The number-one killer in America (for both men and women), heart disease is the result of the narrowing of the arteries that supply the heart with blood, oxygen, and nutrients. This process, called coronary artery disease, can generally be traced to a condition called atherosclerosis, the build-up of cholesterol-rich fatty deposits, or plaques, on the inside of arterial walls. As these deposits accumulate over time, the coronary arteries narrow to the point that the flow of oxygenated blood to the heart is impeded. (Arterial spasms — triggered by smoking, extreme emotional stress, or exposure to very cold temperature —may also cause coronary arteries to narrow suddenly and dangerously.)

The Risk Factors — and How You Can Reduce Yours
Major risk factors for cardiovascular disease include cigarette smoking, high blood pressure, high cholesterol and/or triglycerides, diabetes mellitus, obesity, sedentary lifestyle, and poor nutrition. Prevention and treatment centers around these risk factors — and these approaches will help you lower risk for many other types of illness, as well as helping you feel great and have more energy overall.

1. Don’t smoke.
Cigarette smoking remains the leading preventable cause of cardiovascular disease in women, with more than 50 percent of heart attacks among middle-aged women attributable to tobacco. Risk of cardiovascular disease begins to decline within months of smoking cessation and reaches the level of persons who have never smoked within 3 to 5 years.

2. Lower your cholesterol.
High blood cholesterol is a condition that greatly increases your chances of developing coronary heart disease. Extra cholesterol in the blood settles on the inner walls of the arteries, narrowing them and allowing less blood to pass through them to the heart. Aim for total cholesterol below 200 mg/dL; LDL cholesterol below 130 mg/dL and HDL above 35 mg/dL.

3. Maintain a healthy weight.
Obesity and sedentary lifestyles are epidemics in the United States that contribute to increased risk of cardiovascular disease. The prevalence of obesity has increased among both men and women in the United States in the past decade; currently about one third of adult women (or 34 million) are classified as obese. Also, 60% of both men and women get no regular physical activity. Obesity, especially abdominal adiposity, is an important risk factor for cardiovascular disease in women.

4. Exercise regularly.
Recent evidence suggests that even moderate-intensity activity, including brisk walking, is associated with substantial reduction of cardiovascular disease risk. These findings support the 1995 federal exercise guidelines endorsing 30 minutes of moderately intense physical activity most days of the week, a program that should be feasible and safe for most of the population. Regular exercise and maintenance of healthy weight should also help reduce insulin resistance and the risk of non–insulin-dependent diabetes mellitus, which appears to be an even stronger risk factor for cardiovascular disease in women than in men. Diabetes is associated with a threefold to sevenfold elevation in cardiovascular disease risk among women, compared with a twofold to threefold elevation among men. Approximately half of all deaths in patients with non–insulin dependent diabetes mellitus are due to heart disease.

5. Eat less saturated fat, more produce & more fiber.
Diets low in saturated fat and high in fruits, vegetables, whole grains, and fiber are associated with a reduced risk of cardiovascular disease. Also, a recent study reported in the Annals of Internal Medicine journal confirmed that the consumption of fruits and vegetables, particularly green leafy vegetables and vitamin C-rich fruits and vegetables, seems to have a protective effect against coronary heart disease. You may even think about moving toward more flexitarian or vegetarian eating habits: A vegetarian diet reduces the risk of coronary artery disease, and may even reverse existing coronary artery disease when combined with other lifestyle changes. A Mediterranean diet that uses olive oil can reduce the risk of coronary artery disease.

6. Avoid trans fats.
Trans fatty acids have been linked to adverse lipid profiles and an increased risk of cardiovascular disease. This includes most margarines. The role of other fatty acids, including monounsaturated, polyunsaturated, and marine omega-3 fatty acids, remains controversial.

7. Consume alcohol only in moderation.
Moderate intake of alcohol is related to reduction of cardiovascular disease — but may raise blood pressure and increase risk of breast cancer. Early surgical menopause is linked to increased risk of cardiovascular disease, which appears to be negated by the use of estrogen therapy.

