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
50-99 mg/dL of LDL (low-density lipoprotein)
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.
- Niacin in doses of 1,000-2,000 mg a day will significantly lower total cholesterol, LDL, and triglycerides while boosting beneficial high-density lipoprotein (HDL).3-8 Niacin can cause a skin “flushing” side effect that can be mitigated by taking niacin with aspirin and a meal. Some people cannot tolerate this flushing effect on a daily basis and choose other options to lower LDL and cholesterol.
- A patent-pending extract of Indian gooseberry fruit called Amlamax® has been shown in human clinical trials to reduce LDL, total cholesterol, triglycerides, and C-reactive protein (CRP).9-14 Amlamax® has also been shown to improve endothelial function.15,16 The suggested dose is 380-500 mg each day.
- The liver removes cholesterol from the blood and excretes much of it into the small intestines in the form of bile acids. If these bile acids are reabsorbed from the intestines back into the blood, then too much cholesterol can accumulate in the blood and contribute to atherosclerosis. The ingestion of soluble fiber(s) such as oat beta-glucan,17-19 psyllium,20 guar gum,21,22 pectin,23,24 and/or glucomannan25 can result in significant reductions in LDL, total cholesterol, and glucose. The most common way of using these fibers is to mix them in eight ounces of water and drink them before most meals. These fibers can also be taken in capsule form. Start off with relatively modest doses and slowly work up to higher amounts to enable your digestive tract to get used to this higher fiber intake. Depending on the type of soluble fiber you choose, taking two to eight grams (2,000-8,000 mg) before each meal is a reasonable target to attain.
- Ingestion of 375 mg a day of theaflavins extracted from black tea produces a modest reduction in LDL and total cholesterol.26-28 The primary benefit of theaflavins is to suppress C-reactive protein and LDL oxidation involved in the formation of atherosclerotic plaque.
- Irvingia extract, taken in the dose of 150 mg twice a day, is associated with beneficial changes in LDL and total cholesterol through reductions in weight and overall calorie intake.29-32
- Consume a very low-fat diet (less than 10% of total calories from fat). Make sure to supplement with at least 2,000 mg of EPA/DHA (omega-3 fats) each day. Most people cannot adhere to this kind of strict low-fat diet.
- Consume a very low-calorie diet (often less than 1,400 calories a day). Most people cannot adhere to a very low-calorie diet.33
- Consume a Mediterranean diet, with lots of fresh fruits and vegetables, fish and soy as protein sources, and omega-3 and monounsaturated fats (olive oil), while avoiding saturated fats, refined carbohydrates, cholesterol-laden foods, excess omega-6 fats, and most animal products. An increasing percentage of Americans are adopting this kind of diet.34-37
- Inclusion of specific cholesterol-lowering foods in one’s diet can markedly lower LDL and total cholesterol levels. Cholesterol-lowering foods with documented proven efficacy include almonds,38 soy protein,38 fiber,19,38 and plant sterols.38
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
- Niacin in doses of 2,000-3,000 mg a day may be the most effective way to increase HDL, while simultaneously lowering total cholesterol, LDL, and triglycerides and inducing favorable changes in LDL particles to reduce their atherogenic potential.3-8,47 Niacin can cause a skin “flushing” side effect that can be mitigated by taking niacin with aspirin and food. Some people cannot tolerate this flushing effect on a daily basis and choose other options to increase HDL.
- A patent-pending extract of Indian gooseberry fruit called Amlamax® has been shown in human clinical trials to modestly increase HDL, while reducing LDL, total cholesterol, triglycerides, and C-reactive protein (CRP).9-14,48 The suggested dose is 380-500 mg each day.
- Paraoxonase-1 is an enzyme strongly associated with the anti-atherosclerotic functionality of HDL. When paraoxonase-1 is deficient, HDL oxidizes and is unable to perform its vital mission of removing cholesterol from the arterial wall. Low levels of paraoxonase-1 predict a substantially increased risk of extensive coronary artery disease, regardless of HDL level.49 In patients administered eight ounces of pomegranate juice a day, paraoxonase-1 levels increased by 83% after one year.50 The nutrient quercetin (in an absorbable form) also upregulates paraoxonase-1.51 Since paraoxonase-1 is not a readily available commercial blood test, those seeking to achieve ultimate HDL functionality should drink unsweetened 100% pomegranate juice and/or take 400-500 mg of standardized pomegranate supplements that provide the active constituents of eight ounces of pomegranate juice.
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
Several nutrients block carbohydrate-digesting enzymes in the digestive tract in a similar manner to the drug acarbose. Dietary supplements such as Salacia oblonga or Salacia reticulata extracts inhibit the alpha-glucosidase enzyme and thus decrease the breakdown of simple carbohydrates in the intestine, resulting in a slower and lower rise in blood glucose throughout the day, especially after meals.62,63 Alpha-glucosidase inhibitors (described above) interfere with the breakdown of simple carbohydrates into glucose. Alpha-amylase inhibitors, on the other hand, interfere with the breakdown of large carbohydrate molecules like starch into linked glucose polymers. These simple sugars are then broken down to glucose by the alpha-glucosidase enzyme. The best documented alpha-amylase inhibitor consists of an extract from the white kidney bean (Phaseolus vulgaris). In a placebo-controlled study, those taking standardized white kidney bean extract lost 3.8 pounds over a 30-day period. More importantly, they lost 1.5 inches of abdominal fat and their triglycerides plummeted 26 points (milligrams per deciliter).64 There would appear to be an even greater benefit in combating excess blood glucose by taking both an alpha-glucosidase and an alpha-amylase inhibitor. Such combinations will soon be available in dietary supplement form.
