International Health News

Heart Disease: Causes, Prevention and Treatment

by Hans R. Larsen, MSc ChE

Hans LarsenWhat is cardiovascular disease?
Cardiovascular disease involves the heart and its two networks of blood vessels, the system which circulates the blood throughout the body and the system which circulates the blood through the lungs. The heart, apart from what other mythical and emotional characteristics we may ascribe to it, is basically a living pump. Its failure, for whatever reason, usually means instant death. The heart is one of the hardest working organs in the body; it contracts and expands about 100,000 times every day. It supplies a blood vessel network 96,000 kilometers long and pumps in excess of 10,000 liters of blood around the body every single day.

The heart pumps returning "used" blood through the lung capillaries where waste gas, primarily carbon dioxide, is expelled and fresh oxygen is taken up by the blood. From the lungs the now oxygenated, bright red blood is pumped through the aorta into the smaller arteries, the capillaries, where the actual nutrient and oxygen exchange with individual body cells takes place, and then back to the heart through the veins. Immediately after exiting from the heart the aorta branches off into the right and left coronary arteries which supply the heart itself with fresh blood and the nutrients it needs. The coronary arteries are attached directly to the wall of the heart and are squeezed and expanded 100,000 times a day. This constant stress makes them especially vulnerable to damage and disease.

Coronary heart disease and stroke are the two major manifestations of cardiovascular disease. In the United States, about 500,000 people die every year from coronary heart disease and about 150,000 from stroke(3). The cost of treating cardiovascular disease with surgery and drugs now exceeds $115 billion a year in the United States alone(4). Cardiovascular disease is very much a disease of Western Civilization and its incidence varies from almost 1,000 deaths per 100,000 population in Hungary to less than a third of that in Japan(2).

Coronary heart disease strikes hardest at men in their mid-fifties while women usually are spared until about age 65(5). Coronary heart disease is also known as ischemic heart disease and its most common forms are myocardial infarction (heart attack) and angina pectoris (chest pain). Conduction disturbances, valve malfunctions, and arrhythmias are other common manifestations of heart disease, but their significance pales in comparison with the impact of coronary heart disease. Stroke, intermittent claudication (a peripheral vascular disease) and macular degeneration (a leading cause of blindness involving the central part of the retina) are cousins of coronary heart disease and all have one common ancestor - atherosclerosis(3,5,6).

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Atherosclerosis
Atherosclerosis is a disease of the arteries in which fatty, often calcified deposits develop on the inside of the arterial walls and eventually cause blockages which lead to cardiovascular disease. Atherosclerosis is the result of the body's attempt to patch up injuries to the inside of the arterial walls. These injuries come about because of weaknesses in the walls and because the walls are constantly exposed to mechanical stress induced by the heart's pumping action. This stress is exacerbated by high blood pressure (hypertension) and chronic emotional stress(3,5,7).

Free radical activity also plays a major role in the development and progression of atherosclerosis both through the generation of oxidized, reactive lipoproteins (compounds of proteins and fats which serve as carriers for cholesterol) and through direct attacks on the DNA of the arterial wall cells(7-12). The body attempts to repair the damage to the arterial walls by producing more smooth-muscle cells in the area of the injury; these cells in turn tend to accumulate cholesterol and oxidized lipoproteins and may also undergo calcification(3,5,10). As the deposits grow they narrow the inside opening of the artery and eventually create a blockage. If the blockage is in the coronary arteries angina pectoris may develop or a heart attack may occur. If it is in the brain, a stroke may be the result and if the blockage is in the legs intermittent claudication may occur.

It is interesting that cardiovascular disease is unknown among other mammals. Why are humans the only species afflicted with this disease? Nobel laureate Dr. Linus Pauling and Dr. Matthias Rath, MD, a German physician and leading expert in cardiovascular disease believe that the root of the problem is our inability to produce vitamin C. Only Homo Sapiens, primates and guinea pigs do not manufacture vitamin C internally. Drs. Pauling and Rath believe that cardiovascular disease is a form of early scurvy and that the vitamin C deficiency inherent in both diseases manifests itself by the development of fragile blood vessels lacking in collagen - the reinforcing rods of arteries. They also believe that we developed the artery wall repair mechanism thousands of years ago as a compensation for our inability to produce vitamin C and sufficient collagen to maintain strong, healthy arteries which would not be prone to tears and injuries(2,13,14).

