Most cardiovascular diseases are reversible with lifestyle changes. Even severe coronary atherosclerosis (clogged arteries that lead to heart attacks) can often be reversed without drugs.

In addition to lifestyle changes there are many safe and effective natural medicines that have been proven effective for the treatment of high blood pressure, elevated cholesterol, arrhythmias, congestive heart disease, angina, stroke and atherosclerosis without the dangerous side-effects of drug therapies.

My approach to heart disease includes obtaining a complete health history, reviewing past medical records for EKG, echocardiogram and other test results, performing a physical exam when indicated, and running lab tests that comprehensively assess cardiovascular status.

After all, cholesterol levels are only one risk factor for heart disease and only half the people who have heart attacks even have high cholesterol.

Other significant (but rarely tested) risk factors include lipoproteins, fibrinogen, C-Reactive protein, growth hormone, insulin, blood sugar and low thyroid function. I may also test adrenal status since stress hormones can directly affect cardiovascular health.

Based on this more comprehensive picture, I will prescribe natural medicines that address the individual patient's needs along with diet changes, a fitness program, stress management, and in some patients requiring more aggressive treatment I may use intravenous (I.V.) therapy.

Natural medicines I prescribe for my patients with heart disease include L-carnitine, which has been documented to reduce symptoms of angina, increase the chances of survival after a myocardial infarction (heart attack), and reduce the damage caused by congestive heart failure; Coenzyme-Q10, which has been shown to lessen chest pain, decrease the frequency of repeat heart attacks and actually reduce the risk of cardiovascular disease morbidity.

Patients with congestive heart failure who are given magnesium have less frequency of arrhythmias.

Other medicines I regularly use are EPA and DHA from fish oil, potassium, vitamins A and E, nattokinnase, policosanol, NAC, vitamins B12, B6, selenium, taurine and the herb hawthorn, which has been shown in numerous placebo-controlled, double-blind studies to benefit congestive heart failure patients without any side-effects; and folic acid, which has been shown to significantly reduce the risk of stroke and heart disease.

In patients with high blood pressure, nutritional supplementation such as garlic, EPA/DHA, Co-Q10 plus a combination of herbs prescribed in carefully controlled doses, such as hawthorn, Rauwolfia and Viscum album can have excellent results.

Patients with high blood pressure can often successfully be weaned off dangerous beta-blockers and other drug therapies while taking natural medicines.

More than any other chronic illness, heart disease is affected to a large extent by lifestyle factors, including diet, exercise and stress management.

A high fiber, plant-based diet, including vegetables, beans, whole grains, nuts, seeds and fruit while eating less meat, dairy, sweets and caffeine will significantly help reverse heart disease.

Important Cardiovascular Lab Tests

FIBRINOGEN:

Fibrinogen is a protein in the blood that converts to fibrin, which along with platelets in the blood form clots. High levels of fibrinogen increase one's risk of heart disease and stroke.

High fibrinogen levels are related to less favorable outcomes in patients admitted to the hospital for suspicion of unstable angina or myocardial infarction (heart attack).

In a 1994, the first study showing a link between fibrinogen and heart disease was conducted on 1,500 men who were followed for four years. The association between fibrinogen and heart disease proved to be even greater than the association between high cholesterol and heart disease.

Newer large scale studies demonstrated that high fibrinogen levels increase the risk of coronary disease in patients with angina 3-fold regardless of other risk factors. Worse are those who also have high LDL cholesterol with high fibrinogen. These people face a 6-fold greater risk of developing heart disease.
Fibrinogen may be increased by obesity, stress, smoking, oral contraceptives and inflammation (which has numerous causes).

I routinely monitor fibrinogen levels in all my patients with heart disease or at risk for heart disease. Fibrinogen can also be tested as part of a routine blood screen that could also include other cardiovascular risk factors such as CRP and lipoprotein A.

If high fibrinogen levels are found naturopathic treatments are a safe and effective approach to lowering them. Omega-3 fatty acids found in fish oil can significantly lower fibrinogen levels. Policosonol made from cane sugar can moderately reduce fibrinogen levels. Other natural medicines that help include vitamin C, garlic, glycyrrhizin extract from licorice root and Ginkgo biloba. Natural anti-inflammatory enzymes will also break up clots and lower fibrinogen levels.

