Cardiovascular Risk and Pathology

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

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Metabolic Syndrome and Non-alcoholic Fatty Liver Disease may be the key to poor cardiovascular health and atherosclerotic plaques

A 2012 study at Taipei Veterans General Hospital, Division of Cardiology, in Taiwan (cited below), showed that the root of atherosclerotic plaque formation and cardiovascular disease may often be related to a decrease in numbers and function of endothelial progenitor cells (EPCs) that originate in the bone marrow. The levels and function of EPCs relate to maintenance of the endothelial lining of our blood vessels, or vascular repair capacity. With ill health of the metabolism, especially concerning fatty tissue accumulation in the liver, and Metabolic Syndrome, the capacity to generate healthy EPCs is diminished. The Chinese researchers found that patients with non-alcoholic fatty liver disease and Metabolic Syndrome consistently had low levels of circulating EPCs. These health problems can be successfully treated with an holistic approach with CIM/TCM, but more directly, acupuncture may help restore EPCs. A 2015 study at the Kyung Hee University School of Medicine, in Seoul, South Korea, found in a randomized controlled human clinical trial of 20 patients with cerebral infarction that electroacupuncture stimulation induced improvement of EPC levels and endometrial function. To see this study, just click here:http://www.ncbi.nlm.nih.gov/pubmed/25932899 . Prior studies have also confirmed that ability of electroacupuncture stimulation at the points DU20, LI4, and LV3 in short courses of frequent stimulation to up-regulate the expression of EPCs in the bone marrow and peripheral blood (PMID: 25632566).

By focusing treatment on reduction of fatty tissue accumulation in the liver, rather than simple blocking of cholesterol, patients will be able to reverse the complex pathway of ill health that leads to atherosclerosis and cardiovascular disease. A focus on AGE reduction (advanced glycation endproducts), improved cardiovascular health and repair, and elimination of the dietary and lifestyle problems generating this condition, will result in elimination of the underlying problems generating cardiovascular disease. To better understand Metabolic Syndrome, go the article on this website entitled Metabolic Syndrome and Prediabetic States. The whole picture of atherosclerosis and cardiovascular disease involves a variety of factors, though, including inflammatory stress and neuroendocrine and hormonal imbalance. As we look for a real treatment and prevention protocol we must stop focusing on which specific factor we should treat, and finally admit that we need to develop broader and more holistic treatment regimens.

Underlying chronic inflammation is now strongly linked to the pathogenesis of both obesity and atherosclerosis. Links of atherosclerosis development to chronic infections such as Chlamydia pneumoniae and human cytomegalovirus show that a variety of low-grade chronic infections from both bacteria and viruses could be linked to the development of cardiovascular disease. The systemic and local inflammatory mechanisms could both be important in the pathogenesis, and provide the link between obesity, fatty liver disease and atherosclerosis better than the model of high cholesterol in the diet, an outdated and disproven theory that still drives the main treatment strategy in standard medicine. Chlamydia pneumoniae is distinct from other species of Chlamydia, and in 2014, the U.S. CDC estimated that the total incidence in the U.S. rose to as many as 5 million cases of pneumonia and a half million hospitalizations per year, but also responsible for millions of cases of bronchitis, sinusitis, laryngitis and pharyngitis, often mild or even asymptomatic. Chlamydia pneumoniae, or Chlamydophila pneumoniae, is also now linked to asthma, reactive arthritis and Alzheimer's disease. There is a lack of standardized diagnostic methods and no treatment in standard medicine to prevent recurrence. What is missing from the analysis of threat is that individuals with a healthier immune system and respiratory membrane will have a much lower risk of acquiring this infection, and that Complementary and Integrative Medicine offers a number of effective treatment protocols for both acute and chronic infection, combined with immune strengthening.

