Coronary Disease /
Heart Attack

Coronary Disease / Heart Attack: Overview

Alternative Names: Myocardial Infarction, Acute Myocardial Infarction

Irreversible and unexpected, heart failure is the leading cause of death in Western countries.  For 50% of men who die from heart attacks, the fatal attack is their first symptom.  Coronary artery disease (heart attack, or myocardial infarction) is the number one killer in the United States, yet it barely existed before 1900.  A sampling of older cardiologists still working in the 1950s could not recall a case prior to 1910.  Most people are unaware of this and do not readily believe it.  It is not a highly publicized fact, possibly because it glaringly reminds us of the cause: the way we now live, principally the westernization of diet (the consumption of commercially processed foods).  Some take a position that people were more active then, and we are more sedentary now.  This is true, but should not be used as an excuse to continue eating what we prefer, instead of what we should.

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The high prevalence of cardiovascular disease (CVD) is a major health concern for both health authorities and the general population.  It is a leading cause of death and results in a considerable burden, in terms of illness, disability and economic costs.

Holistic/alternative doctors are now talking about and distinguishing between two types of plaque.  Type 1 is commonly associated with artery obstruction (though it is more stable and new collateral circulation develops).  Type 2 causes only minimal occlusion.  Unexpectedly, Type 2 appears to be responsible for as much as 80% of heart disease and strokes.  This type of plaque, though not blocking the blood flow is dangerous because it has a looser fibrin coat, and a tendency to be more reactive.  The treatment goal is to make it less reactive, to in effect turn it from Velcro to Teflon.

Incidence; Contributing Risk Factors

There is a general misconception that CVD affects only men, leading women to believe that they are not at risk.  Although CVD is more prevalent in men, it is not a gender-specific health problem.  Between 40 and 59 years of age, as many as 1 in 12 women display clinical evidence of heart disease.  This prevalence rises to 1 in 3 among women older than 65.

Although mortality due to CVD is declining due to advances in prevention and treatment, the risk of developing CVD continues to be a concern due to the significant prevalence of modifiable risk factors such as cigarette smoking, high blood pressure, high blood cholesterol levels, poor diet, obesity and limited physical activity.  Many other risk factors can be reduced once they have been tested for.  Laboratory testing is now going far beyond total cholesterol (HCL and LDL ratios) and triglycerides.  Anyone with an elevated risk of heart disease should do specific testing to assess their risk and make the necessary changes.  Such tests include hs-CRP, lipoprotein(a), homocysteine and fibrinogen among others.

Signs and Symptoms

Many who have experienced a heart attack describe the feeling as being "like an elephant was sitting on my chest" or "a squeezing sensation in my arms."

However, not everyone experiences these classic signs.  For some, an 'uncomfortable' sensation, achiness, pain or pressure in their neck, jaw or shoulders is the only sign of heart problems or a heart attack.

Treatment and Prevention

Coronary artery bypass surgery is one of the most widely performed and often unnecessary surgeries in the United States.  While the surgery does increase long-term survival of those with the most severe forms (left main coronary artery occlusion and three-vessel disease) and gives relief of symptoms for 85%, the long-term results actually indicate a reduced survival rate for those with mild to moderate coronary artery disease and a return of symptoms within five years.  Complications arising from coronary bypass operations are common, as this surgery represents one of the most technically difficult procedures in modern medicine.

Signs, symptoms & indicators of Coronary Disease / Heart Attack:

Lab Values - Chemistries

High uric acid level

Elevated levels of serum uric acid increase the risk of heart attack.

In evaluating 5,926 subjects who were between 25 and 74 years of age, after 16.4 years of follow-up, there were 1,593 deaths of which 45.9% were attributed to cardiovascular disease.  It was found that increased serum uric acid levels were independently and significantly associated with the risk of cardiovascular mortality.  [JAMA, May 10, 2000;283(18): pp.2404-2410]

Lab Values - Common

Rapid pulse rate

Heart rate is a stronger predictor of cardiovascular death in the elderly, particularly in men, than traditional risk factors such as diabetes and hypertension.  Elderly men with a resting pulse rate above 80 beats per minute have a significantly higher rate of cardiovascular mortality.  A low heart rate, below 64 beats per minute, is protective against cardiovascular mortality.

Counter-indicators
Slowed pulse rate

Heart rate is a stronger predictor of cardiovascular death in the elderly, particularly in men, than traditional risk factors such as diabetes and hypertension.  Elderly men with a resting pulse rate above 80 beats per minute have a significantly higher rate of cardiovascular mortality.  A low heart rate, below 64 beats per minute, is protective against cardiovascular mortality.

