While the one-sized-fits-all screening and treatment recommendations cover the basics, it is also responsible for why so many people still end up having heart attacks today, even despite ‘appropriate screening’. For example, did you know that 70% of heart attack victims are considered low risk by traditional screening? How about that 3/4 of these victims have only mild coronary heart artery narrowing which is why they are frequently missed by such screening tests like stress tests. This means there is a significant percentage of people who have disease lurking.
The great news is that on the other hand today we have a customized approach to each genetically unique individual that takes far more into account. This specialty of Functional Medicine or Precision Medicine has recently propelled healthcare to new heights in heart health outcomes. Places like Cleveland Clinic Center for Functional Medicine and top notch private practices like ours offer this advanced look at heart disease prevention as part of an interconnected system in the body that functions as a whole. To make sure no one is left behind the most leading edge treatments and prevention revolve around you instead of what is right for the masses. This approach incorporates looking at advanced biomarkers like your DNA, the Gut microbiome, as well as environmental toxins and hormonal imbalances which all which play a valuable role for heart and whole body health. To get the best understanding of this lets first look at the conventional approach:
How to avoid a heart attack and how to prevent cardiovascular disease: Heart disease is the #1 leading cause of death, but it's not inevitable. Avoid the following:
Smokers and 2nd hand smokers are at highest risk factors from this lifestyle habit. Chemicals mixed in tobacco can damage the heart circulation. Smoking reduces the oxygen in the blood, increases blood pressure and heart rate because the heart has to work harder.After quitting you gain benefit from that very day forth at reducing risk heart disease. It is also important to note that second hand smoke is as deadly so living with smokers must also be addressed. ExerciseRegular, daily physical activity can lower the risk of heart disease. Recent data support that an overall reduction in mortality is higher than most other things you can do. So getting active is of paramount importance to preventing and even reversing heart disease and strokes. Preventing a heart attack should always start and end with exercising since it increase collaterals or accessory arteries to the heart around compromised ones. If you haven't been active for a while, you may need to slowly work your way up. The minimum exercise is 150 minutes a week of moderate aerobic exercise which only begins at a jog or brisk walk.1/2 resistance or weight training 1/2 cardio.
This combo is perfect as it has shown to improve blood flow and improve your heart health.
As you practice more and more you will increase your exercise tolerance which is also referred to as V02 max.
This indicates your body is up taking far more oxygen to your cells which you need for all cellular processes.
Ideally getting up to 1 hr per day is the target to prevent heart attacks.
Heart healthy food:
Consuming the followingVegetables and fruits, at least 6 servingsLegumesLean meats and fishLow-fat or fat-free dairy foodsHealthy fats, avoiding excessive saturated fat
Eating according to the DASH diet and the Mediterranean diet which means limiting:SaltSugarProcessed carbohydratesAlcoholSaturated fat (found in red meat and full-fat dairy products) and trans fat (found in fried fast food, chips, baked goods)
Maintaining a healthy weight
By being overweight — especially around the mid section increases the risk of heart disease. Excess weight can lead to high blood pressure, high cholesterol and type 2 diabetes. What else it does is stores fat around your visceral or internal organs. This too is a risk factor. Liposuction cannot get this fat out, whereas lifestyle may.
The body mass index (BMI) uses height and weight to determine whether a person is overweight or obese. A BMI of 25 or higher is considered overweight, over 30 is obese, and over 35 is morbidly obese. The risk of heart disease is higher if the waist measurement is greater than:40 inches (101.6 centimeters, or cm) for men35 inches (88.9 cm) for women
Your Sleep is important: People who don't get enough sleep have a higher risk of obesity, high blood pressure, heart attack, diabetes and depression the literature shows. Most people need 7 plus hours per night.
