By Dr. Shawna Darou, ND
Heart health has been coming up in many consultations lately, and since February is Heart Health Month, and I wanted to share some newer information with you about how to more accurately assess your cardiovascular risk, which then provides a very clear roadmap for your personalized prevention.
In cardiovascular disease, an ounce of prevention is worth a pound of cure, meaning we should be starting to assess risk as young as your 30’s, and definitely into the 40’s. According to the Canadian Heart and Stroke Foundation “Almost 80% of premature heart disease and stroke can be prevented through healthy behaviours.” If this is true, why are we still only assessing risk based on measuring blood pressure and cholesterol levels, when clearly lifestyle is key?
In this article, we will briefly look at additional factors to consider when assessing and reversing your risk of cardiovascular disease.
1) Lifestyle factors
Since lifestyle factors are clearly important, and can reduce heart and stroke by 80%, let’s review what this means.
- Stress – Most of us recognize that stress increases heart disease risk – it can increase blood pressure, cause increased heart rate and arrhythmia, impact insulin levels, weight and lipids, and also enhance coagulation (clotting). It is extremely important to deal with chronic stress, as it is constantly impacting your biochemistry.
- Physical activity – To reduce cardiovascular risk, 150 minutes of moderate- to vigorous-intensity aerobic physical activity per week is recommended. This can vary from gym classes, to brisk walking, to martial arts or dancing.
- Weight and waist circumference – Being overweight or obese according to your BMI (>25) is one risk factor, but more accurately we measure waist circumference: For women, a waist circumference more than 80 cm (31.5 inches) is increased risk; more than 88 cm (35 inches) is substantially increased risk. For men, a waist circumference more than 94 cm (37 inches) is increased risk; more than 102 cm (40 inches) is substantially increased risk. (Measurement thresholds may vary depending on ethnicity, with tighter cut-offs especially for Asian men and women).
- Alcohol – more than 10 drinks per week for women and 15 drinks per week for men increases cardiovascular risk. (But even half of this amount increases risk of several cancers).
- Smoking – Smoking triples the risk of dying from heart disease and stroke in middle-aged men and women.
- Nutrition (will be discussed in detail below).
2) Nutrition and cardiovascular disease
I’m sure that you already know that eating a high-sodium diet, lacking in healthy fats, and containing fried and processed foods is bad for your heart. There are however, many recommendations of food to focus on that reduce cardiovascular risk. At this point in time, a Mediterranean diet has the most positive evidence:
- Lots of vegetables – at least 4 servings daily (colourful is key).
- High in fibre – from vegetables, fruits, whole grains, nuts, seeds and legumes.
- Reduced meat intake, instead focusing on fish and legumes as primary protein sources
- Lower in saturated fats, which are found in meat, eggs and dairy
- Choosing fats coming from olive oil, nuts and seeds primarily
- Including sources of omega-3 fats from oily fish (sardines, salmon, mackerel, herring, anchovies), flaxseeds and walnuts
- Limiting salt (sodium) intake, especially in processed or packaged foods
3) Insulin resistance and pre-diabetes
Testing for insulin resistance is a very simple blood test, and an enormous factor in reducing cardiovascular risk. In fact, in the Functional Medicine world, we look at “Cardiometabolic” risk because the two are so tightly linked. Insulin resistance affects cardiovascular risk through several mechanisms:
- It is on the trajectory to diabetes, which we know greatly increases heart disease risk
- It influences your lipids – raising triglycerides, lowering HDL-cholesterol and increasing the levels of small, dense LDL
- It is associated with increased sympathetic nervous system activity, sodium retention and thus can raise blood pressure.
- It creates inflammation in the body, raising C-reactive protein and fibrinogen levels, two more independent risks of cardiovascular disease.
Remember that insulin resistance and pre-diabetes are reversible. I’ve written about this several times before, here is one link: https://drshawnadarou.com/2017/06/05/testing-insulin-resistance-part-every-physical-exam/.
4) More in-depth lab testing
We are in a place where there is much more in-depth lab testing accessible to us for assessing cardiovascular risk than a standard blood pressure measurement and lipid (cholesterol panel). Did you know that 50% of heart attacks happen in people with a normal LDL cholesterol?
Some more in-depth ways to assess cardiovascular risk through lab testing (all are readily available in Ontario):
- Advanced lipid panel (NMR Lipoprofile) – Tests for particle size and numbers. LDL-particle number is a better predictor of cardiovascular risk than LDL alone.
- Inflammation: hsCRP is a marker of cardiovascular inflammation.
- Lipoproteins: ApoB and ApoA1 are lipid transport molecules that can be easily measured in the blood. The ApoB number indicates the total number of atherogenic particles, the higher the number the higher is the cardiovascular (CV) risk. The ratio of ApoB and ApoA1 is also measured as a strong predictor of cardiovascular risk.
- Blood sugar and insulin: measuring fasting glucose, insulin, HbA1c and C-peptide for an accurate assessment.
- Homocysteine – a marker that is toxic to the blood vessels creating inflammation (and mediated by simple B-vitamins).
- Fatty acid profile – measuring the types of fatty acids in your body (omega-3, omega-6, arachadonic acid) to accurately assess your nutritional intake, and use of supplements to optimize omega-3 fats for cardiovascular risk reduction and lowering inflammation.
5) Other areas to consider
There are also many other areas that we would go through in a personalized cardiovascular risk assessment, and I will mention a few of them here:
- Menopause – Many women notice a rapid rise in cholesterol levels with the onset of menopause. This must be watched for, and treated. Hormones are part of the picture, but weight gain, insulin resistance and stress also play a role.
- Thyroid function – even ‘subclinical’ hypothyroidism can raise cardiovascular risk, especially in women. We see a direct correlation with LDL cholesterol levels rising with higher TSH (hypothyroidism).
- Autoimmunity – Having an autoimmune disease is actually a very significant risk factor for cardiovascular disease, largely due to the inflammation present. When inflammation becomes systemic, it impacts all parts of the body, including the blood vessels. Optimally managing inflammation with nutrition, supplements and sometimes medications is important to reduce cardiovascular risk.
- Gut health – We often don’t think of the gut with cardiovascular risk, but recent research is identifying the gut as a major source of overall body inflammation. The process is through bacteria in the gastrointestinal tract producing something called LPS (lipopolysaccharides) and creating “endotoxemia”. Stay tuned for an article explaining this in great detail soon. Also, don’t be surprised if a program to support gastrointestinal health is part of your cardiovascular prevention plan!
- Personal genetics – There are several genes that can be looked at because of their role in cardiovascular risk: ApoE, MTHFR, COMT, CYP1A2, and others.
- Oral contraceptives and hormone replacement – Both can increase risk of blood clots in susceptible individuals.
If you have a strong family history of cardiovascular disease, are seeing a rise in your personal risk factors, or would simply like to do an accurate assessment of your risk, please ask at your next appointment. With an accurate risk assessment, we can then track changes as you make lifestyle and nutrition changes, and we can also add nutritional supplements to target your individual areas needing support. Remember that lifestyle factors can reduce your risk of cardiovascular disease by 80% – you do have so much control over this one!
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