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December 2003

How You Can Help End the Heart Disease Epidemic
By Heather Lindsey

Testing homocysteine levels
Testing your homocysteine levels is another way to determine your risk of heart disease. Homocysteine is an amino acid in the blood, too much of which is related to an elevated risk of coronary heart disease in patients already at high risk.15 Homocysteine is also associated with stroke16 and peripheral vascular disease.17

This marker may also predict risk of the development of congestive heart failure in adults with no history of heart attack18 and predicts cardiac death in stable patients following premature heart attack.19 Homo-cysteine may also be an independent risk factor for atherosclerosis.20

Homocysteine levels and nutrients
Dietary factors tend to influence homocysteine levels in blood plasma. Folic acid, trimethylglycine (TMG), vitamins B6 and B12 have the greatest effects on homocysteine, helping to break down the amino acid in the body.21-23

According to one study, a daily multivitamin that contains 400 mcg of folic acid should be considered for patients who have documented coronary heart disease, especially when other risk factors are absent or in patients with premature atherosclerosis, and for men and women who have cardiovascular risk factors.24 Increasing vitamins B6 and B12 in the diet of patients with high levels of homocysteine also helps to lower the amino acid.21,25 Higher blood levels of B vitamins are related, at least partly, to lower concentrations of homocysteine.26

In addition to folic acid and vitamins B6 and B12, a variety of other supplements may help to keep cardiovascular disease at bay.

Fish oil
You already know that adding fish to your diet can help lower your risk of heart disease. Can taking fish oil supplements have the same impact? Research indicates that it might.

One recent study of more than 11,000 patients showed that fish oil supplements (1 gram per day) reduced the risk of cardiac deaths after six to eight months in people who have had a prior heart attack. At the end of the trial, patients who took fish oil supplements had a 45% lower death rate than those who did not.27

The American Heart Association notes that people who have elevated triglycerides may need 2-4 grams of EPA and DHA per day provided as a supplement. Those taking more than 3 grams of omega-3 fatty acids from supplements should do so only under a physician’s care. The Food and Drug Administration has noted that high intake could cause excessive bleeding in some people.

Policosanol, a cholesterol-lowering supplement purified from sugar cane wax and taken in doses of 5-20 milligrams daily, may help to lower cholesterol levels.

One clinical study showed that in patients with high cholesterol, policosanol at 5 mg reduced LDL by about 17%, while 10 mg reduced LDL by about 24%. Policosanol at the same doses also lowered total cholesterol by approximately 13% and 16%, respectively. The supplement also increased HDL (“good” cholesterol), which can protect against heart disease.28

Policosanol may rival some statins, commonly prescribed to lower cholesterol, in helping to increase HDL while having minimal side effects. Researchers compared policosanol to the drug atorvastatin, a common lipid-lowering drug, in doses of 10-80 mg/day. Atorvastatin was more effective than policosanol in reducing LDL and total cholesterol; however, policosanol, but not atorvastatin, increased serum HDL levels. Policosanol was also better tolerated than atorvastatin, as revealed by overall frequency of adverse events such as muscle cramps, gastritis, uncontrolled hypertension, abdominal pain and myalgia.29

Coenzyme Q10
Coenzyme Q10 (CoQ10) is a fat-soluble, vitamin-like substance found in all human cells and has shown benefit as an additional treatment to standard treatment methods in people with congestive heart failure (CHF).

CoQ10 produces energy in cells and acts as an antioxidant. It is naturally present in many types of food, including organ meats such as the heart, liver and kidney, as well as in beef, soybean oil, sardines, mackerel and peanuts. CoQ10 is also available as a dietary supplement.

Scientists recently evaluated data from 1974 through 2000 to provide recommendations regarding the safety, effectiveness and dosing of CoQ10 in the management of CHF, angina and hypertension. They found that CoQ10 taken orally appears to be safe and well tolerated in the adult population. Researchers noted that because CoQ10 has favorable effects on ejection fraction (the measure of the amount of blood pumped out when the heart contracts), exercise tolerance, cardiac output (the total volume of blood pumped by the ventricle per minute) and stroke volume (the amount of blood pumped out of one ventricle of the heart as the result of a single contraction), it may be recommended as an additional therapy in selected patients with CHF.30

According to the study, however, CoQ10 therapy in angina and hypertension cannot be substantiated until additional clinical trials demonstrate consistent beneficial effects. Additionally, CoQ10 should not be recommended as monotherapy or first-line therapy in any disease state.30

Earlier research found that patients with CHF benefited from taking CoQ10 in a number of ways. For example, improvements in symptoms were experienced by about 78% of patients with cyanosis (blue skin), 79% with edema, 78% with pulmonary edema, 53% with dyspnea, 53% with heart palpitations, 80% with sweating, 80% with arrhythmia and 73% with vertigo.31

The American Heart Association says that until more data are available, nutritional supplements such as CoQ10 cannot be recommended to treat heart failure.32 (In Japan, CoQ10 has been an approved drug for congestive heart failure for the past 30 years.)

Serrapeptase is a protein-dissolving enzyme that can have an anti-inflammatory effect in patients, according to published studies.32-34 For instance, scientists have reported that serrapeptase can reduce inflammation in patients with ear, nose and throat disorders.32

While anecdotal evidence indicates it may have antiatherosclerotic benefit, no published studies have yet been conducted to confirm this. Hans A. Nieper, M.D., an internist from Hannover, Germany, studied the effects of serrapeptase on plaque accumulations in the arteries, which can lead to hardening of the arteries, stroke and heart attack. He found that the enzyme helped to prevent plaque build-up though its protein-dissolving properties. Further studies are needed to validate this finding.35

The influence of sex hormones, especially testosterone, on coronary artery disease in men has been relatively ignored.36

Men with coronary artery disease, however, have lower concentrations of testosterone in their blood than those with normal heart health.37 Additionally, hypogonadism, a glandular disorder resulting in low testosterone levels, is twice as common in men with heart disease than in the general population.36

Low testosterone is also associated with high LDL, low HDL and high triglycerides, as well as high blood pressure. Administration of testosterone also may help open up blood vessels,37 improve exercise tolerance and reduce angina in men with coronary artery disease.38

Low testosterone in older men may have a negative impact on atherosclerosis and explain their higher incidence of coronary heart disease.

Researchers note that improved formulations of testosterone are gradually becoming available in patches, gels and buccal release.

The bottom line
Although heart disease continues to be an epidemic, you can take a number of steps to lower your risk of developing the condition. Before starting any eating plan, exercise program or nutrition supplement program, be sure to consult with your physician. In addition to checking your blood pressure and cholesterol, make sure your blood is tested for C-reactive protein, homocysteine and free testosterone. If you are overweight, check your fasting insulin blood levels to rule out Type II diabetes. Excess fasting insulin can indicate a pre-diabetic or frank diabetic state. With the proper health strategy, you can help make the heart disease epidemic a problem of the past.