Heart Attack Prevention Update

Conventional medicine is very effective for treating existing and/or severe heart disease, but most doctors don't give nearly enough attention to prevention.

What you may not know: An estimated eight out of 10 heart attack deaths can be prevented-but not by focusing mainly on high cholesterol and prescribing powerful drugs, as most doctors do. With integrative heart care—which combines conventional medicine and alternative therapies—patients get much better results than either type of treatment can offer when used alone.

Problem: Too many doctors have not stayed up-to-date on a number of important heart disease risk factors that have been discovered only in recent years. To protect yourself or a loved one…

• Don't be fooled by a "normal" cholesterol reading. A "normal" total cholesterol level is typically defined as less than 200 milligrams per deciliter (mg/dL). But one-third of patients with heart disease have cholesterol levels that are less than 200 mg/dL.
  

How does this happen? Total cholesterol is the combined total of LDL "bad" cholesterol...VLDL (very-low-density lipoprotein, also a "bad" cholesterol because high levels are linked to heart disease)...and HDL "good" cholesterol levels. Many people who have "normal" total cholesterol levels have dangerously low levels of the beneficial HDL cholesterol. HDL is responsible for removing LDL "bad" cholesterol from the arteries and carrying it to the liver for disposal. HDL also has antioxidant properties that can reduce arterial blockages (atherosclerosis).

Conversely, a total cholesterol reading that is 200 mg/dL or higher might be due to elevated HDL. These patients are less likely to get heart disease than those with the same total cholesterol level and a lower HDL level—but the standard cholesterol test would indicate that they are at increased risk.

Example: A 39-year-old woman I know had a total cholesterol reading of 125 mg/dL. Her doctor thought she was in great health but her HDL was only 15 mg/dL, and she went on to develop coronary artery disease. (HDL should be at least 50 mg/dL in women and at least 40 mg/dL in men.)

To raise "good" HDL: Ask your doctor about niacin. At doses of 1,000 mg to 2,000 mg daily, this form of vitamin B can increase HDL by 29%-that's more effective than the prescription drug gemfibrozil (Lopid), which is used to raise HDL.

Caution: Niacin at these doses can worsen gastroesophageal reflux disease and ulcers, elevate blood sugar, trigger gout (a type of arthritis) and cause liver irritation. Therefore, it should be taken only under a physician's supervision.

Helpful: To reduce flushing, a common side effect of high-dose niacin, take it with food. Do not take popular "flush-free" niacin—anecdotal evidence suggests that it isn't as effective as standard types.

• Don't settle for a traditional cholesterol test. These tests measure levels of total, HDL and LDL cholesterol, along with blood fats known as triglycerides. Newer tests-which still aren't used by most doctors-look at cholesterol subfractions, blood fat measurements that may be more predictive of heart disease than total cholesterol, HDL and LDL alone. Ask for a cholesterol test that looks at...
  
• Ip(a). This is a particle that includes both LDL and a potentially dangerous blood-clotting chemical. People with an elevated Lp(a) are oneand-a-half times more likely to get heart disease than those whose level is normal.
  

Optimal Lp(a) level: Below 30 mg/dL.

Treatment: Niacin 500 mg to 2,000 mg daily-can lower Lpla) by up to one-third

Also helpful: Eating 10 walnuts daily will lower Lp(a) by up to 6).

• LDL size. LDL particles are either small and dense or large and fluffy. Patients with a relatively high percentage of large particles are said to have Pattern A distribution. They're three times less likely to have heart disease than those with a higher percentage of small particles (Pattern B)-even when LDL readings are the same in both groups.
  

Treatment: If you have Pattern B distribution, fish oil may be beneficial because it can convert small particles into large ones.

Typical dosage: 1,000 mg to 4,000 mg of fish oil daily, from supplements containing at least 1,000 mg of combined eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Caution: Fish oil can cause gastrointestinal upset and has a mild blood-thinning effect. It should not be used by patients who take the blood thinner warfarin (Coumadin) and should not be taken two weeks before and after any surgical procedure.

Exercise also decreases the concentration of small LDL particles. Aim for 30 to 60 minutes of aerobic exercise five to seven days a week.

• Find out your high-sensitivity C-reactive protein (hs-CRP) level. Hs-CRP is linked to higher rates of heart disease, yet few doctors test for it routinely. Insist on it. Elevated hs-CRP greatly increases heart attack risk, even in patients with normal cholesterol.
  

Optimal hs-CRP level: Below 1 mg/L.

Treatment: The cholesterol-lowering statin drugs, such as atorvastatin (Lipitor) or simvastatin (Zocor), can lower hs-CRP by up to 40%.

Also helpful: Weight loss (excess fat tissue, especially in the abdominal area, produces inflammatory chemicals that promote hardening of the arteries)...daily brushing and flossing (lowers risk for gum inflammation and dental infections, which are linked to heart disease)... exercise and combining a statin drug with 1,000 mg to 4,000 mg of fish oil daily.

• Take stress seriously. Mainstream medicine greatly underestimates the effects of chronic stress on heart health. Patients with frequent stress maintain high levels of adrenaline and other potentially harmful chemicals and hormones that increase blood pressure and hs-CRP.
  

Treatment: Add stress reducers, such as exercise, yoga and/or meditation, to your daily schedule.

• Consider supplements. People without heart disease who have high blood pressure and mildly elevated cholesterol (requiring an LDL decrease of less than 25%) as well as those who can't tolerate prescription drugs may be good candidates for treatment with over-the-counter (OTC) supplements. Use of the following supplements should be supervised by a physician-they have potential side effects and may interact with medications or other supplements...
  
• Red yeast rice is an OTC product that can lower LDL by nearly 25%. Red yeast rice is helpful for patients with mildly elevated cholesterol (described above)...those who have experienced side effects from prescription statin drugs...or those who simply do not want to take a prescription statin.
  

Typical dosage: 600 mg twice daily. If stronger effects are needed, a maximum dosage of 1,200 mg twice daily.

Caution: Red yeast rice has the potential to cause liver and/or muscle irritation. Use it only under the supervision of a doctor, who can monitor its effectiveness and any side effects. Stop taking red yeast rice if you develop unexplained muscle aches or pain.

• Coenzyme Q10 (CoQ10) is a vitamin-like substance that's naturally present in cells. In supplement form, it lowers blood pressure and improves symptoms of heart failure. Important: Statins lower CoQ10 levels.
  

Typical dosage: 100 mg daily when taking statins...or 200 mg to 300 mg daily when taken for hypertension and/or congestive heart failure.

Caution: CoQ10 is a mild blood thinner, so it should not be taken by people on warfarin.