The Role of Healthy Sleep in Cardiovascular Risk

A 2015 study at the University of Cambridge and the University of Warwick, in the United Kingdom, published in the journal Neurology, found that sleep quality and duration was significantly associated with cardiovascular risk, but not in the way that was expected. A large prospective study of nearly 9000 patients enrolled in the European Prospective Investigation into Cancer, or the Norfolk Consort, that were stroke-free at the time, with ages between 42 and 81 years of age, between the years of 1998-2004, had their health histories examined at a 9.5 year follow-up, to assess sleep patterns and quality and determine possible associations with future incidence of stroke. The results showed that too little sleep had a slight, but statistically insignificant, association with future stroke, but that patients who reported persistently prolonged sleep times, or substantial increases in sleep time, had a very significant increased risk of stroke (PMID: 25716357). What this shows is that the standard protocol of wide prescription of sleep medications to achieve longer sleep times may be a big mistake. The number of hours of sleep is not as important to overall health as the quality of sleep, and patients that report short sleep duration are not at higher risk of cardiovascular disease and stroke. This study also may indicate that patients with depressive mood disorders and persistently longer sleep duration may be at higher risk of stroke. A more detailed study, or set of studies may reveal the answers to these questions.

Another large randomized controlled human study in 2014, at the Dharam Vira Heart Institute, in New Delhi, India, found that sleep quality was associated with heart disease and cardiovascular health. This study of 352 patients found that sleep duration less than 6 hours was associated with coronary heart disease, but that quality of sleep was perhaps more important in association with markers of cardiovascular disease (PMID: 25634385). Since sleep medications induce longer sleep but disrupt healthy quality sleep cycles, it is important to consider restoration of sleep quality with Complementary and Integrative Medicine.

The Risk of Cardiovascular Mortality from Tachycardia and Atrial Fibrillation

Atrial fibrillation (AF) is a common type of abnormal heartbeat in which the rhythm is fast and irregular, usually occurring in short episodes, and caused by fibrillation of the muscles of the atrium of the heart when the neural signal regulating heart rhythm does not originate only in the sinus atrial node (SA), or pacemaker located in the right atrium of the heart tissue, but is interfered with by signals that are believed to be associated with the roots of the pulmonary veins in a majority of cases. Paroxysmal AF may last from minutes to days, while permanent AF occurs all the time. Atrial fibrillation does not cause symptoms in a majority of patients, but noticeable symptoms, such as shortness of breath, palpitations, and dizziness, may be alarming. The condition is estimated to affect over 1 percent of the population of the United States, and 5 percent of the population over age 65 (Journal of the American Heart Association 2001). The underlying causes of atrial fibrillation are still poorly understood, but are believed to be related to fibrosis, inflammatory processes, and loss of atrial muscle mass due to lack of aerobic exercise. Myocardial infarction and cardiothoracic surgery precede about half of the patients with acute atrial fibrillation, but over half of the patients with paroxysmal chronic atrial fibrillation have no obvious clinical cause. Structural abnormalities of the heart atrium may occur in a small percentage of cases, and may have genetic or epigenetic components. Adrenal hypertension, and sustained excess of angiotensin type 2, may result in atrial fibrosis as well. Atrial fibrillation is thought to be progressive, with prolonged fibrillation correlated with increasingly prolonged recovery time of the sinoatrial node, and may lead to problems as well in the atrioventricular node (AV node), eventually producing sick sinus syndrome. The signals that interfere with the normal heart rhythm from the pulmonary veins, or large veins from the lungs, are believed to be related to enhanced automaticity, triggered activity, and microreentry from myocardial sleeves inside these pulmonary vein roots. The reasons why these pulmonary vein root tissues acquire these problems is still poorly understood.

The Mayo Clinic reported in 2011 that the risk of heart attack is not increased due to atrial fibrillation, only ventricular fibrillation, which usually occurs only in diseased hearts. Occasionally, the rapid heart beat, or tachycardia, associated with atrial fibrillation can result in chest pain or discomfort because of reduced blood flow to the heart muscle, but this is different from chest pain, or angina, associated with a heart attack. A heart attack, or myocardial infarction (heart muscle blood flow obstructed), is almost always attributed to a blockage of blood flow to the heart muscle by a moving clot (thrombus), or narrowing of the vessels (stenosis) from atherosclerotic plaque. Atrial fibrillation is associated with increased risk of stroke, but only when other factors of risk were present, such as hypertension and atherosclerosis. Atrial fibrillation may impact the quality of life, and have deleterious effects on the heart over a long time period, such as enlargement of the left atrium, but current studies in 2013 are not clear on the asscociation with increased risk of death from cardiovascular or other causes.

