An important lesson cardiologists have learned over the past few decades is that patients don’t necessarily need to be overweight or out of shape to be at risk for heart attacks and strokes. Even more surprising to some is that the processes that underlie heart disease often begin very early in life. Fatty deposits in arteries or atherosclerosis is no longer considered the exclusive domain of adults. These undeniable facts provide justification for a steady stream of new information about how to best manage the current and ever growing cardiovascular crisis.

Patients and physicians need to be on the cutting edge when it comes to diagnostic testing, diet and medications that may help protect against various insults to the cardiovascular system. This past month alone has revealed some very interesting insights that can assist both interested parties.

Heart Headline #1 – Sometimes Older Physicians Are Best

If you’re under the impression that younger doctors are more open to the idea of using natural approaches to reduce heart risk, think again. A new review in the June 2011 issue of the International Journal of Clinical Practice reports that doctors under the age of 45 are actually more likely to prescribe antidiabetic, antiplatelet, blood pressure and cholesterol lowering drugs than older physicians. According to this investigation, physicians falling in the “46 to 55” and “over 55” age brackets suggest diet and lifestyle modification to a greater extent than their younger colleagues. What’s more, older doctors were more accurate when recording clinical data about patients. Such accuracy has previously been linked to a better cardiovascular (CV) outlook for patients. These findings become all the more relevant when you consider that recent studies have found that: a) common heart medications (aspirin and simvastatin) are ineffective in treating pulmonary arterial hypertension and; b) even short term use of pain relievers (NSAIDs or non-steroidal anti-inflammatory drugs) are associated with an increased risk of heart attacks in patients with cardiovascular disease. (1,2,3,4,5)

Heart Headline #2 – Use Fitness to Help Predict Heart Attack and Stroke Risk

There are a great many diagnostic tools that cardiologists can employ to determine your short term (10 years or less) and long term (25 years or more) heart risk. A simple treadmill test may soon be added to the recommended list. Researchers at the UT Southwestern Medical Center are the latest to confirm the importance of exercise capacity and rate as predictors of lifetime heart attack and stroke incidence. To illustrate their findings, the authors offered the following examples:

• “A 55-year-old man who needs 15 minutes to run a mile has a 30% lifetime risk of developing heart disease.”
• “A 55-year-old woman who can run a mile in 8 minutes has a lifetime risk of less than 10%.”

Also of significance is that exercise appears to offer protection even to those with established risk factors such as diabetes, elevated lipid panels and high blood pressure. The take home message is that a basic treadmill test could and should be included to conventional CV risk assessment as a complementary diagnostic tool. (6,7,8)

Heart Headline #3 – Nonpharmacological Strategies Can Be Lifesavers

Angioplasty is a procedure that inflates a small balloon inside an artery in order to press plaque against the vessel wall. The idea is to allow for more space for blood to freely flow. A stent is then typically placed in the affected area to ensure that the artery remains open. A 14 year analysis in a group of 2,395 angioplasty patients found that those who took part in cardiac rehabilitation (CR) experienced a 46% reduction in mortality as compared to those who did not. CR is a form of follow-up care that involves dietary counseling, exercise training, support with smoking cessation and weight loss therapy. Cardiac rehabilitation isn’t considered an alternative treatment. However, it’s estimated that only about a quarter of all eligible patients receive this type of guidance and monitoring. Most insurance plans cover this therapeutic modality and it should be insisted upon when not offered by a treating physician. (9,10)

Heart Headline #4 – Dairy Doesn’t Increase Cardiovascular Disease Incidence or Mortality

You want to follow a heart healthy diet but you’re having a hard time giving up cheese, milk and yogurt. Take heart: a new study appearing in the journal Nutrition, Metabolism and Cardiovascular Diseases set out to find a link between dairy consumption and cardiovascular risk in a group of 3,630 middle-aged men and women and discovered no such connection. The authors of the paper in question from Brown University theorize that there may be certain protective elements in dairy (calcium, CLA or conjugated linoleic acid, magnesium, potassium, Vitamin D, etc.) that offset any potential consequences relating to dairy’s saturated fat content. This finding is supported by several other recent publications that tend to show a net beneficial or neutral affect with relation to dairy intake and cardiovascular disease incidence and/or mortality. (11,12,13,14,15,16)

High Dairy Diets Decrease Intracellular Calcium and May Lower Blood Pressure

Source: J Am Coll Nutr. 2009 Feb;28 Suppl 1:103S-19S. (link)

Heart Headline #5 – See Red: Eat Tomatoes and/or Supplement with Lycopene

There’s more good news on the nutrition front. Dr. Karin Ried of the University of Adelaide suggests including more tomatoes in your diet as a natural means of controlling cardiovascular risk. According to Dr. Ried, a daily dosage of 25 mg/day of lycopene, an antioxidant carotenoid found in tomatoes, “can reduce LDL-cholesterol by up to 10%”. She goes on to say, “that’s comparable to the effect of low doses of medication commonly prescribed for people with slightly elevated cholesterol, but without the side effects of these drugs, which can include muscle pain and weakness and nerve damage.” And that’s only part of the story. In recent months, publications in the the journal Atherosclerosis, the Journal of Internal Medicine and the Journal of Nutrition confirm that lycopene: a) supports cardiovascular health by protecting arteries from hardening and plaque build up; b) reduces oxidative stress and subsequent endothelial dysfunction; c) inhibits systemic inflammation and pro-thrombotic factors which contribute to abnormal clotting. (17,18,19,20,21)

Of the five headlines presented today, the first three are directly associated with the type of medicine you’ll likely receive from conventional, Western-style physicians. Diagnostic testing, follow-up interventions and medication are familiar components of standard patient care. But you can influence how these modalities are administered by sharing pertinent information and voicing your preference for testing and treatment options. When you combine this proactive approach with the latest data pertaining to diet and self care you’ll establish a powerful and uncommon treatment and wellness alliance.

Be well!

JP