Getting to Know Your Heart Health
Cardiovascular Health Overview
Cardiovascular health refers to the health of the heart and the blood vessels that travel throughout the body to and from the heart. Cardiovascular disease is a group of diseases of the heart and blood vessels including:
Coronary heart disease - Myocardial Infarction (MI, “Heart Attack”), Angina pectoris
Cerebrovascular disease - Stroke, Transient Ischemic Attack
Heart failure
Arrhythmias
Heart valve abnormalities & Heart Murmurs
Peripheral Artery Disease - Intermittent Claudication
Aortic Atherosclerosis, Aortic Aneurysm
According to the World Health Organization (WHO) Cardiovascular diseases (CVDs) are the leading cause of death globally. Lifetime risk of developing CVD approaches 50% for Americans over the age of 30 - rising with age. Many individuals in the general population have one or more risk factors for coronary heart disease (CHD), and over 90 percent of CHD events occur in individuals with at least one risk factor (UpToDate).
The leading risk factors for developing CVD are:
High Blood Pressure (hypertension)
High Blood Cholesterol (hypercholesterolemia) - high LDL, triglycerides and total cholesterol, low HDL
Tobacco Use - in addition to causing inflammation and tissue damage, smoking has also been shown to reduce levels of the protective “good cholesterol” HDL
Alcohol Use
Obesity
Diabetes
Physical inactivity - exercise in an effective way to improve blood pressure, cholesterol, blood sugar levels and other contributors to cardiovascular health.
Dietary habits - diets high in inflammatory processed foods, excessive sugar and over-salted foods increase the risk of HTN and CVD
High stress - stress can have both direct and indirect effects on development of atherosclerosis and can increase risk of MI
Family History - risk of developing hypertension is doubled in those with 1 or 2 parents with hypertension. Other factors such as risk of diabetes and high cholesterol also share genetic influence. Notably, habits also tend to passed down through family.
Race - African American populations are at an increased risk of developing HTN earlier in life and at a more severe degree
Fortunately - with early detection and intervention CVD can be prevented or minimized by reducing risk factors. Working with a Naturopathic Doctor (ND) or Registered Dietitian (RD) can be an excellent way to help manage and reduce your risk factors. However - if you have an increased risk for developing CVD it is important to also see a Cardiologist regularly in addition to your PCP.
High Blood Pressure (Hypertension)
Maintenance of arterial blood pressure is necessary for adequately getting blood to your organs. Blood pressure (BP) is determined by both Cardiac Output (CO) and Systemic Vascular Resistance (SVR).
BP = CO x SVR
There are a variety of genetic, environmental and lifestyle factors that can lead to elevated blood pressure. High blood pressure, or Hypertension (HTN) is a well-established risk factor for CVD - including increasing mortality from Coronary Heart Disease and Stroke. It is important to monitor the patterns in your blood pressure over time - in and out of the office - in order to best assess your risk. If you have been told at the doctor’s office that your pressure is elevated, it can be helpful to purchase an electronic monitor from the pharmacy to check your pressure at home in different settings.
Early intervention is key with managing high blood pressure. According to the American College of Cardiology and American Heart Association it is helpful to begin interventions at 130/80mmHg rather than the previously recommended 140/90mmHg.
The most recent (as of 2022) guidelines for blood pressure categories are:
Normal: Less than 120/80mmHg
Elevated: Systolic between 120-129 and Diastolic under 80
Stage 1 Hypertension: Systolic between 130-139 OR Diastolic between 80-89
Stage 2 Hypertension: Systolic over 140 OR Diastolic over 90
Hypertensive Crisis: Systolic over 180 and/or Diastolic over 120
Causes of Secondary Hypertension
High blood pressure can also be caused secondarily to medical conditions or medication use. In this case, we rely more on the naturopathic tenant of treating the whole person - oftentimes helping someone with one condition may ease the risk of another.
Primary Kidney Disease
Primary Aldosteronism
Illicit Drug Use
Sleep Apnea
Pheochromocytoma
Cushing’s Disease
Hyperthyroidism
Prescription or OTC medications that may increase blood pressure: Oral contraceptives, NSAIDs, Steroids, Antidepressants, Decongestants, Stimulants
High Cholesterol
Lipids (cholesterol and triglycerides) are the water insoluble compounds that require larger protein-containing complexes called lipoproteins to transport them in blood. The protein components of the lipoprotein are known as apolipoproteins or apoproteins. Your body requires cholesterol to build healthy cells and to properly produce hormones. However, very high levels of cholesterol, combined with inflammation, can lead to fatty deposits in the blood vessels (atherosclerosis). These deposits can inhibit blood flow or break apart leading to MI or stroke. Your physician likely checks your cholesterol levels annually or biannually as a part of your yearly physical. If you have high levels or family history of CVD, this may be more often. If your levels are found to be elevated, it is ideal to re-check after a few months to confirm that they were not transiently elevated acutely in response to something else going on in the body.
Low-Density Lipoprotein (LDL) - sometimes referred to as “bad cholesterol” - transports cholesterol from the liver throughout the body, where it may be needed for hormone synthesis, cell maintenance or to manage local inflammation
High-Density Lipoprotein (HDL) - sometimes referred to as “good cholesterol” - picks up and transported excess cholesterol from throughout the body, returning it to the liver. Most standards indicate that this should be between 45-70mg/dL for men and 50-90mg/dL for women.
HDL/Total Cholesterol Ratio as an Indicator of CVD Risk
A often-used indicator of CVD risk is your HDL/Total Cholesterol ratio, which can be easily calculated using a standard lipid panel. In general, the higher the ratio - the higher the risk. Most healthcare providers want this ratio to be under 5.0, with an ideal range under 3.5.
High cholesterol can also be caused secondarily to certain medical conditions.
Chronic Kidney Disease
Diabetes
HIV/AIDS
Chronic infections
Hypothyroidism
Lupus
How We Help Improve Your Cardiovascular Health
Lab testing beyond the standard measures - beyond Cholesterol, we also evaluate for nutritional imbalances, inflammatory markers, chronic infections and other root causes
Personalized nutrition plans that meet you where you are at and grow with you
Herbal and nutritional supplements aimed to restore balance and fill gaps in nutrition while you make changes along the way
Lifestyle counseling - finding routines and exercises that can help you remain active and reduce your risk
Implementing stress management techniques to improve mental health and overall wellbeing
Provide you with education and referrals to other specialists as needed, ensuring you receive complete care