Making this a priority will ultimately be of help. Sleep apnea is when you snore loudly, stop breathing at night with or without awakening yourself and associated with morning fatigue and headaches as well as having high blood pressure and neck sizer greater than 17” in males. This is an independent risk factor for heart disease. Treatments for obstructive sleep apnea are always loosing weight first and getting something called a CPAP which stands for controlled positive airway pressure to ensure oxygen gets to your lungs that was otherwise blocked by fat tissue. Today they have new devices we also direct our patients to getting if warranted, these are called oral appliances. These are not positive airway the gold Standard way but also help improve oxygen delivery by opening up the oral palate and allow air in.
Stress is one of the most overlooked and under appreciated causes of not only heart disease but overall aging and death in America. Stress creates cortisol a hormone that is the only one to increase with age. It breaks down tissue throughout the body and increases the release of inflammatory cytokines. These cytokines can trigger the immune system to over react leading to inflammation in our arteries. This leads to heart disease. These are all compound problems.
High blood pressure, Diabetes, and high cholesterol (Metabolic Syndrome):
These both together can damage the heart and cardiovascular system. Regular screening can tell you what your levels are and what your risk is which should be addressed. Regular blood pressure screenings should start in childhood and people age 40 and older are given a blood pressure test yearly. Blood pressure causes turbulent blood flow in the arteries. These can directly damage our major organs like the heart, brain, and kidneys if allowed to go unchecked. These may even result in heart failure, heart attacks, and strokes also accelerating disease in the heart arteries from this micro trauma allowing cholesterol to more readily flow into them.
Cholesterol screening starts at age 20. If a child is obese or has other risk factors like hypothyroid it may be earlier. The earlier detected the earlier treatment is available. Inflammatory cholesterol depends on the type of food and how much inflammation you have in your system as well as genetic risks in processing it. Diabetes is a risk factor for heart disease. If you have risk factors for diabetes, such as being overweight or having a family history of diabetes, your health care provider may recommend early screening. If not, screening is recommended beginning at age 45, with retesting every three years. Diabetes is a problem due to the breakdown of glucose into advanced glycemic end products which are super inflammatory.Now that we’ve seen the basics, let's turn to more innovative ways of adding to this in an individualized manner to further our success at preventing heart attacks and heart disease and helping make disease elective.
Genetics and your DNA:
Looking at a panel of genes now well known to infer risk of developing heart disease is a great way to see what we can do to help. If a gene is not functioning properly we may help by up regulating its function, provide the end product it might not be making as much of or simply facilitate it through lifestyle, supplements and even medications. For example, LPa is a gene that helps break down clots in the arterial system. By knowing if someone has such a genetic variant ahead of time we know that certain nutraceuticals may help thin the blood, modulating of our omega 3 fatty acid balance and it’s anti-inflammatory effects may too, while avoiding certain foods can help prevent an issue making this risk essentially reduced. How incredible would that be for you to know and know that just because your father and grandfather had such issues early in life, it doesn’t have to be you. Moreover, if you’ve experienced an event already you can prevent further issues and even know if your children may carry similar risk. Another gene variant that is a modifiable risk is called CDKN2A/B which among several other things increases calcification of the arteries.
Vitamin K2 has shown not only to help prevent heart and coronary calcification but also allows calcium to more appropriately be directed towards bone for optimal bone health. Such factors further gives us insight to what to watch out for, adding appropriate screening, therapeutic options for prevention and what diets to chose. Its knowledge like this that allows a personalized precision health approach beyond anything we’ve ever seen before.
The American heart association (AHA) came out with a statement in 2020 that the biggest threats to cardiovascular health is fine particulate matter. Exposure to things like fossil fuel emissions, flame retardants, and solvents contain these which may be higher in certain neighborhoods than others. Living near industrial plants too are some of the higher risk people exposed. This isn’t all though as people who consume certain foods that have been processed are exposed to such chemicals. For example, certain fish, even though caught off our shores, are often sent back for processing in nations such as China according to a recent TED talk on food quality in this country.
