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SECRETS OF HEART HEALTH

            In the last twenty years, heart disease has increased forty nine percent.1 Over three out of ten Americans will die from heart attack, stroke, or congestive heart failure.1 More and more people are placed on statin drugs every day. Normal cholesterol level reference ranges have continued to be lowered from 280 mg/dl in 1980, to 240 mg/dl in 1986, to 200 mg/dl now, with a move to drop to 185 mg/dl in an attempt to reduce cardiovascular events. The sad truth is that half of all people who suffer heart attacks and strokes are under the age of 55 and have what are considered normal cholesterol and triglyceride levels. One –third of the first heart attacks are fatal. The Framingham study, the largest ongoing study of heart health, starting in 1948, now on its third generation of participants, has determined only the following: If your HDL is below 50 mg/dl and your triglycerides are over 150 mg/dl, you have a slightly increased risk for heart attack.2 The best study I could find on the efficacy of statin drugs demonstrates a 1.1 % reduced risk of having a heart attack after three years of medication.3  I see people in my practice every day that have been on statins and have suffered heart attacks. Studies indicate statin drugs increase the risk for dementia,4,5 Alzheimer’s,5 Parkinson’s,6 congestive heart failure,7,8 myopathy,9 neuropathy,9,10,11 and A.L.S.13 Half of all people having heart attacks have what are considered normal cholesterol and triglyceride levels.14 It would appear that using standard HDL and LDL cholesterol and triglyceride levels as a monitoring tool for cardiovascular risk is almost worthless. There has to be a better way.

Far better assessment and treatment options are available. There are at least eleven advanced metabolic markers, tests, or references that are much more accurate than an overall HDL and LDL score to determine cardiovascular risk. They are the following:

  • 1. Small LDL15
  • 2. Apolipoprotein B (APO B)16 
  • 3. HDL2b 17-20
  • 4. Highly Sensitive C-Reactive Protein (HS-CRP)21-23
  • 5. Fibrinogen 24,25
  • 6. Chlamydia Pneumonia 26,27
  • 7. Insulin 28
  • 8. Homocysteine 29-31
  • 9. Lipoprotein A (LpA) 32-36
  • 10. Apolipoprotein E (APO E) 37,38
  • 11. PLA2. 39-41

            I have to say as a health care provider who strives to be on the cutting edge of technology and give my patient’s the latest and greatest that it is extremely frustrating to wait and see, when and if, the standard of care comes around to delivering what our patients really need to prevent disease. Many times, it is already old news before something becomes main-stream. For example, Lipoprotein A was discovered in 1963. Linus Pauling, the Nobel Prize winner and his team did extensive research on this VLDL in the early nineties, well over twenty years ago, and proved conclusively that elevated levels of Lipoprotein A increased the risk for a heart attack by three- fold.42-44However, this test and several others are very seldom checked on individuals despite a strong family history of either coronary heart disease or stroke. This test and ten others will be discussed further.

             Small LDLs can be in two patterns: pattern A is predominately large particles and carries no significant risks, whereas pattern B is predominately small particles that can stick to the inside of your blood vessels. In fact, if you have more than twenty percent of IIIa and IIIb types, you carry significantly increased risk for heart attack or stroke.40 Furthermore, Type IVb  is associated with plaque instability.40 The good news is that you can change these numbers by supplementation of Vitamin C,46-50niacin,51-53 L-Lysine54-56, and L-Proline,55-57 and negate these increased risks for cardiovascular events, but you need to know if there is problem, or not, to ensure appropriate supplementation

            Apolipoprotein B is a more accurate way of processing the number of LDL in your blood, and alerts to the presence of small LDL. The safe range in the blood is 40-60 mg/dl. Dangerous levels are 80 mg/dl or more. In other words, your total LDL could be normal, but if you have elevated APO B, you have a six times greater likelihood to develop significant plaquing.16

