2007 VOL 1, NO 2

Alternative medicine has a preventive and therapeutic role in cardiovascular disease. Medical physicians, including cardiologists, describe their use of alternative therapy as integrative medicine. Chiropractic physicians describe their use of alternative therapy as complementary medicine. This terminology probably reflects the perspective of each physician in the health care milieu; the medical doctor, at the top of the healthcare pecking order, chooses to integrate the research and methods of other practitioners. The chiropractor, who is the leading provider of alternative healthcare, decribes medical interventions that are complementary to traditional medicine. “Cardiologists are coming around,” says Dr. Howard Sacher, Chief of Cardiology at New York College of Osteopathic Medicine, as reported in the January 2003 Holistic Primary Care. “We’re validating and vindicating a lot of so- called ‘alternative’ approaches, and we realize that some of these things really do make sense.”

Coronary artery disease is the most common type of cardiovascular disease and it is the leading cause of death in the U.S. in both men and women. Coronary artery disease (CAD) results from atherosclerosis, a condition that occurs when the coronary arteries become hardened and narrow, due to buildup of plaque (“plack”) on their inner walls. Plaque is composed of fat, cholesterol, calcium and other substances from the blood. As plaque increases in size, the insides of the coronary arteries get narrower and less blood will flow through them. Eventually, reduced blood flow to the heart muscle results in chest pain, called angina. A heart attack happens when a blood clot develops at the site of plaque in a coronary artery and suddenly cuts off most or all blood supply to that part of the heart muscle. Over time, CAD will weaken heart muscle and contribute to heart failure. Heart failure does not mean that the heart has stopped or is about to stop. Instead, it means that the heart is failing to pump blood effectively to the rest of the body. CAD can also cause changes in the normal beating rhythm of the heart, called arrhythmias; some can be quite serious and cause death.

Risk factors for CAD increase with age for both men and women. These include, family history of CAD, high cholesterol, high blood pressure, cigarette smoking, diabetes, obesity, lack of physical activity. Recent research provides evidence that elevated blood levels of the amino acid homocysteine contributes approximately one- fifth of the total risk of CAD. According to other research, high blood levels of a substance called C-reactive protein (CRP) may be associated with developing CAD and having a heart attack. CRP is a protein in the blood that shows the presence of inflammation. The inflammation process appears to contribute to the growth of plaque in arteries. The more risk factors you have, the greater chance you have of developing CAD. Each year, more than half a million Americans die from CAD. Preventing or delaying CAD begins with knowing which risk factors you have and taking action. If you or someone in your family has CAD, be sure to tell your doctor. Make sure everyone in your family gets enough exercise and maintains a healthy body weight. By controlling your risk factors with a balanced diet, healthy exercise and medicines, you may prevent or delay the development of CAD.

Alternative medicine is routinely used in combination with diet and exercise to reduce your cholesterol numbers to a doctor-recommended level and some patients with advanced CAD benefit from their use. These include omega- 3 fatty acids, folic acid, vitamins B3, B6 and B12, vitamin C, vitamin E, coenzyme Q10, selenium and chromium.

• Omega- 3 fatty acids derived from fish oil have been widely researched for their ability to promote cardiovascular health. Omega- 3s reduce heart arrhythmias, lower blood pressure, reduce serum triglyceride levels, promote arterial blood flow and decrease platelet stickiness. “Two large scale trials, DART and GISSI  show regular consumption of omega- 3s translates directly into reduced cardiovascular mortality. The GISSI data suggest that daily supplementation can save 20 lives per 100 post- MI [heart attack] patients, a larger therapeutic effect than statins,” according to Erik Goldman, Editor in Chief of the independent newspaper, Holistic Primary Care. Although flaxseed oil is the single best vegetarian source of omega- 3s, it should be used with caution in men who are at risk for prostate cancer.
  
• Folic acid (folate), vitamin B6 (pyridoxine) and vitamin B12 (cobalamine) are known to reduce and detoxify the amino acid homocysteine, a recognized CAD risk factor, and adequate intake of each nutrient is essential for maintaining normal levels of homocysteine. In some patients after angioplasty, folate and vitamin B12 protects against future clogging of the arteries (restenosis).
  
• Vitamin B3 (niacin), especially in combination with chromium, can have a healthful effect on lipid metabolism and it is prescribed to reduce cholesterol. Very low dose niacin in combination with a statin drug raises “good” HDL cholesterol, but it does not change levels of “bad” LDL cholesterol, total cholesterol or triglycerides. Niacin treatment has been shown to raise blood homocysteine levels and further investigation is needed to determine if patients taking niacin should discontinue therapy or supplement with folate and B vitamins.
  
