Life Extension Magazine®
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. Nutrient options:
Dietary options:
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 Nutrient options:
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 Nutrient options:
Dietary options:
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. Nutrient options:
Dietary options:
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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 Dietary options:
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. Nutrient options:
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). | ||||
HEART ATTACK RISK FACTOR #10: Low Blood EPA/DHA Optimal Blood Level:Commercial EPA/DHA blood tests are expensive and not always readily available. Blood triglyceride levels may be used as a partial surrogate marker to ensure sufficient EPA/DHA intake, along with ingesting the suggested daily amount of EPA/DHA from fish. Scientists long ago documented that those who ingest lots of EPA/DHA from coldwater fish have markedly lower heart attack rates. Controlled clinical studies substantiate a significant reduction in heart attacks in response to fish oil-derived EPA/DHA.207 A study measured levels of EPA/DHA in patients’ blood and established that low EPA/DHA was an independent risk factor for heart attack. Compared with age-matched controls, the risk of unstable angina or heart attack in these patients was reduced 62% for every 1.24% increase in whole-blood EPA/DHA.208 Drug options: EPA/DHA prescription drugs are available that can cost seven times more than comparable EPA/DHA dietary supplements. Nutrient options: Fish oil supplements are widely available as dietary supplements. For most people, a daily dose of 1,400 mg of EPA and 1,000 mg of DHA from fish oil provides optimal dosing. The addition of sesame lignans has been shown to improve the efficiency of fish oil in the body via several mechanisms.129,130,209-211 If you are taking 1,400 mg EPA and 1,000 mg DHA and your triglyceride levels are over 80 mg/dL of blood, then you should increase your fish oil intake until triglyceride levels are reduced below 80 mg/dL. Dietary options: Some studies show that consuming as few as two coldwater fish meals a week reduces heart attack risk.212 We suggest that omega-3 fatty acids (EPA/DHA) should be part of your everyday program, which can be accomplished by eating mackerel, lake trout, herring, sardines, tuna, sea bass, and salmon (and/or by taking EPA/DHA supplements). HEART ATTACK RISK FACTORS #11 and #12: Low Testosterone and Excess Estrogen (in Men) Optimal Blood Level:20-24 pg/mL of Free Testosterone (men only) Aging males can suffer the dual consequence of declining testicular testosterone production, while the testosterone they do produce is often excessively converted (aromatized) into estrogen. Numerous studies link low testosterone (and excess estradiol) with increased heart attack and stroke risk.40,213-217 Many of these studies have identified specific mechanisms by which an imbalance of these hormones promotes atherosclerosis and subsequent heart attack/stroke incidence.52,218,219 Testosterone, for instance, is intimately involved in the reverse cholesterol transport process that involves the removal of cholesterol from the arterial wall by HDL. Excess estrogen is linked with higher C-reactive protein and a greater propensity for abnormal blood clots to form in arteries, causing a sudden heart attack or stroke.213,220,221 Drug options: To restore testosterone to youthful levels, natural testosterone cream is available as a ready-made prescription drug for around $225 a month, or a physician can prescribe a compounded natural testosterone cream that costs around $20 a month. The dose of testosterone prescribed should be based on blood tests showing what baseline free testosterone levels are. To suppress excess estrogen, the aromatase-inhibitor drug Arimidex® can be prescribed in the low dose of 0.5 mg to be taken twice a week. Men with pre-existing prostate cancer should avoid testosterone until their cancer is cured. Nutrient options: For men who suffer low testo-sterone (and sometimes excess estrogen) because they express too much aromatase enzyme, nutrients like specialized plant lignans (30 mg a day and higher of HMR™ Lignan) and Bioperine®-enhanced absorption chrysin (1,500 mg a day) may be all that is needed.222-224 Zinc (50 mg/day) may also help suppress excess aromatase.225 Dietary-lifestyle options: Abdominal fat has a propensity to produce excess aromatase, which converts testosterone into estrogen in aging men.226-228 Losing belly fat with the help of nutrients like Irvingia extract can help restore a more youthful hormone balance.30-32 Restoring testosterone to youthful ranges can also help reduce belly fat mass. Excess alcohol consumption can reduce the ability of the liver to remove excess estrogen. HEART ATTACK RISK FACTOR #13: Excess Insulin Optimal Blood Level:Under 5 mcIU/mL of fasting insulin (difficult for aging people to achieve) Aging people lose their ability to utilize insulin to effectively drive blood glucose into energy-producing cells. As glucose levels rise in the blood, the pancreas compensates by producing more insulin. As “insulin resistance” worsens, even more insulin is secreted in a feeble attempt to restore glucose control. Excess insulin is associated with greater risks of heart attack, stroke, and many cancers.229-232 Many of the same strategies you read earlier to lower excess glucose also lower excess insulin. Drug options: The prescription drug metformin helps to improve insulin sensitivity and suppress factors in the body involved in causing excess blood glucose.57,233,234 Metformin is available in low-cost generic form and has a long enough history of safe human use for those with excess blood insulin to consider taking it even if they are not diagnosed as diabetic. Some of the side benefits of metformin include weight loss, which itself is a proven heart attack risk reducer.235 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 Those with impaired kidney function should not take metformin. Another drug that lowers insulin levels is acarbose, which reduces the absorption of ingested carbohydrates 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 and subsequent excess insulin release.59-61 Nutrient options:
