Heart Disease & Stroke

Your heart disease and risk of stroke depends on a number of factors. These are called coronary risk factors. These are:
- Family History of early heart disease (under the age of 60)
- Smoking
- Blood Pressure
- Cholesterol Levels
- Triglyceride levels
- Diabetes
Then there are a number of other factors which may increase your risk:
- Sedentary Lifestyle
- Obesity
- Use of oral contraceptive pill especially in smokers
- Stress & Type A personality.
- Elevated Blood levels of:
By assessing your coronary risk, and being aware of your coronary risk factors you then have the power to make the necessary lifestyle changes and medication choices to minimize your risk of heart disease , vascular disease and stroke

Blood Pressure: Cardiovascular risk goes up significantly when the top blood pressure reading (Systolic) is above 135, and when the bottom figure (diastolic) is above 90. The Systolic pressure is the blood pressure at the time the heart contracts and pumps out a surge of blood. The Diastolic blood pressure is the resting pressure in between heart beats. An ideal blood pressure is 120/80 or less. Young females often have blood pressures less than 110/60 and this is normal.

Mild increases in blood pressure can be lowered by reducing salt, stopping smoking, weight loss, exercise and reducing alcohol intake.
High blood pressure often runs in families.
Blood pressure often starts to go up at about the age of 40 in males and at menopause in females.
Women who get high blood pressure during pregnancy are more likely to develop high blood pressure as they get older.
You can see how much your coronary risk would reduce if you lowered your blood pressure by entering a lower level into the heart risk calculator and recalculating.

Cholesterol: Cardiovascular risk can be improved greatly by reducing cholesterol. My goals for cholesterol a re pretty tough but are backed up by many organizations such as the National Prescribing Service.

Cholesterol Goals:
- Total Cholesterol < 4.5 mmol/l
- LDL (bad Cholesterol) < 2.5
- HDL (Good Cholesterol) > 1.2
- Triglycerides( Ugly fat) < 1.8
- You can see how much your coronary risk would reduce if you lowered your cholesterol by entering a lower cholesterol level into the heart risk calculator and recalculating.
Lowering cholesterol. Cholesterol can be lowered by diet, and by nutritional supplements like Policosanol and by medicines especially the Statin group of drugs, which slow down your liver's "cholesterol factory" by blocking an enzyme called CoA Reductase. Statins have few side effects in most people and are very effective at lowering cholesterol. In a few people they can cause muscle aches and this may be prevented by supplementing with CoQ10 supplements.
- Our Cholesterol lowering diet is the same as our weight loss diet and is a low fat low GI diet:
- Low saturated fat (<40g/day for females, and < 60g/day for males)
- Pick carbohydrates with a low GI (Glycaemic Index)
- Avoid transaminases such as margarines and avoid polyunsaturates,
- Mono unsaturated oils (olive and canola) and fish oils EPA/DHA are good.
- High fresh fruit and vegetables - at least 5 serves of fresh fruit or vegetables a day and the more colourful the better.
- Drink 6-8 glasses of water a day
- Minimise caffeine,and have none after 4pm.
- Cereals should be high fibre, low fat, low sugar and low GI.
- Eat deep sea fish especially salmon, tuna and swordfish at least 4-5 times a week
- Eat a small handful of nuts (especially macadamias, walnuts & brazil nuts 3 times a week.
- Drink a small amount of alcohol, preferably less than 1 glass of dry red wine daily on 5 days in any week,
- Eat small meals, the biggest meal no more than could be held in your two cupped hands.
- Eat three meals a day with a low fat, low GI, eat high fibre, high protein snack in between each meal if necessary to prevent hunger
- Eat soy products in preference to dairy
- Ensure you are getting adequate iron, calcium, zinc, magnesium & selenium. Supplement if necessary.
- Eat probiotics eg lactobacillus acidophilus and bifidus found in low fat soy or dairy yoghurts.
- If you are over 40 and obese you may well be converting too much of your testosterone to oestrogen, in both males and females which is one of the main causes of middle age spread. This can be slowed by supplementing with Zinc, Chrysin & DIM or IC3.
- If you are over 40 you may also be building up insulin resistance and developing syndrome x, supplementing with chromium may improve your insulin metabolism. Low fat, low GI diets with adequate exercise are essential for people with syndrome x.

Homocysteine Levels

Homocysteine is an amino acid. If raised it poses a significant risk, approximately the same as for cholesterol, of increasing coronary artery disease. Raised homocysteine levels are related to a large number of other conditions including dementia. Goal levels of homocysteine is to be in the LOWER half of the normal range.

Homocysteine can easily be lowered in most cases by:

Folic acid (folate) at least 800mcg a day. I suggest supplementing with 5mg tablets (most folate supplements are only 0.5mg i.e. 1/10 of this dose).
Vitamin B12 & B6, Biotin and other B group vitamins (a multi B supplement is recommended here).
TMG is a supplement which combined with folic acid and B vitamins breaks Homocysteine down into beneficial SaME.

Fibrinogen

Fibrinogen is a protein made by the liver involved in clotting and plaque formation; it is difficult to specifically lower fibrinogen but the following may help:

Aspirin 100mg/day; should not be used with salicylate allergy and increases the risk of intestinal bleeding. Preferably us an enteric coated form such as Cartia.
High Dose Fish Oil, but you probably need 5g or more daily.
Fibrate drugs such as gemfibrozol (Lopid) which also improve triglycerides. These should NOT be combined with the statin class of cholesterol lowering drugs.

Apolipoprotein a

If raised apolipoprotein a can be lowered by :

Statin drugs such as Lipex, Lipitor or Pravachol
Niacin Vitamin B3 is a very effective lowerer of cholesterol and apolipoprotein a as well as triglycerides. Unfortunately most peolple can't tolerate it because of unpleasant skin flushing.
IHN (Inositol hexanicotinate) is a form of niacin which lowers lipids effectively without flushing at a dose of 500mg/day.

Apolipoprotein b

Statin drugs such as Lipex, Lipitor or Pravachol
Niacin Vitamin B3 is a very effective lowerer of cholesterol and apolipoprotein a as well as triglycerides. Unfortunately most peolple can't tolerate it because of unpleasant skin flushing.
IHN (Inositol hexanicotinate) is a form of niacin which lowers lipids effectively without flushing at a dose of 500mg/day.