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Cardiovascular Risk Assessment

by Kate Neil(more info)

listed in heart, originally published in issue 97 - March 2004

Cardiovascular disease remains a leading cause of death in Britain. There is now a good understanding of its development and it is increasingly possible to identify individuals at risk.

Peter is 45, and came so that he could reduce his risk of having a sudden heart attack. He has reason to be concerned as his mother and grandfather on his maternal side died of a sudden heart attack in their late fifties. Several other of his close relatives also suffer from cardiovascular problems. His older brother, now aged 55, had a coronary bypass operation when he was 52.

Peter has high blood pressure and it has been on the high side of normal for ten years. He struggles to keep weight from settling around his middle. Central weight gain is associated with increased cardiovascular risk. He considers his life stressful, has little time for exercise, drinks about 14 units of red wine each week, loves cereals, bread and pasta, eats few green leafy vegetables but likes fruit.

He eats red meat once or twice a week and mainly eats chicken and fish. Recently he has tried to cut back on red meat and butter.

Given his family history, I recommended a Cardiovascular Risk Assessment blood screen so that I could tailor a nutritional programme to more specifically meet his needs. This screen looks for increased levels of markers associated with greater risk including: homocysteine, apolipoprotein (a) and activated factor XII. The screen also checks for general haematology and biochemistry, which includes blood levels of triglycerides, a breakdown of cholesterol levels and iron status.

The test results revealed raised levels of the following:

  • Homocysteine
  • Apolipoprotein (a)
  • Total cholesterol
  • LDL cholesterol

Triglyceride levels were high normal and HDL cholesterol levels were low. Iron status was normal and all other measurements screened for were essentially normal.

I explained to Peter that homocysteine is naturally produced in the body and that excess levels can be highly damaging to body tissues, especially artery walls, and that to handle this substance safely, the body requires good levels of folic acid, vitamin B12 and vitamin B6. This marker can be raised due to dietary shortfalls of these nutrients and/or a genetic predisposition resulting from an enzyme defect enabling homocysteine to accumulate. I recommended that Peter included two portions of green leafy vegetables each day for folic acid and in addition supplements for these three nutrients to help modulate the effects of homocysteine.

The supplements also included betaine, which can help bypass any enzyme defect. High levels of homocysteine are associated with several degenerative disorders.

Homocysteine acts like a free radical and can initiate damage on artery walls. For cholesterol to really cause harm it must gain entry into the inner lining of the artery wall. Within the inner lining the cholesterol can become oxidized due to the very high levels of oxygen in this environment. Minimizing the initial damage is an important step in preventing cholesterol from entering the inner lining. Another important point about cholesterol is that it is quite hard for it to enter the inner lining if it is large and buoyant. Diets high in fat and sugar can pressure the body to make the cholesterol small and dense making it much easier for the cholesterol to gain access into the inner lining. Antioxidant nutrients are needed to protect cholesterol from being oxidized.

LDL cholesterol is considered more problematic. LDL cholesterol brings cholesterol to the cells and unlike HDL cholesterol, which takes cholesterol away from the cells to the liver for excretion, it does not contain its own antioxidant protective enzyme. The ratio of LDL to HDL cholesterol is an important cardiovascular risk assessment.

The level of oxidized cholesterol gradually builds up within the inner lining and overtime, if left unchecked, will push through to the surface and meet the blood stream. Then fats and cholesterol in the blood stream are attracted to it and may build up over time to completely block the flow of blood, resulting in a heart attack due to a sudden lack of oxygen to the heart muscle.

Vitamin C is very important for keeping artery walls intact and a deficiency can lead to 'leaky' arteries. Apolipoprotein develops to help repair the artery wall and maintain its integrity. According to Linus Pauling, we may have developed the ability to deposit complexes like apolipoprotein to increase our chances of survival in times of vitamin C deficiency. I recommended that Peter eat 8-10 portions of vegetables and fruit a day to help give good antioxidant protection and extra vitamin C to help restore the integrity of the artery walls. I also recommended that he supplement good levels of antioxidants as well as increasing dietary sources. In addition I recommended that he started supplementing with l-lysine, as this amino acid binds to lipoprotein (a) and may inhibit the formation of plaque on the artery wall.

Too much fat and sugar in the diet also increases the level of triglycerides in the blood and pressures the hormone insulin into increased activity. Over time, insulin may lose its ability to function optimally. Sub-optimal insulin function is intimately involved in the production of small, dense cholesterol. Starches from bread, pasta, cereal etc break down to sugar. I recommended that Peter reduce his intake of cereal starches and replace with vegetables and some fruit.

I commended him on his recent reduction of butter and red meat and suggested he included nuts, seeds, fish and olive oil as suitable replacements. I indicated that two glasses of red wine a day should be overall protective to his blood vessels and that he should not exceed this level, as excess alcohol is detrimental.

Fish oil should improve the function of insulin, helps keep the blood thin, raises the level of HDL cholesterol and helps keep down inflammation. As inflammation is at the heart of cardiovascular disease, I recommended that Peter included two portions of oily fish a week and to supplement with extra fish oil.

Further Information

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About Kate Neil

Kate Neil, RN RM DipION, is a trained nurse, midwife and nutrition consultant. Kate practises nutrition in Harley Street and Berkshire and specializes in women's health and children within the learning disorder spectrum. She is Director of NS3UK's Centre for Nutrition Education, which provides exclusive training courses in Clinical Nutrition as well as workshops for the public. She is author of Balancing Hormones Naturally and Editor of the professional journal The Nutrition Practitioner and can be reached on Tel: 01344 360 033;

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