            HDL2b is the specific kind of HDL that goes and cleans up the LDL cholesterol s in the blood vessels and takes it back to the liver to recycle. Individuals require at least thirty five per cent or more, for men and post-menopausal women, and forty percent or more, for pre-menopausal women for adequate protection. If you have less than thirty five percent of the total HDL, there is not enough good cholesterol to outweigh the bad cholesterol.2,53,18,19

            Highly Sensitive C-Reactive Protein (HS-CRP) is an inflammatory marker and is two times more likely to produce a heart attack as LDL indicators. A safe range is under 0.2 mg/L. Atherosclerosis is a chronic low-grade inflammation and an elevated HS-CRP increases the likelihood of causing a heart attack by four to seven hundred percent.21-23

            Fibrinogen is our marker that promotes blood clots. Elevated levels of over 400mg/dL increase your risk for myocardial infarction. We can reduce our fibrinogen levels by doing the following: quitting smoking, losing weight, and taking niacin.24,25

            Chlamydia Pneumonia is a bacteria that is common in hospitals. It is common among smokers and people prone to chronic bronchial infections. This bacteria significantly increases risk for coronary heart disease and heart attacks.26,27

            Insulin is our seventh marker. Elevated levels of insulin of over 12 miU/L indicate an increased risk for coronary heart disease.28Insulin is a hormone produced by the pancreas to regulate sugar, keeping it from going too high or too low.  Elevated levels develop with repeated sugar intake and elevated leptin levels or leptin resistance. You eat something. Your body produces insulin to control the sugar in the blood. The receptors have become resistant, so the blood sugar stays high. The pancreas works harder to produce even more insulin. Eventually, the pancreas cannot keep up, and your sugar levels stay high, and you develop diabetes type II.  The best way to control elevated insulin is exercise and weight control. Hyperinsulinism and Type II diabetes can be reversed with appropriate diet modification and exercise.28

            Our number eight marker is homocysteine, a naturally occurring by-product of the amino acid, methionine. Levels over 14 umol/L indicate increased cardiovascular risk. Although it is highly indicative of heart disease, elevated levels increase your risk of stroke even more, by three hundred percent.29-31 It is easily fixed by taking a methylated B vitamin complex with folic acid, B6, and B12, ideally a sublingual form with liposome technology.

            Elevated Lipoprotein A is an independent risk factor as discussed earlier.  Abnormal levels over 20 mg/dl in your blood will put you at a three hundred percent increase for a cardiac event independent of anything else.32-36 This can occur despite a person being slender, exercising regularly, and having normal blood pressure. Lipoprotein A is produced by the liver, and thought to be used to repair arterial wounds. It was theorized by Drs. Linus Pauling and Mathias Rath, and their research team, that this trait came in handy during the Ice Age when fruits and vegetables containing vitamin C were scarce.32-34 Lack of vitamin C causes blood vessel fragility and micro-bleeding. Lipoprotein A came in handy to keep those that had the gene variant from hemorrhaging to death from scurvy. They theorize it may have become a more dominant trait as it allowed those humans who could produce it a greater likelihood of surviving. The trait which allowed short term survival in the Ice Age is now a detriment to longevity in our modern society. Optimal levels of estrogen, as well as Vitamin C, niacin, L-Lysine and L-Proline have been shown to dramatically reduce Lipoprotein A and its inherent cardiovascular risks.33,34,43-46,57

