15 Feb Let’s Talk about HEART!
by Marina Kucher, PA
& Elena Klimenko, MD
Heart is a well-known theme of February and not just because of Valentine’s Day. February is dedicated to American Heart Month!
Cardiovascular disease is far too common and carries a tremendous health burden to our patients and challenges to our healthcare system. Heart disease remains the leading cause of death in the United States. In 2021 there was a spike in cardiovascular disease, heart attacks and related fatalities. This statistical uptick is consequent to the COVID-19 pandemic stress, inactivity, poor diet, and the inflammatory sequelae of the virus itself.
Metabolic disorders like obesity, diabetes, metabolic syndrome, pre-diabetes
Obstructive Sleep Apnea – The United States is ranked second in the prevalence of this disorder, surpassed only by China.1
Autoimmune conditions more than double the risk of cardiovascular disease. This occurs by the indirect mechanism of autoimmune processes driving cholesterol molecules into the artery wall and forming calcific plaques that lead to arterial stiffness and heart disease.4
Lifestyle risk factors:
Exposure to harmful substances like tobacco, alcohol, toxic metals, etc. Heavy metal toxicity is an independent risk factor for cardiovascular disease. Although the mechanism is not fully understood, it appears to be caused by the reduced antioxidant activity as well as formation of free radicals, which result in DNA damage and drives heart diseases in susceptible individuals. 6
Sedentary lifestyle – maybe you have heard the expression “sitting is a new smoking”. Many of us were stranded near the computers during the last few years because of remote working or learning.
SAD (Standard American Diet)
PREVENTION IS BETTER THAN CURE
The objective is to prevent cardiovascular disease. Prevention of heart disease is rooted deeply in nutrition, lifestyle behaviors, and relationships. It is a well-established fact that the incidence of cardiovascular disease is multifactorial and rises with age. Furthermore, coronary artery disease (CAD) is a progressive process and begins decades before the onset of symptoms.
Through the lens of Integrative Cardiology, the goal is the prevention of cardiac disease and its contributing ailments early in life. Inflammation is a major player in the development and progression of cardiovascular disease. By checking and monitoring inflammatory markers and assessing vascular health through innovative, non-invasive blood tests, the earliest risk factors can be identified and addressed, thereby protecting individuals against the cumulative burden of cellular and vascular inflammation.
An Integrative Approach to cardio-vascular risk assessment and disease progression is multifactorial. It is not just about cholesterol or correcting high blood pressure, which is also important. In functional medicine, we look deeper and try to resolve upstream factors affecting the clinical outcome. We look at specialized tests, genetics, and overall lifestyle and exposure potentially affecting individual risk of diseases like CAD, PAD, and CVS manifestation.
In our practice, we utilize special cardio-vascular functional medicine testing like Boston Heart and PULS test. These are blood-based tests collected in our office that help evaluate additional biomarkers contributing to detecting risks and prescribing proper treatment. These tests look at more sophisticated markers, including Apo B lipoprotein, Lp(a), lipoproteins particle size/number, omega 3 Fatty Acid Indices, and markers of vascular/cardiac inflammation.
Cholesterol has been implicated in cardiovascular disease; however, it is only part of the story. Approximately 50 percent of heart attacks occur in individuals with normal lipid profiles. Hence, a screening method of cholesterol alone is an insufficient assessment of one’s cardiac risk. Furthermore, it is critical that an individualized screening approach is implemented. One based on family history, lifestyle factors, and environmental considerations.
Implementation of genetic tests, such as 3X4 Genetics to identify vulnerable pathways that may predispose one to heart disease can offer an additional advantage in health optimization and prevention of heart disease.
Science shows the importance and influence of the gastrointestinal microbiome on the risk and progression of cardiovascular disease. In recent years, research data showed gut microbiota and its metabolites play a pivotal role in cardiovascular health. Therefore, identifying and balancing a patient’s microbiome is another pathway that can benefit heart health.
Another culprit microbiome reservoir is one’s mouth. Dental health has been directly connected to the risk of cardiovascular health. In our practice, we do proper dental exams and refer to biological dentists for necessary work. Did you know that old root canals are the reservoir of infection linked to the incidence of sudden heart attacks? 8. The amalgam fillings are linked to mercury and other toxic metals burden and for some individuals could be a crucial risk factor in the progression of cardiovascular disease. 9
We now know that the process of inflammation lies in the core of cardiovascular disease progression and clinical events. One of the goals of prevention is to mitigate inflammation. This can be achieved through several interventions.
“Food is Your Medicine”
Diet plays an integral role in our cardiac health as well as overall well-being.
Food is medicine. Food is information. Certain foods have the potential to activate protective biological mechanisms, whereas others can trigger damaging processes.
Eating “rainbow a day” by including into your daily menu colored vegetables (preferably organic) and deeply pigmented fruit (specifically berries and pomegranate), beneficial dietary fiber, dietary antioxidants, and phytonutrients is what you need to keep the inflammation at bay. Additionally, a diverse, phytonutrient-rich diet contributes to microbiome diversity, which in turn mitigates inflammation and its downstream effects.2
A moderate amount of high-quality protein from sustainably and organically raised animals is ideal. Such as pasture-raised organic poultry, eggs, and small amounts of meat/organs are essential to a healthy diet. Seafood and small-size fish from wild sources or from bio-sustainable fish farms are also great sources of protein. Also remember plant sources of proteins are nuts, seeds, and legumes.