Symptoms - Abdomen

Moderate/severe/significant right hypochondriac pain or mild right hypochondriac discomfort

Cardiac pain may occasionally present as upper abdominal pain.  An acute myocardial infarction can cause upper-right or epigastric discomfort that may be similar to that of a gallbladder attackCongestive heart failure may stretch the liver capsule.

Moderate/severe/significant epigastric pain or mild epigastric discomfort

Cardiac pain may occasionally present as upper abdominal pain.  An acute myocardial infarction can cause upper-right or epigastric discomfort that may be similar to that of a gallbladder attack.

Symptoms - Bowel Movements

Undigested fat in stools

In one study, subjects with heart disease had 10 times more fat in their stool than heart-healthy individuals.  This means those with heart disease weren't absorbing their fats [Am J Cardiology 5: p.295, 1960].

Symptoms - Cardiovascular

Pain in chest or left side

In cases of heart disease, pain will usually be felt in the left or middle of the chest, but it can also be felt in the inner sides of the left arm, neck, jaw, or between the shoulder blades.

Symptoms - General

Hiccups

Hiccups can be one of the first signs of heart muscle damage or heart attack.

Symptoms - Hair

Male pattern hair loss or being nearly/totally bald

A Harvard study found that male-pattern baldness may be a marker for increased risk of coronary heart disease.  Severe hair loss on the top of head resulted in a 36% increased risk.  The risk became lower with less hair loss.  [Archives of Internal Medicine, Jan.  24, 2001]

Symptoms - Head - Ears

Diagonal creases on earlobes

The presence of a diagonal earlobe crease has been recognized as a sign of cardiovascular disease since 1973.  Over 30 subsequent studies have been reported in the medical literature, with the largest involving 1,000 unselected patients.  The earlobe is richly supplied with blood, and a decrease in flow over an extended period of time is believed to result in collapse of the vascular bed, leading to a diagonal crease.

It appears that individuals with an earlobe crease have a 55% greater risk of dying from heart disease than those without the marking, with the risk becoming even more significant if diagonal creases appear on both earlobes.  However, this predictive value does not apply to Orientals, Native Americans, or persons born with certain hereditary disorders.

Symptoms - Metabolic

Moderate/major unexplained weight loss

Weight loss is a common finding among individuals with chronic heart failure.  It is evident that malabsorption of fats is related to heart failure.  In one study, subjects with heart disease had 10 times more fat in their stool than heart-healthy individuals.  This means those with heart disease weren't absorbing their fats [Am J Cardiology 5: p.295, 1960].  Yet heart patients are typically placed on low-fat diets! These individuals were leaner, but not healthier.

Symptoms - Respiratory

Symptoms - Skeletal

Heaviness of the legs

Tired and heavy legs may indicate that the return blood flow from the legs to the heart is impaired.  Gravity and impaired veins combined with possible heart problems result in oxygen-depletion in the legs, producing that heavy, tired feeling.

(Severe) non-specific arm pain

Arm pain, usually in the left arm, can signal a heart attack or impending heart attack.

Pain between shoulder blades

In cases of heart disease, pain will usually be felt in the left or middle of the chest, but it can also be felt in the inner sides of the left arm, neck, jaw, or between the shoulder blades.  This pain, also known as 'referred pain', should not be ignored.  The pain that you experience is a manifestation of something going wrong in your body.

Conditions that suggest Coronary Disease / Heart Attack:

Circulation

Dental

Periodontal Disease - Gingivitis

Some studies show that people with gum disease are more likely have heart disease than those with healthy gums.  In 2012, a scientific statement from the American Heart Association supported an association between heart disease and gum disease.

Periodontitis is a serious gum infection that damages the gums and can destroy the jawbone.  It can also lead to an increase in inflammation across the body; overactivity of inflammatory pathways is a strong risk factor for the development of atherosclerotic heart disease and heart attack.

Habits

Excessive Yawning

Excessive yawning can be caused by a vasovagal reaction and may indicate a heart problem.

Lab Values

Hypoalbuminemia (A low albumin level)

Hypoalbuminemia can be caused by certain heart conditions such as congestive heart failure or pericarditis that lead to low albumin levels in the blood.

