Life Extension Magazine May 2009
How to Circumvent 17 Independent Heart Attack Risk Factors
By William Faloon
HEART ATTACK RISK FACTOR #6: Excess C-Reactive Protein
Optimal Blood Level:
Under 0.55 mg/L of C-reactive protein in men
Chronically elevated C-reactive protein blood levels indicate you are suffering from a continuous systemic inflammatory state. Chronic inflammation damages every cell in the body. The chronic inflammation that occurs in the vascular wall is a significant cause of atherosclerosis and subsequent heart attack and stroke.111,112
C-reactive protein is produced in many cells throughout the body. The C-reactive protein that concerns us from a vascular risk standpoint is what is produced by fat cells (adipocytes) and the liver in response to excess interleukin-6 released by abdominal fat that is then dumped directly into the liver.
Drug options: Statin drugs such as Lipitor®,113 simvastatin,112 pravastatin,114 and Crestor®115 lower C-reactive protein, as do aspirin116,117 and ibuprofen.118 In order to significantly reduce C-reactive protein, it sometimes requires daily doses of these drugs that are higher than what many people can safely tolerate. A more pragmatic solution to reduce C-reactive protein is to use natural approaches described below, and take a smaller dose of drugs or no drugs at all. (Note: Low-dose aspirin [81 mg/day] should be taken by virtually anyone seeking to reduce their heart attack risk.)119
Nutrient options: The following nutrients have been shown to either directly reduce C-reactive protein or indirectly suppress factors that promote chronic inflammatory reactions in the body:
Nutrient-Dietary options: In response to the after-meal surge of ingested sugars and fats into the bloodstream, there are proinflammatory bursts of oxidative stress. The ingestion of soluble fiber(s) such as oat beta-glucan,17-19 psyllium,20 guar gum,21,22 pectin23, 24and/or glucomannan25 before a meal can slow down the absorption of sugars and fats and reduce the proinflammatory response. These same fibers also reduce LDL, total cholesterol, and glucose.143-146 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. Studies document significant reductions in C-reactive protein in response to higher fiber ingestion.147,148
Hormone options: As humans age, they often encounter a progressive increase in systemic inflammation that manifests in the blood as elevated C-reactive protein. Normal aging is also accompanied by a severe hormone imbalance. In men, low levels of testosterone and/or DHEA (and excess estrogen) are associated with persistent elevations of C-reactive protein.151-153 DHEA deficiencies in women can contribute to chronic inflammatory conditions.154-156 Restoring DHEA to youthful ranges may help reduce chronic inflammatory conditions in either sex.
For men, restoring youthful levels of testosterone and suppressing excess levels of estrogen may be particularly beneficial in combating chronic inflam-matory reactions. 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.
Lifestyle modification: People with destructive gum disease almost double their risk of heart attack.157 Studies indicate that C-reactive protein levels decline dramatically when periodontal disease is effectively treated.158
HEART ATTACK RISK FACTOR #7: Insufficient Vitamin D
Optimal Blood Level:
Over 31 ng/mL of 25-hydroxyvitamin D (Some studies suggest the optimal range is between 50 ng/mL and 65 ng/mL)
Vitamin D has long been known to protect the bones and in recent years to lower the risk of many forms of cancer. Findings released last year show that men with low vitamin D levels suffer more than twice as many heart attacks.159
Vitamin D may protect against heart disease via several different mechanisms, including reducing chronic inflammatory reactions that contribute to coronary atherosclerosis.160
Drug options: Potent forms of vitamin D (such as calcitriol) are sold as prescription drugs and may benefit individuals with certain kidney disorders.
For most people, however, there is no reason to consider these drugs when super low-cost vitamin D3 supplements are widely available.
Nutrient options: Vitamin D3 can be taken in supplemental form at the minimum dose of 1,000 IU a day, though most people could benefit greatly from higher doses in the range of 6,000 IU each day. The amount of supplemental vitamin D3 one needs is dependent on their body weight (large people need lots more supplemental vitamin D3) and sunlight exposure. When it comes to vitamin D3, it is not the amount ingested that is most important. What matters most is the achieved blood level of a vitamin D metabolite called 25-hydroxyvitamin D. Conventional medicine does not diagnose vitamin D deficiency until levels drop below 12 ng/mL, yet experts now state that 25-hydroxyvitamin D levels below 32 ng/mL represent a vitamin D insufficiency that increases one’s risk of contracting age-related disease.161,162
Dietary options: While vitamin D is present in healthy foods like fish, one would not want to try to obtain enough vitamin D via their diet as they are unlikely to obtain optimal levels.
