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Table of Contents

LE Magazine December 2003

How to Be Proactive with Your Doctor

Part of taking care of your heart is becoming a proactive participant in your health care and communicating with your doctor. Following are some of the questions you should ask your physician to determine your risk for cardiovascular disease.

What is my blood pressure and how does it compare with new national guidelines?

The National Heart Blood and Lung Institute (NHBLI) issued new blood pressure guidelines in May 2003 that state the following:1

Normal:
less than 120/
less than 80 mm Hg

Prehypertension:
120-139/
80-89 mm Hg

Stage 1 hypertension:
140-159/
90-99 mm Hg

Stage 2 hypertension:
at or greater than 160/
at or greater than 100 mm Hg
It is crucial that blood pressure remain in the normal range.

What is my total cholesterol and lipoprotein profile?

A lipoprotein profile measures total cholesterol; high-density lipoprotein (HDL), which helps prevent cholesterol from building up in the arteries; low-density lipoprotein (LDL), which causes cholesterol to build up in the arteries; and triglycerides, which are another form of fat in the blood.2
The following guidelines have been established by conventional doctors to assess cardiovascular risk:

Total cholesterol:
less than 200 mg/dL is desirable
200-239 is borderline high
240 and above is high

LDL:
less than 100 mg/dL is optimal
100-129 is near optimal
130-159 is borderline high
160-189 is high
190 and above is very high

HDL:
less than 40 mg/dL is
considered a risk factor
more than 60 lowers your risk

Triglycerides:
Under 100 mg/dL is ideal
150-199 is borderline high
200 or more is high

If I’m taking a statin, should I be taking Coenzyme Q10 supplements?

While millions of Americans take statins to reduce their cholesterol levels, many do not realize these drugs can also lower levels of Coenzyme Q10 (CoQ10). This enzyme produces energy in cells and helps the heart muscle function. Consequently, if you are taking a statin drug, you may want to talk to your doctor about taking a CoQ10 supplement.6

References

1. Centers fror Disease Control and Prevention. About Cardiovascular Disease. Available at: http://www.cdc.gov/cvh/aboutcardio.htm Accessed June 5, 2003

2. Healthy People 2010. Chapter 12. Heart Disease and Stroke. Available at: http://hin.nhlbi.nih.gov/cvd_frameset.htm. Accessed on June 5, 2003.

3. Appel LA, et al. Effects of dietary patterns on blood pressure. N Engl J Med. Apr 17;336 (16):1117-1124.

4. Sacks FM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001 Jan 4;344(1) 3-10.

5. Obarzanek E, et al. Effects on blood lipids of a blood pressure-lowering diet; the Dietary Approaches to Stop Hypertension (DASH) Trial. Am J Clin Nutr. 2001 Jul;74(1):80-89.

6. Mozaffarian D, et al. Cardiac benefits of fish consumption may depend on the type of fish meal consumed: The Cardiovascular Health Study. Circulation. 2003 Mar 18;107(10):1372-1377.

7. Auder J, et al. C-reactive protien and coronary artery disease. Jpn Heart J. 2002 Nov;43(6):607-619.

8. Ridker PNM, et al. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002 Nov 14;347(20):1557-1565.

9. Speidl WS, et al. High-sensitivity C-reactive protein in the prediction of coronary events in patients with premature coronary artery dis- ease. Am Heart J. 2002 DSep;144(3):449-455.

10. Ridker PM, et al. High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of cardio- vascular disease. Circulation. 2001 Apr 3; 103(13):1813-1818.

11. Ridker PM, et al. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000 Mar 23;(342)12:836-843.

12. Kuller LH, et al. Relationship of C-reactive protein and coronary heart disease in the MRFIT nested case-control study. Am J Epidemiol. 1996;144:537-547.

13. Mendall MA, et al. C-reactive protein relation to total mortality, cardiovascular mortality and cardiovascular risk factors in men. Eur Heart J. 2000Oct;21(19):1584-1590.

14. Ridker PM, et al. Plasma concentration of C- reactive protein and risk of developing periph- eral vascular disease. Circulation. 1998 Feb 10;97(5):425-428.

15. De Bree A, et al. Homocysteine determinants and the evidence to what extent homocysteine determines the risk of coronary heart disease. Pharmacol Rev. 2002 Dec;54(4):599-618.

16. Kelly PJ, et al. Homocysteine, MTHFR677C --T polymorphism and risk of ischemic stroke: results of a meta-analysis. Neurology. 2002 Aug 27;59(4):529-536.

