Cholesterol, Heart Health, Cholesterol Levels, Heart Disease, Functional Testing
Do you know what the number one killer is in the United States?
It’s not gun violence or the coronavirus. Not even the flu could touch this culprit’s death rate. Most likely you know someone who has fallen victim to its detrimental influence because the CDC cites that it causes 1 out of every 5 deaths.
Would It surprise you to hear that heart disease is the most deadly predator in the United States and also the world?
Do you have a family history of heart disease?
If you have a family history of heart disease some indicators might already be on your radar. You might be thinking about aging, weight, your nutritional intake, alcohol consumption, smoking habits, and your ability to manage stress. These contributing factors most often undermine heart health.
If you have diabetes, hypertension or metabolic syndrome your conventional medical doctor may have already run a blood panel to check your LDL and HDL cholesterol levels. Cholesterol is the main indicator of heart disease – depending on the levels found in your body, LDL the detrimental cholesterol and HDL beneficial.
What other things should you consider in terms of testing for heart disease?
There is more to consider about heart disease than just cholesterol. Functional testing takes a deeper look at the health of your heart beyond history and cholesterol. A more extensive blood panel can locate markers that a traditional panel might miss.
Here are twelve tests you should contemplate in relation to measuring your heart health beyond mere cholesterol numbers:
According to this recent article written by Michael Downey, several tests beyond a basic blood panel are outlined and explained:

  1. LDL P (LDL particles) – Although this test is technically an indicator of cholesterol in your body, more than a typical blood panel, it helps you understand the overall number of LDL particles in your body.
  1. Small LDL – Again, this test acknowledges cholesterol in your body and takes it a step further by letting you know how many small LDL particles are present. In the case of cholesterol, small particles are particularly important because they can penetrate arterial walls resulting in plaque build-up.
  1. LP-IR indicates insulin resistance and it’s severity. High insulin resistance is a leading cause of diabetes and a contributing factor for heart disease.
  1. Oxidized LDL – A test to discover the oxidation level of small LDL particles which are more likely to oxidize and become more dangerous as they do.
  1. MPO blood test – Tests for and enzyme called MPO causes inflammation in the arterial walls and contributes to arterial plaque especially when oxidized LDL are present.
  1. C-Reactive Protein (CRP) – this test measures levels of inflammation and whether or not chronic inflammation is present. The higher the levels of inflammation indicate a greater risk of heart disease overall.
  1. Apolipoprotein B (ApoB) – “Apolipoprotein B proteins are now “widely accepted as the most important causal agents of atherosclerotic cardiovascular disease.”13”
  1. Homocysteine – additional testing for cell damage and inflammation of the arterial walls
  1. Vitamin D 25-Hydroxy – a test used to measure levels of vitamin D which is beneficial in preventing heart disease
  1. CBC/Chemistry Profile – a test for general and immune health
  1. HbA1c – measures glucose levels
  1. Omega-3 Index – measures levels of omega fatty acids in the body; omegas another beneficial nutrient in preventing heart disease

There are so many things for your team to consider when managing your heart health. It’s important to dig deeper than just cholesterol levels, especially if you have a history of heart disease or are experiencing the onset of any of the contributing factors listed above.
As a naturopathic physician I can help you get to the root of your symptoms and work through functional testing beyond cholesterol levels. I am able to consult with you and create an individualized plan in conjunction with your conventional medical doctor’s directives to ensure your most optimal heart health.
Are you living in the Guilford/ Branford/ New Haven/ Madison/ Clinton area and would like to learn more about integrative solutions for your health care needs.
Call (203) 453-0122 or CLICK HERE to schedule a consultation.


Rethinking the Risk of Low HDL

Despite plenty of evidence that people with low levels of “good”cholesterol are more prone to heart attacks, a large new study suggests that the lacking lipid is not to blame.

The analysis of data on nearly 70,000 people in Denmark affirmed the link between low levels of high-density lipoprotein (HDL), the so-called “good” cholesterol, and raised heart attack risk in the general population. But in people with a gene mutation that lowers HDL, heart attack risk was not found to be higher at all.

“Association itself doesn’t mean causality,” said lead author Dr. Ruth Frikke-Schmidt, a consultant in the Department of Clinical Biochemistry at Rigshospitalet in Copenhagen.

The results, published in the Journal of Clinical Endocrinology and Metabolism, indicate that just having low HDL is not what raises the likelihood of a heart attack.

“People with low ‘good’ cholesterol also have a whole bunch of other factors that relate to heart disease,” said Dr. Christopher Cannon, professor of medicine at Harvard Medical School and editor of the American College of Cardiology’s website.

It’s difficult to study and isolate “good” cholesterol, added Cannon, who was not involved in the new study. People with low HDL often suffer from obesity, high blood pressure and diabetes and sometimes have higher levels of LDL, or “bad” cholesterol, he said.

To try to isolate the effects of HDL itself, Frikke-Schmidt and her colleagues focused on people with a well-known variant of a gene called LCAT, which lowers HDL levels and occurs in about four percent of the population.

The variant gene is used as a stand-in for low HDL, she noted, but people with the variant don’t necessarily have the other risk factors that usually affect HDL levels in the larger population.

