Life Extension Magazine May 2009
How to Circumvent 17 Independent Heart Attack Risk Factors
By William Faloon
One of our most enthusiastic members just sent me a dismaying email. After a sudden angina attack, this 64-year-old man was diagnosed with severe coronary artery blockage. His doctors ordered bypass surgery. Based on the severity of his coronary blockage, surgery was his only option.
Since this member lived in rural England, comprehensive blood tests were not readily available to him. The best that socialized British medicine provided was a report showing that he had high cholesterol and very high blood pressure. A review of his supplement program revealed gaping holes in what we know is needed to protect against atherosclerosis.
This member’s failure to detect and treat his increasing blood pressure and cholesterol undoubtedly contributed to his coronary occlusion. We suspect other causes were involved as well and are trying to obtain more comprehensive blood tests. This is a real-life example of someone doing many of the right things, but failing to circumvent all the proven risk factors for artery disease.
Atherosclerosis was once considered an inevitable consequence of aging. The problem now is that too many people think they can protect against heart attack by picking and choosing among various components of an anti-atherosclerosis program.
From our observations over the past 29 years, I can categorically state that without annual blood tests (and regular blood pressure checks), an aging human is literally shooting in the dark if they think they can avoid contracting a vascular disease.
Today’s population remains in a virtual state of denial when it comes to heart attack risk. What makes this such a travesty is that there are so many proven ways to protect against the number one killer. This article will succinctly review 17 independent heart attack risk factors and provide a range of options that can enable aging humans to defuse each one of them.
The order in which I discuss these cardiac risk factors has no relevance as to which is more dangerous than the other. It does not matter if your fatal heart attack is caused by high cholesterol, low testosterone, or excess glucose—the end result may be the same, unless all of these risk factors are brought under control.
The encouraging news is that simple steps that enable one to lower risk factors such as elevated LDL simultaneously protect against other dangers such as excess C-reactive protein.
HEART ATTACK RISK FACTORS #1 and 2: Excess LDL and Total Cholesterol
Optimal Blood Level:
160-180 mg/dL of total cholesterol
Low-density lipoprotein (LDL) transports cholesterol from the liver to cells throughout the body, where the cholesterol provides numerous life-sustaining functions. As people age and/or consume the wrong foods, LDL and cholesterol levels tend to increase to a point whereby they cause or contribute to the development of atherosclerosis. It is thus important to maintain total cholesterol and LDL levels in optimal ranges.
Drug options: Take the lowest dose of a statin drug that achieves optimal LDL and total cholesterol levels. Some people will need only 5-10 mg of simvastatin or 20-40 mg of pravastatin per day. These low doses seldom cause side effects, other than to reduce coenzyme Q10 (CoQ10) synthesis in the body. Supplemental CoQ10 can correct a CoQ10 deficiency caused by statin drugs.1,2 Many people can avoid statin drugs by making dietary changes and incorporating certain nutrients and fibers into their daily program.
Hormone options: Many women (and some men) suffer from excess cholesterol because they are deficient in thyroid hormone. Blood tests that evaluate TSH, T4, and T3 can help a qualified doctor restore thyroid hormone status to optimal ranges. Cholesterol is a precursor to testosterone and other hormones in the body. When testosterone is deficient in men, the body may compensate by synthesizing more cholesterol. When testosterone and other hormones are restored to more youthful ranges, cholesterol levels may decrease. Aging men sometimes have higher than desirable levels of estradiol.39,40 Excess estrogen in men contributes to elevated LDL and cholesterol.41 Elevated levels of estrogen can be suppressed in men by taking 0.5 mg twice a week of the prescription drug Arimidex®42 or using nutrients like plant lignans (30 mg a day and higher of HMR™ Lignan)43,44 and Bioperine®-enhanced absorption chrysin (1,500 mg a day).45
HEART ATTACK RISK FACTOR #3: Low HDL
Optimal Blood Level:
Over 50-60 mg/dL of HDL
High-density lipoprotein (HDL) functions via several mechanisms to protect against atherosclerosis, including removing cholesterol from the arterial wall for disposal in the liver. The technical term for this removal of cholesterol is “reverse cholesterol transport.” In order for optimal reverse cholesterol transport to occur, the blood should contain both enough HDL particles and factors that HDL requires to facilitate the reverse cholesterol transport process.
Drug options: Statin drugs provide only slight increases in HDL. The most effective drug to significantly increase HDL is called Niaspan®, a form of extended-release niacin. Niaspan® costs far more than niacin supplements, but may be better tolerated by some individuals. The potential danger of Niaspan® is that because of its continuous release, it may damage the liver. According to the manufacturer’s website: “Liver damage has been reported when substituting Niaspan® for immediate-release niacin.”46
Dietary options: Eating the cruciferous vegetables broccoli, watercress, and cabbage may enhance HDL functionality via several mechanisms. Excess abdominal fat seems to contribute to low HDL. Losing weight and increasing physical activity can result in higher HDL levels by helping to reverse metabolic syndrome. Red wine can also have a profound impact on increasing HDL levels. One glass of red wine with your heaviest meal is suggested, as long as you can tolerate the alcohol.