17. Kuan YM, et al. Homocysteine: An aetiological contributor to peripheral vascular arterial dis ease. ANZ J Surg. 2002 Sep;72(9):668-671.

18. Vasan RS, et al. Plasma homocysteine and risk for congestive heart failure in adults without prior myocardial infarction. JAMA 2003 Mar 12;89(10):1251-1257.

19. Retterstol L, et al. Plasma total homocysteine levels and prognosis in patient with previous premature myocardial infarction: a 10-year follow-up study. JIntern Med. 2003 Mar;253(3):284-292.

20. Nehler MR, et al. Homocysteinemia as a risk factor for atherosclerosis: a review. Cardiovas Surg. 1997;5:559-567.

21. Chambers JC, et al. Improved vascular endothelial function after oral B vitamins: An effect mediated through reduced concentra- tions of free plasma homocysteine. Circulation. 2000 Nov 14;102(20):2479-2483.

22. Selhub J, et al. Relationship between plasma homocysteine and vitamin status in the Framingham study population. Impact of folic acid fortification. Public Health Rev. 2000;28(1-4):117-145.

23. Verhoaf P, et al. Homocysteine metabolism and risk of myocardial infarction: relation with vita- mins B6, B12 and folate. Am J Epidemiol. 1996 May 1;143(9):845-859.

24. Abby SL, et al. Homocysteine and cardiovascu- lar disease. J Am Board Fam Pract. 1998 Sep- Oct;11(5):391-398.

25. Undas A, et al. Treatment of hyperhomocys- teinemia with folic acid and vitamins B12 and B6 attenuates thrombin generation. Thromb Res. 1999 Sep 15;95(6):281-288.

26. Chao CL, et al. Effect of short-term vitamin (folic acid, vitamins B6 and B12) administra- tion on endothelial dysfunction induced by post-methionine load hyperhomocysteinemia. Am J Cardio. 1999 Dec 1;84(11):1359-1361.

27. Marchioli R, et al. Early protection against sud- den death by n-3 polyunsaturated fatty acids. Circulation. 2002 Apr 23;105(16):1897-1903.

28. Castano G, et al. Effects of policosanol in older patients with type II hypercholesterolemia and high coronary artery risk. J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M186-192.

29. Castano G, et al. Comparisons of the efficacy and tolerability of policosanol with atorvastatin in elderly patients with type II hypercholes- terolemia. Drugs Aging 2003;20(2):153-163.

30. Tran MT, et al. Role of coenzyme Q10 in chron- ic heart failure, angina and hypertension. Pharmacotherapy. 2001 Jul;21(7):797-806.

31. Baggio E, et al. Italian multicenter study on the safety and efficacy of coenzyme Q10 as adjunc- tive therapy in heart failure. CoQ10 Drug Surveillance Investigators. Mol Aspects Med. 1994;15 Suppl:s287-294.

32. Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult. Available at:http://www.acc.org/
clinical/guidelines/failure/hf_index.htm. Accessed May 25, 2003.

33. Esch PM, et al. Reduction of postoperative swelling. Objective measurement of swelling of the upper ankle joint in treatment with ser- rapeptase-a prospective study. Fortschr Med. 1989 Feb 10;107(4):67-8,71-2.

34. Majima Y, et al. The effect of an orally admin- istered proteolytic enzyme on the elasticity and viscosity of nasal mucus. Arch Otohinolaryngol. 1988;244(6):355-359.

35. Mazzone A, et al. Evaluation of Serratia pepti- dase in acute or chronic inflammation of otorhinolaryngology pathology: a multicenter, double-blind, randomized trial versus placebo. J Int Med Res. 1990 Sep-Oct;18(5):379-388.

36. Brewer Science Library website. Available at: http://www/mwt.net/~drbrewer/niep_art.htm. Accessed May 28, 2003.

37. Channer KS, et al. Cardiovascular effects of testosterone: implications of the “male menopause?” Heart 2003 Feb;89(2):121-122.

38. English KM, et al. Men with coronary artery disease have lower levels of testosterone than those with normal coronary angiograms. Eur Heart J. 2000 Jun;21(11):890-894.

39. English KM, et al. Low-dose transdermal testosterone therapy improves angina thresh- old in men with chronic stable angina: A ran- domized, double-blind, placebo-controlled study. Circulation. 2000 Oct 17;102(16):1906-1911.

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