Increased fibrinogen levels may also occur in those with rheumatoid arthritis, multiple myeloma and other diseases, while decreased fibrinogen may occur in those with liver disease and cancer, making it important for a clinician to rule out other causes if abnormal fibrinogen levels are detected.

HIGH Lp(a) LEVELS:

Lipoprotein(a), also referred to as Lp(a), is a fat in the bloodmade up of LDL (that's the "bad" cholesterol) and a protein called apolipoprotein(a).

Lp(a) is a major inheritable risk factor for cardiovascular disease,even in people with normal cholesterol, normal body weight andwithout other signs of cardiovascular disease.High levels of Lp(a) in the blood may promote progressive plaquebuild-up in damaged arteries and increase potentially dangerousblood clotting mechanisms.

Research has demonstrated that Lp(a) levels are quite predictive ofmajor coronary events in men. In a prospective population study of788 middle-aged men, the risk of a major coronary event was almosttrippled in men whose Lp(a) levels fell in the highest 20%, compared to those with lower than average levels.

The significant risks associated with high Lp(a) levels are even more extreme in men who also have high LDL cholesterol, low HDLcholesterol, and high blood pressure.

For women past menopause Lp(a) is as significant a risk factor forcoronary artery disease as it is for men.

Most interesting is the fact that people having heart attacks between 6 o'clock in the morning and noon have significantly higher levels of Lp(a) than those having heart attacks at other times ofthe day. Heart attacks ocurring during this time of day tend tocause more damage to the heart muscle than those occurring at anyother time of day.

What steps can a physician and patient take to lower elevated Lp(a)levels? Testing testosterone levels in men is a good place tostart. Testosterone therapy has been shown to decrease elevated Lp(a) levels in healthy elderly men, while reducing total cholesterol and LDL. Less specifically, low levels of testosterone have also been associated with heart disease in general and supplementing testosterone has been shown to improve angina inpatients with heart disease.

A case report of a woman with a high Lp(a) level whose 6-monthtreatment consisted of only high doses of ascorbic acid (vitamin C) and the amino acid lysine had her Lp(a) levels drop 48%. It hasbeen theorized that lysine inhibits Lp(a) attachment to the arterialvessel wall, while vitamin C helps repair the collagen injury to the blood vessel and provides antioxidant protection.

Supplemental niacin and the amino acid L-proline are also effectivetreatments for lowering Lp(a). Supplemental niacin should be prescribed and monitored by a physician.

While soy food consumption, such as tofu and soy milk, will generally decrease one's risk of cardiovascular disease, soy consumption may actually increase Lp(a) levels according to a study of 179 healthy women and men. The good news is that the study participants, after three months of soy protein supplementation, also significantly reduced their systolic, diastolic and average blood pressures, lowered triglycerides and the LDL/HDL cholesterolratios. Because soy foods generally lower the risk of heart disease,osteoporosis and cancer, I don't recommend the elimination of soyfoods. I would however, suggest that patients with elevated Lp(a)abstain from soy foods until their levels are normalized.

CHOLESTEROL & HYPOTHYROIDISM

Low thyroid hormones (hypothyroidism) can be a contributing factor in cardiovascular disease because of their effect on cholesterol. Hypothyroidism occurs when the thyroid gland does not manufacture enough hormones.

There are many studies showing a strong correlation between heart disease, cholesterol and hypothyroidism. One study of 1,600 patients taking supplemental thyroid hormones to treat their hypothyroidism found that there was an amazing 94% decrease in the probability of coronary disease. Without the thyroid medication it would be expected that 72 of these patients would have had heart disease, whereas only 5 patients in this group had heart disease.

Thyroid hormone replacement therapy can improve cardiac function, total cholesterol and low LDL cholesterol, but does not appear to lower high triglycerides.

I treat my patients with natural desiccated Armour thyroid hormones along with specific vitamins, herbs and other supplements that help maintain thyroid function while monitoring cholesterol and other risk factors for cardiovascular disease.