8. Arm yourself with risk-reducing supplements.
Antioxidant vitamin supplements, particularly vitamin E and homocysteine-lowering agents such as folate and B6, have promising roles in prevention of cardiovascular disease, but conclusive evidence may hinge on the results of several ongoing randomized clinical trials. When it is found in unusually high levels, homocysteine brings the same degree of risk as having high cholesterol does. The B vitamins, especially folic acid and B12, will drive elevated homocysteine levels down to normal, often without the need of any prescription medication.

9. Give yourself some new stress-management tools.
Poorly controlled stress may have an adverse effect on blood lipids. An attitude of hostility has been powerfully linked with a higher incidence of cardiac events, and cynical distrust has been associated with accelerated progression of carotid artery disease. Relaxation methods (meditation, breathing exercises), yoga, and stress management techniques are essential for preventing cardiovascular disease and coronary artery disease and for reducing the risk of recurrent cardiac problems. Meditation improves exercise tolerance and decreases electrical changes associated with poor circulation to the heart. Meditation has also been shown to lower cholesterol and reverse carotid artery thickening. Also consider acupuncture, which has been shown to help relax the myocardium and improve circulation.

10. Ask your health professional about herbs and nutritional supplements that may be useful in preventing and treating cardiovascular disease, including:

- Bilberry
- Turmeric (curcumin)
- Fenugreek
- Ginger
- Guggul
- Ginkgo
- Garlic (one garlic clove is roughly equal to 4 mg to 1 gram of garlic; a daily dose of 600 to 800mg may be recommended)
- Onion
- Vitamin B12
- Folic acid (500 to 5000 micrograms daily may be recommended)
- B6
- L-Carnitine
- Coenzyme Q10 (100 to 300 mg daily may be recommended)
- Vitamin E (400 to 800 International Units daily may be recommended)
- Magnesium (200 to 400 mg daily may be recommended)
- Niacin (A typical oral dose of 100 mg, three times daily; may gradually increase to avg. dose of 1 gram three times daily, with a maximum dose of 6 grams. Extended release tablets: Dosing may begin with one 375-milligram tablet at bedtime and be increased by no more than 500 mg per four-week period, to a maximum of 2,000 mg, given as two 1,000-milligram tablets before bed)
- Fish oils (6 grams daily may be recommended))
- Soy (Isoflavones may be recommended))

A new risk factor for heart disease has been discovered, although this time it is something that can easily be corrected. Scientists say that a growing body of evidence has suggested that vitamin D deficiency increases the risk of heart disease and is also linked to other well-known risk factors for heart disease such as diabetes, obesity, and high blood pressure.

Several large studies have shown that people that had low vitamin D levels were twice as likely to have a stroke, heart attack, or other heart-related event during follow-up, compared to the people that had higher levels of vitamin D. Researcher James H. O’Keefe, M.D. and director of preventative cardiology at the Mid America Heart Institute in Kansas City, MO., stated, “Vitamin D deficiency is an unrecognized, emerging cardiovascular risk factor, which should be screened for and treated. Vitamin D is easy to assess, and supplementation is simple, safe and inexpensive.”

The skin, in response to exposure to the sun, meets most of the body’s requirements for vitamin D. Other less potent sources of vitamin D include foods such as cod liver oil, sardines, and salmon. Also, vitamin D can also be found in D-fortified foods milk and some cereals. If you do not get enough vitamin D you can also take vitamin D supplements on a daily basis.

A deficiency of vitamin D is traditionally associated with muscle and bone weakness, but in recent years a number of studies have shown that the low levels of vitamin D may predispose the body to congestive heart failure, blood pressure, and chronic blood vessel inflammation (which is associated with the hardening of the arteries). It can also alter hormone levels, which will increase insulin resistance, which can raise the risk of diabetes.

In an article that was published in the Journal of the American College of Cardiology, the researchers surveyed recent studies on the link between heart disease and vitamin D deficiency to come up with some practical advice on screening and treatment. They also concluded that the vitamin D deficiency is much more common that they previously thought, and could be affecting up to half of adults and children in the United States.

The researchers say that higher rates of vitamin D deficiency could be due in part to people spending more time indoors and in the effort to reduce sun exposure through the use of sunscreens. If you use a sunscreen that has a sun protection factor (SPF) of 15, you should know that it blocks nearly 99% of vitamin D synthesis by our skin.