Lab Values - Common

Recent onset/medium-term/long-term hypertension

While systolic blood pressure is a better predictor of cardiovascular events than diastolic blood pressure or pulse pressure, all three measures are strongly and directly related to the risk of coronary and cerebrovascular events.  [Archives of Internal Medicine, 2001; 161: pp.1183-92]

Reproductive

Erectile Dysfunction (ED, Impotence)

A buildup of plaque in the penile arteries can lead to difficulty achieving or maintaining erection.  A long-running study of over 2,000 men found that erectile dysfunction is associated with a more than threefold higher risk of heart attack.  Lead researcher Dr. Steven J.  Jacobsen, a professor of epidemiology at the Mayo Clinic, reported the findings Nov.  11, 2003 at the American Heart Association's annual conference in Orlando, Florida.  According to Jacobsen, "We can't say that it is cause-and-effect, but erectile dysfunction is a marker for future events of cardiovascular disease." Overall, men with a heart attack from 1979 to 1995 were 3.5 times more likely to have erectile dysfunction in 1996 than men who did not have a heart attack.

Risk factors for Coronary Disease / Heart Attack:

Addictions

Cigarette Smoke Damage

According to a report from the U.S.  Surgeon General, "Cigarette smoking should be considered the most important risk factor for coronary heart disease." Statistical evidence reveals a three- to five-fold increase in the risk of coronary artery disease in smokers compared to nonsmokers.  Risk of dying from a heart attack or stroke depends the number of cigarettes smoked, the number of years smoked, the age of smoking onset and depth of inhalation.  However, when a woman stops smoking, no matter how long or how much she smoked, her risk of heart disease drops by 50% in the first year alone.  Similar benefits would be expected for a man.

Cocaine Addiction

In 1999 the Journal of the American Medical Association reported that the risk of death from a heart attack rose 24-fold in the first hour after cocaine use.

Circulation

Poor Circulation

Not everyone with heart disease gets peripheral vascular disease, and vice versa.  For some reason, the process of atherosclerosis seems to affect different people in different places.  However, if you have one, you are definitely at increased risk for the other.

Diet

Family History

Habits

The Effects Of Overtraining

A review of research evidence by US physicians published in the medical journal Mayo Clinic Proceedings in June of 2012 suggests that excess exercise (for example intensive training schedules or extreme endurance competitions) can cause dangerous long-term damage to the heart.  According to this review, the safe upper limit for heart health is a maximum of one hour of strenuous exercise a day, after which we reach a point of diminishing returns.

Since then, several studies have confirmed that the health benefits of exercise diminish for those who exercise excessively, for example among people who run more than 20 miles (32km) a week, more than six days a week, or faster than eight miles per hour (13kph).

During prolonged, intense exercise the body burns sugar and fat for fuel which creates free radicals as a byproduct.  Free radicals bind with cholesterol to create plaque buildup in the arteries which increases risk of developing heart disease.

Lack of Sleep

If you sleep less than six hours per night and have disturbed sleep you stand a 48% greater chance of developing or dying from heart disease.

Problems Associated With A Sedentary Lifestyle

According to Dr. Emmanuel Stamatakis of University College London's Department of Epidemiology and Public Health, the risk of heart disease and premature death from any cause increases significantly for those spending more than fours hours a day watching television, surfing the web, or playing computer games.

The study was published in the Journal of the American College of Cardiology in January of 2011 and involved 4,512 adults who were respondents of the 2003 Scottish Health Survey.  It found a 48% increased risk of all-cause mortality and an approximately 125% increase in risk of cardiovascular events among those spending more than four hours a day in front of a screen, and also suggests that even two hours of screen time each day may place someone at greater risk for a cardiac event.  The risk appears to be irrespective of factors such as smoking, hypertension, BMI, social class, and even exercise.

Hormones

Low Male Testosterone Level

Researchers at Columbia University Medical School studied 55 men undergoing X-ray exams of their arteries and found that those with a lower testosterone level had higher degrees of heart disease (blockage of the coronary arteries).  This study also found that the protective HDL cholesterol levels were higher in men with higher testosterone levels.

Low testosterone is linked to hypertension, obesity, atherosclerosis and increased waist-to-hip ratio – all of these being heart attack risk factors.  Administration of testosterone to men has been reported to decrease the risk factors for heart attack.

Hypothyroidism

The thyroid affects every organ in the body, including the heart.  Almost any type of heart disease can be worsened by thyroid disorder, so thyroid function should always be checked if cardiac symptoms are worsening.  Hypothyroidism weakens the heart muscle in both its contraction and relaxation phases, resulting in less blood being pumped.  And, because the heart muscle does not relax normally in between beats, a potentially serious condition called diastolic dysfunction may result.

Lab Values

Elevated Homocysteine Levels

Elevated homocysteine levels are believed to exacerbate oxidative injury to blood vessels and increase pro-clotting mechanisms linked to stroke and heart attack.