Mercury exposure from Amalgam teeth fillings many were exposed to is an environmental toxin. Eating lots of Sushi (large fish in particular) may also expose people to higher Mercury levels. These raise the risk of cardiovascular disease as we know including high blood pressure (Hypertension. There have been people we have correctly identified with such issues and detoxifying them through a process called Chelation and not only were symptoms of chronic toxin exposure better but so was their blood pressure. Diet is also important here. Those with less consumption vegetables including cilantro and parsley for example may help bind and excrete such toxins. Nutrients like selenium may help our own bodily enzymes excrete Mercury in the kidneys which is found in plant based foods like nuts. These foods also contain antioxidants which help fight the inflammation caused by such toxins proving to have multi therapeutic effects.
This is the guts ecosystem of organisms that live in all of us. It is association with numerous health conditions including cardiovascular disease. Gut health is king when it comes to a heart healthy lifestyle as we know of certain metabolites produced from the consumptions of inflammatory foods. A substance called TMAO arises in many who’s diet is high in eggs, milk and meats which have been associated not only with cardiovascular disease but now also heart failure. Saturated fat consumption vs more plant based cause more gram negative organisms to grow in the gut which can have vastly different impacts on our health. Recently studies have revealed the gut microbiome of children vary greatly from those of aging older adults in conjunction with aging and inflammation. For example, LPS (a dangerously inflammatory cell wall protein) may permeate across the gut and into our bodies when more gram negative bacteria grow in the gut in response to certain foods. This LPS has been shown to cause ALS a neurodegenerative disease in animal models and significant inflammation as well across many species in a condition often referred to as ‘leaky gut’. Such LPS is even associated with autoimmune conditions. All of this proves a strong case for finding the right foods for you. There have been several patients in our practice that have apparently ‘cured themselves’ of autoimmune conditions by radically altering their diet from carb heavy/processed foods to more plant based anti-inflammatory organic food.
Did you know that women are 3x more likely to die of a heart attack than men after age 65. Why is that? After menopause they loose their ability to make protective hormones. Estrogen, Progesterone, and Testosterone are all critical in female health and stop with the cessation of their cycle. We know that less hormones isn’t just associated with heart disease but bone health integrity and osteoporosis and muscle to fat ratio decreases.
It is well established that metabolic syndrome (higher fat content, cholesterol, and waist size) increase risk for heart disease, yet all of these are attributable to hormonal decline in women as well as in some men. Replacement of hormones has also been clinically associated with a decrease in these parameters as well as menopausal symptoms. Women didn’t only love the way they felt but clinically, were healthier. The literature is now showing how effective these hormones are on bone density, heart health, stem cell secretion, but also cognitive health. We know from a genetic perspective that certain women with estrogen receptor or hormone manufacturing issues can respond well to hormones after menopause when they get it as well.
There was a scare about hormones and cancer years back but the literature review and prospective studies looking at women on proper bio identical topical hormones has since refuted that. There have even been studies showing a decrease in women's cancers done at the American Cancer Society which are all nicely outlined in the book Estrogen Matters for those who wish to take a closer look at the literature by a Phd researcher and Oncology physician who outlined the truth about hormone therapy. The same rules apply to men as well. We have known for decades how beneficial testosterone therapy is for men, from muscle building and preventing sarcopenia (loss of muscle with aging), bone health integrity, and heart disease prevention as of recent studies it has even shown to help repair the heart after a heart attack. This is a remarkable therapeutic as well as preventive treatment in those who need it since its benefits span beyond the cardiovascular system.
So why isn’t it more touted in women? The only thing to consider in such a scenario is to never go cheap when it comes to your health. As we give most value to what we pay most for, it should be remembered when such places are offering discount plans, services and treatments. This may be where you want to buy stereo equipment for example, but it should not be for where you go for comprehensive health balance. Ensure today you find a properly trained Functional Medicine or Age Management physicians with endocrinological training and experience to get optimal results.
Learn more about Dr. Dinetz heart health approach.