Many scientific studies have shown that a lack of vitamin C and other antioxidants increases the risk of heart disease and stroke(2,15-23). Other major risk factors for cardiovascular disease are smoking, a high level of cholesterol and lipoproteins, diabetes, hypertension (high blood pressure), obesity (especially around the abdomen) and lack of exercise(3,5,24,25,26). Genetic predisposition can also be a factor in the development of heart disease, but some experts downplay its importance(3,5,25).

Excessive exposure to free radicals generated through contact with pesticides, chlorinated water, air pollutants and other toxic chemicals is a strong risk factor for cardiovascular disease(7,10). Chronic emotional stress is also a significant risk factor and acute emotional or physical stress may precipitate a heart attack(3,24,27,28). Stress not only raises the blood pressure and constricts the arteries, it also generates large quantities of adrenalin which the body converts to adrenochrome - a potent free radical(29).

The role of alcohol in the development of cardiovascular disease is controversial. Recent research has shown that consumption of moderate amounts of wine, especially red wine, actually reduces the risk of developing heart disease; other studies dispute this. The consensus of opinion now seems to be that a couple of glasses of wine or a beer or two a day will not promote heart disease and may even help to prevent it. Heavy drinking, however, is still considered a potent risk factor for heart disease(30-33).

Iron has recently been implicated in heart disease(34,35). Researchers at Harvard University now conclude that it is not the overall iron intake which increases the risk of heart attack, but rather the intake of heme iron as found in red meat. The Harvard researchers found that men who ate beef four times or more per week had a 38% greater risk of having a heart attack than did men who ate beef once per month or less(36). More recent studies show that the body is remarkably efficient in keeping the blood's iron content within safe limits(37).

Cholesterol is an important intermediary in the production of many vital hormones. The liver supplies all the body's needs (about 3000 mg/day) and any excess dietary intake is unnecessary and harmful(24,25). A high overall cholesterol level and a high level of LDLs (low density lipoproteins) are strong risk factors for cardiovascular disease in men. One recent study found that men with cholesterol levels higher than 6 mmol/l (240 mg/dl) have a three times higher risk than men with a level below 5 mmol/l (200 mg/dl)(3). Another study found that men who had a high cholesterol level in their youth are twice as likely to develop heart disease as are men with a low to normal level(38).

Cholesterol risk factors are different for women. The high density lipoprotein (HDL) level and the level of triglycerides are far more important risk factors for women than are total cholesterol and LDL levels. Women with low levels of HDL have a three times higher risk of dying from cardiovascular disease than do women with higher levels. Women with a low level of HDL and high levels of triglycerides have a death rate almost eight times greater than women with normal triglyceride levels and low HDL levels(39,40).

Recent research has shown that a high level of the amino acid, homocysteine, in the blood increases the risk of cardiovascular disease very significantly(41-44). Finnish researchers have discovered that mercury is a potent initiator of heart disease and other researchers have found that the risk rises with the number of amalgam tooth fillings(45). The Helicobacter pylori bacterium has also been implicated in the development of coronary heart disease(46).

The prevention of heart disease and stroke is synonymous with the prevention of atherosclerosis. Atherosclerosis can be prevented by developing strong artery walls, by controlling the factors which cause injuries to them and by minimizing the level of fats, lipoproteins, cholesterol and homocysteine in the blood.

PREVENTION

A healthy diet is the strongest protection against cardiovascular disease. A heart-healthy diet is rich in fruits and vegetables and low in saturated fat, cholesterol, meat, and sugar(2,3,24,25,47-49). A recent study carried out in Germany showed that the death rate among male vegetarians due to cardiovascular disease was only 39% of that of the general population while the death rate of female vegetarians was only 46%(50). Other studies have shown that high fat diets significantly increase the risk of cardiovascular disease(3,47). Trans-fatty acids found in hydrogenated vegetable oils are particularly harmful(51,52). A recent study at the Harvard Medical School found that people who had a high intake of margarine had more than twice the risk of having a heart attack than did people with a low intake(53). Another study found that women who had changed from butter to margarine to lower their cholesterol and avoid heart disease actually had a 67% higher incidence of heart disease than did women who had not made this switch(54).

