Cardiovascular Risk and Pathology

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Cardiovascular risk of stroke and heart attack is one of the chief health concerns of the U.S. population, and a majority of people are now looking to some form of Complementary Medicine and an integrated medical approach to decrease risk of occurrence or recurrence, and avoid some of the side effects of their pharmaceutical medicines. It is always good to discuss cardiovascular issues with a cardiologist, especially if standard tests reveal significant risk, or if you fall into a high risk demographic. On the other hand, the latest findings in Complementary and Integrative Medicine (CIM) present an array of health issues that the cardiologist may not have sufficient expertise with which to guide the patient, and instead may be relying too much on information given to him by the pharmaceutical industry.

There is very little instruction in dietary and lifestyle issues in current University Medical Schools, little instruction in actual preventive medicine, and almost no instruction in the complex subjects of herbal and nutrient medicines. This is where a Complementary Medicine physician, a specialist in these subjects, such as a knowledgeable Licensed Acupuncturist and herbalist, or Naturopathic Doctor, can help make sense of the wide array of health research on reducing cardiovascular risk, and tailor a program specific to the individual patient. The Medical School training for these health professionals emphasized a thorough knowledge of herbal and nutrient medicine, dietary science, and a holistic approach to prevention of disease. As you will see from this article, there are a wide variety of herbs, nutrient therapies, dietary and lifestyle changes, and therapeutic techniques that are proven helpful in prevention of cardiovascular risk, and care from a professional herbalist, such as a Licensed Acupuncturist or Naturopathic Doctor, insures that the right individualized course of therapy, and quality professional products, are utilized. Acupuncture enhances the effectiveness of these protocols, improving homeostatic function and regulation in cardiovascular health, and is proven to greatly aid recovery from stroke and heart attack when integrated into care. Integrative medical care is the best approach when trying to prevent or reverse cardiovascular problems, and may be the key to a safe effective treatment protocol for any of the related pathologies, such as atherosclerosis, hypertension, high cholesterol, etc. As we now see, risk of stroke and heart attack involves much more than cholesterol and blood pressure, and needs a more thorough approach in prevention.

Unlike standard care in cardiovascular medicine, Complementary and Integrative Medicine (CIM/TCM) offers the patient the goal of restoring the health of the system, not just blocking the highest risk factors. With stroke and heart attack the most likely cause of death from disease in the United States, it is the single most important aspect of your health to address as you age, and ignoring the proven benefits of dietary changes, herbal and nutrient medicine, and acupuncture is just not sensible. Complementary and Integrative Medicine (CIM) could play an important role in cardiovascular disease prevention and quality of life if it was truly promoted in the United States, as well as the rest of the planet. Integration of acupuncture and herbal / nutrient medicine is low-cost and effective.

Just below iatrogenic deaths, death from heart attack and stroke is the second most common statistical cause of death in the United States, at 768,755 per year in 2005, which rose to 787,000 per year by 2011. Sticking with the status quo rather than integrating a more holistic approach is not a good idea. The World Health Organization states that in 2008, 30 percent of all deaths on the planet were attributed to stroke and heart attack, with 7.3 million deaths due to coronary heart disease and 6.2 million due to stroke occurring each year. How do we actually determine if we are at high risk of cardiovascular health problems? Only a thorough and individualized assessment can truly reveal the degree of cardiovascular risk, with a number of underlying problems slowly contributing to vascular inflammation, sclerotic plaque, calcification of vessel membranes, and the creation of emboli that block circulation. Diet, lifestyle, environmental toxins, metabolic concerns, lack of activity and exercise, poor quality sleep, and even periods of prolonged depression are all linked to higher cardiovascular risk. Simply taking an array of medications to block lipid cholesterol and try to lower blood pressure will not protect one with higher risk from eventual harm. The estimated cost of cardiovascular disease in the U.S. is more than $320 billion per year, and the cost of integration of CIM/TCM into standard care and prevention is miniscule compared to this. While standard medicine has improved immensely in the acute care of heart attack and stroke, reducing the rate of death upon incidence, the number of people afflicted with cardiovascular disease, a slowly progressive health problem, has also risen dramatically, accounting for the continuing rise in the number of deaths per year.

