The Preventive Medicine Center Of Gainesville

The “war” on cholesterol to reduce heart disease has been going on for decades. Heart disease remains the number one cause of death in the U.S. and the number of deaths from this disease has not changed in the past 25 years, in spite of new cholesterol lowering drugs, advances in heart surgery with stents and angioplasties, a myriad of foods that are cholesterol-free, etc..

I encourage my patient’s to be “independent thinkers” ask the question “why”? Patients are often times surprised at the answers I give them when they discuss “cholesterol” with me. For instance, I tell them the important thing is not so much how high, average or low their cholesterol is, but whether it is sticking in the arteries that counts. If this were not the case, then why do half of all patients who die from heart disease have a cholesterol that is “normal” or below 200mg/dL.

Is Cholesterol the “Enemy?”

Cholesterol is a substance that is produced by the body and is also consumed in the diet. 90% of the body’s cholesterol is produced by the liver and only 10% is dietary. Because cholesterol has been portrayed as an “enemy” most people do not realize that cholesterol is critical for health and is a precursor to sex hormones such as testosterone, estrogen, and progesterone. Elevated cholesterol is only one of many risk factors in the development of heart disease, and is not very accurate as a predictive factor for death from heart disease. People who have cholesterols well below 200mg/dL. and vegetarians die from heart disease, whereas a lot of elderly grandparents with cholesterols in the 300's do not. What is important is whether cholesterol is sticking in the arterial wall or not in response to inflamation. The concept of heart disease being an inflammatory disease is relatively new.

Balz Frei, Ph.D., who is the Director and Endowed Chair of the Linus Pauling Institute spoke at the ACAM conference and shared with us research on oxidative stress, adhesion molecules, and atherosclerosis. He pointed out that atherosclerosis is an oxidative event where LDL cholesterol is oxidized, and where anti-oxidants may prevent this process. Ascorbate (vitamin C) and Glutathione are the most abundant anti-oxidants naturally occurring within the cells. Transitional metals such as mercury, lead, iron, and copper may play a role in the development of atherosclerosis, but by adding metal chelators to cell cultures, atherosclerosis and adhesion molecules are blocked. He further pointed out that arterial narrowing by itself did not cause a heart attack or stroke. There must be a rupture of the arterial plaque, exposing the surface of the artery causing vasospasm, platelet aggregation (clumping together of platelets), and clot formation leading to complete blockage or occlusion. Once this happens, a heart attack or stroke occurs. Nitric oxide blocks this from occurring. As little as 500mg of vitamin C a day dramatically improves vascular function by improving nitric oxide production.

Facts and Risk Factors

Another wonderful presentation on emerging concepts of heart disease was given by Dr. Allan Magaziner, D.O.. He is the current president of ACAM (American College for the Advancement in Medicine) and the author of The All-Natural Cardio Cure: A Drug-Free Cholesterol and Cardiac Inflammation Reduction Program (Avery, 2004). Much of this talk is summarized in this paper :

• Cardiovascular disease remains the leading cause of death in the U.S.
• 750,000 deaths per year or 1 in 5 deaths.
• The number of deaths has not changed in the last 25 years.
• 250,000 people die from heart attacks every year without even making it to the hospital.
• 1 in 5 heart disease deaths are linked to smoking. Another 40,000 are linked to second hand smoke.
• More than 350,000 people undergo by-pass surgery and more than 600,000 have angioplasties each year.
• Diabetes is a tremendous risk factor – 80% of diabetics die of heart disease.
• Other risk factors are obesity, hypertension, sedentary life style, stress, family history, hypercholesterolemia. Smoking is the #1 risk factor.
• Half of all patient who have heart attacks do not have elevated cholesterols.

New risk factors are emerging that include the following:

• Inflammation
• Infections including periodontal disease
• Oxidized LDL cholesterol
• Homocysteine
• Fibrinogen
• Lipoprotein(a)
• Platelet dynamics and blood viscosity

What Is the Most Accurate Marker for Heart Disease Risk?

HS (high sensitivity) CRP or Cardiac CRP is a marker of inflammation, and is now recognized as the single most significant diagnostic tool for assessing health risk associated with future risk of heart attack and stroke. Simply measuring cholesterol levels is inadequate. At the Center, we have been measuring HS CRP protein levels on our patients for years. Those with HS CRP levels in the highest quartile are three times more likely to develop heart attacks compared to those in the lowest quartile. Those with severe periodontal disease are more likely to have elevated blood levels of HS CRP. Levels below 1.0mg/L are associated with low heart disease risk.

Another risk factor is homocysteine, an amino acid derived from dietary protein. High levels of homocysteine may account for 25 - 30% of all cases of heart disease. Levels above 15 can damage arterial walls and are associated with accelerated plaque formation. Optimal levels are below 10. High homocysteine can be corrected in most cases with vitamins B6, B12, and folic acid. As many of you know, we have also been measuring homocysteine levels in our patients along with HS CRP and lipid profiles since the Center opened.

Heavy metal toxicity with lead, mercury, cadmium, and other heavy metals is a significant risk factor not generally recognized in heart disease among either the public or traditional Western physicians. We live in a polluted environment and heavy metals oxidize LDL cholesterol which causes arterial injury. They also deplete vitamins B6, B12 and folate by putting nutritional stress on the detoxification pathways, causing an increase in homocysteine levels. Removing these metals with chelation therapy is now thought to be the mechanism by which chelation works to reduce the risk of heart disease.