The fat content of the average American diet is 40-50% of calories consumed and is mostly saturated fats(24,25,55). The World Health Organization recommends that dietary fats should only supply between 15 and 35% of daily energy intake with 30% being the maximum for sedentary individuals. Less than 10% of the daily energy intake should be in the form of saturated fat and the daily cholesterol intake should not exceed 300 mg (one egg)(56).

Leading experts in the prevention and treatment of cardiovascular disease go even further in their dietary recommendations. Dr. Dean Ornish, MD recommends a diet containing no more than 20% of calories from fat with the fat source being mostly polyunsaturated or mono-unsaturated. Dr. Ornish also recommends no more than 10 mg of cholesterol per day(24). To put these recommendations in perspective consider that just one "Quarter Pounder" hamburger with a side order of french fries provides about 30% of total daily energy intake, contains 100 mg of cholesterol and is loaded with saturated fat and trans-fatty acids; definitely not a heart-healthy meal(24,55). Other researchers recommed an increased intake of non-contaminated fish as an effective way of reducing the risk of cardiovascular disease(57-60).

Most medical experts agree that a high total cholesterol level is a critical risk factor for cardiovascular disease and that a reduction in overall cholesterol levels is an important measure in preventing and treating atherosclerosis(3,5,24,25,61). There are, however, dissenters who provide compelling evidence that reducing total cholesterol levels has little if any effect on the progression of atherosclerosis and does not lower overall mortality or even mortality from cardiovascular disease(62-64). It may well be that a high cholesterol level is relatively unimportant in comparison to the major risk factors of hypertension, smoking, obesity, diabetes, and physical inactivity(65). Whatever the truth, there is now a growing consensus that a concerted effort should be made to lower cholesterol levels by dietary changes before considering drug therapy(3,66,67).

A significant increase in the intake of fruit, vegetables, grains and legumes and a drastic reduction in the consumption of saturated fats, cholesterol, meat and sugar are the cornerstones in any cholesterol reduction program. There is extensive evidence that such dietary modifications on their own can bring about impressive reductions in overall cholesterol levels(24,25,55,61,62,67-70). Very effective cholesterol-lowering programs have been developed by Dr. Julian Whitaker MD, Dr. Dean Ornish MD, and Dr. Hans Diehl. These programs are based on low fat diets, exercise and stress reduction. They not only lower cholesterol but actually reverse blockages in the arteries(24,25,55).

There are many specific dietary components and supplements which are highly effective in lowering cholesterol levels. Among them are wheat germ, oat bran, soy protein, calcium, green tea, nuts, garlic, and omega-3 fatty acids specifically fish oils and flax oil(71-84). Cholesterol levels can also be lowered by the use of pharmaceutical drugs(3,5). However, there is considerable controversy as to the overall benefits of this approach(85,86). Niacin (vitamin B3) is equal or superior to pharmaceutical drugs in its ability to lower the "bad" cholesterols and increase the "good" (HDL) cholesterol(87-90).

Some researchers believe that low levels of HDL (high-density lipoprotein) are even more detrimental to cardiovascular health than are high total cholesterol levels and high LDL levels. HDL cholesterol counteracts the effects of low density cholesterol by scavenging excess cholesterol from the walls of the arteries and taking it to the liver where it is broken down and excreted(5). Exercise, dietary modifications, weight control and niacin therapy are effective in raising the blood levels of HDL cholesterol(3,47,87-90).

Avoidance of smoking and secondhand smoke vie with dietary modifications as the single-most effective measure in avoiding cardiovascular disease. Smoking kills over 400,000 Americans every year and over 125,000 of them die from cardiovascular disease(3,91). Women smokers who also use oral contraceptives increase their risk of heart attack substantially(3). Smoking also aggravates angina(92). Secondhand (passive) smoking increases the risk of heart disease and may aggravate existing angina pectoris(93). The benefits of quitting smoking occur fairly quickly. Smokers who quit lower their risk of stroke by 27% two years after stopping. Their risk reaches the level of non-smokers after about four years(94).