CHOLESTEROL & COQ-10

I have high cholesterol and take Lipitor. My local vitamin shop suggested I take coenzyme Q10. Will this help lower my cholesterol? Ann, Massachusetts

I am not aware of any studies regarding the benefits of CoQ10 on cholesterol levels. The likely reason this was suggested to you is because you're taking a statin drug. This drug will lower your body's CoQ10 levels, which in itself can increase risk for cardiovascular disease! Symptoms of low CoQ10 levels include fatigue and muscle pain. I strongly recommend anyone on a statin drug take 60 mg of CoQ-10 once or twice daily.

There is a solid body of clinical evidence showing that CoQ10 can safely help with other cardiovascular problems, including high blood pressure, angina, congestive heart failure, cardiomyopathy and myocardial infarction.

Treating Angina, Naturally

I read that pantothenic acid is good and safe to take for angina. Is there any real advantage to taking this? Cynthia, New Hampshire

I believe whatever you read probably was referring to pantethine (a B5 vitamin) which is the biologically active form. There is no scientific basis for taking pantothenic acid, but there is definitely research supporting the use of pantethine in those with angina.

I also recommend that my patients with angina take the herb Hawthorne as well as high doses of Coenzyme Q10, magnesium and carnitine.

This is only the first step in properly treating angina. In almost all cases of angina, angioplasties and bypass surgeries have not proven to provide long-term benefits to the patient. However, naturopathic treatments and proper monitoring is always the best strategy, whether surgical procedures are done or not.

I always monitor fasting blood levels of CRP, fibrinogen, Lipoprotein (a) and a cholesterol profile. If indicated I check for iron, blood sugar and heavy metal toxicity (lead, mercury, cadmium and arsenic).

C-reactive protein (CRP), a sign of inflammation, can identify patients who are most likely to experience a recurrence of unstable angina within a year, even after their initial symptoms have stopped. Once study showed that half of all patients had elevated CRP , even after angina symptoms stopped. Specific nutritional therapies can help lower C-reactive protein.

Fibrinogen is an important risk factor for heart disease and stroke, and many studies have shown that high fibrinogen is associated with a six-fold greater risk of developing coronary disease when combined with high LDL cholesterol, and a three-fold greater independent risk of suffering a coronary event in patients with angina. Herbs and nutritional therapies can help lower fibrinogen levels.

I have a patient whose angina was brought on solely by long term exposure to second-hand smoke. This and other toxic exposures must be ruled out also.

Lifestyle changes that encourage a low fat, low sugar diet, regular exercise and stress management have all been winners against this reversible and preventable disease.

Stroke and Natural Medicine

Question: I had a "mini" stroke last month and was wondering if perhaps there were vitamins or herbs that would help prevent another stroke from occurring. Anonymous, Massachusetts

There are a number of dietary and supplemental things to consider. Eating a whole-foods, low-sodium diet can make a big difference in avoiding stroke recurrence. Eating lots of fresh fruits and vegetables which are high in potassium is important. Exercise is very important in helping prevent another stroke.

Ask you doctor to order blood tests that help determine risk factors in addition to cholesterol and high blood pressure.

These include C-reactive protein (CRP), homocysteine and fibrinogen. These are all independent risk factors for stroke, regardless of blood pressure, weight, family history or cholesterol levels.

Stroke patients with a high CRP have a 2.4 times greater likelihood of having another stroke or a heart attack, regardless of how severe the first stroke was. When I find elevated CRP levels I often prescribe garlic, gingko biloba, and fish oil.

High fibrinogen levels also correlate significantly with increased stroke risk. Lowering fibrinogen levels with policosonol (an extract from sugar cane), garlic, nattokinnase (an enzyme shown to break up clots), fish oil, vitamins C and E and licorice extracts are the best bet.

DISCLAIMER: This newsletter is provided FOR INFORMATIONAL USE ONLY AND MAY NOT BE CONSTRUED, CONSIDERED OR USED IN PLACE OF MEDICAL ADVICE OR INSTRUCTION. No action should be taken based only on this newsletter. Readers should consult a licensed naturopathic physician or medical doctor. The information and editorials in this newsletter are believed to be accurate, but readers who fail to
consult with a physician assume the risk of injuries.

(C) Copyright 2002 - 2006 Susan B. Kowalsky, N.D. All rights reserved.

Dr. Susan B. Kowalsky is a naturopathic physician specializing in cancer and chronic medical conditions. She offers expert solutions integrating the best of alternative and complementary medical care. Subscribe today for our monthly newsletter at http://www.DrKowalsky.com