Evidence-based Practice: Cardiovascular Health - A Different Perspective
Heart disease and stroke (cardiovascular disease, otherwise known as CVD) are the main causes of death in the UK. More than one in three deaths can be attributed to CVD in 2005.
But there are also a lot of people who live with effects of CVD. For example:
• One million people per year have a heart attack;We think of heart disease as being a problem for the older generation, but it is (actually) a slow and progressive disease that starts much earlier than you might think. A 1953 study showed that around 230 of 300 male soldiers aged just 22 showed major evidence of heart disease.
• One million people per year suffer with angina;
• Almost one million, aged 45 and over, have progressive heart failure.
The Framingham Heart Study (1940s-1960s), proposed a convincing model that stated high cholesterol, high blood pressure, obesity, smoking and lack of exercise were the main risk factors for cardiovascular disease. High cholesterol has remained the most treated risk factor of CVD, and Lipitor (atorvastatin) is the world’s top-selling drug with sales of nearly US$13 billion in 2006.
However, newer research is pointing to a far more likely suspect. It was a study published in 2000 that was the first of a number to support the vascular inflammation theory, and looked at C-Reactive Protein (CRP) as an important marker. Dr Paul Ridker, lead author of this study, and his team believe that we have to start looking at CVD as an inflammatory disease.4 This theory helps to explain why more than half of all people who experience heart attacks and strokes have normal, or even low, cholesterol levels.
The Inflammation Theory
Structure – arteriol walls are made of smooth muscles that contract and expand in response to the heartbeat. The endothelium is a very thin and delicate lining that is one cell thick and the point of contact with the blood.
Damage – the endothelium can become damaged very easily:
• A simple gum infection can leak bacteria into the blood stream; or,
• High blood glucose levels; and
• Lifestyle factors such as stress, chemicals, smoking and poor dietary choices.
Repair – the damaged lining attracts LDL cholesterol as part of the immune response. This becomes trapped in the damaged arterial wall and oxidizes, therefore, becoming toxic to the white blood cell trying to engulf it as part of immune processes. More cells rush in and suffer the same death. This is what causes the long white streaks in the arteries. The fatty white streak continues to build, and the arteries begin to reshape themselves to accommodate the build-up. This can ultimately lead to a loss in their elasticity (hardening).
More immune system elements join the fray, including C-Reactive Protein. It stimulates cells to release tissue factor, a protein central to clotting, the body’s natural response to injury.
Stress – this is what can be the triggering factor for a heart attack. The arteries can be very forgiving as plaque builds up, but the problem arises when emotional stress strikes. This can cause arterial spasms that reduce blood flow back to the heart. If this is severe enough it will lead to a heart attack.
What all this proposes is that LDL cholesterol is not the ‘bad guy’ in CVD.
LDL cholesterol is an important raw material in your body, as it is used to make steroid hormones and vitamin D. This is as well as being an important component of digestion, in bile, and cell membranes. We should also remember that cholesterol is essential to brain function, as it is needed to make brain cells and myelin sheath (the insulation around neurons that facilitates transmission). This is why statin drugs are linked to problems with memory and cognitive processes.
When you are working with someone in your practice, consider assessing CRP as part of a risk profile. It can measure the extent of inflammation in the body before detectable symptoms of CVD and chronic disease set in.
But this test is not just an indicator of CVD; it can also be used to assess inflammation in clients with Inflammatory Bowel Disease, Rheumatoid Arthritis and other autoimmune diseases, or even osteoarthritis.
For example, for Ruby, 59, one of her medications was a non-steroidal anti-inflammatory (NSAID) for osteoarthritis. This drug carries increased risk of heart attack or stroke that increases over the period of use. It can also increase the risk of bleeding or perforation of the gut, so Ruby was not happy to continue taking it.
The results in Ruby’s first test showed that CRP was high at 8mg/l (normal should be less than 3mg/l). However, after a comprehensive hormone evaluation, Ruby followed a natural approach to restoring fatigued adrenals, to better modulate immune response, as well as supplements to help support the body’s natural anti-inflammatory response. We saw a significant drop in Ruby’s CRP level within a few weeks to 5mg/l. In addition, she was experiencing a remarkable difference in her mobility and energy that was lifting her spirits too.
1. Allender S et al. Coronary Artery Disease Statistics. British Heart Foundations Health Promotion Research Group. 2007.
2. Enos W et al. Coronary Disease Among US Soldiers Killed in Action in Korea. JAMA. 152: 1090-1093. 1953.
3. Loftus P. Pfizer’s Lipitor Patent Reissue Rejected. The Wall Street Journal Online. 2007.
4. Ridker P et al. C-Reactive Protein and Other Markers of Inflammation in the Prediction of Cardiovascular Disease in Women. New England Journal of Medicine. 342 (12): 836-43. 2000.
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