Antioxidants are very effective in preventing atherosclerosis. They work by deactivating free radicals and peroxidized fats and thereby prevent them from adhering to existing deposits on the artery walls(15,23,95-100).

Vitamin C helps to strengthen the artery walls by building up their collagen content. Numerous studies have found that vitamin C or vitamin C-rich foods help prevent heart disease(2,25,101,102). A low vitamin C intake has also been linked to an increased risk of heart disease and stroke(103-105). A recent study showed that vitamin C supplementation helps protect the blood against oxidation and another showed that antioxidants protect fats in the blood against harmful peroxidation(95,105). Vitamin C helps thin the blood, regenerates vitamin E and lowers blood pressure(2,7,25,98,107). Vitamin C is safe and free of side effects even at high concentrations(108).

Vitamin E prevents cardiovascular disease in several different ways: by protecting low density lipoproteins from oxidation, by inhibiting smooth muscle cell proliferation (a major cause of atherosclerosis), by reducing platelet adhesion (an important factor in the formation of blood clots), and by increasing the concentration of "good" cholesterol (HDL) in the blood(7,8,25,109-115). The evidence of the protective effect of vitamin E is impressive and growing daily. Two large studies carried out at the Harvard Medical School concluded that people who had taken 100 IU of vitamin E for two years or more had a 40% lower incidence of coronary heart disease and a 30% lower incidence of ischemic stroke. The studies involved over 125,000 nurses and other health professionals(8,22,116). Other studies have shown that men who took 100-250 IU per day of vitamin E had a 44% lower risk of coronary heart disease than did men who did not supplement. The decrease in risk was only observed in men who supplemented; a high intake of vitamin E-rich foods did not decrease the risk significantly(116). Vitamin E is also useful in preventing diabetes which often leads to heart disease(117). Vitamin E is entirely safe in dosages up to 1000 mg/day (1000 IU/day) and no toxicity has been observed with dosages as high as 3200 IU/day(108,118,119). Medical advice should, however, be obtained before starting a supplementation program in the case of individuals who have a vitamin K deficiency, a tendency to prolonged bleeding or who are taking anticoagulants like warfarin(108).

Beta-carotene is another fat-soluble antioxidant which is highly effective in protecting against free radical damage. Beta-carotene is particularly effective in protecting smokers from lipid peroxidation and thereby lowering their risk of heart disease(22,120). Several studies have found that people with a low level of beta-carotene in their blood have an increased risk of developing coronary heart disease(16,17,23,102). Beta-carotene is approved by the U.S. Food and Drug Administration as a dietary supplement and is considered safe even in large intakes. Yellowing of the skin may occur in people taking more than 30 mg/day for extended periods. This condition, however, is entirely benign and disappears when supplementation is discontinued(108).

The importance of selenium as a dietary antioxidant is becoming increasingly clear. Selenium is a component of the body's natural antioxidant, glutathione peroxidase, and also plays an important role in combatting the toxic effects of mercury(121). A low content of selenium in the blood has been linked to an increased risk of cancer and heart disease(122,123). A daily intake of 50-200 micrograms is safe and adequate(123).

Some very recent research has shown that Ubiquinol-10, the reduced form of ubiquinone-10 (coenzyme Q10) is even more powerful than vitamin E and beta-carotene in protecting low-density lipoproteins (LDLs) against peroxidation(124-127). It is, unfortunately, only found in very low levels in LDLs, but its concentration can be significantly increased by supplementing with coenzyme Q10(109,127). Coenzyme Q10 is relatively free of adverse effects in daily intakes as high as 300 mg/day(128).

The B-vitamins are receiving increasing attention as important factors in the prevention of cardiovascular disease. Folic acid, vitamin B6 and vitamin B12 are all required for the metabolism of homocysteine and supplementation with 400 micrograms/day of folic acid is effective in normalizing homocysteine levels(41,42). Supplementation with niacin (vitamin B3) reduces the risk of developing diabetes(129). Larger amounts of niacin are also very effective in lowering cholesterol levels(87-90).

