Arteriosclerosis
(The "Missing Link" Between Strokes And Heart Attacks)Â
Introduction: The Framingham study
and many other newer prospective studies have shown that the degree of hardening
of the arteries throughout the body, called "arteriosclerosis", determines
the risk of whether or not we are developing strokes and heart attacks (Ref. 1,
5 and 6). The risk factors for heart attacks are identical to the risk factors
for strokes and vice versa. Here is a recent fact
sheet of the American Heart and Stroke Association showing that strokes
and heart attacks are the number one killer for men and women in the US. Gum
disease and tooth decay that is left alone will cause hardening
of the arteries, heart attacks and strokes. Strangely enough, brushing
your teeth regularly and flossing will prevent heart disease and strokes. The
following risk factors for arteriosclerosis have been identified: 1.
Smoking
2.
High LDL cholesterol (low density lipoprotein,
also known as "bad cholesterol") and low HDL cholesterol (high
density lipoprotein, also known as "good
cholesterol"). 3. Hypertension, which is
not controlled. 4. Lack of physical activity (sedentary
life style). 5. Excessive weight and the associated
high triglyceride levels. 6. Diabetes mellitus
when not closely controlled. 7. Hormone deficiencies: Women
outlive men by 10 years on average, likely because of the cholesterol lowering
effects of the female hormones (estrogen effect) during their reproductive years.
In males a lack of testosterone causes cardiovascular disease. As is discussed
below bio-identical hormone replacement in males and females can prolong life.
Here is a review of the bio-identical
hormone option. Another review discusses the pros
and cons of bio-identical hormone replacement. 5500 physicians, naturopathic
physicians and other health practitioners attended a conference of the A4M in
Las Vegas (Ref.16) and there was consensus that bio-identical hormones, given
judiciously will save lives. 8. Unhealthy gums
and tooth decay not taken care of will lead to an inflammatory condition that
affects the lining of the arteries and causes heart attacks and strokes. The reason
for this is that the lining of the arteries will stop producing the life prolonging
nitric oxide (=NO). 9. Hereditary factors: certain
hyperlipidemias and homocysteinuria are associated with heart attacks at a young
age. They require a close follow-up by a cardiologist or internist with a special
interest in these metabolic diseases. The crucial question
is: What can be done to prevent premature arteriosclerosis?
Here are some suggestions (Ref. 2 and 3):
| This can be done to
prevent heart attacks and strokes: | | factor
to change: | Comments
regarding facor to change: | | balanced
diet | 20% fat, low cholesterol, 55% natural
carbohydtrates, 25% protein (zone-like) | | diabetes |
needs to be controlled tightly | | exercise | all
studies show that this reduces risk significiantly | | hormone
replacement | Newer anti-aging medicine
approaches are useful for both women and men for prevention of heart attacks and
strokes. Testosterone
in men and estrogen/progesterone
in women release nitric oxide (=NO), which lowers blood pressure and widens
arteries. This reduces strokes and heart attacks by 40% in both sexes. |
| medical
problems | high blood pressure needs control;
high levels of cholesterol, triglycerides or homocysteine need appropriate treatment
(eat green-leaved vegetables, they contain NO). | | stop
smoking | all medical studies show a clear
risk reduction in strokes and heart attacks | | vitamins
and supplements | vitamin C and E, Omega-3-fatty
acid, Co-Q-10, NEO 40 (newer NO source from hawthorne and beet root) |
| weight
reduction | achieved by combination of
exercise and balanced diet |
Exercise:
With this I mean to walk briskly 30 to 40 minutes 4 to 5 times per week,
better even every day. Even such moderate exercise is effective in reducing heart
attack rates and strokes by 50%! Exercise will increase the HDL
blood level thus protecting the LDL cholesterol from being oxidized. This prevents
or reduces arteriosclerosis.