Statin Drugs vs. Natural Supplements to Lower Cholesterol

Patients often come to the Center and ask me about Statin drugs that they are taking or are advised to take by their primary care physicians who are concerned about a total cholesterol level above 200mg/dL.. Statin drugs work by lowering HS CRP and reducing arterial inflammation. However, there have been deaths from these drugs and they deplete coenzyme Q10 levels which is necessary for heart muscle health. Co-Q-10 depletion may be a contributing factor in the potentially fatal muscle disease associated with statins, rhabdomyoloysis. There are alternatives to lower HS CRP including eating cold water fatty fish, pineapple, ginger, blueberries, soy products, green tea, shiitake mushrooms, and garlic and onions. Vitamin E reduces inflammation and HS CRP in diabetic patients, and Omega 3 fish oils inhibit naturally prostoglandins that cause blood vessel inflammation. Eskimo’s whose diets are high in omega 3 oils, have the lowest incidence of heart disease on the North American continent.

Red Yeast Rice is a fermented product of rice on which red yeast is grown. It has been used for centuries in China. Red Yeast Rice contains 9 different monacolins, that are substances that inhibit cholesterol production. One of these monacolins is Lovastatin. There have been no reports of liver enzyme elevation or renal impairment, although rare headaches and stomach discomfort may occur. We do not know if there is Co-Q-10 depletion while taking this product. In 324 hypercholesterolemic adults given 1.2 grams daily of Red Yeast Rice for 8 weeks, cholesterol decreased 23%, LDL 31%, triglycerides 34%, and HDL increased 20%. We carry the Thorne Labs brand of Red Yeast Rice at the Center.

Another product that lowers cholesterol naturally is Policosanol, which is extracted from sugar cane. It inhibits cholesterol formation in the liver and also inhibits the aggregation of platelets, which improves exercise response in patients with heart disease. A study published in 1999 compared patients taking 10mg/day of Policosanol with taking Pravastatin for eight weeks. Policosanol reduced the total cholesterol by 13.9%, LDL by 19.3%, increased HDL by 18.4%. The benefits were similar to the drug. We also carry this product at the Center from Biotics Research.

Heart Healthy Foods

A healthy diet is the basis for reducing risk of heart disease. Here are Ten Heart Healthy Foods:

• Apples are packed with pectin, a source of soluble fiber that may reduce cholesterol
• Beans are a good source of saponins, fiber, folic acid and may reduce homocysteine and cholesterol
• Berries are loaded with vitamin C, pectin, and other substances that may reduce body fat.
• Broccoli contains vitamin C, carotenoids, and sulfurophane which protect the arteries.
• Garlic contains anti-clotting factors and flavonoids thought to lower cholesterol
• Nuts such as almonds, brazil nuts, and walnuts are good sources of monounsaturated oils.
• Oatmeal is rich in cholesterol-lowering soluble fiber.
• Wild salmon contains omega-3 fatty acids which reduce heart disease risk (farm raised salmon does not have high omega-3 levels and has PCB’s)
• Soy isoflavones can reduce cholesterol.
• Grapes contain resveratrol and lowers the risk of heart disease and cancer.

EDTA Chelation Therapy and Subsequent Cardiac Events
Although chelation therapy has been used safely for decades, there is still a lot of controversy among traditional Western physicians as to whether it works and why it works. A large, multi-center study called the TACT trial is begin funded by the National Institutes of Health and is currently underway in the U.S. to further evaluate EDTA’s benefits in patients with known heart disease. EDTA is a synthetic amino acid approved by the FDA for use in lead detoxification.

Terry Chappell, M.D. presented an unpublished study at the ACAM conference where 246 patients with known vascular disease were treated with EDTA chelation therapy and underwent a 3 year follow-up to determine the incidence of cardiac events. The data was analyzed by Rakesh Shukla, Ph. D., who is a specialist in biostastical analysis at the University of Cincinnati Center for Biostatistical Analysis.

In this study 71% were males, average age 64 (range 40 - 85 years) and the mean number of treatments was 58, with a minimum of 20 treatments with monthly maintenance treatments. 17.6% smoked at the beginning of treatment, 8.5% at the end of treatment. In this group there were NO deaths, NO heart attacks, and 3 minor strokes (all of which resolved over time). 5 patients (2%) underwent cardiac bypasses and 3 (1.2%) underwent angioplasties. 4 patients (1.8%) had the onset of cancer. What was also interesting about this study was 35% of the patients had been told that they should undergo vascular surgery and refused, and another 10% were told they needed surgery but that they were too high risk. In other words, 45% of patients had surgical severity of disease but underwent chelation instead.

167 patients had symptoms at the beginning of treatment whereas 118 (70.7%) were symptom-free at the end of the 3 year period. These results were far better than one would expect in a high-risk population.

The chelation group was then compared with other published groups, matching age, numbers in the study, smokers, gender, etc.. and follow up interval of three years. These other groups were divided into 3 categories:
1) Those initially treated with angioplasty.
2) Those initially treated with CABG (by pass surgery) .
3) Those initially treated with standard medical therapy.

Findings at the end of 3 years are summarized:

	Heart attacks	Deaths	Need for Angioplasty	Need for By Pass
Angioplasty group	7.3%	3.2%	22.3%	11.8%
CABG group	7.8%	4.0%	5.5%	1.2%
Medical Therapy	3.6%	1.3%	15.5%	4.4%
Chelation group	0%	0%	1.8%	2.7%

This analysis suggests that the rates of cardiac events, strokes and death from all causes appear to be much lower in patients with cardiovascular disease if they receive chelation therapy.

Summary

The etiology of cardiovascular disease includes a much broader approach than cholesterol alone. Nutritional supplements play a vital role in the prevention and treatment of heart disease. Exercise, smoking cessation and stress reduction must be part of a comprehensive cardiovascular disease reversal program. Chelation therapy is a safe therapy when properly administered and is a secondary prevention tool for vascular disease.