A magnesium deficiency is closely associated with cardiovascular disease. Lower magnesium concentrations have been found in heart attack patients and administration of magnesium has proven beneficial in treating ventricular arrhythmias(3,130-138). Fatal heart attacks are more common in areas where the water supply is deficient in magnesium and the average intake through the diet is often significantly less than the 200-400 milligrams required daily(130).

Omega-3 fatty acids found in flax oil and fish oil are all powerful preventers of heart disease(57,60,81-84). Recent research has shown that supplementation with 3 grams of fish oil per day lowers blood pressure substantially in people with borderline hypertension(139).

Garlic lowers cholesterol levels and blood pressure; it also prevents clotting and plays a significant role in the natural "digestion" of blood clots (fibrinolysis)(80,140). Flavonoids, found in onions, tea and red wine, also lower the risk of coronary heart disease significantly(78,141).

Potassium, calcium, and magnesium are all very effective in the treatment of hypertension, one of the major risk factors for cardiovascular disease(142-146). A high intake of dietary fiber (24 g/day or more) lowers high blood pressure(143).

Regular exercise is one of the most important measures in the prevention of heart disease, stroke, hypertension, obesity, and diabetes(3,24,25,147-154). It is also effective in increasing the blood level of good HDL cholesterol(3,47). British researchers conclude that frequent, regular walking plus participation in a recreational activity or sport once a week lowers the risk of heart attack and stroke by over 50% in middle-aged men(152). Another study shows that men who bicycle to work (6 km round trip) every day are half as likely to suffer a heart attack or a stroke as those who chose a less strenous way of getting to work(153). Recent research has shown that postmenopausal women can cut their risk of a heart attack in half by going for a 30-45 minute walk three times a week(154). Studies have also shown that men and women who exercise at least once a week lower their risk of developing diabetes by 30%(151).

Avoidance of excessive stress is another important weapon in the fight against cardiovascular disease. A recent study by the Harvard Medical School found that men with a high anxiety level had a two to three times higher risk of dying from coronary heart disease than did men with a low level of anxiety(27). Another study showed that men with a high anxiety level have twice the risk of developing hypertension than do men with a low anxiety level(155).

Exercise, tai-chi, qi gong, meditation, long walks, indulging in a hobby, listening to music or relaxation tapes, and making a conscious effort to reduce one's exposure to stress all go a long way towards reducing the risk of cardiovascular disease. It is clear that there are many, many things we can do to effectively prevent cardiovascular disease. However, these diseases take a long time to develop and for many people it is too late to consider prevention; treatment and in many cases, urgent treatment is required.

As is the case with most degenerative diseases there are two avenues of treatment - conventional (allopathic) and alternative (natural) treatment. Conventional medicine employs surgery and drugs to treat the symptoms of cardiovascular disease but rarely gets to the root cause of the disease. Alternative methods, on the other hand, bolster the body's innate healing powers and focus on removing the cause of the disease rather than on treating its symptoms. Both types of treatment have a place in the fight against cardiovascular disease.

CONVENTIONAL TREATMENT

Conventional medicine has the edge when it comes to the diagnosis and treatment of acute, life-threatening events. Alternative therapies, on the other hand, are gentler, have far fewer side effects, and are capable of actually reversing heart disease and regaining full health. Searching through your herb book, cutting out the fat in your diet or swallowing a handful of vitamins is not the answer when a heart attack or stroke strikes. This is a case where conventional medicine is very much needed. Well-equipped ambulances, trained paramedics and a smoothly functioning emergency department and intensive care unit can mean the difference between life and death when it comes to an acute myocardial event (heart attack) or a stroke.

Diagnosis and Conventional Treatment
In many cases the first indication of cardiovascular disease is a sudden heart attack. There are more than 1.5 million heart attacks in the United States every year and 30% of them are fatal within the first month(5,24). As one popular medical textbook puts it: "Sudden death is the first and only manifestation of coronary heart disease in about 25% of patients."(5)

The most useful non-invasive tests for diagnosing early heart disease involve electrocardiograms taken at rest and during exercise and continuous cardiograms taken over a 24-hour period using a portable Holter monitor. These tests are particularly indicative in people with a number of risk factors for coronary disease (smoking, diabetes, obesity and hypertension); they will also show if a patient has already suffered a mild heart attack without noticing it. Norwegian researchers recently discovered that people whose blood pressure rises significantly during exercise have double the risk of eventually having a heart attack(156).

