A Functional Approach to Cardiovascular Wellness

In this episode of Wellness Connection MD, Dr. McMinn and Coach Lindsay discuss a functional (root cause) approach to cardiovascular disease (CVD), the leading cause of death worldwide for both men and women. Your chances of dying from this disease are greater than for any other cause. You’ll find the information that you need in this podcast to improve your odds of suffering with, and dying from heart disease. 

This episode starts by defining exactly what is meant by the term “cardiovascular disease,” and discussing the various disorders affecting the heart and blood vessels, including coronary artery disease, high blood pressure, stroke, heart failure, arrhythmias, and peripheral arterial disease, among others.

Then Dr. McMinn and Lindsay break down the various cardiovascular risk factors, both modifiable and non-modifiable, and they present evidence-based practical solutions, both from the functional and integrative perspective, as well as conventional approaches for prevention and treatment, with an emphasis on personalized strategies. 

The key takeaway is that understanding and addressing modifiable risk factors is crucial for both prevention and treatment of cardiovascular disease. 

The episode also refers to many additional resources available at McMinnMD.com, including “The Daggers of Cardiovascular Disease,” a summary of metabolic syndrome, integrative therapies for high blood pressure, sleep therapy options, Dr. McMinn’s stress toolbox and strass plan, a document about natural ways to balance lipids, information about smoking cessation, and Dr. McMinn’s cardiovascular wellness plans.

If you enjoy the podcast please leave a review on iTunes and share it with a friend. Feel free to contact Dr. McMinn at doctormcminn@yahoo.com for feedback or topic suggestions.

In closing: Your health is your greatest gift. Cherish your gift of heart health, and put together a personalized plan to live a long and healthy life by warding off cardiovascular disease.  

Chapters

• 0:03 Cardiovascular Disease Risk Factors Discussion
• 12:31 Nutrition and Cardiovascular Health
• 17:56 Cardiovascular Risk Factors and Prevention
• 29:03 Cardiovascular Risk Factors and Recommendations
• 44:14 Organ Cross-Talk Impact on Cardiovascular Health
• 53:46 Cardiovascular Risk Factors and Management
• 1:02:55 Lifestyle Medicine and Cardiovascular Risk

Transcript

Speaker 1: 0:03

Hello, I'm Dr McMahon and welcome to the Wellness Connection MD podcast. In this episode we're going to explore a functional approach to cardiovascular disease, the number one cause of death in men and women worldwide. The main emphasis of the podcast is a thorough discussion of the modifiable risk factors of heart disease. Unfortunately, recent studies show that these risk factors are on the rise, but it doesn't have to be that way. We give you practical, evidence-based solutions from functional, integrative and conventional medicine to help you avoid this dreaded disease. We also discuss additional resources at mcmindmdcom, including information about metabolic syndrome, natural blood pressure therapies, stress management tools, cholesterol management, sleep therapeutic options, smoking cessation support and Dr McMinn's cardio wellness plan. We hope you enjoy the show.

Speaker 2: 0:52

Welcome to the Wellness Connection MD podcast with Dr McMinn and Coach Lindsay, where we bring you the latest up-to-date, evidence-based information on a wide variety of health and wellness topics, along with practical take-home solutions. Dr McMinn is an integrated and functional MD and Lindsay Matthews is a registered nurse and IIN-certified health coach. Together, our goal is to help you optimize your health and wellness in mind, body and spirit. To see a list of all of our podcasts, visit McMinnMDcom and to stay up to date on the latest topics, be sure to subscribe to our podcast on your favorite podcast player so that you'll be notified when future episodes come out. The discussions contained in this podcast are for educational purposes only and are not intended to diagnose or treat any disease. Please do not apply any of this information without approval from your personal doctor. And now on to the show with Dr McMinn and Coach Lindsey.

Speaker 1: 1:46

Hello and welcome to the Wellness Connection MD Podcast with Dr McMinn and Coach Lindsey the evidence-based podcast with all things wellness where we bring you honest, commercial-free, unbiased, up-to-date and evidence-based information, along with practical solutions in order to empower you to overcome your healthcare challenges and to optimize your wellness in mind, body and spirit, and to become a great captain of your ship when it comes to your health and wellness. We thank you so much for joining us today. I'm Dr Jim McMinn and I'm here today with our co-host nurse and certified health coach, ms Lindsay Matthews. Good morning, coach.

Speaker 3: 2:20

Good morning, dr Mack. It's good to be back with all you listeners. We are excited to be recording another show here. So, dr, talking about cardiovascular disease, every single cell in the body needs a constant blood supply to deliver oxygen and nutrients that are necessary for our life, and it's really the job of the cardiovascular system to make that happen.

Speaker 1: 2:59

You know, coach, by now.

Speaker 1: 3:00

I hope you appreciate that we are the evidence-based functional medicine podcast, and in the realmbased functional medicine podcast and in the realm of functional medicine, we always look at things from the why point of view.