Steering clear of processed and ultra-processed foods, fried foods, simple sugars, and refined carbohydrates is extremely important. Consumption of inflammatory oil and large quantities of saturated fats, as well as processed products, increases systemic inflammation and contributes to a multitude of chronic diseases, including heart disease.
“I like to move it!”
Regular exercise provides protection against many chronic health ailments, heart disease included. Movement and exercise improve blood circulation throughout the body, trains heart muscle, regulate blood pressure and heart rate, and assist detoxification efforts, among many other benefits. Although it is generally recommended to participate in moderate-intensity exercise/movements for thirty minutes or more, four times per week, there is no “one fits all” approach to the type of exercise, duration, and intensity. Hence, specific exercise recommendations should be discussed with your provider.
Additionally, sauna sessions are an excellent intervention for detoxification and cardiorespiratory fitness.
“Chill when you can”
Stress is a bad player when it comes to heart disease. Particularly, chronic stress, even at low levels promotes systemic inflammation and contributes to cardiovascular disease. Studies suggest that meditation can lead to improvement in exercise duration and improved cardiovascular circulations.3 Other forms of stress modulation include mindfulness practices, earthing, breathwork, prayer, and gratitude journaling.
“Protect and Repair the Vascular Wall”
An artery is a hollow tube of several layers of smooth muscle, membranes, and specialized endothelial cells that line the inner wall of the artery. A layer of endothelial glycocalyx covers the inside of arterial endothelium. This is a slippery gel-like layer that helps blood and nutrients within the vessel flow smoothly and efficiently. The glycocalyx integrity is critical to maintaining endothelial health. It is crucial that an artery remains elastic and its endothelium is smooth and conditioned to preserve vascular health and reduce cardiac and vascular risk. All of the risk factors mentioned earlier, compromise these functions and result in stiffening of the arterial wall, plaque buildup, abnormal blood clotting, and other dysfunctions within the vascular wall, thus leading to various forms for heart disease.
In addition to dietary interventions, we utilize natural supplements, herbs, and vitamins to heal and maintain healthy endothelial function in our practice. Some revolutionary products, like Arterosil, is an algae-based product that repairs and rebuilds the endothelial glycocalyx. Other products supporting arterial health are beetroot powder, L-Arginine, Omega 3 Fatty Acids, B vitamins, turmeric, and many other preparations that can offer additional protection as an adjunct to dietary and lifestyle interventions. The approach must be individualized to your particular needs and risk factors.
Women are misrepresented when it comes to heart disease. In women of reproductive age, thyroid disease, autoimmunity and adverse conditions associated with pregnancy, such as pre-eclampsia, eclampsia and gestational diabetes are drivers of heart disease. Post-menopausal women lose the heart-protective effects of estrogen and have an increased risk for heart disease. It is important to note that presentation for heart disease in women may be atypical and often, diagnosis is delayed. 1
Read this article dedicated specifically to issues in women’s cardiovascular disease.
About the co-author
Marina Kucher is a physician assistant registered and certified in the state of New York.
In 2009, Marina graduated as a Physician Assistant from SUNY Downstate Medical Center and has been practicing in the field of internal medicine and cardiology for the past twelve years.
Marina has been humbled by providing high-quality healthcare to the underserved community of Canarsie in Brooklyn, heavily affected by cardiovascular disease burden, and has also worked at Coney Island Hospital Emergency Department.
After years of working as a clinical PA, Marina recognized that the current allopathic medical model is not meeting the needs of patients. To fill the gap she explored further education in Functional Medicine through IFM ( Institute of Functional Medicine).
Marina is also an active member of AAPA and IFM.
Cardiovascular disease (CVD) is a multifaceted progressive process, thus, its prevention and treatment are complex and should target several mechanisms or pathways. If you would like to learn more about cardiovascular disease and treatments from functional medicine, schedule an integrative medicine consultation at our office, call 212-696-4325.
2. Marco Wilkowski, Taylor L. Weeks, Stanley Hazen. Gut Microbiota and Cardiovascular Disease. Circulation Research. 2020;127: 553-570.
3. Meditation and Cardiovascular Risk Reduction. A Scientific Statement From the American Heart Association. https://www.ahajournals.org/doi/10.1161/JAHA.117.002218
4. Virani et Al. Heart Disease and Stroke Statistics— 2021 Update: A Report From the American Heart Association.
5. Li-Hao Huang, et al. Interleukin-17 Drives Interstitial Entrapment of Tissue Lipoproteins in Experimental Psoriasis. Cell Metabolism, 2018; DOI: 10.1016/j.cmet.2018.10.006
6. Eman M Alissa et al. Heavy metal poisoning and cardiovascular disease. J Toxicol. 2011.
7. Jari A Laukkanen et al. Cardiovascular and Other Health Benefits of Sauna Bathing: A Review of the Evidence. Mayo Clin Proc. 2018 Aug.
8. Gomes, M.S. et al ; Apical Periodontitis & Incident Cardiovascular Events in the Baltimore Longitudinal Study of Aging; International Endodontic Journal April 49(4) 2016