High Levels Of Triglycerides

There are a group of studies clearly indicating that elevated triglycerides combined with low HDL (two abnormalities known to be caused by high insulin) are much more predictive of cardiovascular disease than either elevated total cholesterol or elevated LDL levels.

Lab Values - Chemistries

Counter-indicators
Counter-indicators

Lab Values - Scans

Counter-indicators

Medical Procedures

Tonsils/adenoids out before age 20

Swedish researchers reported in 2011 that having tonsils (or the appendix) removed before age 20 increases one's risk of suffering a heart attack at a young age – 44% increased risk for tonsils, and 33% for the appendix.

Appendix removed before age 20

Swedish researchers reported in 2011 that having the appendix (or tonsils) removed before age 20 increases one's risk of suffering a heart attack at a young age – 33% increased risk for the appendix, and 44% for tonsils.

Medications

Birth Control Pill Issues

If you smoke, it should be noted that there is a synergistic effect between smoking, oral contraceptives and the risk of cardiovascular disease.

Mental

Stress

Stress may increase magnesium excretion and the resulting temporary magnesium depletion may make the heart more sensitive to electrical abnormalities and vascular spasm that could lead to cardiac ischemia.

Metabolic

Problems Caused By Being Overweight

Even if you never become diabetic, high levels of insulin contribute to cardiovascular risk by increasing the process of atherosclerosis.  Insulin increases the rate at which cholesterol-laden plaque builds up on arterial walls.  The abnormally high levels of insulin produced by all overweight individuals, diabetic or not, is an independent risk factor for early cardiac death.

Anorexia / Starvation Tendency

Being severely underweight can cause heart failure.

Hemochromatosis (Iron overload)

Male carriers of the common hemochromatosis gene mutation are at 2-fold risk of a first heart attack compared with noncarriers.  Some 10% to 20% of the population carry at least one gene for hemochromatosis.  Full-blown hemochromatosis affects about 0.5% and gene carriers usually do not know that they are at increased risk.  They have almost no increase in iron stores over those without the mutation [Circulation: Journal of the American Heart Association September 21, 1999;100].

Giving blood is the best way to lower iron stores, but a more recent study found no protective effect against heart attack among men who donated blood regularly.  [Circulation January 2, 2001]

Musculo-Skeletal

Gout / Hyperuricemia

Elevated uric acid levels, as seen in gout, may be associated with a higher incidence of coronary heart disease amongst alcohol abstainers, but has not been seen to occur in those who were light, moderate or heavy drinkers.  [ Journal of Clinical Epidemiology,1996;49(6) pp.673-678]

Nutrients

EFA (Essential Fatty Acid) Type 3 Requirement

Many studies have shown that higher omega-3 fatty acid intake can cut the rate of sudden cardiac death by nearly one-half, in both apparently healthy patients and those who have suffered a previous heart attack.

To better understand this protective effect, Danish researchers examined the dietary patterns and individual fatty acid status of nearly 300 patients with ischemic heart disease, comparing them with specific parameters of cardiac function.  They found that the patients who ate more fish had higher levels of omega-3 polyunsaturated fats in their blood cell membranes and in their fat cells.  A higher level of two specific fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) – especially within the cell membrane – was associated with higher heart rate variability in the patients.  An increased heart rate variability indicates healthier pulse regulation, and appears to significantly reduce the risk of arrhythmia and cardiac death.

Organ Health

Diabetes Type II

Cardiovascular disease is the leading cause of diabetes-related death.  People with diabetes are two to four times more likely to develop cardiovascular disease.  At least 65% of people with diabetes die from heart disease or stroke.

Diabetes Type 1.5

It is not clear yet if people with type 1.5 have the same high risk for cardiovascular problems as individuals with type 2.

Personal Background

African ethnicity

African-Americans have higher rates of diabetes, prostate cancer, hypertension and coronary heart disease than whites.

Reproductive

Polycystic Ovary Syndrome (PCOS)

Women with the PCOS have a five to seven times higher risk of myocardial infarction and ischemic heart disease than other women.  Surprisingly, the increased risk was found to be independent of obesity, supporting the argument that insulin resistance alone is important in determining cardiovascular risk.  [Fertil Steril 2000;73(1): pp.150-156, J Clin Endocrinol Metab 1999;84(6): pp.1897-1899]

Postmenopausal Issues

Certain risks to cardiovascular health begin around the time of menopause, and rapidly increase after menopause.  Examples include changes in blood pressure and cholesterol levels, and a more sedentary lifestyle.