STOP SMOKING:
To stop smoking is likely the single most important
step in your life to reduce your risk for a heart attack, lung cancer, stroke
etc. |
Use nicotine patches,
nicotine gum, self hypnosis cassettes with "stop smoking" suggestions.
I don't care how, but stop smoking. One helpful medication that came out recently
is bupropion (brandname: Zyban), an antidepressant, which helps with the craving
aspect of smoking. Why am I so adamant about this? Because cigarette smoke has
a myriad of chemicals, which are readily absorbed through the lungs directly into
the blood stream. These chemicals will increase and oxidize the LDL cholesterol,
decrease the protective HDL cholesterol, attack the arterial wall and make the
coronary arteries constrict ( this is called the nicotine effect). In short, it
leads to premature and severe arteriosclerosis. Apart from this it also leads
to many cancers, in fact it causes 40% of all cancer deaths in males and about
20% of all cancer deaths in females.
Low
fat diet and reduction of excessive cholesterol intake:
Most North Americans eat 25 to 50% of their daily calorie
intake as fat. If this is reduced to 10 to 25% in the daily calorie intake, triglycerides
in the blood as well as LDL cholesterol are significantly reduced. The reason
the total cholesterol intake matters is that about 50% of the body's cholesterol
comes directly from our diet, the other 50% is manufactured by the liver. Our
circulating LDL cholesterol (the "bad" cholesterol) will automatically
be reduced, if we cut down on the consumption of meat, poultry and dairy products
and if we switch to more fish, soybean, vegetables and grains. Meat and dairy
products have hidden fats in them, which are metabolized by the liver into triglycerides,
which in turn will circulate in the blood and then get stored as fat around breasts,
in the chest wall, the abdomen and abdominal wall, buttocks and thighs. The
fat won't sit still, but gets metabolized ("turned over"), which in
turn will elevate the triglyceride blood level. These feed into the fat deposit
of the arterial wall, which is one of the hall marks of arteriosclerosis (called
"atheromatosis"). When obesity with increased body weight has been established,
a particularly dangerous condition, the insulin resistant syndrome (IRS) can develop.
This has nothing to do with the IRS that collects U.S. Citizens' tax money. The
IRS syndrome is worse: it takes life away by a combination of high LDL cholesterol,
high triglycerides, low HDL cholesterol levels and high insulin levels leading
to an accelerated arteriosclerosis development with frequent strokes, heart attacks
and blockage of arteries to the legs often requiring amputations. By changing
the factors mentioned above the IRS syndrome can be reversed and a normal life
expectancy can be obtained! The bottom line is that the low fat diet factor
can cut heart attacks and strokes into half over two decades
or more. But even 1 or 2 years of a low fat diet will reduce the risk significantly.
Control
medical problems that would affect
arteriosclerosis: If you have hypertension (high blood pressure)
make sure to see your doctor to control it with adequate medication. Buy your
own blood pressure monitoring equipment to be able to know how well your blood
pressure is controlled. By doing this you prevent a hemorrhagic stroke, heart
disease, kidney disease and help prevent accelerated arteriosclerosis.
A minority of people may have a genetic trait such as hypertriglyceridemia or
homocysteinuria, which requires other medicines or specific vitamins, which the
doctor or cardiologist needs to prescribe. If the other measures mentioned above
have not lowered the cholesterol, it may be necessary for you to take one of the
"statin" family of medications (CoA reductase inhibitors) to achieve
normal LDL blood levels. These medicines, which the doctor will prescribe for
you, inhibit a liver enzyme thus lowering the LDL and often at the same time increasing
the HDL cholesterol as well, resulting in a lowered arteriosclerotic risk.
Control
of excessive weight: Weight
loss can be achieved fairly easily by a combination of regular exercise, low fat
food, avoidance of sweets and reduction of excessive starchy food intake. Often
patients who are newly diagnosed with diabetes at age 40 years or more will normalize
their diabetes on such a diet, if they were obese at the time of the initial diagnosis.