Atherosclerosis usually develops slowly, and there are no symptoms until the artery becomes highly atherosclerotic, or small emboli break off and cause such problems as chest pain or neurological episodes. Chest pain and referred pain to the left arm are not the only symptoms of mild heart attacks, though. Studies have shown that about 80 percent of patients with an acute ischemic heart attack, called a myocardial infarction (heart muscle circulation obstructed by a thrombus or embolus), experience sudden sweating with the chest pain, and about half reported sudden shortness of breath. Other causes of chest pain, such as myofascial pain, or non-ischemic heart and lung diseases, rarely involve these accompanying symptoms. An effort to recruit women into cardiovascular studies has finally been emphasized, as a clear bias toward recruiting men for these studies in the past is now well documented, despite the fact that, since 1984, the number of cardiovascular deaths for females has exceeded those for males in the United States, and CVD is the leading cause of death from disease for women in the United States. Recent research by the National Institutes of Health has found that women suffer different symptoms before heart attacks than men, with 70 percent reporting severe fatigue, 48 percent reporting sleep disturbances, and about half reporting anxiety, indigestion and shortness of breath. These symptoms correlated with reports of symptoms experienced during the heart attacks for about half of the women studied, along with profuse cold sweat and dizziness. These common health problems could be a sign that cardiovascular stress is increasing, and attention to the whole cardiovascular health picture that is started early may be important to prevent future cardiovascular problems.

An alarming statistic that points to the need for early prevention, and may also indicate a failing of standard pharmacological therapy, is the high incidence of recurrence of stroke and heart attack within three years of a serious event. The Northwestern University Feinberg School of Medicine reported in 2009 that when following over 32,000 patients with atherothrombosis, patients who reached a symptomatic state with vascular disease had a 14.4% average rate of recurrence one year after having a heart attack or stroke, and a 18.4% average rate of recurrence within 3 years of that first stroke or heart attack. Patients with atherosclerosis in multiple sites had a 40.5% average rate of recurrence within 3 years, despite being on standard pharmaceutical drugs! Data from the REACH Registry (Reduction of Atherothrombosis for Continued Health), also showed that almost all strokes were preceded by mild transitory ischemic attacks (TIAs), often mild enough to go unreported. Ischemia is a term meaning local decrease in blood oxygen and nutrients to tissues, and a transitory ischemic attack, or TIA, is usually short, and the lack of blood flow to parts of the brain often creates a period of confusion and poor judgement due to the mild injury to the brain tissue. The mild temporary confusion occurring with TIAs contributes to the lack of alarm and recognition of the seriousness of these events. Data on the recurrence of stroke and heart attack can be accessed by clicking here: http://news.feinberg.northwestern.edu/2009/09/alberts-paper/ . Studies in recent years have identified a host of simple treatment protocols in Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) that could be integrated to decrease this risk of recurrence. For instance, a 2014 study at the Tianjin University of Traditional Chinese Medicine, in Tianjin, China found that when cerebral ischemia was induced in laboratory animals, that electroacupuncture stimulation increased blood flow to the area, with angiotensin 2 and its receptors significantly lowered (PMID: 25387826). Such studies have led to large retrospective cohort studies to see if integration of acupuncture actually decreased recurrence of stroke, and such a study in 2015, at Taipei Medical University, in Taiwan, and the Fielding School of Public Health at the University of California, Los Angeles (UCLA), found that acupuncture integration did appear to lower the risk of stroke recurrence. To see this study summary, click here: http://www.ncbi.nlm.nih.gov/pubmed/26426630 . As this extensive article shows, many herbal and nutrient medicines can help reduce this risk as well, and can be combined with acupuncture stimulation in short courses of therapy.