Lifestyle options: Vitamin D is synthesized when the skin is exposed to sunlight. Intentional sunlight exposure is not recommended because of increased risks of basal cell, squamous cell, and melanoma skin cancers. Also, the skin of older people often does not efficiently synthesize enough vitamin D.163
HEART ATTACK RISK FACTOR #8: Insufficient Vitamin K
Optimal Blood Level:
Vitamin K blood tests assess levels of vitamin K to maintain healthy coagulation, but at this time are not used to identify optimal levels to reduce heart attack risk. Fortunately, there are also considerable data to substantiate that the proper vitamin K supplements correct insufficient vitamin K.164-169
Vitamin K is essential for regulating proteins in the body that direct calcium to the bones and keep it out of the arterial wall. Low vitamin K status predisposes aging humans to arterial calcification,170-173 chronic inflam-mation,125,126 and sharply higher heart attack risks.174
While most people have enough vitamin K in their blood to ensure healthy blood coagulation, many suffer from insufficient vitamin K to protect against arterial calcification and osteoporosis.175-178
Drug options: Vitamin K1 (phytonadione) is sold as a prescription drug, primarily to reverse the effects of a Coumadin® (warfarin) overdose.179 Low-cost vitamin K2 supplements are more effective for cardiovascular and bone health benefits in part because they can supply longer-acting forms of vitamin K.
Nutrient options: Vitamin K is sold as a dietary supplement as vitamin K1, vitamin K2 menaquinone-4 (MK-4), or vitamin K2 menaquinone-7 (MK-7). The MK-7 form has generated the most recent excitement because it achieves higher blood levels over a sustained 24-hour period. There is also strong supporting evidence to substantiate the vascular-protective effects of K1 and MK-4. Based on the totality of scientific data, an ideal daily vitamin K intake would consist of:
Dietary options: Vitamin K is found in two dietary forms: vitamin K1, which occurs in leafy green vegetables; and vitamin K2, which exists in organ meats, egg yolks, dairy products, and particularly in fermented products such as cheese and curd. While some ingested K1 is converted to K2 in the body, the most significant arterial benefits occur when vitamin K2 itself is supplemented.174 The absorption of K2 into the bloodstream is relatively efficient, whereas relatively little K1 is absorbed from plant foods.180 The kinds of foods rich in K2 in the Western world (organ meats, eggs, and dairy) should not be eaten in excess. Japanese who eat large quantities of a fermented soybean food called natto have lower rates of heart disease and osteoporosis.181,182 Natto is naturally rich in vitamin K2, but most people in Western worlds find it unpalatable.
HEART ATTACK RISK FACTOR #9: Elevated Triglycerides
Optimal Fasting Blood Level:
Under 80 mg/dL of triglycerides
Optimal Fasting Blood Level for individuals with pre-existing cardiovascular disease:
Under 60 mg/dL of triglycerides
Optimal Non-Fasting Blood Level:
Under 116 mg/dL of triglycerides
Triglycerides are the form in which most fat exists within the body. Triglycerides in the blood are derived from fats eaten in foods or are made in the body from other sources like carbohydrates. Calories ingested in a meal that are not used immediately by tissues are converted to triglycerides and transported to fat cells to be stored. Triglycerides are also present in the blood.
Triglycerides can accumulate on the walls of arteries and contribute to the buildup of atherosclerotic plaque. Elevated triglycerides increase risk of stroke and heart attack.183 Elevated blood triglycerides are involved in the deadly metabolic syndrome that predisposes individuals to type 2 diabetes and its related vascular complications.184
Triglycerides are the major constituent of belly fat. Excess blood triglycerides induce an accumulation of undesirable body fat (especially in the visceral abdominal region). Abdominal obesity is a major risk factor for heart attack, stroke, dementia, and a host of chronic inflammatory diseases.185-187
Conventional medicine says that triglyceride levels up to 149 mg/dL are safe, but Life Extension has long maintained that optimal fasting triglycerides are under 100 mg/dL of blood. Now, new evidence suggests that optimal fasting triglyceride levels are even lower.
Findings published over the past two years indicate that higher non-fasting triglyceride levels significantly increase heart attack and ischemic stroke risk. One study showed that compared to women with non-fasting triglyceride levels less than or equal to 104 mg/dL, women with a non-fasting triglyceride level of 105-170 mg/dL had 48% greater incident cardiovascular disease, and women with a non-fasting triglyceride level of greater than or equal to 171 mg/dL had 94% greater incident cardiovascular disease. These results were corrected for baseline differences in age, blood pressure, smoking, and use of hormone therapy.188
Another study found that the 10-year risk of ischemic stroke in men aged 55 years or older with non-fasting triglyceride levels of 443 mg/dL or greater was about five-fold higher than in men younger than 55 years with non-fasting triglyceride levels of less than 89 mg/dL.189 Still another study found heart attack risk was 46% higher in women and 18% higher in men for each 88.5 mg/dL increase in non-fasting triglyceride levels after adjustment for age.190
What do these new data mean? In response to eating a meal containing fat or high-glycemic index simple carbohydrates, blood triglyceride levels will increase. Those with healthy metabolic function should rapidly convert these dietary-induced triglycerides into energy or fat storage if needed.
As we age, our ability to healthily metabolize dietary fats and sugars diminishes, resulting in our bloodstream being chronically overloaded with triglycerides that contribute to the development of type 2 diabetes, metabolic syndrome, and obesity. By over-consuming too many of the wrong kinds of calories, many of those following Western dietary patterns are in a state of postprandial (after-meal) hypertriglyceridemia (too many triglycerides in the blood) for most of the day.