In the new study, a 13 percent decrease in HDL relative to average levels in the population was linked to an 18 percent increase in heart attack risk — if the low HDL was not explained by a gene variant. For people with the variant gene, the same HDL reduction was not linked to any increased risk of heart attack.

The findings fit in with Frikke-Schmidt’s earlier research showing that two other genetic variants that lower “good” cholesterol levels are not associated with an increased risk of heart disease.

According to both Frikke-Schmidt and Cannon, the debate is particularly important, because there are currently drugs in trials that would raise “good” cholesterol.

If low HDL is not a cause of heart attacks, raising HDL may not be protective, they point out.

Ruling out low levels of “good” cholesterol, Frikke-Schmidt said the most likely cause of the increased risk is so-called remnant lipoproteins, which are like “bad” cholesterol and carry fats through the blood.

Until the real mechanisms are sorted out, Cannon said it’s still important for people to try and raise their “good” cholesterol by exercising and losing weight.

“Beyond that there are so many question marks,” he said. “We’re kind of in a wait and see mode.”

SOURCE: The Journal of Clinical Endocrinology and Metabolism, online November 16, 2011.

Carbohydrates and Heart Disease

Clinically, I’ve seen consistent improvements in heart disease markers when implementing a low glycemic diet. The glycemic index is an indicator of how high the carbohydrate portion of a food causes blood sugar to rise-this is especially important for diabetic patients, but is also useful when trying to limit the effect of carbohydrates on the body. A new study published in the Archives of Internal Medicine found that eating lots of high-glycemic-index foods puts women at higher risk of developing heart disease. Some highlights from the study are as follows:

• Women with the highest carbohydrate intake were twice as likely to develop heart disease as women with the lowest intake.

• Only high-glycemic-index carbohydrates were associated with heart disease risk; low-glycemic-index carbohydrates were not.

• Having a high dietary glycemic load more than doubled the risk of heart disease in women.

• No relationship between heart disease and carbohydrate intake, high-glycemic index food consumption, or dietary glycemic load was seen in men.

The bottom line is that all carbohydrates aren’t created equal-paying close attention to the glycemic-index of foods, along with incorporating foods that help to keep the glycemic load down (nuts, beans, lentils, seeds), is a proven method of lowering your heart disease risk.

Cholesterol and Red Yeast Rice

High cholesterol should often be considered an indicator of excess oxidation, inflammation, and other underlying factors. However, despite the appropriate lifestyle changes, genetics often stand in the way of achieving optimal cholesterol levels. In these instances, supplements such as red yeast rice may prove beneficial:

Red Yeast Rice Extract Lowers M.I. Incidence and Mortality from Coronary Disease

Author: Steve Austin, N.D.

Reference: Li J-J, Lu Z-L, Kou W-R, et al. Beneficial impact of Xuezhikang on cardiovascular events and mortality in elderly hypertensive patients with previous myocardial infarction from the China Coronary Secondary Prevention Study (CCSPS). J Clin Pharmacol 2009;49:947-56.

Design: Randomized double-blind intervention trial

Participants: 1530 elderly (≥65 years of age) hypertensive subjects with a history of myocardial infarction (MI)

Study Medication and Dosage: Subjects received either Xuezhikang, a red yeast rice (RYR) extract, administered as 600 mg b.i.d., or placebo for an average of 4.5 years. Each 600 mg capsule of RYR contained 2.5-3.2 mg of monacolin K plus “a small quantity of lovastatin hydroxyl acid as well as ergosterol and some other components.”

Primary Outcome Measures: Recurrent coronary events

Key Findings: Compared with the placebo group, there was a 38% reduced risk of suffering a coronary event (primarily MIs) (P=0.0009). Similarly there was a 29% reduced risk of dying from coronary disease during the course of the trial (P=0.05). Secondary endpoints revealed a 21% decline in LDL levels in the RYR group (P=0.0001) and a 12% decline in triglyceride levels (P=0.003) compared with trivial declines in the placebo group. Total mortality also declined by 36% in the group receiving RYR (P=0.003).

Practice Implications: RYR extracts are known to reduce cholesterol levels in humans and have been traditionally used in China to treat people with cardiovascular disease. RYR naturally contains the same molecule found in the prescription drug lovastatin. Previous RYR research has focused primarily on cholesterol reduction, though some evidenc
e for reduction in inflammatory markers has also surfaced.

The current trial goes several steps further, showing clinically (and statistically) significant reductions in coronary disease incidence and mortality. Hidden in the data is a near-statistically significant (P=0.06) 37% reduction in the risk of stroke and a statistically significant (P<0.04) reduction in total cancer incidence when compared with the placebo group. No current understanding of the effects of RYR clearly explains these additional positive findings.

One caveat requires mentioning: a previous report studying the pharmacokinetics of a related statin drug found that area-under-the-curve response was twice as great in Chinese subjects compared with white subjects (Clin Pharmacol Ther 2005;78:330-41). Should further investigations confirm these findings in regard to monacolins found in RYR, white (and potentially black) patients might require significantly higher doses of RYR to achieve the same clinical outcomes that occurred in the new report, which studied Chinese subjects.

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