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CARDIOVASCULAR RISK FACTORS OTHER THAN CHOLESTEROL


Dr. James Belanger & Dr. Karen Braga 

Seven hundred fifty thousand people die every year from cardiovascular disease.  This number represents forty four percent of all deaths in the United States and unfortunately, has not changed over the last twenty five years, despite the widespread treatment of high cholesterol. Part of this failure can be explained by recent studies which demonstrated that half of all heart attacks and strokes occur in people with normal cholesterol levels.  Many people, however, are led to believe that if they have normal cholesterol levels, they will not get heart disease.  This, unfortunately, is not true. This newsletter will discuss other risk factors for heart attacks and strokes besides cholesterol such as cardio-CRP, homocysteine, lipoprotein(a) and fibrinogen.  We feel it is important to monitor these blood tests in addition to cholesterol levels in all our patients, to make sure your risk of heart disease is as low as possible. 

CardioCRP (C-Reactive Protein)

CardioCRP is a substance produced by your liver. High levels of this substance in the bloodstream can create inflammation in the blood vessels which can then cause plaque to develop. Over time, the plaque can build up and completely obstruct blood flow through the vessel and deprive any nearby tissue of oxygen. A lack of oxygen can then cause a heart attack or stroke.   CardioCRP is often elevated in the elderly, smokers and in people with high blood pressure, obesity or diabetes.  It can also be elevated in people who have a history of herpes or chlamydia infections and women on hormone replacement therapy.  

According to a recent study, a cardioCRP level is a stronger predictor of a heart attack or stroke than cholesterol levels. Currently cardioCRP values are separated into 5 quintiles based on risk of a cardiovascular event


Quintile
Level in the Blood
Risk of a Cardiovascular Event
1
&Mac178;0.6 mg/L
Lowest Risk
2
0.7 to 1.1 mg/L
Low Risk
3
1.2 to 1.9 mg/L
Moderate Risk
4
2.0 to 3.8 mg/L
High Risk
5
&Mac179;3.9 mg/L
Highest Risk


If your CRP level is <1 you are at a low risk for having a cardiovascular event and if you have a value of >2, you have a 2-fold increased risk for a stroke, a 3-fold increased risk for a heart attack and a 2-4 fold increased risk for arterial disease in your legs. If you CRP is >3 and your cholesterol is high, you have eight times greater risk of having a heart attack or stroke than someone with normal values.

If you are found to have a high level, do not worry because cardioCRP can be lowered with weight loss, diet modification, smoking cessation, vitamin E and fish oil.  Vitamin E will only lower cardioCRP if it is taken in high doses. The best form of vitamin E is the natural mixed form. In other words, it should say “mixed tocopherols” on the bottle. Vital Nutrients is a company that makes an excellent natural vitamin E. The amount of fish oil required to lower cardioCRP is very high and a liquid is often easier to take than a handful of capsules. A company called Longevity Science has an excellent liquid fish oil which has been deodorized and scented with lemon and rosemary. One tablespoon twice a day of this excellent tasting fish oil can lower the highest cardioCRP and has been proven to reduce your risk of a heart attack. Even if you do not have a family history of cardiovasculare disease and/or you have a good diet and take Vitamin E and fish oil, you should still have a cardioCRP level checked at least once a year to ensure a low risk and to make sure you taking the right dose of the supplements. 

Homocysteine

Homocysteine is a protein breakdown product normally found in the bloodstream.  After you ingest anything that contains protein, the protein is broken down into building blocks called amino acids. Homocysteine is derived from a certain type of amino acid called methionine. In a healthy person, homocysteine is quickly metabolized and converted into useful products such as the antioxidant glutathione. If homocysteine, however, is not metabolized efficiently, it can build up in the bloodstream and cause damage to the walls of the arteries.  This damage can promote hardening of the arteries and blood clot formation and cause a heart attack, stroke or circulation problems in your legs. This does not happen overnight, but rather the damage is done very slowly over many years.
  

In order to metabolize homocysteine efficiently, the body needs an adequate supply of folic acid, vitamin B6, vitamin B12, riboflavin, magnesium, zinc and something called trimethylglycine.  If you are not eating many leafy green vegetables, fruits and whole grains, you can develop deficiencies in these nutrients and your homocysteine will rise.  Coffee, alcohol, birth control pills, hormone replacement therapy, seizure medications and a drug called methotrexate can also cause deficiencies in these nutrients and have been shown to increase homocysteine levels.  People on a high protein diet, diabetics, smokers and people with kidney disease or a genetic predisposition for cardiovascular disease can also have a high homocysteine level.   