            The number 10 marker, Apolipoprotein E, is very important. APO E is a protein that binds to some lipoprotein (fat/protein) particles. There are three major types; E2, E3, and E4.  The most common form in both APO E alleles is E3/E3.  E2/E2 is very rare but causes Type 3 hyperlipidemia, denoted by marbles of fat under the skin of the eyes, elbows, and back. This trait can increase your risk for coronary artery disease by two to three hundred percent. The best ways to control this gene variant is a lower calorie diet and to reduce sugar intake. This type of genetic trait is often prescribed fibrates medication. Sugar dramatically causes this problem to worsen. Taking niacin and a lower fat diet also helps to control this genetic trait.37,38,96-98 Having APO E4 also increases coronary heart disease risk and Alzheimer’s.37,38 The good news is that it is very responsive to niacin treatment.96-98 With niacin treatment in one study, E3 carrying lipoproteins were reduced by fourteen percent, E2 carrying lipoproteins were reduced by sixteen percent, and E4 carrying lipoproteins were reduced by twenty three percent. Having the E3/E3 gene variant increases the risk of Alzheimer’s by twenty percent. The gene variant E4/E3 increases the risk by forty nine percent and  the homozygous gene variant E4/E4 increases the risk by ninety percent.37,38  Regular exercise decreases the negative genetic expression of APO E. Again, these are genetic traits that can be, or not be, expressed based on an individual’s food choices and lifestyle. The benefit of genetic testing is that it provides the needed information for appropriate nutritional intervention to prevent the epigenetics from ever occurring. However, if you don’t test for it you will not know what action you can take to negate it.

            The last, number 11 marker, PLA2, is a new one. It was discovered by a research group in Scotland. It is a very important marker. It is the marker for sudden death, the “widow maker”. It is the marker for unstable plaque.39,40,41 You need to know if it is a risk in order to work on the prevention. PLA2 is a good marker for endothelial dysfunction. Low risk levels are under 200 ng/mL. It is a good marker to monitor to help prevent a first or a repeated cardiovascular event.

            Most of these markers can be found in advanced lipid profiles through LabCorp, Quest, or my favorite lab, Any Lab Test Now. Any Lab Test Now is a consumer-friendly lab that anyone can walk off the street and request their own tests at a fraction of the costs of labs using insurance.

            An individual with the combination of elevated insulin, lipoprotein A and APO B, has a two thousand percent increased risk for a heart attack.16, 28 All these factors can be controlled to a certain extent, but you have to know what is wrong to know what action must be taken to negate it. There are way too many people on statins than don’t need to be, and there are many who may have normal HDL and LDL reference range levels that are at great risk. A more advanced panel  that contains these markers will better determine the true risk factors more accurately. The current system of screening and treatment with statins is not working.

            Another risk factor is vasoreactivity.57 This condition is the equivalent of a muscle spasm in your arteries. These are dangerous because you may have a fifty percent blockage and get a vasospasm, and it will completely block the artery. Factors that contribute to increased vasoconstriction are diets high in saturated fat, smoking, low LDLs, high triglycerides, caffeine,  cocaine, and nutritional deficiencies of nutrients such as magnesium or Coenzyme Q10.

            Fixed factors in heart health are that pre-menopausal women are at less risk for heart disease than post-menopausal women and men.58 The more youthful levels of estrogen/progesterone in the pre-menopausal women give protection to the blood vessels. However, women catch up to men in risk after menopause. Heart disease, not breast cancer, is the number one killer of women. Heart disease is eight times more prevalent in women than breast cancer.10

            Inherited genetic factors increase the risk for Asian Indians, Native Americans, Mexican Americans, Native Hawaiian, and Pacific Islanders.58

            Lifestyle factors that increase the risk for heart attacks, strokes, and cardiovascular disease are smoking, diet, exercise, sleep, and stress patterns, i.e. the six essentials to health; what you eat, what you drink, how you rest, how you exercise, what you breathe, and what you think.58

            Mitigating factors that increase the likelihood of having a cardiovascular event are diabetes, high blood pressure, peripheral artery disease (PAD), chronic infections, chronically high blood sugars, low LDL, high triglycerides, and hardening of the arteries.58

            The physical sign predictors of heart disease are the following:

  • coronary ear creases (horizontal lines running from back to front of ear lobe),59-61
  • thinning of hair on the vertex of head (top, back of head), 62,63 and
  • Arcus Senilus (a dark ring surrounding the outer edge of the iris).64,65

All these physical signs have been associated with increased incidence of heart attacks and  should signal warning signs for a more detailed advanced cardiac blood panel as outlined in the prior discussion.