Understanding what atherothrombosis is, and how to prevent it, is the task of all patients interested in preventing cardiovascular disease and death. The term athero-, from the Greek word athere, or porridge, refers to the appearance of the inside of arteries affected by the accumulation of atheroma, or deposits of fats, calcium, and fibrins on the inside of the blood vessels, or epithelium. A thrombus is a clot, or coagulated mass of blood cells, resulting from inappropriate hemostastic (stopping of bleeding) processes, which occur in chronically injured blood vessels due to inflammatory processes, trauma, or mechanical stress. Normally, the thrombus, or scab, should form to protect the artery or vein, but then dissolve once the blood vessel regains health. If the atherothrombosis grows, and is not broken down and the vessel repaired, decreased blood flow will result. We may not immediately feel this decreased blood flow, but the subsequent circulatory problems will contribute to poor tissue nourishment, failure to properly regulate inflammatory processes and tissue repair in the body, and various physiological dysfunctions, as well as chronic pain. If the atherothrombosis is not broken down and the vessel repaired, a piece of it can break off eventually, and this blood clot is called an embolus, the chief cause of strokes, heart attacks, and peripheral circulatory disorders. An embolism is an obstruction or occlusion (narrowing) of a blood vessel by an embolus. This embolus may be composed not only of a part of a thrombus that breaks off, but also of a mass of bacterial bodies, or other microbes, when chronic inflammation and biotic imbalance are not maintained.

Since the atherothrombosis is composed of lipids, or fats, along with calcium deposits and fibrins (proteins formed by the action of thrombin), scientists originally thought that the lipids, or fats, were responsible for the accumulation of the atherothrombosis. We now know that other mechanisms are chiefly responsible for the chronic perpetuation of these atherothromboses, and atherosclerosis, on the inner linings of our blood vessels. In 2016, the standard preventive treatment for atherosclerosis is still statin drugs, fibrates, niacin, and low-dose aspirin, and newer drugs, such as Ezetimibe (Zetia) and various bile acid sequestrants, do not even provide the results of statin drugs, reducing absorption of dietary cholesterol, which is now recognized by the American Heart Association as an insignificant factor in total cholesterol lipids. Bile acid sequestrants were designed to inhibit low density lipoproteins, but common side effects include constipation, abdominal discomfort, bloat, nausea, diarrhea, weight loss, flatulence, heartburn, and gallstones, and the benefits may not outweigh the adverse effects for most patients. In addition, the normal recirculation of bile acids from the intestine is an important metabolic process, and the strong ability of these bile acid sequestrant drugs to bind to other pharmaceutical medications and prevent absorption is a concern. Much research in recent years has proven that long term use of statin drugs presents an alarming incidence of adverse health effects and benefits that are lower than simple diet and lifestyle regimens, and that addition of fibrates does not afford a significantly improved outcome. Clearly, there is a need for a better and more holistic approach, and CIM/TCM now provides and evidence-based proven array of treatment protocols to add to diet and lifestyle regimens that need to be individualized with sound professional advice.

Atherosclerosis, or the buildup of plaque deposits on arterial walls, is the major underlying cause of cardiovascular ischemia, or restriction of blood flow, as well as peripheral vascular disease (PVD), congestive heart failure, heart attack and stroke, and inflammation and low-grade infection play key roles in both the buildup of plaque and the rupture of the plaque that causes dangerous atherothrombus. The persistence of low-grade bacterial infections in arterial plaque is due to the formation of bacterial and other microbial biofilm, a defense strategy evolved to evade the immune complement system. Almost all of these bacterial biofilms in studies of atherosclerotic plaque reside in the innermost layer of the plaque near the elastic lamina and within fibrous tissue. A number of species of bacteria have been identified with arterial plaque biofilm, including Pseudomonas aeruginosa, which has been shown to disperse in response to free iron in circulation, released from transferrin after interaction with sufficient levels of catecholamines such as norepinephrine (adrenalin). With such dispersion of bacteria from biofilm, bacterial enzymes are released that may damage surrounding tissues and facilitate plaque rupture and cause atherothrombosis and embolism to occur (PMID: 24917599). Both problems with low-grade bacterial infection and problems with iron homeostasis, as well as stress-related excess of adrenaline are involved in this pathological process. Such study as this, at the Binghampton University School of Medicine, in New York, USA, in 2014, shows finally the physiological connection between hormonal states and the potential for heart attack and stroke. We see that a more holistic and comprehensive treatment strategy is needed to resolve the pathology, and the importance of Complementary and Integrative Medicine and a more open-minded assessment in utilizing an effective holistic treatment protocol. Study of bacterial biofilms has shown that anti-inflammatory herbal chemicals such as Berberine and Curcumin are effective in dispersing these bacterial biofilms, as well as providing other beneficial effects studied in the treatment and prevention of cardiovascular disease. A variety of treatment protocols can be easily combined with CIM/TCM therapy, and individualized to insure the best outcomes.