Acupuncture and herbal/nutrient medicine may be a safer method of treating atrial fibrillation than the current pharmaceutical and surgical treatments. It is always wise to first try the treatment protocol that has the least risk of adverse effects, and both acupuncture and herbal/nutrient medicine are now evidence-based treatments for this condition.

Current pharmaceutical treatments include blood thinners (anticoagulants) such as warfarin and heparin, rate controlling drugs such as beta-blockers (atenolol, metoprolol), calcium-channel blockers (verapamil, diltiazam), and anti-arrhythmic (cardioversion) agents such as amiodarone. If the more benign drugs are not effective, amiodarone is prescribed. Amiodarone comes with an FDA warning, issued in 2008, for significant risk of rhabdomyolysis, or accumulation of damaged muscle proteins that may cause organ failure in severe cases. This accumulation of muscle proteins also comes from the use of cholesterol lowering statin drugs, and the warnings involve concurrent use of statins. Amiodarone is also very inhibiting of the cyotchrome P450 liver enzyme metabolism, altering the circulating levels of many other drugs, creating potentially harmful effects. Some drugs that are contraindicated with amiodarone are simvastatin, warfarin, viagra (sildenafil), procainamide (another anti-arrhythmic agent), digoxin, cyclosporin, quinidine, and theophylline (treating COPD and asthma), some of which may be used, or previously used, to treat the atrial fibrillation and cardiovascular or respiratory problems. But other common drugs that use the P450 metabolism and may alter the circulating level of amiodarone or be altered themselves in this way include NSAIDS, caffeine, estradiol and progestins (birth control or hormone replacement), cortisones, naproxen and other NSAIDS, glipizides and tolbutamide (diabetic medications), sulfonylureas (diabetic medications and other uses), diazepam and benzodiazepines (anti-anxiety), antidepressants, antipsychotics, macrolide antibiotics, tamoxifen, codeine and cocaine.

Because of the poor results in treatment with pharmaceuticals the medical profession has adopted cardiac ablation (radiofrequency ablation), as the preferred treatment in many cases now. A type of treatment called electrical cardioversion, with clinical treatments using electrical shocks, has a success rate in various types of atrial fibrillation of over 75 percent, but in a small percentage of cases may result in worsened arrhythmias. The 2012 Radiofrequency Ablation for Atrial Fibrillation Trial (RAAFT 2) indicated in a multicenter trial that ablation may be superior to rhythm control drugs such as amiodarone, for a variety of reasons, but long-term efficacy of ablation is still unclear. Another 2012 study, the Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF), published in the New England Journal of Medicine, showed that in patients with low-risk but bothersome atrial fibrillation that the success rates for ablation was 85 percent compared to 71 percent with drugs, but more than a third of patients needed a second surgical procedure to stop the fibrillation within 2 years, and more than 8 percent needed more than 2 surgical ablations, in an ideal setting. Overall rates of success were evaluated in 2012 by the University of Adelaide, in Australia, and this meta-review was published in the Journal of the American Heart Association, showing that patients with atrial fibrillation getting a single cardiac ablation has a 53 percent return of atrial fibrillation in 2-5 years, with patients with paroxysmal AF successfully avoiding a return of atrial fibrillation only 54 percent of the time. The 80 percent success rate involved patients with multiple cardiac ablations. The review noted that only one study so far has evaluated patients beyond 5 years, and long-term success is still completely unknown.