• Vitamin C may reduce all- cause mortality and people who consume 50 grams daily of fruit and vegetables may live longer than their junk- food eating friends. Until recently, it was believed that vitamin C deficiency was associated with higher risk of cardiovascular disease; there is evidence now that therapeutic doses (300 mg or more per day) of vitamin C protect against CAD. Many physicians prescribe high dosage vitamin C for their CAD patients. Says Dr. Sacher, “I give at least 1,000 mg twice daily. Vitamin C is essentially harmless, so it is better to err on the side of more.” Vitamin C is known to protect blood vessels from damage related to heart failure and it will increase blood flow to the heart; this may assist in the control of blood pressure and thereby lower the risk for arrhythmias. Vitamin C also lowers the risk for restenosis after angioplasty. A word of caution: one population of relatively healthy people showed evidence of thickening of the walls of the carotid arteries following megadosing (greater than 500 mg daily for at least one year), and a recent study warned that vitamin C therapy in postmenopausal women with diabetes was associated with increased risk of mortality from cardiovascular disease.
  
• Vitamin E is generally associated with decreased risk of CAD in both men and women. This, from the results of at least five large observational studies that measured vitamin E consumption over a number of years in presumably healthy people, as reported by the Linus Pauling Institute. The Cambridge Heart Antioxidant Study (CHAOS) found that vitamin E decreased the risk of a second nonfatal heart attack, and this would seem to be supported by the statistical analysis in the Italian GSSI- Prevenzione study, that showed vitamin E actually reduced deaths due to heart disease by 20 to 25%. Confusingly, however, the article’s abstract claims that “vitamin E had no benefit.” There is little current research to validate vitamin E supplementation in CAD. The main function of vitamin E appears to be that of an antioxidant and it may reduce platelet aggregation. Selenium appears to support vitamin E activity and it can prevent cellular damage resulting from vitamin E deficiency. Many physicians find this to be a strong rationale for prescribing vitamin E and selenium, while others await the results of ongoing research to help understand the role vitamin E plays in patients with CAD.
  
• Coenzyme Q10 is a compound that is made by the body and consumed with food. It is vital to cells, allowing the “powerhouse of the cells”- the mitochondria- to generate energy (ATP). CoQ10 is widely used in Japan and has been gaining acceptance in America. This compound is a powerful antioxidant, it is useful in the treatment of angina and it may support the health of heart muscle during coronary artery bypass graft surgery. CoQ10 research has demonstrated improvements in heart function measures in some patients with congestive heart failure and some doctors are quite enthusiatic about it’s use in CAD. Although there is some evidence that CoQ10 supplementation may be of benefit, large well- designed intervention trials are needed to determine whether it has value in the treatment of CAD.
  

Traditional medicine may be needed to treat CAD. Some drugs decrease the workload on the heart and relieve CAD symptoms. These include angiotensin-converting enzyme (ACE) inhibitors, beta blockers, calcium channel blockers and nitroglycerin or similar acting drugs called long-acting nitrates. Other drugs prevent clots from forming in the arteries; these include anticoagulants and antiplatelet medicines. Thrombolytic agents dissolve the clots that can occur during a heart attack; they are given after a heart attack starts. Prescription drugs that lower high cholesterol are of two classes. Ezetimibe drugs work in the digestive tract by blocking absorption of cholesterol from food. Statin drugs work mainly in the liver and are the most widely prescribed class of cholesterol lowering drugs. These drugs are not for everyone. Statins are used in patients with multiple risk factors for heart disease: high blood pressure, type 2 diabetes, low HDL, age, smoking and family history. Statins and ezetimibe drugs might be prescribed for use with low- fat diet and exercise to lower cholesterol but no studies show this type of use confers benefit exceeding the risk of serious side effects. Statin studies evaluated by the University of California San Diego showed middle aged men with multiple significant risk factors received some benefit from statins, but no study has shown statins or other cholesterol lowering drugs to lower overall mortality in either men or women. Current U.S. guidelines for statins were reviewed by the British Columbia Office of Technology Assessment and they found the U.S. guidelines were, at the time of that review, to be among the least evidence- based. If diet, exercise and nutritional supplements do not effectively lower high cholesterol, ask your doctor if your health risk for cardiovascular disease outweighs the risk of using cholesterol lowering drugs.

Cardiovascular health comes primarily through a combination of a healthy and balanced diet, moderate exercise to maintain optimal weight and positive change in the emotional patterns that affect the way you think and feel about yourself. Dietary changes can be simple, such as eating fewer high- fat foods and more foods that naturally lower cholesterol, like oats, whole grains, vegetables and soy. Aerobic exercise is an excellent way to increase “good” cholesterol and control your weight; it can be as easy as going for walks or taking stairs instead of an elevator. If you’re ambitious, join a gym or explore new sports. The important thing is to eat healthy, delicious foods and do things you like to do with friends, family and community. People who feel connected to a supportive and nurturing community have lower illness and death rates.

Cardiovascular disease is preventable. Whether you have CAD or are at risk, you can reduce your overall risk for heart attack. Talk to your doctor today about reducing your risk factors and improving your quality of life. Your doctor will help you find the combination of diet, exercise and medicine that is right for you.

-KA Morgensen, DC