Radioisotope studies are useful in spotting inadequate blood flow in and around the heart. Echocardiography is another non-invasive technique which is useful in evaluating the heart's performance. Newer techniques for studying heart function without invasive procedures include positron emission tomography (PET scanning), CT scanning, and magnetic resonance spectroscopy.

Coronary arteriography is an invasive technique used to determine the extent and location of blockages in coronary arteries. It is normally used as a prelude to heart surgery such as angioplasty or bypass surgery. It is less useful and not recommended for diagnosing angina pectoris(5). Angiography is not very accurate in determining the extent of blockage and is a relatively dangerous procedure(5,25). It is, unfortunately, a favourite with cardiologists and heart surgeons. A recent study concluded that 80% of all angiograms may be unneccessary and often lead to further dangerous and unneccessary procedures like angioplasty and bypass surgery(157).

The two most common indications of cardiovascular disease are angina pectoris (chest pain) and myocardial infarction (heart attack). The pain felt in angina pectoris occurs because blocked arteries prevent an adequate supply of oxygen and nutrients from reaching the heart. Stable angina is brought on by increased physical effort, emotional stress, exposure to secondhand smoke, or even by certain meals or weather changes. Unstable angina can occur during rest or even while sleeping and is often considered to be an intermediate condition between stable angina and a full blown heart attack. Angina is treated medically with nitroglycerin, beta-blockers or calcium entry blockers. Nitroglycerin is often used to combat acute attacks and works by relaxing the heart muscle. Beta-blockers (propranolol, nadolol) reduce the heart's oxygen demand by slowing it down while calcium entry blockers (verapamil, diltiazem) also work by dilating the large arteries. Both types of drugs thus lower the demand on the heart, but of course, do nothing to treat the atherosclerosis causing the angina. Neither beta-blockers nor calcium entry blockers significantly reduce mortality or prevent a future heart attack and both have serious side effects(5). Beta-blockers are a poor choice for patients engaging in vigorous exercise(158).

A heart attack involves the death of part of the heart's muscle tissue (ischemic necrosis) caused by a sudden disruption in the blood flow to the area. About 25% of all heart attacks are immediately fatal(5). If the patient makes it to the hospital the chances of survival go up considerably; injections of magnesium sulfate within the first three hours of the attack has been found to increase survival by over 20%(131-138). The medical treatment of heart attack survivors is aimed at preventing a second attack and daily intake of relatively small amounts of aspirin has been found quite effective(5,159). Arrhythmias are common complications of heart attacks and other heart problems. They are often treated with antiarrhythmic drugs like digoxin, verapamil and amidarone; these drugs however, have serious side effects and often do more harm than good(160,161).

A stroke (cerebral infarction) is similar to a heart attack except that it occurs in the brain. When brain tissue is deprived of blood and oxygen it is destroyed within a few minutes. Atherosclerosis is by far the most common underlying cause of a stroke. Most strokes occur when loose atherosclerosis plaque or clotted blood block a brain artery already narrowed by atherosclerotic build-up. Strokes can also be caused by the rupture (aneurysm) of an artery in the brain most often in connection with hypertension. There is no therapy which will restore the function of brain tissue destroyed in a stroke so medical treatment essentially consists of rehabilitation and measures to avoid a second stroke.

Intermittent claudication involves pain in a muscle to which the blood supply has been restricted due to atherosclerosis. The pains occur with exercise and subside within a couple of minutes once the exercise is stopped. Conventional medical therapy includes an emphasis on daily walks, weight reduction, and total avoidance of smoking.