The ingestion of soluble fiber(s) such as oat beta-glucan,17-19 psyllium,20 guar gum,21,22 pectin,23,24 and/or glucomannan25 can result in significant reductions in fasting glucose and post-meal insulin release. These fibers also help reduce LDL and total cholesterol. The most common way of using these fibers is to mix them in eight ounces of water and drink them before heavy meals. These fibers can also be taken in capsule form. Start off with relatively modest doses and slowly work up to higher amounts to enable your digestive tract to get used to this higher fiber intake. Depending on the type of soluble fiber you choose, taking two to eight grams (2,000-8,000 mg) before each meal is a reasonable target to attain.
Irvingia extract, taken in the dose of 150 mg twice a day is associated with beneficial changes in fasting glucose in subjects losing weight over a 10-week period.29-32,65-68
The mineral chromium can improve insulin sensitivity and help lower fasting glucose.69-73 The suggested daily dose of elemental chromium is 700-1,000 mcg, preferably in the form of chromium polynicotinate, a highly bioavailable chromium that allows for enhanced absorption and utilization of this critical mineral. Take antioxidants such as green tea extract, curcumin, or grape seed with chromium to mitigate chromium’s potential free radical-generating effects. Make sure your daily supplement program also includes at least 1,000 mcg of biotin to further help maintain glucose control. Biotin enhances insulin sensitivity and increases the activity of glucokinase, the enzyme responsible for the first step in the utilization of glucose by the liver.74-76
The amino acid L-carnitine lowers blood glucose and a measurement of long-term glucose control called hemoglobin A1C.77,78 Carnitine does this by increasing insulin sensitivity and glucose storage, while helping to optimize fat and carbohydrate metabolism. The suggested dose is 1,500-2,000 mg of the more bioavailable acetyl-L-carnitine.
Coenzyme Q10 (CoQ10) improves blood sugar control while helping to protect against LDL oxidation. When given to type 2 diabetics, CoQ10 improves glycemic control as measured by lower hemoglobin A1C.79,80
Magnesium deficiency is widespread. Supplementation with magnesium has been shown to reduce fasting glucose and hemo-globin A1C in type 2 diabetics who are magnesium-deficient by improving insulin sensitivity.81 The suggested dose of elemental magnesium is 500 mg a day (and higher for some individuals). Magnesium replenishment can also reduce C-reactive protein.82
Cinnamon contains unique polyphenols that enhance insulin sensitivity and facilitate cellular glucose uptake with subsequent reduction in fasting blood glucose levels. Cinsulin® is a standardized water extract of cinnamon that has demonstrated the most significant glucose control effect in clinical studies.83,84 Cinsulin® has also been shown to reduce triglycerides, total cholesterol, and LDL.83,85-87 The daily dose of Cinsulin® is 175 mg taken before each meal (three times a day).
Coffee berry contains well-studied phytochemicals such as chlorogenic acid and caffeic acid, which are the two primary nutrients in the coffee berry that benefit individuals with high blood sugar. Glucose-6-phosphatase is an enzyme that promotes the release of stored glucose (glycogen) from the liver. It is often overactive in people with high blood sugar.88 Reducing the activity of the glucose-6-phosphatase enzyme leads to reduced blood sugar levels. Chlorogenic acid has been shown to inhibit the glucose-6-phosphatase enzyme resulting in reduced glucose production.89 Chlorogenic acid also has an antagonistic effect on glucose transport, decreasing the intestinal absorption rate of glucose.90 Caffeic acid increases glucose uptake into cells, helping remove it from the bloodstream.91 The suggested daily dose of standardized coffee berry extract is 100-200 mg.
Consume a very low-calorie diet (often less than 1,400 calories a day). Most people cannot adhere to a very low-calorie diet.33
Consume a Mediterranean diet, with lots of fresh fruits and vegetables, fish and soy as protein sources, and omega-3 and monounsaturated fats (olive oil), while avoiding saturated fats, refined carbohydrates, cholesterol-laden foods, excess omega-6 fats, and most animal products. An increasing percentage of Americans are adopting this kind of diet.34-37
Avoid sugary fruit juices (almost all fruit juices contain too many sugars) and beverages spiked with fructose, sucrose, and/or high-fructose corn syrup. Consume a low-glycemic index and low-glycemic load diet.
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.
To facilitate the remethylation of homocysteine into safer compounds such as SAMe (S-adenosyl-methionine), the following nutrients should be taken in the following doses each day:
Folic acid: 800-3,200 mcg100-102
Vitamin B12: 500-2,000 mcg103,104
Trimethylglycine (TMG): 500-8,000 mg105-107
Multivitamin with B complex and zinc108
(High-dose vitamin C has also been reported to help lower homocysteine).109
To facilitate the cystathionine b-synthase enzyme that converts homocysteine into beneficial cysteine and glutathione (via the trans-sulfuration pathway), increased doses of vitamin B6 are often needed. The high dose of conventional vitamin B6 (pyridoxine HCl) needed to lower homocysteine has raised concerns among some doctors. Fortunately, a form of vitamin B6 called pyridoxamine provides the body with the most biologically active form of vitamin B6 in a safe dose range.110 To reduce elevated homocysteine, 100-250 mg a day of pyridoxamine should be used.
1. Consume a vegan diet devoid of meat, with protein obtained primarily from plant sources (nuts, legumes, and soy).
2. Consume a Mediterranean diet, with lots of fresh fruits and vegetables, fish and soy as protein sources, and omega-3 and monounsaturated fats (olive oil), while minimizing meats like beef, pork, chicken, and turkey.34-37