging evidence that Chiamydia pneumoniae a common virus may predispose for heart disease. Blood pressure, and lack of exercise are also predictors of CHD.

Our office recommends a yearly screening of LDL-HDL balance (High HDL is as much a part of an optimal cholesterol profile as low LDL.) and total cholesterol, triglycerides, homosysteine levels, and creactive protein (A plaque-building byproduct of inflammation recently identified as a reliable predictor of CHD and stroke.). Keep in mind that absolute LDL levels should be below 120 and with a ideal total cholesterol of 150 (below 200 is acceptable) and an HDL of above 45. Triglycerides should be below 200.

Here are some research-based healthy heart tips for all adults and especially those with hereditary or lifestyle risk factors for cardiovascular disease. It is possible to reverse heart disease. Keep in mind that you should always consult your physician regularly regarding your cardiovascular health and any measures you are taking (such as those below) to avoid or treat CHD. New scientific findings may invalidate, or alter the below recommendations and you should utilize this information as only one part of your self-study in cardiovascular health.

Engage in moderate physical activity on a daily (or at least three times a week) basis for 30 minutes each session.
Reduce your cholesterol that leads to buildup on coronary arteries. This can be done by reducing saturated fat (and trans fat) intake and maintaining a low-fat diet. We recommend the diet plan developed by cardiovascular specialist Dean Ornish author of Eat More, Weigh Less, but caution that it is important to supplement this diet with protein, as it is deficient in this regard. (Replace animal protein with soy (25 grams per day) which can decrease total and LDL cholesterol.) Carbohydrate (especially complex carbohydrates) intake should be 55-60 percent of calories. Fat level should be kept below 30 percent of total calories and below 10 percent if you have CHI) risk factors. (Also, keep in mind that an extremely low-fat diet tends to cause an increase in fat receptors in the gut with a corresponding increase in fat utilization by the body.)
Get a deep sleep each night.
Eliminate excessive alcohol consumption. One alcoholic beverage daily may have a protective cardiovascular benefit.
Cut down on caffeine and eliminate the use of nicotine which can increase the heart's workload and reduce the blood's capacity to cany oxygen.
Maintain normal blood pressure, preferably with diet and exercise, but also with medicines if natural methods are not effective.
Reduce intake of dietary sodium.
Keep weight within normal range through diet and exercise.
Minimize chronic stress. Maintain a positive attitude, have warm relationships and try to go through life with little anger or hostility. Our thoughts and moods (brain chemicals) do influence our physical health, including our organs, immune system, and the rest of your nervous system and cells. There is a direct brain-body and body-brain connection. Our brain releases chemicals and hormones that can influence our physical health, and in turn our body releases chemicals and hormones that can influence our brain. Anger and anxiety in particular have been linked in research studies with higher levels of cardiovascular disease.
Practice guided imagery exercises daily.
Practice relaxation techniques.
Eat between 35 and 45 grams of soluble fiber and 20-30 grams of insoluble fiber daily! Complex carbohydrates, such as grains and legumes, are a good source. Supplementation with golden flax seed may be desirable. (See below.)
Incorporate heart-protective foods such as hot peppers, shiitake mushrooms, flax seeds, raw garlic (2 cloves per day), salmon and green tea and plenty of fresh fruits and vegetables. Variety is key since each one contains a different carotenoid or flavonoid.
Use supplemental herbs, vitamins and antioxidants as appropriate. Our office can provide you with a specific antioxidant plan. Antioxidants especially helpful in fighting cardiovascular disease are: N-acetyl-cysteine, Nacetyl-carnitine, coenzyme Q-l0 (25-100 mg per day for it's ability to strengthen the heart muscle by nourishing the mitochondria in the heart muscle.) and Vitamins C and E. (The April 4, 1996, issue of Medical Tribune briefly mentioned a study done in Boston that showed 2,000 mg of vitamin C to improve blood flow, and possibly prevent heart attacks, in people with coronary artery disease. Their vessels even dilated. In a randomized, controlled study published in 1996, vitamin E, 400 units a day, substantially reduced the rate of myocardial infarction (heart attack) in those who were proven by angiography to have symptomatic coronary atherosclerosis (plaques). The beneficial effects were apparent within one year of therapy). Also include a multivitamin (with minerals potassium, calcium, magnesium, and selenium), a "B-SO" or "B- 100" complex with 400 micrograms of folic acid (which has been shown to lower homosysteinecystine levels), proanthocyanidin complex, garlic or garlicin (2,250 micrograms), omega-3 fatty acids (1/4 to 1/3 cup golden flax seeds daily). Tocotrienols appear to strengthen capillary walls and inhibit lipid oxidation and free radical formation. Trimethylglycine, a naturally occurring amino acid can help to reduce the production of homocysteine. Betacarotine (5,000 IU daily) appears to reduce LDL cholesterol oxidization. L-Carnitine, an amino acid, helps deliver long-chain fatty acids into the mitochondria so that your cells are able to utilize essential fatty acids for energy increasing heart muscle efficiency. Niacin (Vitamin B-3) in a time-release, wax-impregnated form (e.g. "Niacin Time" made by Carlson Laboratories) is strikingly effective in lowering cholesterol, but can disturb liver function which must be monitored after taking a baseline reading. Always stay below 1,000 mg per day and take niacin under medical supervision. Know the symptoms of liver disease: unexplained loss of appetite, nausea, a feeling of abdominal fullness, abdominal pain, and any other unusual digestive symptoms.
If you're female, consider low-dose estrogen/progesterone replacement after menopause. The ideal dosages, combinations, and forms (estrone, estradiol, estriol, or horse estrogen's as provided by Premarin [obtained from horse urine]) are still debatable. Estrogen is also believed to protect against tooth loss by maintaining bone mass in the jaw (Journal of the American Dental Association, March, 1996)
A blood thinner such as aspirin, or pycogenol should also be considered. Take one baby aspirin daily. Be careful about taking more than one blood thinning product at the same time unless under medical supervision.
DHEA supplementation will also likely have a role to play in the prevention of heart disease but research is not yet clear in this area.
If you have a serious cholesterol problem consider using the proven statin drugs such as Lipitor along with 60 to 100 mg of Coenzyme Q 10 a day (as statin drugs can block production of this important enzyme). Side effects of these drugs include liver stress.
There are a wide variety of phytomedicinal plants which can have a positive or negative effect on cardiovascular health. There are several additional options to consider if you have already been diagnosed with cardiovascular disease such as congestive heart failure, systolic hypertension, angina pectoris, atherosclerosis, cerebral insufficiency, venous insufficiency, or arrhythmia. These interventions can have adverse drug interactions (Crataegus potentates digitalis activity.) or deleterious physical effects (Aesculus can have renal and hepatic toxic effects.) and should be approached more carefully than the first 18 recommendations above.