Such a diet, low in fat, low in sugar and starch with an emphasis on vegetables,
will slow down the aging process by postponing arteriosclerosis. Self hypnosis
cassettes that you listen to daily for some time can also be very effective for
weight loss provided you combine this with the other measures mentioned above.
Read more about low glycemic, low fat foods
and on basic exercises to improve your fitness
under these links.
Diabetes
mellitus needs to be controlled tightly:
The best control of diabetes is usually achieved by insulin injections two or
three times a day in combination with home glucosometer readings and three monthly
blood tests where the hemoglobin A1C level is determined. Only when the
hemoglobin A1C values and the home glucosometer readings are close to normal levels,
will the major target organs such as the brain, heart, the kidneys and the eyes
stay healthy. If the blood sugars are chronically elevated, lipid abnormalities
develop, which accelerate arteriosclerosis and brings damage to the target organs.
The end result is blindness from diabetic retinopathy, brain damage from diabetic
encephalopathy, heart attacks, strokes and damage to the arteries of the hands
and lower legs resulting in gangrene and amputations. I cannot overemphasize :
Prevention is more powerful
than any cure! |
Vitamins
and supplements: a)
Recently many trials have been published, which convincingly give
evidence that vitamin E lowers cholesterol. At least
200 IU or more (typically 400 to 800 IU per day) will reduce LDL cholesterol.
Heart attacks and strokes are reduced by 40 to 50%, which is a highly significant
finding and just as effective as exercise and the "statin"type cholesterol
lowering agents (Ref. 4).
b)
Beta-Carotene, a precursor of Vit. A, has also been shown to reduce
heart attacks and strokes, although a few studies could not prove effectiveness.
The dose is 20 mg every other day. However, two carrots a day will do the same
and in one study it has been shown to cut the risk of stroke in half among men
who were at risk of heart disease.
c) What about bioflavonoids? These cholesterol
lowering phytochemicals are found in red grapes, red wine, broccoli, apples and
many other fruits and vegetables. A small glass of red wine per day (less than
4 oz.) Will prolong life significantly by lowering cholesterol. The key is: low
dose, but regular. However, alcoholics should refrain from this approach because
this alcohol content could trigger a loss of control. For them the old saying
counts (as well for those who do not like red wine):" an apple a day keeps
the doctor away..." Yes, we now know that it's the fiber and the bioflavonoids
that does the trick. A Dutch study of elderly men showed that with the regular
intake of the equivalent amount of bioflavonoids found in one apple per day, there
were 50% less heart attacks in that group of men than in the control group who
did not take the bioflavonoids.
d)
Garlic, anyone? For centuries it was postulated that garlic
would prolong life. Several well controlled studies have shown now that this in
fact is true. Garlic lowers blood pressure marginally, lowers LDL cholesterol
and has an important anti clotting effect, which in combination will reduce heart
attacks and strokes by 40 to 50% when taken regularly. I would caution that the
anti hypertensive effect is rather mild and would have to be combined with conventional
blood pressure medication for people with high blood pressure. e)Other
vitamins: Vitamin B3, B6 and B12 have their place in certain
metabolic diseases such as for instance mild cases of homocysteinuria. Vitamin
C has been studied extensively and has use as an antioxidant preventing oxidization
of LDL cholesterol, but not every study has been conclusive. As a contrast, all
studies showed that Vit. E consistently demonstrated powerful antioxidant effects
. However, Vit. C has other useful effects as it has been shown to prevent many
types of cancers.