Speaker 1: 3:09

So let's apply that same functional medicine thinking to heart disease. So, coach, why do people get heart disease? Well, that's what we're going to be talking about today, coach. We're going to look at cardiovascular disease from the point of view of risk factors for heart disease, because understanding these risk factors is crucial for prevention and for treatment and with so many things in functional medicine, if you identify and treat the root cause, then you'll get better outcomes. So we're going to identify those root causes, or risk factors, as we call them, of cardiovascular disease today and, in most cases, give you some practical solutions. And, for your viewing pleasure, we put together a list of these risk factors for heart disease, which you can find at bickmanmdcom under the documents menu. It's entitled the Daggers of Cardiovascular Disease and, by the way, coach, I think it's the most thorough list of cardiovascular risk factors that you'll find anywhere.

Speaker 3: 4:00

I love this visual and I like just thinking about like a dagger to the heart. You know what are those things. So it kind of falls into two big categories when you're looking at the actual visual itself. And those two categories are ones that are modifiable risk factors, which means that you get control over that risk factor, you can modify it. And then there's the non-modifiable ones, things that you really don't have control over. So, for instance, you can't change your family history, you can't change your personal history, like how old you are, your race, your gender, your genetic predisposition, but those factors, those non-modifiable factors, still profoundly affect your risk of heart disease. So we want to make sure that we don't underestimate those. So there was a study published in the Journal of the American College of Cardiology that found that individuals with a family history of premature heart disease had two times as many heart attacks or strokes. So you got to pick your parents wisely, I guess, is the moral of that story the next time you want to avoid heart disease.

Speaker 1: 5:09

Yeah, coach, there are some people to use an old phrase that are just what I call born behind the eight ball. Do you know what that means, coach? Have you heard that phrase before I?

Speaker 3: 5:16

have heard that phrase before.

Speaker 1: 5:18

I used to play pool years ago, and so that's where I got that from. But when it comes to heart risk factors, however, there are many other risk factors that are modifiable, and that's what we're really going to focus on today and, as usual, coach, most of it goes back to being a good captain of your ship, like we talk about on every single show.

Speaker 3: 5:34

We really do, you know. It also reminds me talking about the old eight ball being in the wrong position. It reminds me of the old serenity prayer which says you've got to help me accept the things that we can't change and then have the courage to change the things that we can, and then the wisdom to know the difference between the two. So I think that applies to so many things in life and in this case we want to help you listeners identify the things that you can change so that you can be empowered and encouraged to really avoid this common disease that can be pretty disastrous.

Speaker 1: 6:13

And let me be clear possessing one or more risk factors definitely increases a person's risk of developing cardiovascular disease, but it does not mean that cardiovascular disease is inevitable. I've known patients in their 90s who have huge cholesterol levels and they don't have a lick of heart disease and they go on to live a long, happy life.

Speaker 3: 6:30

Right. So before we dive into the risk factor discussion, let's be sure that we're all on the same page. Let's just define what we mean by the term cardiovascular disease. So simply put, it's a group of disorders affecting the heart and blood vessels, and on this podcast you might hear Dr Mack and I abbreviate that with CVD, which stands for cardiovascular disease.

Speaker 1: 6:55

And the reason we feel it's important to define the term cardiovascular disease is that, for instance, stroke is considered to be a cardiovascular disease. Now, before I got into medicine, I might have thought stroke was just mainly a brain disease, right, but it's really a vascular disease which just happens to be in the brain, so it really falls into the category of cardiovascular disease.

Speaker 3: 7:13

And then, when we talk about cardiovascular disease, there's common types. So first type, coronary artery disease, so that's the narrowing or blockage of arteries around the heart. And then two another type of cardiovascular disease would be high blood pressure. Three, heart failure, which really refers to the heart's inability to pump the blood effectively out to the body. Four, arrhythmias, so that's where your heart rate or rhythm is abnormal, like atrial fibrillation. Afib Stroke would be number five, and that's caused by a reduced or blocked blood supply to the brain, like you mentioned, dr McMahon.

Speaker 1: 7:56

And then we have number six, which is peripheral artery disease, which is narrowing of the blood vessels in the arms and legs. And then number seven is congenital heart disease, and these are structural abnormalities in the heart present from birth. Number eight is cardiomyopathy, which is a disease of the actual heart muscle itself. It affects its shape, size and pumping ability. And then we have rheumatic heart disease, caused by strep infections, which causes damage to the heart valves. And then we have venous thromboembolism, which is where a person gets blood clots in the veins which can then travel to bad places like the lungs or the brain and cause serious mayhem.

Speaker 3: 8:31

Before we move further and describe the risk factors, let's break down the four major components of cardiovascular disease. So first we have, or just really have, the cardiovascular system. So we've got a pump which is the actual heart muscle. Then we've got all the pipes right, the vessels which go all throughout your body, to every single cell in your body.