Hormone options: When HDL removes cholesterol from the arterial wall, it is taken to the liver where it is broken down for disposal and transformed into beneficial compounds such as vitamin D. The liver contains a receptor called scavenger receptor B1 that acts to stimulate cholesterol uptake for processing and disposal. The liver also has an enzyme called hepatic lipase that functions to remove cholesterol from the surface of HDL and helps enhance the uptake of these HDL-derived lipids by scavenger receptor B1.52,53 The activity of scavenger receptor B1 and hepatic lipase is a crucial component of the reverse cholesterol transport process. Testosterone beneficially increases the activity of scavenger receptor B1 and hepatic lipase.54 It is especially important for men to restore testosterone to youthful levels in order to ensure that the cholesterol that HDL removes from the arterial wall is safely disposed in the liver. Men with pre-existing prostate cancer should avoid testosterone until their cancer is cured.
HEART ATTACK RISK FACTOR #4: Excess Glucose
Optimal Blood Level:
Under 86 mg/dL of fasting glucose
Back when Life Extension started making disease risk-reduction recommendations, the medical establishment thought fasting glucose levels up to 125 mg/dL were acceptable. The establishment soon reduced its upper acceptable limit to 110 mg/dL. In recent years, it has come to believe that 100 mg/dL of fasting glucose is too high.
Scientific studies indicate that any amount of fasting glucose over 85 mg/dL incrementally adds to heart attack risk.55 In fact, if you can choose an absolute ideal fasting glucose number, it would probably be around 74 mg/dL.56 We know that some people are challenged to keep their glucose under 100 mg/dL, which makes following as many steps as possible to suppress blood glucose especially important. The good news is that many of the approaches to reduce fasting glucose also reduce fasting insulin, LDL, total cholesterol, and C-reactive protein.
Drug options: An antidiabetic drug that Life Extension suggests normal aging people consider taking to lower their fasting glucose level is metformin, and it is available in low-cost generic form. Metformin has a long enough history of safe human use, plus intriguing data suggest that it may possess anti-aging properties, so those with excess blood glucose may consider taking it even if they are not diagnosed as diabetic.57 Some of the side benefits of metformin include weight loss, which itself is a proven heart attack risk reducer. The dose of metformin varies considerably. The starting dose may be as low as 250-500 mg once a day with a meal. If hypoglycemia (low blood sugar) does not manifest, the dose of metformin may be increased to 500-850 mg taken before the two largest meals of the day, all under the supervision of your physician, of course. One side effect of metformin is that it can cause homocysteine levels to elevate.58 The next section discusses safe methods to suppress excess homocysteine. Those with impaired kidney function should not take metformin.
Another drug that lowers glucose levels is acarbose, which reduces the absorption of ingested carbo-hydrates by inhibiting the alpha-glucosidase enzyme in the small intestine. A typical dose is 50 mg of acarbose taken before each meal (three times a day). Some people experience intestinal side effects, but otherwise, acarbose is highly efficacious in reducing blood glucose levels and reducing several cardiac risk markers in the blood.59-61
Hormone options: As humans age, they experience a reduction in insulin sensitivity. This enables excess glucose to accumulate in the blood instead of being efficiently absorbed into energy-producing cells such as muscle. Normal aging is also accompanied by a sharp decline in hormones that are involved in maintaining insulin sensitivity and hepatic glucose control. Restoring dehydroepiandrosterone (DHEA) levels to youthful ranges may help enhance insulin sensitivity and glucose metabolism in the liver.92-95 For men, restoring youthful levels of testosterone has been shown to be particularly beneficial in facilitating glucose control.96 Blood tests can assess your hormonal status so that you can replenish DHEA (and testosterone) to more youthful ranges. Men with pre-existing prostate cancer should avoid testosterone until their cancer is cured and women with certain types of breast cancer are advised to avoid DHEA until their cancer is cured.
HEART ATTACK RISK FACTOR #5: Excess Homocysteine
Optimal Blood Level:
Under 7-8 mcmol/L of homocysteine
Homocysteine is a breakdown product of an amino acid (methionine) most commonly found in meats. Those who consume high-meat diets often have higher homocysteine levels. Excess homocysteine also occurs in response to remethylation deficits and a deficiency of an enzyme called cystathionine b-synthase.
Excess homocysteine can both initiate atherosclerosis and facilitate its progression.97-99 Some poorly designed studies over the past four years have caused the medical establishment to ignore the atherogenic dangers of excess homocysteine. The problem with these studies is that they used varying doses of B vitamins to induce modest reductions in blood homocysteine levels. When there were no reductions in heart attack incidences, doctors claimed there was no benefit to homocysteine reduction. These studies also failed to individualize programs to provide different forms of nutrients to study subjects to ensure maximum homocysteine reduction. For instance, if your homocysteine level is 16, and you take a multivitamin preparation that reduces it to 13, you are unlikely to see a vascular disease risk reduction. If on the other hand you aggressively slash your homocysteine down to below 8, your risks for a wide range of disorders (including heart attack) may be significantly reduced.
Drug options: Elevated homocysteine blood levels can usually be brought into safer ranges by taking folic acid, vitamin B12, trimethylglycine (TMG), and vitamin B6 dietary supplements. Reducing one’s intake of methionine-rich foods (such as meats) also assists in reducing homocysteine. There are individuals, however, who suffer from remethylation deficits and/or cystathionine b-synthase deficiencies. In these cases where homocysteine levels remain stubbornly high despite aggressive use of supplements, an expensive prescription drug called Cerefolin® is available. This drug contains 5,200 mcg of a special form of folic acid called L-methylfolate plus very small amounts of vitamins B12 and B6. The reason this drug is called Cerefolin® is because excess homocysteine is known to damage the brain, ergo the name “Cere”folin to imply “cerebral” folic acid. Due to its high cost, Cerefolin® is recommended only when natural approaches fail.