For
women only (since 2006 also for men): |
Recently several large studies
were published, which investigated women in menopause with or without estrogen
replacement. There was a 40 to 50% reduction of heart attacks in women who supplemented
with estrogen compared to women who did not supplement. Not every postmenopausal
woman should necessarily take estrogen replacement and you should consult your
doctor for more details. However, an overview of the literature showed (see Family
Practice, Oct.5, 1998) that the benefits outweigh the risks for most postmenopausal
women. It was thought that men could not take advantage of this form of therapy
as they would change their nature and physical appearance. The Women's
Health Initiative (Ref. 12) has taught physicians a tough lesson: you cannot mess
with nature's hormones or else you create a risk of strokes (41%), heart attacks
(29% more), blood clots (twice as many), breast cancer (26% more), colorectal
cancer (37% more) and you increase Alzheimer's disease (76% more often). This
was a trial involving over 16,000 postmenopausal women. The truth is that these
synthetic estrogen-like and progesterone-like substances that were used are not
bio-identical hormones. These synthetic hormones are artificial hormones that
are functioning as "xenohormones". The end result is that physicians
create estrogen dominance in these women and together with the progestins (=modified
progesterone molecules) this is the reason for the above listed complications
(Ref. 13). If, however, the treating physician puts postmenopausal women on bio-identical
hormones (bio-identical estrogen and bio-identical progesterone) the postmenopausal
women will simply feel younger for longer. The reason for this is that HDL cholesterol
is elevated and LDL cholesterol reduced, which effectively postpones arteriosclerosis.
I mentioned earlier that women through their reproductive years gain a 10 year
survival advantage over men. This likely is due to the accumulative estrogen exposure
effect from the ovaries. Since the realization that bio-identical hormones can
safely be given to postmenopausal women life-long without side-effects, anti-aging
researchers think that life can be prolonged a total of 15 to 20 years by giving
bio-identical estrogen along with bio-identical progesterone after menopause.
All of the beneficial effects listed in this
table will be available to women on this bio-identical hormone replacement
treatment. The observations of the Women's Health Initiative (Ref.12) were
made with synthetic estrogen replacement hormones and synthetic progestins. These
hormone-like substances do not fit into the hormone receptors of the body. The
body does not like this and the side-effects listed above take place. There are
no side-effects with bioidentical hormones as Suzanne Somers has described it
in her book (Ref. 9) and Ref. 10, 11 and 13 also confirm. What's more, it
is possible for men to take advantage of the natural hormone effects, but in the
male the main hormone to replace is bio-identical testosterone. Dr. Shippen (Ref.
15, p. 85-88) has described research showing that a lack of testosterone in men
leads to increased heart attacks and deaths while replacing testosterone with
bio-identical testosterone opens up coronary arteries in high risk men with severe
angina. Testosterone does all of the good things in men that estrogen does in
women: testosterone lowers fibrinogen (prevention of clots), lowers the bad LDL
cholesterol and triglycerides, increases the protective HDL cholesterol, decreases
lipoprotein A, lowers blood pressure, decreases insulin output, increases energy
and strength and prolongs life. In a Chinese study of 62 elderly males who had
severe angina 77% had very noticeable relief from chest pains on testosterone
replacement while in the placebo group only 6% were improved. Echocardiography
studies documented 68.8% improvement of blood supply to the heart in the testosterone
group (Ref. 15, p. 87).
A male in andropause also benefits from about 1/4
of the estrogen dosage that a postmenopausal woman would use (dosage determined
by saliva tests, see Ref. 13 and 14).
Follow this link for anti-aging
medicine for women and men. Dr. Rimkus in Germany (an obstetrician/gynecologist
and bioidentical hormone replacement expert) has shown that even without replacing
testosterone, the male can convert bioidentical progesterone into testosterone.
He benefits from small amounts of estrogen and his breasts will not grow with
these minute estrogen doses. However, a small amount of bio-identical progesterone
is usually also required as this will balance the estrogen effects, will help
degenerating joints, restore hair growth and improve skin appearance. All of the
hormone requirements are based on saliva hormone tests, which reflect the tissue
levels closest. | Ask your physician for more details.
If your physician does not support bio-identical hormone replacement, find
an anti-aging physician. | |
For further details read the chapter
on health, nutrition and fitness. You can use this link. It gives
detailed suggestions regarding life style changes for better health. | |