To effectively reverse the accumulation of atherothrombi and atherosclerosis, or the hardening and narrowing of blood vessels, we need to do more than just block lipid formation and eat a less fatty diet. This strategy has led the population to believe that taking statin drugs alone will prevent their stroke and heart attack, but a thoughtful patient will realize that only a restoration of health of the blood vessels, a better system of tissue repair, and a decrease in the chronic inflammation and mechanical stress put on the blood vessels, will truly restore this cardiovascular system to a healthy state. As scientific research goes forward, much has been learned about safe and effective means to complete this task. Both reduction of atherothrombosis and restoration of the health of the blood vessels is possible with Complementary and Integrative Medicine (CIM). Ignoring the problem and depending on statin drugs and baby aspirin is a ticket for failure, and the price of failure may be devastating.

A More Comprehensive Approach is Sorely Needed to Really Reduce Cardiovascular Risk

Many patients are turning to healthy alternatives early in life rather than waiting until the cardiovascular problems arise and harsh drug therapy becomes necessary. Both effectiveness and degree of risk are concerns with standard pharmacological therapy. Some of the latest findings on standard cardiovascular treatment are disturbing. The new drug touted to reduce arterial plaque, torcetrapib, created to compete with Complementary Medicine's goal of improving cardiovascular health by raising HDL (high density lipoproteins) has been pulled from the market because large studies on the human population showed that it caused more deaths than it saved. This drug, like the popularly prescribed statins, which lower LDL, works by blocking genetic expression of a key protein in lipid metabolism. Modern research now confirms that the problems with atherosclerosis and cardiovascular degeneration are more complicated than just the levels of cholesterol in your body. Inflammory regulation, accumulation of harmful oxidants, and a host of specific metabolic concerns, especially the accumulation of advanced glycation endproducts (AGEs), are now known to be the cause of the buildup of atherosclerotic plaques that contain cholesterol carried lipoproteins, but are not caused by them. The ability of your body to clean up atherosclerotic plaque is also of prime importance and is overlooked in standard therapy to a large extent. Not just prevention, but also reversal of atherosclerosis is important. Allopathic drugs may not be enough to reverse this complex degeneration of your blood vessels and reverse atherosclerosis. Even if you are happy with standard drug therapy, and the chronic side effects are still mild, Complementary Medicine offers not an alternative, but a partnering, or integrating, with standard medicine to achieve greater health goals.

The prime drug emphasis with atherosclerosis is still the blocking of production of cholesterol and cholesterol carrying lipoproteins with statin drugs. The problem with these allopathic drugs are that, while they do statistically raise HDL and lower LDL, the chemical manipulation involved produces altered proteins and poor quality HDL and LDL. In other words, quantity rather than quality is altered. Since HDL and LDL, lipoproteins mistakenly called cholesterol because these molecules transport cholesterol steroid hormones, are essential to the healthy function of the human body, it is vitally important that the quality and function of these molecules is healthy, as well as the quantities. Misformed or genetically altered lipoproteins (HDL and LDL) cause the serious side effects associated with statin drugs, mainly the accumulation of broken proteins in the tissues that cause much muscle and joint pain and inhibit organ function, especially in the kidney, over time. Other important side effects come from the inhibition of other important chemicals in the body related to cholesterol production, such as CoQ10, or ubuquitone, an important cellular antioxidant, and Vitamin D3 hormone. In addition, serious reassessment of widespread statin drug prescription is occurring in 2012, as studies now reveal the significant risk of inducing diabetes with long-term use in patients with metabolic syndrome, or the pre-diabetic state. As you may see from reading this article, depending on cholesterol lowering drugs and hypotensives alone may not be a smart and effective protocol for decreasing risk of stroke, heart attack and atherosclerosis.