            Our hormones are vital to our heart health. Melatonin, which is usually thought of as a cure for jet lag, plays a key role to heart health. Melatonin is the oldest of all the hormones, probably more than three million years old. It is contained in not only all humans, but in all plants and animals. Studies show that people with coronary heart disease, and who have suffered myocardial infarction have very low levels of melatonin, about one-fourth of the levels of normal subjects they were compared to people who live to be one hundred years old have higher levels of melatonin.66-68Women generally have higher levels of melatonin compared to men.

            Human growth hormone is measured indirectly in the blood through IGF1 which is a by-product of growth hormone, produced from the liver. Like all hormones, it is better to be in the top of the class, or top quartile (25%) vs. the bottom quartile (25%). An individual runs an increased risk of four hundred percent of having ischemic heart disease if they are in the bottom levels, under 140 ug/dl.69-71 I again want to emphasize that that any individual is at increased risk in the bottom quartile of the reference range, even though they are in the normal reference range. This statistic for increased risk for heart disease, and many other chronic diseases holds true when comparing hormone levels in the bottom quartile vs. the top quartile of almost all hormones. Growth hormone deficits cause increased blood pressure, increased tension in the aorta, and abdominal obesity.72-74

            Our thyroid function is essential to a healthy heart. When blood levels of thyroxine (T3) are under 100 mcg/dg, coronary artery disease progresses, and when levels are over 150mcg/dg, the coronary artery disease stops progressing and begins reversing.75 Too much thyroxine (T3) can increase the risk for heart attack.76 However, most people who have thyroid issues tend to be hypothyroid. It is important to have the thyroid balanced. Adequate thyroid hormone increases the strength of heart contractions, and patients with congestive heart failure may benefit from this therapy. Heart attacks were simulated in both rats and dogs, and those receiving the thyroid therapy afterwards suffered much less cardiac damage. A study on ischemic heart disease patients vs. a control group found over a one hundred percent difference in favorable response for the group receiving thyroxine treatment.77 Another study on chronic heart failure patients over a fourteen year period showed a one hundred percent survival rate for the group given thyroxine vs. a thirty seven percent survival rate for those not receiving the treatment.78 It should be borne in mind that these patients were given physiological doses (normal ranges), enough to bring the thyroid into better function, not supra-physiological doses. In assessing Cumulative Death’s Hazard Rates in Cardiac Patients, patients with low T3 levels had an index of 3.582 vs. the index of 2.955 for patients with abnormal cholesterol and triglyceride readings. What this means is that low T3 was a better predictor than cholesterol and triglycerides for cardiac risk.77

            DHEA has sometimes been referred to as “the Fountain of Youth”.78 In a study on rabbits, it was found that there was an inverse relationship between the levels of DHEA and stenosis (narrowing).79-80 The lower the DHEA levels, the more stenosis.79 In rat models, restoring DHEA to the minimum of reference levels reduced stenosis by fifty percent.80 Two hundred six human patients were monitored for a period of twelve years. The group that had DHEA levels below 140 ug/dl in their blood had a sixteen percent cardiovascular risk and the group that had 140 ug/dl or above only had an eight percent cardiovascular risk during this time.81,82 It should be noted that levels of 140 ug/dl are nowhere near ideal. One could expect even greater heart protection at ideal levels, in the top quartile. Other studies have shown that there is a three hundred percent  increase of coronary insufficiency (not enough blood getting to the heart muscle), increased heart attacks, and reduced survival rate following a heart attack when a person had levels below 140 ug/dl in their blood.83 Low DHEA levels increase your risk for a heart attack by five hundred percent, and for a stroke one thousand percent.84 Macular degeneration has been linked to heart disease, and lower DHEA levels have also been associated with macular degeneration.

