Pathways to Care: Cardiovascular Disease
Understanding Cardiovascular Disease
Unfortunately, despite tremendous medical advances over the past decades, America’s number one killer continues to be cardiovascular disease. This killer is largely due to fatty deposits in the walls of your arteries called atherosclerotic plaque.
Consider the following statistics from the American Heart Association:
- Nearly 801,000 people in the U.S. died from heart disease, stroke and other cardiovascular diseases in 2013. That’s about one of every three deaths in America.
- About 2,200 Americans die each day from these diseases, one every 40 seconds.
- Cardiovascular diseases claim more lives than all forms of cancer combined.
- About 85.6 million Americans are living with some form of cardiovascular disease or the after-effects of stroke.
- Direct and indirect costs of cardiovascular diseases and stroke total more than $316.6 billion. That includes health expenditures and lost productivity.
- Nearly half of all African-American adults have some form of cardiovascular disease, 48 percent of women and 46 percent of men.
- Heart disease is the No. 1 cause of death in the world and the leading cause of death in the United States, killing over 370,000 Americans a year.
- Heart disease accounts for 1 in 7 deaths in the U.S.
- Someone in the U.S. dies from heart disease about once every 84 seconds.
This buildup of plaque, known as atherosclerosis, is hardening of the arteries by pockets of cholesterol rich gunk that builds up within the inner linings of arteries. The process occurs over decades, slowly bulging into the space inside the arteries and narrowing the space for blood to flow. Eventually, the plaque can rupture and a blood clot can form within the artery. The resulting blockage of blood flow can cause a heart attack.
When you think about heart disease, you probably think of friends or family who suffered for years with high blood pressure, high cholesterol, angina, shortness of breath, or other symptoms of cardiovascular disease. However, for the majority of Americans who die suddenly from heart disease, the first symptom may be their last.  This is known as “sudden cardiac death,” and is when death occurs within an hour of symptom onset. Unfortunately, many of these people do not even know they are at risk. This is why it is critical to prevent heart disease in the first place.
Many people believe that CVD is just a consequence of aging and eventually everyone will develop it. However, a large body of evidence shows there were once large areas of the world where coronary heart disease simply did not exist. For example, in the famous China Study, researchers investigated the eating habits and incidence of chronic disease among hundreds of thousands of rural Chinese. In Guizhou province, an region comprising half a million people, over the course of three years, not a single death could be attributed to coronary artery disease among men under sixty-five.2
In another area in Uganda, a population of millions in eastern Africa, coronary heart disease was found to be almost non-existent.3
Immigration studies of these areas of low heart disease show that this resistance to heart disease is not genetic. In fact, when people move from low-risk to high-risk areas, their disease rates skyrocket as they adopt the diet and lifestyle habits of their new homes. 4
So while, as statistics show, heart disease is the number one cause of death in America, it is largely avoidable through lifestyle choices. This means it is up to each of us to make our own lifestyle decisions as to what to eat and how to live. It is my goal to make sure you are equipped to make these choices through education about the predictable consequences of your actions and the most current understanding about the disease process.
For decades, you have been told the five risk factors linked to almost all cases of heart disease are: high cholesterol, high blood pressure, obesity, diabetes mellitus, and smoking. You have been told that if you just keep these 5 risk factors in check you have nothing to worry about.
Unfortunately, heart disease is not a single entity. It is a complex, chronic disease with many diverse causes. It involves constant interactions among genetics, environment, and lifestyle that make each individual unique.
To prevent heart disease, we must understand the pathways that are of greatest concern. These include:
- Oxidative stress
- Vascular autoimmunity
- Blood pressure
- Blood sugar
- Obesity and increased body fat
Additionally, we now understand heart disease begins in the arteries, more specifically, in the endothelium. The endothelium is the point of contact between blood and the artery and is only one cell layer deep. If the endothelium is damaged you will find yourself on the road to numerous ailments including heart disease, even if you are thin, a nonsmoker, and have great cholesterol levels and low blood pressure.
According to Mayo Clinic, the following are symptoms of cardiovascular disease.
Symptoms can include:
- Chest pain (angina)
- Shortness of breath.
- Pain, numbness, weakness or coldness in your legs or arms if the blood vessels in those parts of your body are narrowed.
- Pain in the neck, jaw, throat, upper abdomen or back.
Clearly you do not want to wait until you experience they symptoms of CVD until you take action. As you are now aware, CVD is largely preventable with lifestyle changes.
Elevated cholesterol and blood pressure, diabetes, obesity, and smoking certainly do not improve your health, but the real concern is whether you have the inflammation, oxidation, and autoimmune dysfunction that trigger endothelial dysfunction and set the stage for coronary heart disease.
Only testing for these five conventional risk factors is inadequate. Research shows there are hundreds of risk factors and predictors that set in motion the processes that lead to endothelial dysfunction and eventually CVD.
Early functional changes eventually result in structural changes in the heart and arteries. This means early identification of the risk predictors and resulting changes, followed by aggressive testing and treatment offer the best means of effectively combating CVD. Ultimately, prevention is the key.