What do we mean when we refer to the quality of cholesterol and lipoproteins? For many years, researchers have been puzzled at the low incidence of cardiovascular disease in targeted populations in Europe, despite the standard high dietary intake of fats. Research in Spain in 2010 (cited below) found that low rates of strokes and heart attacks, and a low incidence of death attributed to cardiovascular disease, occurs in Spain despite a high prevalence of standard cardiovascular risk factors, including a high consumption of unsaturated fatty acid rich foods. The researchers found that the fats generally consumed were still of high quality, with high proportions of healthy essential fatty acids, such as DHA (docosahexaenoic acid), alpha-linolenic acid, and oleic acid. The research showed that high intake of healthy fats had a strong correlation in individuals studied with low rates of cardiovascular disease. These quality fatty acids were found in phospholipids in the body, and were carried in serum phosphatidylcholine (a lecithin metabolite). High quality phospholipids had a strong relationship to decreased incidence of carotid artery atherosclerosis.

More recent research has revealed that phytosterols and stanols, found in the oily hulls of whole grains, legumes, nuts and seeds, as well as certain Chinese herbs, are now proven to significantly lower excess LDL cholesterol, improve cardiovascular epithelial dysfunction (reduce atherosclerosis and arterial defects such as thrombosis and weak arterial walls), and supply important chemicals that were rich in the early human diet, but were removed with modern food processing and the limiting of popular food staples by the food industry. These phytosterols and stanols are now proven to even decrease cancer risks, especially colon, breast and prostate, and exert significant anti-inflammatory benefits. Phytosterols are steroid alcohols that are very similar to cholesterol, and show that the benefits of healthy cholesterol in the metabolism are very important to health maintenance. Such renowned medical institutions as the Cleveland Clinic now recommend that when high cholesterol lipids are found, or increased risk of cardiovascular disease, that the first line of therapy should be adoption of a plant-based diet with whole grains and legumes, fresh nuts and seeds, and limiting of saturated fats, while increasing the variety of unprocessed polyunsaturated and monounsaturated oils. The second step should be consumption of about 2 grams per day of phytosterols and stanols, from foods, supplements, and herbs. Finally, the advice and treatment protocols of Complementary Medicine are becoming mainstream.

Has our medical community led us to believe that simply taking cholesterol inhibiting statin drugs and hypertension medications with limited benefits would protects us from cardiovascular injury? Has this advice and treatment protocol led millions of Americans to a false reality and contributed to the avoidance of a real preventive medicine protocol? Serious questions are being raised about the standard medical protocol to reduce cardiovascular deaths, accounting for more than 40 percent of all deaths in the United States, and to prevent and treat the myriad ill effects of poor cardiovascular health. Real preventive care is not the primary focus in standard medicine, and while our hospitals and clinics sometime provide excellent care when a stroke and heart attack occurs, and integration of Complementary Medicine is essential to actually forming a sensible holistic protocol individualized to the patient that addresses the many needs.

There has been an overemphasis on cholesterol in prevention of cardiovascular disease. Cholesterol itself is not a lipoprotein, but rather is a steroid hormone carried by lipoproteins. Cholesterol is primarily made in the liver, but is also produced by cells in the lining of the small intestine, as well as individual fat cells in the body. The molecule Acetyl coenzyme A is the building block to cholesterol, as well as the building block of an important neurotransmitter, acetylcholine, the most important neurotransmitter in the autonomic nervous system. Acetyl coenzyme A is derived from healthy fatty acids, many from the diet, and in the production of cholesterol is turned into mevalonic acid. Statin drugs block the production of the enzyme that controls the rate of production of mevalonic acid, thus reducing the endproduct cholesterol steroid hormone. Unfortunately, a number of other important molecules are also blocked downstream from mevalonic acid, including the precursors to the Vitamin D hormone, and the important antioxidant Coenzyme Q10, both of which more recent research has revealed are essential to cardiovascular health. This ironic fact is still largely unspoken by cardiologists advising patients.