Dietary options:
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 DHEA 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 insulin sensitivity.96,236 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 #14: Nitric Oxide Deficit Optimal Blood Level: Commercial blood tests are not yet available at affordable prices to assess nitric oxide status. Aging individuals should assume they are developing a nitric oxide deficit in their inner arterial wall (the endothelium) and follow simple steps to protect themselves. Even when all other risk factors are controlled for, the age-related decline in endothelial nitric oxide too often causes accelerated atherosclerosis unless corrective measures are taken. Nitric oxide is required for healthy inner arterial wall (endothelial) function. Nitric oxide enables arteries to expand and contract with youthful elasticity and is vital to maintaining the structural integrity of the endothelium, thus protecting against atherosclerosis. The age-related deficiency in endothelial-derived nitric oxide predisposes maturing humans to today’s epidemic of heart attack and stroke.237-239 Drug options: One of the little-known benefits of statin drugs is that they promote endothelial nitric oxide synthesis.240 Our current recommendation is for aging people to take the lowest statin drug dose to achieve desired LDL levels. Some people only require 5-10 mg of simvastatin or 20-40 mg of pravastatin per day. At these modest doses, side effects are rare. Supplemental CoQ10 is needed to protect against statin-drug induced coenzyme Q10 deficiency.1,2
Nutrient options: The classic nutrient to boost nitric oxide levels is high-dose arginine, an amino acid found in many foods. Arginine is a precursor to the natural synthesis of nitric oxide in the endothelium. The problem is that arginine is rapidly degraded in the body by five different enzymes, thus requiring dosing of arginine every 4-6 hours. Even if one were to take this much arginine, changes that occur in the arteries of aging people cause rapid depletion of endothelial nitric oxide. A more effective way of boosting nitric oxide is to protect it from excessive degradation. One of the many beneficial vascular effects of pomegranate is its ability to increase endothelial nitric oxide levels.241-243 By virtue of its effect in restoring nitric oxide, pomegranate may help combat endothelial dysfunction—the leading cause of atherosclerosis. Daily consumption of eight ounces of pure pomegranate juice has been used in human studies that show significant regression of markers of atherosclerotic occlusion.50,244-248 There is concern that the sugar calories in pomegranate juice could create glucose control issues. There are standardized pomegranate supplements that provide the active constituents of eight ounces of pomegranate juice in 400-500 mg capsules. Additional nutrients that can protect precious nitric oxide against degradation include a patented SOD-boosting complex called GliSODin® and standardized cocoa polyphenols.249,250 Dietary options: Consuming fruits (pomegranate), berries (blueberry, raspberry), and teas (green tea) that contain polyphenols can protect nitric oxide from oxidative degradation.242,251,252 HEART ATTACK RISK FACTOR #15: Excess Fibrinogen Optimal Blood Level:Less than 300 mg/dL of fibrinogen Many heart attacks and strokes are caused by a blood clot that obstructs the flow of blood to a portion of the heart or brain. When blood flow is interrupted, cells are deprived of oxygen and die. The build-up of atherosclerotic plaque increases the risk of abnormal blood clotting inside arteries. Blood clots kill more than 600,000 Americans every year, yet conventional medicine has largely ignored well-documented methods of reducing abnormal blood clot formation.253,254 Low-dose aspirin and certain nutrients (like plant polyphenols) provide partial protection against abnormal blood clots, but the risks associated with excess fibrinogen mandate that additional measures be taken to prevent heart attacks and strokes. Fibrinogen is a component of blood involved in the clotting process. High levels of fibrinogen predispose a person to coronary and cerebral artery disease, even when other known risk factors such as cholesterol are normal.255-258 Drug options: Prescription drugs that lower fibrinogen (like gemfibrozil) have side effects that have precluded their routine use. Statin drugs can indirectly reduce fibrinogen by lowering LDL levels. Nutrient options: Nutrients that people take to reduce other heart attack risk factors also lower fibrinogen. These include:
Dietary-lifestyle options: Avoid exposure to cold temperatures, as cold increases fibrinogen by 11%.267 Incorporate olive oil into your diet and avoid high-cholesterol foods and saturated fats. Keep homocysteine levels low as excess homocysteine interferes with the natural breakdown of fibrinogen in the body (refer to Heart Attack Risk Factor #5 to review ways of suppressing excess homocysteine). HEART ATTACK RISK FACTOR #16: Hypertension Optimal Blood Pressure level: This risk factor for heart attack and stroke cannot be detected by a blood test. One’s blood pressure should be checked regularly by a medical professional. Home blood pressure monitoring devices can also help keep track of blood pressure and assess the efficacy of antihypertensive drugs or natural therapies. High blood pressure causes hundreds of thousands of Americans to needlessly die each year. Most people will develop hypertension at some point in their life. Since hypertension is not new, and antihypertensive drugs are not extensively promoted to the public, vast numbers of even health-conscious people neglect this critical part of a heart attack prevention program.