Respiratory

Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea increases a person's risk of having a heart attack or dying by 30% over a period of four to five years, according to a Yale University study presented at the American Thoracic Society 2007 International Conference in May of 2007.  Sleep apnea is associated with many physiological changes that increase the risk of both heart attack and stroke.

Supplements and Medications

Current birth control pill use

Statistics now show that the wide use of the Pill has given rise to health hazards such as breast cancer, high blood pressure and cardiovascular disease on a scale previously unknown in medicine.

(Discontinued) calcium supplementation

May 23, 2012: A study of approximately 24,000 people between the ages of 35 and 64 and published in the journal Heart found that participants who took regular calcium supplements were 86% more likely to have a heart attack than those who didn't take supplements.

Counter-indicators
Regular aspirin use

A November 2012 study published in the New England Journal of Medicine showed a 34% reduction in the risk of death associated with heart attack among patients who used aspirin daily.

Counter-indicators
Much/some B-complex supplementation

The B vitamins help prevent cardiovascular disease by reducing levels of homocysteine, which damages the arteries and promotes the buildup of plaque in the arteries (atherosclerosis).  Researchers at Harvard University found that a high level of homocysteine in the blood more than triples the risk of heart attack.

Symptoms - Cardiovascular

Symptoms - Food - Beverages

Counter-indicators
Moderate/low alcohol consumption

Drinking in moderation has been linked with a lower risk of having a fatal heart attack.  [Journal of the American Medical Association April 18, 2001; 285: pp.1965-1977]

Symptoms - Food - General

Severe/extreme calorie restriction

Extreme calorie restriction, which is common among yo-yo dieters, can increase levels of the stress hormone cortisol which, when present in the body over long periods of time, can increase one's risk of developing serious health problems such as heart disease, diabetes and even cancer.  Risk increases each time the cycle of dieting and weight gain repeats.

Long-term/short-term low-carb dieting

Essentially every single study on low carbohydrate diets that measured uric acid levels has shown that uric acid levels rose.  [Obesity Research 9 (2001): p.1s] Uric acid itself has been tied to cardiovascular disease risk in virtually every instance it's been studied over the last 50 years, and may be an independent risk factor by increasing free radical damage or making the blood more susceptible to clotting.  [American Journal of Cardiology 85 (2000): p.1018]

In another clinical trial, despite statistically significant weight loss reported in the Atkins group, every single cardiac risk factor measured worsened after a year on the Atkins Diet (measures included LDL, triglycerides, total cholesterol, HDL, total-to-HDL cholesterol ratio, homocysteine, Lp(a), and fibrinogen).  While the LDL in the Atkins group increased 6%, the LDL cholesterol levels in the whole-foods vegetarian group was cut in half – dropping 52%.

Based on an analysis of the Atkins Diet, long-term use of the Atkins Diet is expected to raise coronary heart disease risk by over 50%.  [Journal of the American College of nutrition 19 (2000): p.578]

Symptoms - Food - Intake

Counter-indicators
Counter-indicators
High/moderate legume consumption

Men and women who ate legumes at least four times a week were found to have a 22% lower risk of coronary heart disease over 19 years than those who consumed legumes once weekly, researchers report in the November 26th issue of the Archives of Internal Medicine.  The study was based on interviews and medical exams of more than 9,600 Americans who did not have heart disease when the study began.  [Archives of Internal Medicine 2001;161: pp.2573-8].

Symptoms - Metabolic

Symptoms - Muscular

Counter-indicators
Being very skinny or being underweight

Having a lean body reduces the stress on the heart, lungs, and other internal organs.  Thin people experience less heart disease and stroke risk.

Symptoms - Sleep

Sleeping more than necessary

An Australian study of 230,000 subjects reported in 2016 that prolonged sleep – especially when combined with a sedentary lifestyle – increases risk of premature death from diseases such as heart disease, diabetes and cancer by up to 300%.

In addition, sleeping too much may be an indicator of illness such as cardiovascular disease.

Long-term sleep surplus

An Australian study of 230,000 subjects reported in 2016 that prolonged sleep – especially when combined with a sedentary lifestyle – increases risk of premature death from diseases such as heart disease, diabetes and cancer by up to 300%.

In addition, sleeping too much may be an indicator of illness such as cardiovascular disease.

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Coronary Disease / Heart Attack suggests the following may be present:

Metabolic

Anorexia / Starvation Tendency

Being severely underweight can cause heart failure.

Problems Caused By Being Overweight

Even if you never become diabetic, high levels of insulin contribute to cardiovascular risk by increasing the process of atherosclerosis.  Insulin increases the rate at which cholesterol-laden plaque builds up on arterial walls.  The abnormally high levels of insulin produced by all overweight individuals, diabetic or not, is an independent risk factor for early cardiac death.