Many cases of coronary heart disease (angina and heart attack) are ultimately treated with surgery. The two most common procedures are angioplasty (percutaneous transluminal coronary angioplasty) and bypass surgery. In angioplasty a small balloon is guided on a wire into the blocked artery. It is positioned at the blockage and inflated. This causes the arterial wall to stretch and may also dislodge part of the plaque deposit thus resulting in a widening of the artery. Angioplasty is often used in the treatment of an acute heart attack. Over 300,000 angioplasty operations were performed in the United States in 1990 with an approximately equal number done in the rest of the world(5). Angioplasty is dangerous; it is estimated that 2.5-5% of patients undergoing this operation have a heart attack during or after the surgery and that 2.5-5% require immediate coronary bypass surgery for complications. The overall mortality rate is 0.5 to 1% and highly dependent on the skill of the surgeon(5). Although angioplasty has proven successful in many cases of stable angina it is often a temporary measure only. About 30 to 45% of patients undergoing angioplasty reform the blockage within six months and are then back to where they started or in need of another angioplasty operation(162).

In bypass surgery sections of a vein from the leg are grafted on to the coronary artery in such a way as to bypass the blockages created by atherosclerotic deposits. Bypass surgery is most commonly used when three or more arteries are blocked (triple or quadruple bypass operation). When only one or two blockages are involved angioplasty is preferred. Bypass operations often reduce angina pains and improve survival after a heart attack, however, they are dangerous and temporary in nature. Surgical mortality rates are between 1 and 3% but can go as high as 10%. The operation accelerates atherosclerosis in and around the grafts and its benefits rarely last more than five or at the most ten years(5). About 380,000 bypass operations were performed in the United States in 1990. According to some experts half of them were unnecessary or of no benefit(157).

ALTERNATIVE TREATMENT

Conventional (allopathic) therapy is largely aimed at ameliorating the symptoms of cardiovascular disease and providing temporary relief of pain and improvement in quality of life. Alternative treatments, on the other hand, aim at containing and reversing the underlying cause of cardiovascular disease, ie. atherosclerosis. They are generally based on the principles which also guide prevention.

Diet and lifestyle changes are perhaps the most important tools in the natural treatment of cardiovascular disease. Dr. Dean Ornish, MD has developed a comprehensive program which effectively reverses atherosclerosis in a relatively short time. Dr. Ornish's program focuses on stress management, development of greater intimacy and increased social contact, a diet devoid of animal products (except egg whites and nonfat dairy products) and very low in fats and cholesterol, and a program of moderate exercise. The overcoming of smoking and other addictions is also a key component in the program. Scientific evaluations of Dr. Ornish's program have shown that participants who follow the program for just 24 days reduce their chest pain by over 90%, improve their exercise capacity by 55%, and reduce their cholesterol levels by 21%. Patients who followed the program for a year reduced their coronary artery blockages by significant amounts and also reported a much improved sense of well-being. Dr. Ornish's program has proven so successful in reversing heart disease that major insurance companies now cover the cost of it as an alternative to angioplasty or bypass surgery(24). Dr. Julian Whitaker, MD operates the Whitaker Wellness Institute in California. Dr. Whitaker's program also emphasizes dietary and lifestyle changes and is highly successful in reversing heart disease(25).

Antioxidants and other supplements can be of great benefit in the treatment of heart disease.

Vitamin C lowers blood pressure and cholesterol levels, helps prevent heart attacks and strokes by thinning the blood and protects the lining of the arteries against further atherosclerotic build-ups(2,7,25,98,107). Vitamin C also increases the production of HDL-cholesterol which removes deposits from artery walls(2). Dr. Mathias Rath, MD provides convincing evidence that a supplementation program based on vitamin C, vitamin E, B vitamins and the amino acids l-lysine and l-proline can reverse atherosclerosis(2).

Vitamin E is highly effective in preventing abnormal blood clotting, it increases the level of HDL and together with selenium has been found useful in reducing angina pain(25). Long term (3 months or more) supplementation with vitamin E reduces the leg pain in intermittent claudication and improves exercise tolerance(25,116,163-165). A recent study concluded that men who supplemented with over 100 IU per day had a significant reduction in the progression of their atherosclerosis as measured by angiography(116). Vitamin E in combination with niacin and colestipol is also effective in reversing atherosclerosis(166). It is also noteworthy that vitamin E supplementation markedly reduces the tendency of arteries to close up again (restenosis) after angioplasty(116).