There are also a variety of reasons why each individual may have a higher level of circulating cholesterol or lipoprotein. Allopathic medicine tries to find a single treatment that works for a majority of patients, but with this approach comes an attitude that tends to treat each patient the same, ignoring individuality in the health profile to a great extent. Increased circulating cholesterol may be a sign of increased need for this hormone in the body, and a growing number of medical doctors and researchers are questioning the need to reduce, or block, cholesterol production, in a great number of patients. With any molecule in the body, there is a tendency to express variants that do not work well in the body. This is why the body may express large amounts of certain valuable molecules. Cholesterol is certainly an important molecule in the body, playing a host of vital roles, such as the daily precursor to other steroid hormones, such as progesterone, estrogen etc. There is now some concern that the number of poor quality cholesterol molecules in the body could be hurting our health, and a host of factors may be causing the difficulties with quality cholesterol production. Certainly, fatty acid imbalance is a factor, but poor liver function, metabolic stress, and the chemical blocking of the pathway of cholesterol production, may all play a part in poor quality cholesterol. Fatty acids are long chain hydrocarbons that are the backbone of triglycerides and phospholipids, whose degradation products form the sterol base of cholesterol. A number of fatty acids are essential fatty acids or conditionally essential, meaning that it is essential that we obtain them from our food for biological processes, or obtain their precursor from our diet. Building a holistic basis for healthy cholesterol and lipoproteins requires quality natural foods and oils, daily essential fatty acid balance in the diet, good liver function and health, decrease in metabolic stress, and overall hormonal balance.

The importance of lifestyle considerations cannot be overlooked, and an attitude of reliance on standard drug regimens to protect against cardiovascular risk has downplayed the importance of these protocols, which need to be integrated into a more holistic and individualized preventive approach. In 2015, researchers at McMaster University, in Ontario, Canada, as part of the PURE (Prospective Urban Rural Epidemiology) study, showed in a large 17 country population study, that grip strength was indeed highly correlated with cardiovascular risk in patients age 35 to 70. Enrolling 142,861 participants, this finding from prior studies, showing that reduced muscular strength was highly associated with cardiovascular pathology and mortality, indicates that overall health and fitness is an important concern. In fact, grip strength was more highly correlated with cardiovascular risk than systolic blood pressure. Grip strength was specific to cardiovascular risk as well, with no correlation seen between grip strength and diabetes, COPD, or bone fracture incidence. Another large 2015 study, sponsored by the American Heart Association and led by experts at the Harvard T. H. Chan School of Public Health, found that patients over 50 who had experienced a period of prolonged depression in their lives had double the cardiovascular risk. The implications of these studies show that attention to the whole health is very important in prevention of cardiovascular disease. Such studies indicates that the standard protocol in cardiovascular prevention, relying on cholesterol lowering and blood pressure medications, was perhaps giving a false sense of security that was not real, and could have actually lulled patients at risk into ignoring overall health and a more holistic approach. Common advice in the prevention of cardiovascular disease risk has been oversimplified and proven incorrect, such as the advice to eliminate salt to lower blood pressure and prevent stroke and heart attack. Finally, in 2015, experts at the McMaster University Population Health Research Institute showed that while excess sodium, not salt, was correlated with hypertension and cardiovascular risk, that daily salt intake less than 3 grams was also correlated with a similar degree of risk for both hypertension and cardiovascular disease. To see this study, just click here: http://www.ncbi.nlm.nih.gov/pubmed/25983308 . Can we really trust standard medicine to provide us with a real set of guidelines to prevent cardiovascular disease?