What you do not know about heart disease could kill you

Recent studies show that heart disease accounts for 40 percent of all U.S. deaths — more than all forms of cancer combined.

by Steven W. Parcell — 

Despite the fact that heart attacks are the number one cause of death for Americans, many people still do not understand how to prevent one, or how to work with their doctors to identify coronary artery disease or atherosclerosis early in life — before it becomes dangerous.

Atherosclerosis is an inflammatory condition of the arterial wall that affect the arteries of the heart. If one of these coronary artery plaques breaks apart or ruptures, a clot may ensue, blocking blood flow to the heart muscle.

High cholesterol is not the main cause of heart attacks. Merely treating cholesterol prevents approximately 30 to 40 percent of heart attacks, at best. This is why it is very important to understand risk factors and what you can do to stop plaque buildup, or even reverse it.

Most Americans think that if they do not have any symptoms, they are fine. People typically say that they had their yearly physical and received a clean bill of health. They may have had an EKG or exercise treadmill test, and since they passed it, they believe they are good to go.

This is a problem, because an EKG only shows electrical abnormalities in the heart, and may indicate a past heart attack and changes in heart size or arrhythmia, but it cannot tell the doctor anything about the level of plaque in the arteries of the heart. It is plaque that causes heart attacks most of the time. A person can have advanced atherosclerosis and have a normal EKG. Even worse, an exercise treadmill test can give a false sense of security.

For those who fail the treadmill test, obstructive coronary artery disease is likely present. This may lead to a surgical procedure that could very well save their life. On the other hand, for those who do pass the test, they are likely told that everything is fine; yet, this may not be true.

Often during the beginning stages of atherosclerosis, the outside diameter of an artery will enlarge to accommodate the increased amount of plaque within its muscle layers, leaving the inside diameter (where the blood flows) largely unchanged. The heart muscle will still get plenty of blood during the exercise treadmill test, leading to a normal EKG and a lack of chest pain during exercise.

Another reason why someone may pass the exercise treadmill test is that he has a long history of cardiovascular fitness (e.g., runners, swimmers, cyclists and rowers). The arteries of the heart in this group may form what is called collateral circulation or collateral branches. This is an adaptive change the heart makes to gain the blood supply it needs in the face of compromised blood flow.

Most of us have heard that hypertension is a silent killer. It is called this because people can be completely unaware they have it until it becomes severe. Usually, when hypertension is severe, symptoms such as headaches or ringing in the ears will result.

There is still one more silent killer — atherosclerosis. Often a person will have absolutely no symptoms until their first major heart attack. Two specific screening tests are very important — the heart scan and the carotid intima-media thickness test. Ideally, these tests should be done together. The first checks for plaque in the heart and the second checks for plaque in the major neck arteries. It is important to note that not everyone is a candidate for these tests. People at extremely low risk for heart disease do not need to run out and get a heart scan, and people with many risk factors do not necessarily need one because the test will almost always show plaque.

Heart disease is the leading cause of death for men and women in the U.S. Recent studies show that heart disease accounts for 40 percent of all U.S. deaths — more than all forms of cancer combined.

More than 2,500 Americans die from heart disease each day, equaling one death every 34 seconds. Unfortunately, preventative measures are often glossed over during medical exams and action is only taken when a serious problem has developed.

Here is an example of a 33-year-old female runner with a total cholesterol of 180, triglycerides of 80, an LDL of 101, HDL of 65, no history of smoking and no first-tier relative dying of a heart attack before age 50. If she is given a heart scan she will be exposed to unnecessary radiation, and almost always she will register a score of zero plaque.

Another example is a 58-year-old man with a pack-a-day history of smoking, moderate abdominal obesity, rheumatoid arthritis, triglycerides of 168, LDL of 150 and HDL of 35. Additional risk-factor analysis and aggressive treatment would be indicated immediately, regardless of heart scan results. However, a heart scan and carotid artery test could be used to monitor effectiveness of treatment. Someone like this should see a cardiologist for an exercise treadmill test right away, because of concern about the narrowing of an artery.

Another issue is hormones. The estrogen present in premenopausal women appears to have cardio-protective effects, which is one reason premenopausal women are at a lower risk of heart attack. After menopause, women catch up fairly quickly to men with plaque buildup and are more likely to die from heart attacks. Even though men have more heart attacks, women are more likely to actually die from them.

Another protective factor for women might be the loss of iron during menstruation in the premenopausal years. Iron is pro-oxidative and is linked to inflammation in the arterial wall. Since men do not lose iron every month, they typically have much higher iron levels than women.

Additionally, low testosterone (also known as hypogonadism) may occur in men as they age. This natural decrease in testosterone as men age is called andropause. Not all men will experience it to the same degree. Typically a baseline testosterone level should be done at age 40 and repeated yearly if it is borderline low. Low testosterone levels are associated with increased risk of heart attack, as well as atherosclerosis, high triglycerides, metabolic syndrome and abdominal obesity.

Regarding cholesterol, different risk levels are associated with the size and number of the cholesterol particles themselves. This is why I sometimes say that it is the lipoproteins that need to be watched, not cholesterol. Lipoproteins are the little balls (particles) in which the cholesterol travels. If these balls are small, they can get into the arterial wall and increase inflammatory atherosclerosis and heart attack risk. The good cholesterol, HDL, also travels in little balls, and bigger HDL particles indicate improved cholesterol transport away from the artery wall to the liver for reprocessing.

People should be doing a lot more to assess their heart attack risk in this country. Currently, the standard of care (as it is called) is really not adequate enough to prevent heart attacks. Detailed personal and family histories and assessment of traditional heart attack risk factors, in addition to advanced testing and possibly a heart scan and carotid intima-media thickness test, are indicated for everyone 40 years or older. Men may want to consider these diagnostic tools at age 30. A female with a first-tier relative who experienced a heart attack before age 50 may also want to consider a preventive cardiology visit earlier than age 40.

Steven W. Parcell is a naturopathic doctor specializing in the field of preventive cardiology. Parcell currently has a naturopathic clinic in Boulder, Colo., and is the author of Dare to Live.  www.naturemedclinic.com or 303-884-7557.

Reprinted from AZNetNews, Volume 30, Number 3, June/July 2011.