Recommendations for Coronary Disease / Heart Attack:

Amino Acid / Protein

L-Lysine

Linus Pauling discovered that supplemental L-lysine reduces the binding of lipoprotein-a, also known as Lp(a), in its binding to the walls of arteries.  By preventing this action, plaque buildup is discouraged since plaque is made up primarily of Lp(a).  The naturally occurring amino acids lysine and proline assist Lp(a) in its deposition and binding to stressed or injured vascular wall sites.  However, when there is an extra quantity of lysine and proline in the blood stream, the Lp(a) attachment sites get blocked by these amino acids creating a "Teflon-like" layer around the lipoprotein particles.  This prevents the Lp(a) from binding to artery walls, as well as helps detach Lp(a) plaque from preexisting sites in the vascular wall.  This supplemental use of these amino acids can prevent plaque build-up and initiate the reversal of plaque deposits.  The amount will vary between individuals.  Seriously ill heart patients require 5-6 grams (5,000 to 6,000mg) of lysine daily.  This strategy may be useful for treating type 2 plaque.

Cysteine / N-Acetylcysteine (NAC)

Cysteine is sometimes used to help lessen the risk of coronary artery disease.

Botanical

Detoxification

Diet

Animal/Saturated Fats Avoidance

Where heart disease is concerned, animal fats are generally considered unhealthy due to their association with high cholesterol levels in the blood.

Increased Water Consumption

A Seventh Day Adventist study found that those who drank 5 glasses of water per day have on average half the cardiac mortality and half the fatal stroke rate of the general population.

Caffeine/Coffee Avoidance

Coffee, including decaf, contains significant amounts of Vitamin K which is an important factor for blood coagulation.  People at high risk for blood clots, strokes, and heart attacks should avoid coffee and decaf for this reason.

Monounsaturated Oils

The use of monounsaturated oils such as olive oil may be more protective than a low fat diet.  Use olive oil or coconut oil exclusively when frying.  Avoid the use of hydrogenated fats (they contain trans-fatty acids) which may be worse than saturated fats in contributing to heart disease.

Drug

Aspirin

If you are at risk of having a heart attack, taking one aspirin daily can greatly reduce this risk.  A quarter of heart attacks occur within three hours of waking up, when the blood is thickest and stickiest and the circulation is at its slowest, increasing the risk of clot formation.  Therefore, the most effective time to take aspirin for the prevention of heart attack, stroke and deep vein thrombosis is before sleeping.

During a heart attack, it is important to get some aspirin into your bloodstream as quickly as possible by chewing 1 adult-strength or 2 to 4 low-dose aspirin.  Most heart attacks occur when a cholesterol-laden plaque ruptures in a coronary artery, attracting platelets to its surface and causing a clot (thrombus) to build up.  If the clot blocks the artery completely, it deprives part of the heart of oxygen and causes a heart attack.  Aspirin helps by inhibiting platelets; only a tiny amount is needed to inhibit all the platelets in the bloodstream – in fact, small doses are better.  This will slow clotting and decrease the size of the blood clot that is forming.

After a heart attack, aspirin can help prevent further attacks when taken daily.  An appropriate preventative dose is around half a regular aspirin tablet (150-160mg), or two baby aspirin tablets (81mg each.)

Extract

Policosanol/Octacosanol

Policosanol has other actions against heart disease in addition to lowering cholesterol.  Like statin drugs, policosanol helps stop the formation of arterial lesions.  One of policosanol's important actions is to inhibit the oxidation of LDL, which is the major contributor to arterial damage.  Oxidized LDL promotes the destruction of blood vessels by creating a chronic inflammatory response.

Habits

Hormone

DHEA

A landmark study in 1986 of 242 men aged 50-79 and based on 12 years of research stated that a small supplementation of DHEA corresponded to a 48% reduction in death from heart disease and a 36% reduction in death from any cause, other than accidents.  Indirect evidence does suggest that DHEA supplements might reduce the risk of heart disease, especially in men, but this is far from proven.

Lab Tests/Rule-Outs

Bacteria / Pathogen Testing by PCR

A Cardiovascular Disease Panel (Blood or Tissue Biopsy) can test for the presence of Chlamydia pneumoniae, Mycoplasma pneumoniae, Helicobacter pylori, Cytomegalovirus (CMV) and Human Herpes Virus 6 (HHV-6).