Much study has elucidated the role of the autonomic nervous system in modulating cardiac arrhythmias, showing the potential for a restoration of autonomic homeostasis as a safe and simple treatment approach for these conditions of arrhythmia and atrial fibrillation. For instance, a 2014 meta-review of studies by experts at the Indiana University School of Medicine's From Krannert Institute of Cardiology, in Indianapolis, Indiana, U.S.A. noted that atrial fibrillation shows simultaneous sympathetic and parasympathetic activations underlying the symptom, while the more serious ventricular fibrillation involves proarrhythmic sympathetic activity and antiarrhythmic parasympathetic activation. Such study has brought up the idea that autonomic modulation could both prevent and treat these arrhythmias. Currently, standard medicine utilizes either cardiac ablation or cardiac stimulation to achieve this goal, but this is only proven to work with long QT syndrome, and in most arrhythmic diseases these treatments are still under investigation (PMID: 24625726). There is also emerging study that acupuncture stimulation is effective in modulating heart rhythm by autonomic modulation, though, presenting the potential that a very simple, very safe, and inexpensive therapy could achieve this goal of autonomic modulation. Such therapy could be tried first in prevention or treatment, or be integrated with these other modalities in standard medicine to achieve better outcomes.

One example of such study is seen here in a multicenter collaboration between the University of Bergen in Norway, and the Southern Medical University, in Guangzhou, China, where a randomized, controlled human clinical trial of acupuncture stimulation at just one point, HT7, proved that such treatment does indeed modulate the autonomic nervous system and restore normal heart rate variability: http://www.ncbi.nlm.nih.gov/pubmed/25476448 . Of course, more study will be needed to determine the exact effects on patients with different types of arrhythmia and fibrillation, but with the complete safety, low expense, and simplicity of these acupuncture treatments, patients do not need to wait years for these larger clinical trials to produce the final proof. In fact, even without definitive proof, and evidence of harm, as well as great expense, most medical doctors are already rushing to utilize cardiac ablation and cardiac stimulation with anti-arrhythmic drugs for all of these patients. To deny the patient a simple treatment like acupuncture, which is combined with other helpful treatment modalities as well in holistic treatment, is not sensible. Further study in 2014, at the Cedars-Sinai Heart Institute and University of California, Los Angeles, California, U.S.A. showed that traditional acupuncture stimulation has a significant benefit for modulating autonomic function in patients with stable ischemic heart disease: http://www.ncbi.nlm.nih.gov/pubmed/25103909 . With such findings from renowned standard institutions, patients and their doctors should not hesitate to integrate acupuncture and TCM into their care.

A couple of studies in Europe in 2012 evaluated the success of acupuncture to treat atrial fibrillation, and found that this treatment worked as well as treatment with the anti-arrhythmic drug amiodarone.

A study at the University of Milan, Italy (Frederico Lomabardi et al) was published in the World Journal of Cardiology in March of 2012 and found that a simple treatment with 10 acupuncture sessions using just 3 points, P6, the ear point Shenmen, and the heart shu point UB15, once per week, in patients with paroxysmal atrial fibrillation, and persistent AF patients who had undergone cardioversion, produced a similar anti-arrhythmic effect to the long-term use of amiodarone that was sustained. Another study at the Universita degli Studi di Milano, Italy (A Lomuscio et al) showed that patients with persistent atrial fibrillation that had undergone cardioversion and received 10 acupuncture sessions with the above points showed a 65 percent success rate after 12 months, similar to those that were prescribed Amiodarone as an anti-arrhythmic, but without the risks and adverse effects of this drug (PMID: 20807278). Clearly, many experts in the field in Europe are starting to understand that acupuncture presents an effective treatment strategy that is without risks and adverse effects and costs very little. Since both paroxysmal and persistent atrial fibrillation presents with no risk of a heart attack, and only a long-term increased risk of stroke when combined with hypertension or atherosclerosis, trying the acupuncture treatment first seems a sensible and conservative treatment protocol. If the patient has a persistent atrial fibrillation, a session of electrical cardioversion should be administered first. The added benefits of the acupuncture include those that are gotten from a more skilled treatment and broader effects from a larger point protocol than in these studies, as well as the beneficial effects from professional herbal and nutrient medicines prescribed by the acupuncturist. The only side effects are better overall health and prevention of future health problems.