Many doctors allow a patient’s blood pressure to reach 140/90 mmHg before prescribing antihypertensive drugs. This can be a lethal mistake. While the standard upper limit for blood pressure has been 120/80 mmHg for decades, findings from a myriad of published studies reveal that optimal blood pressure ranges are under 115/76 mmHg.268-271 What this means is that many people are being told by their doctors that their blood pressure is fine, when it really is much too high. Another common error is improperly prescribing antihypertensive drugs that either fail to lower blood pressure enough, or allow gaps at certain times of the day when blood pressure shoots too high. According to a study published in the Journal of the American Medical Association, the risk of cardiovascular disease incrementally increases when blood pressure readings pass 115/75 mmHg.272 Plain and simple, this means that the vast majority of adults living in the Western world are walking around with blood pressure that is dangerously too high! Drug options: Concern about side effects has kept too many people from using safe antihypertensive medications. The cleanest and most effective anti-hypertensive drugs are the angiotensin II receptor antagonists. Cozaar® is a popular drug in this class and should be taken in the dose of 25-50 mg two times a day.273 Once-a-day dosing of Cozaar® and many other antihypertensive drugs does not always provide all-day reduction in blood pressure. A once-a-day drug in this class of antihypertensives is called Benicar®, which can be taken in the daily dose of 20-40 mg a day.274 Additional antihypertensive medications can be added if blood pressure is not adequately reduced. Nutrient Options: There are a number of nutrients that can assist in lowering blood pressure and may help mitigate some of the damaging effects that hypertension inflicts. Under no circumstances, however, should anyone assume that taking these nutrients will protect against a heart attack or stroke if their blood pressure is not brought under control, using either antihypertensive drugs and/or dietary and lifestyle modifications. Nutrients that have been shown to reduce blood pressure include:
Dietary-lifestyle options: Blood pressure can be brought down in a significant number of people if they modify their lifestyle by losing weight, cutting out salt, consuming a healthy diet, and stopping smoking. The Dietary Approaches to Stop Hypertension (DASH) diet is recommended by both mainstream and integrative medical practitioners as a first-line approach to manage hypertension.272,297 The DASH diet is high in fruits, vegetables, and other nutritious foods that are rich in potassium, calcium, and magnesium. People who utilize the DASH diet are encouraged to decrease their saturated fats and replace them with foods high in monounsaturated fats and omega-3 fatty acids, such as those found in fish. Salt restriction is also a major part of the DASH diet—recommendations are that people with hypertension limit their salt intake to less than 2,400 mg (about one teaspoon) a day. Studies have shown that people who follow the DASH diet can decrease their systolic pressure by 11 points and their diastolic pressure by about six points.298 Obesity puts a person at increased risk of developing hypertension at an early age, as well as developing more severe hypertension. With weight loss, hypertension can be significantly controlled. In a seven-year study of people who restricted their salt intake and were on a weight-loss program, 80% of the people who stayed on the diet lowered their blood pressure to such a degree that they were able to completely stop their prescription blood pressure medication.299 A lifelong calorie-restriction program will significantly lower blood pressure, but few people can adhere to these kinds of very low-calorie diets.300,301 Hormone options: Sex hormone receptor sites are present in the inner lining of the arterial system (the endothelium). As men and women age, their sex hormones decline as their blood pressure increases. Men should refer to Heart Attack Risk Factors #11 and 12 to review how they can safely restore testosterone levels to youthful ranges. Aging women (without pre-existing hormone-sensitive cancer) should seek to maintain more youthful levels of estrogens and progesterone to help control blood pressure. | |||||