            Estrogen and progesterone provide protection in the pre-menopausal woman. Estradiol gives protection from sudden death syndrome and ischemic heart disease. In a study of women patients with ischemic heart disease, forty four percent had low estrogen levels.85-86 Estradiol (E2) increases HDL and decreases LDL, lowers cardiovascular risk and protects against atherosclerosis.85-86 In a study of Rhesus monkeys, half were given synthetic estrogen and half were given bio-identical estrogen. After four weeks, all were given a medication that simulates the effect of a heart attack. The monkeys given synthetic estrogen had to be administered emergency medications or would not have survived. The group with the bio-identical estrogen needed no such measures, and fared much better.86

            Testosterone is a great protector for men from heart disease. Testosterone improves body composition, decreases insulin resistance, reduces metabolic syndrome, reduces inflammation, reduces CRP (C-Reactive Protein), which is bad indicator for heart attack, decreases inflammatory cytokinase, and reduces congestive heart failure risk.87 Low testosterone levels  contribute to more myocardial infarction, more coronary artery disease, decreased fibrinolysis (the process that controls the size and growth of blood clots), and is associated with abnormal cholesterol and triglyceride levels.33

            There have been some interesting studies on nutrients in regards to heart health. One large study consisted of 800 men suffering acute myocardial infarctions, half received 1200 mg of vitamin C/day and 600 IU of vitamin E/day. The other group did not. There were twenty percent less complications with the group receiving the vitamin supplementation.88 Another  study involved administering one gram of omega-3s to a group after acute myocardial infarction. The group that received the omega 3 had a fifty percent decreased sudden death compared to the untreated group. Also the one gram of omega-3s stopped ventricular tachycardia (run-away rapid heart beat), and decreased atrial fibrillation.89 Broccoli has been found to aid in repairing the damage to blood vessels from diabetes. Eight percent of Americans are diabetic and another sixteen percent are pre-diabetic. Two-thirds will die of heart attack, stroke, or vascular disease. The sulforphone in broccoli protects the cells from oxidative stress, reducing it by seventy three percent. A study of 16, 000 Americans over a ten year period demonstrated a reduction of almost half in heart disease by supplementing only 300 mg of vitamin C daily.90 A study of 36, 000 Americans over a six year period demonstrated a one-third reduction of heart disease with vitamin E supplementation.91 Another study of 36,000 Americans over a six year period demonstrated a reduction of almost half from beta-carotene supplementation.92 Recent studies on Reishi mushroom supplementation demonstrate the ability to prevent, arrest, and reverse atherosclerotic plaquing.93, 94

            In conclusion, adequate testing using advanced cardiac panels beginning in younger populations under the age of thirty, as it has been found that the majority of even twenty-two year olds have significant plaquing ,95 and hormonal panels for populations over the age 40 will give much better indicators of cardiac risk factors. Adequate testing allows for earlier intervention of dietary changes, natural vitamin supplementation, and bio-identical hormone supplementation for prevention, correction and or reversal of atherosclerosis or heart pathologies. As coronary artery disease, congestive heart failure, heart attack , and stoke are risk factors for almost forty percent of the population, and the current standard of screening and treating is not working, new standards should be put in place, especially for any individuals who wish to be pro-active, and want to achieve a longer quality of life.

Kelly Miller DC NMD FASA FBAARM CFMP

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Kelly Miller, DC NMD* FASA FBAARM* CFMP* is an international lecturer on the topic of nutritional, genetic, and hormone influences on heart health. Call today for an appointment at 813-985-1322, Temple Terrace, Florida 33617

*There is currently no licensure for Naturopathic Physicians (NMD) in the state of Florida and the Florida Board of Chiropractic Medicine does not currently recognize the credentialing of the  Fellowship from the Brazil-American Academy for Aging and Regenerative Medicine (FBAARM), or the Certification in Functional Diagnostic Medicine (CFDMP) from Functional Medicine University.