According to the Mayo Clinic, the complications of heart disease include:
- Heart failure. One of the most common complications of heart disease, heart failure occurs when your heart can't pump enough blood to meet your body's needs. Heart failure can result from many forms of heart disease, including heart defects, cardiovascular disease, valvular heart disease, heart infections or cardiomyopathy.
- Heart attack. A blood clot blocking the blood flow through a blood vessel that feeds the heart causes a heart attack, possibly damaging or destroying a part of the heart muscle. Atherosclerosis can cause a heart attack.
- Ischemic stroke. The risk factors that lead to cardiovascular disease also can lead to an ischemic stroke, which happens when the arteries to your brain are narrowed or blocked so that too little blood reaches your brain. A stroke is a medical emergency — brain tissue begins to die within just a few minutes of a stroke.
- Aneurysm. A serious complication that can occur anywhere in your body, an aneurysm is a bulge in the wall of your artery. If an aneurysm bursts, you may face life-threatening internal bleeding.
- Peripheral artery disease. Atherosclerosis also can lead to peripheral artery disease. When you develop peripheral artery disease, your extremities — usually your legs — don't receive enough blood flow. This causes symptoms, most notably leg pain when walking (claudication).
- Sudden cardiac arrest. Sudden cardiac arrest is the sudden, unexpected loss of heart function, breathing and consciousness, often caused by an arrhythmia. Sudden cardiac arrest is a medical emergency. If not treated immediately, it is fatal, resulting in sudden cardiac death.
Root Cause Healing
According to William C. Roberts, the editor in chief of the American Journal of Cardiology, the only critical risk factor for atherosclerotic plaque buildup is cholesterol, specifically elevated LDL cholesterol in your blood. 5 Indeed, LDL is called “bad” cholesterol because it is the vehicle by which cholesterol is deposited into your arteries. However, current research teaches us we need to look at the HDL, LDL, VLDL, and blood fat levels along with the total cholesterol. Our knowledge has advanced well beyond the basic blood lipid profiles which most physicians still test for. It is time to go beyond the big five conventional risk factors and look at dozens of cholesterol fractions and associated particles. These include:
- Overall number of LDL particles
- Sizes and types of LDL cholesterol
- VLDL or Triglycerides
- HDL cholesterol
- Lipoprotein(a) or Lp(a)
- Apolipoprotein B
Additional tests that indicate your risk of coronary heart disease include testing for levels of:
- Paraoxonase - (an enzyme that prevents the oxidation of HDL and the subsequent inflammation it can cause).
- Apolipoprotein C-II - (A protein that helps break apart VLDL and the fat particles called chylomicrons).
- Apolipoprotein A-I and A-II - (Protein complexes that carry HDL in the blood).
- Serum Free Fatty Acids - (Fat in the blood that takes the form of tiny, free-floating particles that increase the risk of coronary heart disease).
These are key items your physician should be looking at when trying to determine if your cholesterol, blood fat, and related substances are posing a danger, not just the potentially misleading total cholesterol, LDL, and HDL numbers.6
Please watch for our upcoming articles and webinars which provide more detailed information about this and other chronic disease prevention and treatment strategies including topics like:
- Understanding disease pathology.
- Recommended labs (including what labs to talk to your doctor about).
- Understanding your labs (understanding optimal levels).
- Treatment options and strategies.
- Disease avoidance and reversal.
- Nutritional interventions and recommendations.
- Conventional and alternative approaches.
- Regular updates on current scientific studies.
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Vitopia Health is dedicated to helping you understand complex disease processes, providing you with the necessary tools and knowledge to identify and treat the underlying cause. Following this approach encourages prevention and/or reversal of chronic disease.
Please check our our in-depth articles on preventing and healing chronic diseases utilizing a Functional Medicine approach. We also encourage you to subscribe to our distribution list so you can receive the most current scientific information on preventing and treating chronic disease.
 Myerburg RJ, Junttila MJ. 2012. Sudden cardiac death caused by coronary heart disease. Circulation. 28;125(8):1043-52
2 Campbell, TC, Parpia B, Chen J. Diet, lifestyle, and the etiology of coronary artery disease: the Cornell China study. Am J Cardiol. 1998;82(10B):18T-21T.
3 Shaper AG, Jones KW. Serum-cholesterol, diet, and coronary heart-disease in Africans and Asians in Uganda: 1959. Int J Epidemiol. 2012;41(5):1221-5.
4 Benfante R. Studies of cardiovascular disease and cause-specific mortality trends in Japanese-American men living in Hawaii and risk factor comparisons with other Japanese populations in the Pacific region: a review. Hum Biol. 1992;64(6):791-805
5 Benjamin MM, Roberts WC. Facts and principles learned at the 39th Annual Williamsburg Conference on Heart Disease. Proc (Bayl Univ Med Cent). 2013;26(2):124-36.
6 What Your Doctor May Not Tell You About Heart Disease. Mark C. Houston, MD, MS. Associate Clinical Professor of Medicine, Vanderbilt University School of Medicine, and Director of Hypertension Institute nd Vascular Biology, Saint Thomas Medical Group, Saint Thomas Hospital. 5:70.
Please check out our in-depth articles on preventing and healing chronic diseases utilizing a Functional Medicine approach. We also encourage you to subscribe to our distribution list so you can receive the most current scientific information on preventing and treating chronic disease.
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