HEART ATTACK RISK FACTOR #17: Oxidized LDL Optimal Blood Level: Commercial blood tests are not yet available at affordable prices to measure oxidized LDL. Aging individuals should assume their endogenous antioxidant levels (superoxide dismutase, catalase, and glutathione) are being depleted and that the oxidation of their LDL (low-density lipoprotein) is progressively worsening. The over-promotion of “statin” drugs has resulted in today’s cardiologists focusing on reducing their patient’s LDL and total cholesterol levels. Pharmaceutical company advertising makes it appear as if the only cause of atherosclerosis is excess LDL and cholesterol. Beginning in 1979, however, researchers made discoveries indicating that the oxidation of LDL results in severe arterial damage. Thousands of studies now reveal how oxidized LDL contributes to the entire atherosclerotic process from start to finish.302 Drug options: Statin drugs help protect against LDL oxidation; however, by inhibiting coenzyme Q10 synthesis, they deprive the body of one of its most important protectors against LDL oxidation. Nutrient options: Most Life Extension members take nutrients that have been shown to significantly reduce LDL oxidation such as gamma tocopherol,303,304 sesame lignans,305 and lycopene.306,307 A number of studies document the ability of ubiquinol CoQ10 to protect against LDL oxidation better than lycopene, alpha tocopherol, and other lipid-soluble antioxidants.308 Perhaps no other nutrient has demonstrated better anti-LDL oxidation effects than pomegranate. In a clinical study, human subjects taking pomegranate showed a remarkable 90% reduction in the LDL basal oxidative state.50 There are standardized pomegranate supplements that provide the active constiutuents shown to reduce LDL oxidation. The usual dose is 400-500 mg of these standardized pomegranate capsules a day. The suggested dose for ubiquinol to reduce LDL oxidation is 100-200 mg a day. Dietary options: The term postprandial oxidative stress means the oxidation that occurs after ingesting a meal. The higher the calorie, sugar, and fat content of the meal, the greater the level of post-meal oxidative stress. Reduce calorie content and take antioxidant supplements with each meal. Some people also consume polyphenol-rich beverages such as green tea, red wine, or pomegranate juice with meals to reduce postprandial oxidative stress.50,203,242,309 Beware of the high sugar calories in red wine and pomegranate juice. Hormone options: The hormones melatonin and DHEA confer significant protection against LDL oxidation. As these hormones decline with normal aging, LDL oxidation increases, as does heart attack and stroke risk. Aging humans can supplement with melatonin doses as low as 300 mcg all the way up to 10-20 mg. Women usually need only modest DHEA dosing (15-25 mg in the morning), whereas men usually need 50 mg of DHEA each morning and sometimes higher. A DHEA blood test enables one to restore their DHEA to the optimal youthful range of 500-640 mcg/dL for men and 250-380 mcg/dL for women. Those with hormone-sensitive cancers are often advised to avoid DHEA. Virtually No One Should Be Having Heart Attacks Today!A question that future medical historians may ask is why so many people kept having heart attacks and strokes when proven ways existed to detect and correct the known risk factors. Based on decades of intensive scientific research, the underlying causes of heart attack and stroke are not a mystery. For reasons that relate to apathy and ignorance, along with drug company propaganda, the majority of aging humans are walking around with a time bomb (coronary atherosclerosis) ticking in their chests. Many are doing nothing to prevent heart attack, while others are making such partial efforts that they are only postponing the inevitable. I spent an inordinate amount of time assembling the data to write this article because I am shocked that so many dedicated Life Extension members are failing to correct for all 17 of these proven vascular disease risk factors. Please remember, if you do almost everything right, but ignore even one of these 17 risk factors, you subject yourself to the horrific consequences of blockage of critical arteries that carry blood to your heart, brain, and kidneys. It is my sincere desire to never again hear from a health-conscious person that they have been diagnosed with coronary artery occlusion. That’s why we have made comprehensive blood testing available at ultra-low prices. With the data presented in this article, you can order low-cost blood tests, find out what your heart attack vulnerabilities are, and take immediate corrective actions. You should also make sure you know your blood pressure and take whatever steps are needed to keep it at 115/75 mmHg or lower (there are exceptions to this, such as those suffering from diabetic and certain kidney disorders). To order a panel of comprehensive blood tests, call 1-800-208-3444 or log on to https://www.lifeextension.com/lab-testing. To view the comprehensive lab test panels available, visit the lab test link above. To view the comprehensive blood test panels available to Foundation members, visit the Blood Test link above. If you have any questions on the scientific content of this article, please call a Life Extension Wellness Specialist at 1-800-226-2370. | |
| References | |
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