Mineral

Selenium

Selenium is considered to be from 200 to 500 times more potent an antioxidant than Vitamin E.  Selenium and Vitamin E are synergistic as antioxidants and inhibit or prevent the damage to tissues by free radicals which have been cited as causal factors in heart disease.

Salt Intake Reduction

Research suggests that people who reduce salt in their diet by about 3gm per day can reduce their chances of developing cardiovascular disease by a quarter.

Nutrient

Essential Fatty Acids

Many studies have shown that higher omega-3 fatty acid intake, through fish consumption or through supplementation, can cut the rate of sudden cardiac death by nearly one-half, in both apparently healthy patients and those who have suffered a previous heart attack.

To better understand this protective effect, Danish researchers examined the dietary patterns and individual fatty acid status of nearly 300 patients with ischemic heart disease, comparing them with specific parameters of cardiac function.  They found that the patients who ate more fish had higher levels of omega-3 polyunsaturated fats in their blood cell membranes and in their fat cells.  A higher level of two specific fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) – especially within the cell membrane – was associated with higher heart rate variability in the patients.  An increased heart rate variability indicates healthier pulse regulation, and appears to significantly reduce the risk of arrhythmia and cardiac death.

Anti-inflammatory agents such as the omega-3 oils are especially useful when inflammation is present.  [Circulation 2001;104(19): pp.2269-2272]

Oxygen / Oxidative Therapies

Ozone / Oxidative Therapy

If infection is present, selected antibiotic therapies such as UV blood irradiation or oxidative therapies (H2O2/ozone) can reduce the risk associated with certain infections.

Physical Medicine

Pressure

Aside from CPR and dialing 911, there may be additional measures one can take when a heart attack occurs.  Without help, a person whose heart stops beating properly and who begins to feel faint has only about 10 seconds left before losing consciousness.

These victims can help themselves by coughing repeatedly and vigorously.  A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest.  A breath and a cough must be repeated about every two seconds, non-stop until help arrives or until the heart is felt to be beating normally again.  Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating.  Some claim that biting or stimulating the tips of the little fingers (heart meridian) can provide needed stimulation at this critical time, and improve the prospects of recovery.

Psychological

Stress Management

People who live in a chronically stressed-out condition are more likely to take up smoking, frequently overeat, and be far less likely to exercise.  All of these stress-related behaviors have a direct effect on the development of coronary artery disease.

It is also known that the surge in adrenaline caused by severe emotional stress causes the blood to clot more readily (a major factor in heart attacks) and that the stress of performing difficult arithmetic problems can constrict the coronary arteries in such a way that blood flow to the heart muscle is reduced.  Stress increases homocysteine levels, a known risk factor for coronary artery disease.

Surgery/Invasive

Vitamins

Vitamin C (Ascorbic Acid)

Supplemental vitamin C can help heal injured arteries when used with L-lysine and proline for plaque prevention and possibly removal.  A typical prescription would be 3-6gm vitamin C, 3-6gm lysine and 0.5-2gm proline.  Furthermore, vitamin C deficiency (as indicated by low plasma ascorbate concentration) is a known risk factor for coronary heart disease.

One year of supplementation with vitamin C (500mg bid) and vitamin E (400 IU bid) retarded the early progression of transplant-associated coronary arteriosclerosis in a study of 40 patients up to 2 years after cardiac transplantation.  [Lancet 2002;359(9312): pp.1108-13]

Vitamin C treatment has a possible role in benefiting patients with coronary heart disease by countering the adverse effects of a high-fat meal.  Researchers found that postprandial serum triglyceride concentration increased significantly at 2-5 hours after a high-fat meal in all groups.  The postprandial flow-mediated dilatation was significantly aggravated in people not taking vitamin C (both with and without heart disease), but this parameter in patients and subjects taking vitamin C showed no significant change.  [Clin Cardiol 2002;25: pp.219-224]

Vitamin E

Vitamin E may protect the endothelial cells of the arteries from becoming oxidized.  Free radical stress can be reduced with antioxidants such as vitamin E.

In a study published in Epidemiology in 2002, a substantial inverse association with myocardial infarctions (MI) was found for total dietary vitamin E (assessed by food-frequency questionnaire), in a case-control study of 475 survivors of a first MI and 479 controls in Costa Rica.  Dietary gamma tocopherol intake was not associated with the risk of myocardial infarction.  This study again indicates that alpha tocopherol may be the preferred form of vitamin E for protection from MI.  [Epidemiology 2002; 13(2): pp.216-223]

See also: [Stephens NG, Parsons A, Schofield PM, et al.  Randomized controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS).  Lancet 1996; 347: pp.781-6]

Preventive measures against Coronary Disease / Heart Attack:

Botanical

Not recommended
Marijuana

The risk of a heart attack jumps nearly five-fold during the first hour after smoking marijuana, posing a particular threat to middle-aged users of the drug, according to a study in 2001.  Starting in the third hour after smoking marijuana, no significant risk rise was documented.