Americans are spending less time outside now than previous generations, and older adults and people that are obese or overweight are less efficient at making vitamin D when exposed to sunlight. A little bit of sunshine each day is good, but the use of sunscreen to protect against skin cancer is important if you plan out staying outside for more than 15 to 30 minutes of intense sunlight exposure.

You can find out what your vitamin D levels are via a blood test that looks at a specific form of vitamin D called 25-hydroxy vitamin D (25(OH)D). A deficiency of vitamin d can be defined as a blood 25(OH)D level of below 20 ng/dL. A normal level is considered to be above 30 ng/dL.

The researchers recommend a 25(OH)D screening for that that have known risk factors for a deficiency of vitamin D including:
• Reduced exposure to the sun due to variation or by living far away from the equator
• Old age
• Liver or kidney disease
• Obesity
• Skin that is darkly pigmented
• Smoking

The government’s current recommendation daily allowance (RDA) for vitamin D is 200 international units (IU) daily for individuals that are under the age of 50. For those that are between 50 and 70, it is recommended to take 400 IU daily, and for those that are over the age of 70, the RDA is 600 IU. Most experts believe that these recommended does are still too low, and that somewhere between 1,000 and 2,000 IU of vitamin D daily is necessary to maintain adequate levels of vitamin D. The upper limit of vitamin D that is safe to take on a daily basis is 10,000 IU.

Vitamin D supplements are available now in two different forms: Vitamin D3 and Vitamin D2. Although both types appear to be effective in raising the levels of vitamin D, Vitamin D3 supplements appear to result in a boost in the levels of vitamin D that is longer-lasting. However, there are no current guidelines for restoring and maintaining a healthy level of vitamin D in people that are at risk for heart disease, for those that are vitamin D deficient, the researchers recommend an initial treatment with 50,000 IU of vitamin D2 or D3 once weekly for eight to 12 weeks, that is followed by maintenance with one of the following strategies:
• 50,000 IU vitamin D2 or D3 bi-weekly
• 1,000 to 2,000 IU of vitamin D3 every day
• Sunlight exposure for at least 10 minutes for white patients (longer for people that have increase skin pigmentation) between the hours of 10 a.m. and 3 p.m.

Once the maintenance therapy has been initiated, rechecking 25(OH)D blood levels is highly recommended after three to six months of ongoing supplementation.

O’Keefe stated, “Restoring vitamin D levels to normal is important in maintaining good musculoskeletal health, and it may also improve heart health and prognosis. We need large, randomized, controlled trials to determine whether or not vitamin D supplementation can actually reduce future heart disease and deaths.”

What are the Right Numbers?

Depending on where you look, recommended blood glucose levels can vary. The American Diabetes Association (ADA) numbers differ from the American College of Endocrinology (ACE) guidelines. The ACE recommendations are more strict than the ADA’s. How do you know which to follow? Ask your healthcare provider which goals are right for you. The table below compares the two sets of guidelines for blood glucose, blood pressure and cholesterol.

How many times a day should you check your blood glucose levels?

Checking your blood glucose levels often through out the day will help you to figure out how to keep good control. First thing in the morning before breakfast, two hours after a meal and before bed are good times to test. Other recommended times include before, during and after an exercise session, especially if it is strenuous or if you are feeling like your blood sugar may be low or high.

What is the A1C?

It’s a blood test that helps you and your doctor monitor your overall glucose control.

It gives an average of the amount of glucose in your blood over a few months’ time. It is usually ordered 2 to 4 times a year. If you are newly diagnosed or having trouble maintaining good day-to-day control, it may be ordered more often.

Sources:

“Checking Your Blood Glucose.” American Diabetes Association. ADA. 15 Dec 2006

American Association of Clinical Endocrinologists and the American College of Endocrinology, “The AACE System of Intensive Diabetes Self-Management – 2002 Update.” The American Association of Clinical Endocrinologists Medical Guidelines for the Management of Diabetes Mellitus. Endocrine Practice Vol. 8. 2002.

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