Coenzyme Q10 improves the exercise capacity of patients with angina pectoris(167). Oral supplementation has also been used with good success in patients suffering from congestive heart failure and essential hypertension(168-171). Research is ongoing to evaluate the benefits of ubiquinone supplementation prior to cardiac surgery and preliminary results are promising(172,173). There is also evidence that coenzyme Q10 is useful in the treatment of mitral valve prolapse and ventricular arrhythmias(174-176). Most treatment protocols use between 30 and 100 mg daily(128).

Magnesium is proving to be very important in the maintenance of heart health and in the treatment of heart disease. Magnesium, calcium, and potassium are all effective in lowering blood pressure(142-146). Magnesium is useful in preventing death from heart attack and protects against further heart attacks(131-138). It also reduces the frequency and severity of ventricular arrhythmias and helps prevent complications after bypass surgery(177).

Fish oil supplementation lowers blood pressure, helps prevent heart attacks, and reduces the extent of restenosis (reclosing) of arteries which have been unblocked with angioplasty(139,162,178). Alpha-linolenic acid, a major component of flax oil and purslane, helps prevent a second heart attack(82).

Niacin (vitamin B3) lowers the level of "bad" cholesterol and raises the level of "good" cholesterol; it also helps reduce atherosclerotic plaque(87-90). Niacin is also effective in the treatment of atrial fibrillation and helps prevent diabetes, a major risk factor for heart disease(29,129). Thiamine (vitamin B1) has been found useful in the treatment of congestive heart failure(179).

Gingko biloba is effective in the treatment of intermittent claudication and improves the blood supply to the brain(180).

Hawthorn (Crataegus oxyacantha) has long been used in Europe as a heart medicine. It is used in the treatment of arrhythmias, is non-toxic, and has also been found to improve cardiac performance in general(181-183).

Exercise is an important component in the rehabilitation of heart disease patients. Light exercise is just as effective and less dangerous than high intensity training in rehabilitating heart attack victims(184). Moderate exercise decreases platelet adhesiveness while vigorous exercise may actually increase it(185). Regular exercise helps prevent obesity and diabetes both important risk factors for heart disease and has also been found to enlarge existing arteries and help build new ones(25).

Chelation therapy is the alternative equivalent of heart surgery. It is an established medical practice for the removal of lead and other toxic materials from the body and is now being used to an increasing degree for the removal of calcified atherosclerotic deposits(7,186). Chelation therapy is performed on an out-patient basis and usually involves about 20 treatments each lasting 3 to 4 hours. The patient sits in a comfortable position while receiving an intravenous infusion of EDTA (ethylene diamine tetraacetic acid), vitamins and minerals. The therapy is usually combined with a program of dietary and lifestyle modifications. Chelation therapy restores blood circulation and can help to avoid angioplasty and bypass surgery. It is also used in treating arrhythmias, intermittent claudication, and macular degeneration(186,187).

Chelation therapy is safe, is used by thousands of doctors all over the world, and has by now been used to successfully treat many hundreds of thousands of patients(186). Danish doctors report beneficial results for 80-91% of patients treated for atherosclerosis. An astounding 89% of patients scheduled for heart surgery were able to avoid it after chelation therapy. Among patients suffering from intermittent claudication, 82% showed significant improvement(188). Oral chelation agents are used to reduce atherosclerosis and cholesterol levels. They are, however, not a substitute for intravenous chelation as they are less effective and act considerably slower(186).

It is clear that there is an enormous range of alternative therapies and natural supplements which are highly effective in both preventing and treating cardiovascular disease. These alternative methods deserve thorough evaluation and trial before submitting to a lifelong dependency on pharmaceutical drugs or dangerous, short term, surgical solutions.

REFERENCES
  1. U.S. Department of Health and Human Services, Public Health Service. Healthy People 2000: National health promotion and disease prevention objectives, 1991, p. 71
  2. Rath, Matthias. Eradicating Heart Disease. 1993, Health Now, San Francisco, CA
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This article was first published in International Health News in February - April 1996

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