What makes the new findings about non-fasting triglycerides so shocking is that it does not require particularly high triglyceride blood levels to substantially increase vascular disease risk. In fact, most doctors consider these kinds of triglyceride readings to be “normal.” It is also completely “normal” for aging people to suffer heart attacks and strokes, as these conditions remain the leading causes of death and disability.
A fasting blood draw is done 12 hours after eating. A non-fasting blood draw may be done 2-8 hours after one eats a typical meal. If fasting triglycerides are over 99 mg/dL, there is a good chance your non-fasting triglycerides are higher than they should be. We are therefore reducing our recommendation for optimal fasting triglyceride level to under 80 mg/dL of blood. We know that achieving this lower level will be challenging to certain individuals, especially those suffering from obesity, type 2 diabetes, and/or metabolic syndrome. Fortunately, there is an arsenal of nutrients and drugs at your disposal that can dramatically slash triglyceride blood levels.
Drug options: The two most effective triglyceride-lowering prescription drugs are Niaspan®,46 which is extended-release niacin, and Lovaza®, which is highly concentrated fish oil.191 The triglyceride-lowering benefits of these drugs can easily be duplicated with low-cost dietary supplements.
Those with stubbornly high triglyceride levels may consider the prescription drug metformin in the starting dose of 250 mg twice a day and moving up to 850 mg two to three times a day as long as fasting glucose levels do not drop below 72-74 mg/dL of blood. Metformin reduces triglycerides along with glucose.192
The prescription drug orlistat (Xenical® or its over-the-counter version Alli™) reduces dietary fat absorption by 30% and will drastically reduce triglyceride levels when taken in the dose of 120 mg before each meal (three times a day).193 The gastrointestinal side effects of these kinds of lipase-inhibitor drugs cause us to recommend them for only a 60-day initiation period, with the objective of using them to motivate the user to reduce dietary fat consumption over a long- term basis (even after they discontinue the drug).
The alpha-glucosidase inhibitor drug acarbose blocks a carbohydrate-degrading enzyme and can reduce triglyceride levels when taken in the dose of 50 mg three times a day.194 Alpha-glucosidase inhibitors are also available as low-cost dietary supplements (such as Salacia oblonga or Salacia reticulata extracts). Like acarbose, they function by decreasing the breakdown of simple carbohydrates in the intestine, resulting in a lower rise in blood glucose throughout the day and a corresponding reduction in triglycerides.195,196
Alpha-amylase inhibitors may be even more effective than alpha-glucosidase inhibitors for reducing triglycerides. The best documented alpha-amylase inhibitor consists of an extract from the white kidney bean (Phaseolus vulgaris). In a placebo-controlled study, those taking 445 mg/day of 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).197
There would appear to be an even greater benefit in combating excess triglyceride blood levels by taking an alpha-glucosidase and an alpha-amylase inhibitor. Such combinations will soon be available in dietary supplement form. Alternatively, one can be prescribed 50 mg three times a day of the drug acarbose and take 445 mg a day of a white kidney bean extract supplement.
Dietary-Lifestyle options: Weight loss can greatly reduce triglycerides and postprandial lipoproteins, particularly when it is achieved using a diet that is low in simple carbohydrates, high in protein, and moderate in monounsaturated fats. Cutting out processed carbohydrates (such as breads, crackers, breakfast cereals, bagels, and pretzels made with refined, processed white flour) alone can yield a 30% reduction in postprandial lipoproteins.205,206 Increasing your intake of yogurt, cottage cheese, and other low-fat dairy products, raw almonds and walnuts, and fish, chicken, turkey, and other sources of lean protein will also yield substantial reductions in postprandial lipoprotein particles. Weight loss restores the insulin responsiveness lost in metabolic syndrome, which also reduces postprandial lipoproteins.
If you are overweight, cut down on calories to reach your ideal body weight. This includes excess calories from fats, proteins, carbohydrates, and alcohol. Reduce the saturated fat, trans fats, and cholesterol content of your diet. Reduce your intake of alcohol considerably as even small amounts of alcohol can lead to large changes in plasma triglyceride levels. Eat vegetables and non-fat or low-fat dairy products most often. Eat whole fruits rich in fiber, but do not overindulge. Fruit sugar (fructose) can raise triglyceride levels when consumed in excess. For this reason, avoid commercial fruit juices due to their concentrated calorie content and high fructose levels. Get at least 30 minutes of moderate-intensity physical activity on five or more days each week. Substitute monounsaturated and certain polyunsaturated fats—such as those found in olive and canola oil—in place of saturated fats. Avoid high-glycemic load foods. Incorporate fish that is high in omega-3 fatty acids (such as mackerel, lake trout, herring, sardines, tuna, and salmon) in place of red meats high in saturated fat and arachidonic acid (the building block for the proinflammatory series 2 prostaglandins).