Diet

Nut and Seed Consumption

A Seventh Day Adventist study that was reported at the 2002 International Congress on Vegetarian Nutrition found those that ate a serving of nuts 5 times per week had half the cardiac mortality.

Increased Fruit/Vegetable Consumption

A diet high in fruits appears protective against heart disease.  The total number of deaths from cardiovascular disease was found to be significantly lower among men with high fruit consumption in one study.  A large study of male healthcare professionals found that those men eating mostly a "prudent" diet (high in fruits, vegetables, legumes, whole grains, fish, and poultry) had a 30% lower risk of heart attacks compared to men who ate the fewest foods in the "prudent" category.  A parallel study of female healthcare professionals showed a 15% reduction in cardiovascular risk when they ate a diet high in fruits and vegetables compared to the effect of a low fruit and vegetable diet.

High/Increased Fiber Diet

A high-fiber diet, particularly one that is high in water-soluble fiber (such as fruit), is associated with decreased risk of both fatal and nonfatal heart attacks, probably because presence of such fiber is known to lower cholesterol.  Numerous studies have linked diets rich in fiber with low levels of cholesterol.  In particular, soluble fiber alters and lowers fat and cholesterol absorption in the large bowel, helping to reduce LDL, the 'bad' cholesterol.

Fiber-rich foods are also good sources of phytochemicals and anti-oxidants that help to lower the risk for heart disease.  Blood pressure, a major heart disease risk factor, may also be reduced by eating diet rich in fiber, further helping to reduce the risk of heart disease.

Making positive dietary changes immediately following a heart attack is likely to decrease one's chance of having a second heart attack.  In one study, individuals began eating more vegetables and fruits, and substituted fish, nuts, and legumes for meat and eggs 24 to 48 hours after a heart attack.  Six weeks later, the diet group had significantly fewer fatal and nonfatal heart attacks than a similar group that did not make these dietary changes.  This trend continued for an additional six weeks.

Plant-Based Nutrition

Fruits and vegetables contain antioxidant substances, such as vitamin C, vitamin E, and carotenoids, which protect cells against oxidative damage, which is related to cancer risk and other health problems.[1] The multitude of phytochemicals found in various fruits, vegetables, grains, legumes, and nuts are thought to protect against heart disease and cancer.[2]

  1. Jacob RA, Burri BJ.  Oxidative damage and defense.  Am J Clin Nutr 1996;63:985S-90S
  2. Craig WJ.  Phytochemicals: guardians of our health.  J Am Diet Assoc 1997;97:S199-S204

Drug

Habits

Aerobic Exercise

A sedentary lifestyle of physical inactivity is almost as great a risk factor for heart disease as smoking because of diminished circulation and weight gain.

Research has shown that even moderate exercise can substantially reduce the incidence of coronary events.  Aerobic exercise reduces cardiac risk by lowering LDL- and raising HDL-cholesterol levels, and by reducing blood pressure, body fat, blood sugar, mental stress, and blood clotting.  Exercise also improves the heart's pumping ability, greatly enhancing the body's functional capacity and stamina.

It is never too late to start.  Healthy people who begin exercising after age 45 can reduce their death rate by 23%, and even patients who have already had heart attacks can use medically-supervised aerobic exercise to reduce their risk of another heart attack by up to 25%.

Mineral

Calcium

One study showed a 30% to 35% reduction in ischemic heart disease risk in women with a high intake of supplemental calcium.  Dietary calcium achieved no significant change in heart attack risk, the researchers noted.

Chromium

Getting the right amount of chromium each day may help protect against heart attacks in people that are at high risk, such as those who have diabetes.  Chromium seems to improve levels of blood fats such as cholesterol.

Nutrient

Lycopene

In Europe, researchers have found a statistically significant association between high dietary lycopene and a 48% lower risk of heart disease.  [Am J Epidemiol 1997;146: pp.618-26]

Vitamins

Folic Acid

Reduces homocysteine levels (major cause of heart disease), thereby decreasing risk of heart disease.  A study found that people with a dietary intake of at least 300mcg per day of folic acid reduced their risk of stroke and heart disease by 20% and 13% respectively, compared with those who consumed less than 136mcg of folic acid per day.  [Stroke 2002;33: pp.1183-9]

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