Gugulipid, an Ayurvedic remedy, is an extract of a resin (gum guggul) from the mukul shrub found in India. The active ingredients in Gugulipid (Z-guggulsterone and E-guggulsterone, can lower cholesterol and triglyceride levels by increasing the liver's metabolism of the "bad" LDL cholesterol. Some research suggests 250 mg as a recommended dose.
Crataegus oxycantha is an anti-ischemic cardiotonic derived from the berries and flowers of the common Hawthorn. Crataegus' cardiovascular effects appear to be primarily due to it's inotropic and chronotropic effects, enhanced blood vessel integrity and effects on coronary blood flow. Unlike many cardioactive synthetic drugs, in animal studies Crataegus extract had the effect of prolonging the refractory phase of the myocardium and potentially reducing the risk of arrhythmias. Crataegus also appears to have a positive effect on blood lipids but does not work well in the treatment of acute angina so is more appropriate for long-term, versus acute, treatment. Normal dose is one 80 mg capsule standardized to contain 15 mg (aprox. 18%) oligometric proanthocyanidins taken twice daily.
Terminalia arjuna is another Ayurvedic cardioactive botanical derived from the bark of the Terminalia arjuna tree. Its primary mechanism of action appears to lie in improvement of cardiac muscle function and subsequent improved pumping activity of the heart. The saponin glycosides in Terminalia may be responsible for this effect. A statistically significant reduction in systolic blood pressure among stable (not unstable) angina patients, a reduction in time to appearance of ECG ST-T changes during treadmill testing, significant improvements in stroke volume and end-systolic ventricular volumes and improvement in left ventricular ejection fraction have all been noted with long-term use. Dose-related decreases in total and LDL cholesterol have also been found with use of large amounts of Terminalia.
Inula racemosa, a member of the Compositae family has been in use as a anti-ischemic in the Ayurvedic medical tradition. At least four sesquiterpene lactones have been isolated from Inula including alantolactone, isoalantolactone, dihydroalantolactone and dihydroisoalantolactone. Along with beta sitosterol, daucosterol and inunolide these chemicals are thought to be at least partially responsible for Inula's therapeutic qualities. Dosage is normally 3 grams of root powder. Inula compares favorably with nitroglycerine for the prevention of anginal symptoms. Decreases in total cholesterol of 39% have been reported with 51% decreases in triglycerides and 32% decrease in total blood lipids have been reported with Inula use.
Astragalus membranaceus is a cardioactive and inimunostimulatory Chinese botanical. It contains unique flavones including kumatakenin and 3',7-dihydroxy-4' methoxyisoflavone and their glucosides. Astragalus' immunostimulatory properties lie in the polysaccharides present in the root. (Also present are several saponins, called Astragalosides Ito X. In an in vitro study Astragalus was found to inhibit lipid peroxidation by 40% in rats. Marked improvements in angina and cardiac output have been recorded as well as significant improvements in left ventricular activity, end-systolic volume, and end-diastolic volume.
Cholestin made from Chinese red yeast can lower total cholesterol an average of 16.4% and LDL an average of 21% with no significant side effects.

In addition to these more common cardioactive plants, there are a large number of other phytomedicinal substances which can play a role in the treatment of cardiovascular disease. R-serpentia (snakeroot), Stephania tetrandra, Ligusticum wallichii, Uncaria rhynchophylla, Veratrum, Evodia rutaecarpa, P notoginseng, Salvia miltiorrhiza, Mararishi amrit kalash 4 and 5, Ginkgo biloba. Rosmarinus officinalis (rosemary), Aesculus hippocastanum, and Ruscus aculeatus (butcher's broom) are a few examples. These less-researched options should not be undertaken without close consultation with a cardiologist and a practitioner skilled in phytomedicinal interventions.

Warnings: The information above is provided for educational purposes and may not be construed as a medical prescription or as a substitute for the advice of your physician Do not use this product without first consulting your physician especially if you are pregnant or lactating. Be advised that some herbs and dietary supplements can cause severe allergic reactions in some individuals and may also have an adverse result in conjunction with other medications, or treatments. You should regularly consult your physician in matters regarding your health and particularly in respect to symptoms and conditions which may require diagnosis or medical attention. Reevaluate use of this product after 6 months.

"A 1999 study by Harvard Medical School affiliated Brigham Hospital in Boston found a daily cup of black tea can reduce the risk of heart attack by 44 percent."

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