Homocysteine values should be less than 6.3umol/L in the bloodstream after an overnight fast. Any value over 6.3 increases your risk of a heart attack.  If your homocysteine reaches 15 you have a 3-fold increase of a heart attack compared to someone with a normal value. High levels of homocysteine have also been linked with increased risk for strokes, peripheral vascular disease, schizophrenia, multiple sclerosis, Parkinson’s disease and Alzheimer’s disease.  To ensure that you are metabolizing homocysteine efficiently, we recommend that you have your homocysteine checked every year after the age of forty. New studies suggest that it is more accurate to check both homocysteine levels after an overnight fast and six hours after a methionine load (an amino acid found in protein). 

If your values are high you will need to take a combination of folic acid, vitamin B6, vitamin B12 and trimethylglycine.  The active forms of folic acid and vitamin B12 (folinic acid and methylcobalamin, respectively) are more effective than other forms.  An excellent product that contains all these vitamins in their active forms is Methyl Guard by Thorne Research. A diet high in green leafy vegetables, fruit and whole grains and lower in red meat and chicken can also lower homocysteine and decreasing caffeine and alcohol is also recommended. 

Fibrinogen

Fibrinogen is a substance normally found in the bloodstream.  If the body needs to form a blood clot it converts the fibrinogen into a substance called fibrin. Fibrin collects at the injured site to attempt to seal the wound. If fibrinogen levels get too high in the blood stream, bloodclots can occur more frequently. Some of these blood clots might develop in narrowed arteries and cause a heart attack or stroke. A high level of fibrinogen in the blood, in fact, has been associated with increased risks of stroke, peripheral arterial disease, blood clots in the legs, atrial fibrillation, heart failure and angioplasty failures.  Normal values are less than 3.35g/L.  Every half a point above 3.35g/L increases your risk of a heart attack or stroke by about 20%.   Lowering a high fibrinogen level has been proven to decrease your risk of having a cardiovascular event. 

The best and safest substances to lower fibrinogen include fish oil and Lactobacillus plantarum, a friendly bacteria found in foods like yogurt and sauerkraut. If your fibrinogen value is high, it often takes about two tablespoons of a concentrated fish oil supplement to bring it down.  We recommend the excellent tasting fish oil by Longevity Science. Yogurt and sauerkraut, unfortunately, do not contain enough Lactobacillus plantarum to lower a high fibrinogen. We, therefore, recommend the capsules by Allergy Research.  Other forms of Lactobacillus, such as Lactobacillus acidophilus are not effective.

Lipoprotein(a)

Lipoprotein(a) is a substance made in the liver and it is normally found in the bloodstream. Its exact function is not known, but it may help repair wounded blood vessels. When a blood vessel is injured, lipoprotein(a) deposits itself in the wall. If lipoprotein(a) levels are too high in the blood it will over collect in the vessel wall causing narrowing and blood clot formation. This can be exacerbated if you also have a high homocysteine and/or cholesterol level. 

Lipoprotein(a) is often elevated in postmenopausal women, in men with low testosterone levels and in people with liver disease, kidney disease, diabetes or hypothyroidism. The amount of lipoprotein(a) in the bloodstream is also strongly under genetic control.  According to the research, you have a 70% increased risk of cardiovascular disease if your lipoprotein(a) is >26mg/dl compared to people with lower values. 

The most effective way to lower lipoprotein(a) is with niacin. We recommend time-released niacin, a perscription item. Regular release niacin can cause uncomfortable facial flushing and has to be taken several times a day. Time-released niacin on the otherhand, causes very little flushing if it slowly introduced in the body and taken concurrently with an aspirin. Time-released niacin also, only needs to be taken once a day. Other forms of niacin, such as flush-free niacin, have not been proven to lower lipoprotein(a).  Time-released niacin is available only with a perscription and is a very safe as long as it is monitored by a doctor.  Niacin has been proven to lower your risk of dying from cardiovascular disease over the next fifteen years by eleven percent.  Coenzyme Q10 is also effective at lowering lipoprotein(a), but it only works in the water soluble form called Q-gel. Q-gel is about three times more absorbable than other forms of coenzyme Q10.
 


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