Speaker 1: 8:54

And next we have the electrical system which innervates the heart and the vessels, and then we have the blood vessels and then we have the blood itself, and this is important because some blood problems, such as clotting disorders, can greatly affect cardiovascular risk. Unfortunately, there are many things that can go wrong in all four of these major components our cardiovascular system.

Speaker 3: 9:21

And now we're going to move into the modifiable risk factors. So you can, if you want to, if you have space and time, pull up the daggers of cardiovascular disease that handout we were talking about and you can follow along. We'll start with high blood pressure, and also known as hypertension. You might've heard that term. It's really a silent killer because most of the time you can't even feel it, but it can sneak up on you and cause serious problems.

Speaker 1: 9:48

So that high blood pressure goes on to cause heart failure, coronary artery disease, stroke, peripheral artery disease, aortic stenosis, which is a heart valve disease, and cardiac rhythm problems such as atrial fibrillation, as well as other things like kidney disease, dementia and early death.

Speaker 3: 10:06

The Framingham Heart Study, known as one of the largest studies of its kind, showed that individuals with blood pressure higher than 160 over 95 had about a fourfold increase in the risk of coronary heart disease compared to those that had just a fourfold increase in the risk of coronary heart disease compared to those that had just a normal blood pressure.

Speaker 1: 10:28

Non-pharmacologic, non-invasive treatments of high blood pressure include things like low-sodium diet, adequate potassium intake, routine physical activity and attaining a healthy body weight. Smoking cessation and, for some people, reduction of alcohol may also help, and there are also some other non-drug strategies that have some solid evidence to back them up. These are too numerous to list here, but we have a document at mcmindmdcom under the document section that lists these for you, so check that out.

Speaker 3: 10:56

At the end of the day, though, you've just got to do what you've got to do to bring your blood pressure down to an acceptable range. So if your blood pressure is not too high and it's okay with your provider, you might like to try some lifestyle and natural remedies that we mentioned, but if that doesn't work, then your provider will probably want to start you on some meds, and most doctors start to think about meds when the blood pressure exceeds 140 over 90. Really, a target goal for therapy is to kind of get that blood pressure down below 130 over 80.

Speaker 1: 11:27

So the bottom line when it comes to blood pressure is to work with your provider and to get your blood pressure under control, whatever it takes. This is just super important, because failing to do so can cause lots of badness.

Speaker 3: 11:39

So let's turn over to the diet, the modern American diet, with this excess of saturated fats, trans fats, sugar, refined carbs, ultra processed foods, high levels of sodium, low nutrient density, aka the SAD diet, right, standard American diet. It's a major risk factor for heart disease disease. So, on the other hand, we've got the PREDIMED study which demonstrated that the Mediterranean diet which, if you've listened to our podcast before, you've heard us mention it several times, right, dr Mack, of course Supplemented with extra virgin olive oil or nuts, so it has all those good, wonderful fats reduce the risk of major cardiovascular events by 30%.

Speaker 1: 12:26

Yeah, it's really impressive. Yeah, never underestimate the healing power of a good diet. There is a specific diet called the DASH diet, which is a spinoff of the Mediterranean diet, which can bring down blood pressure. The letters DASH stand for Dietary Approach to Stopping Hypertension. So diet-wise, we should limit excessive sodium, ultra-processed carbohydrates, sugar-sweetened beverages like sodas and sweet tea, alcoholic beverages, trans fats, saturated fats and ultra-processed meats and we should be eating more vegetables, fruits, legumes, nuts, whole grains, seeds and fish.

Speaker 3: 13:02

You know again the good old Mediterranean diet. It's good for whatever ails you, dr Mack.

Speaker 1: 13:07

For real.

Speaker 3: 13:07

It was recently named the best diet for overall health for the eighth year in a row, and one of the amazing things I think about the Mediterranean diet that I think is highly worth mentioning when we talk about cardiovascular health is olive oil, like I briefly mentioned earlier. But the Mediterranean diet uses a lot of olive oil and research indicates that olive oil has benefits on both inflammation and cardiovascular disease. There was a study out of Yale that showed a 19% lower risk of heart disease with just a half a tablespoon of olive oil daily.

Speaker 1: 13:38

Wow, that's pretty impressive. I think it also helps with dementia and stuff like that too.

Speaker 3: 13:42

Yes, yes, just because of that overall inflammatory effect you know, I know you know this, dr Mack, but Tyler and I supplement olive oil. We take it like a supplement every day. I like to take it as a shot glass personally. But, Tyler likes to get it on his food. And anyway, I just think the power of good, old-fashioned olive oil.

Speaker 1: 14:00

Right, right, right. It's pretty amazing. I had a patient one time, leslie. She was so into like eating non-processed food. I told her to take some olive oil. She said well, doctor, isn't that processed? Shouldn't I just eat olives?

Speaker 3: 14:14

So I guess that takes it to a whole nother level. It does take it to a whole nother level, but wow.

Speaker 1: 14:18

I was impressed.

Speaker 3: 14:27

Personally, I don't take it that far, coach? I don't think I do either. But you know, anyway, that's interesting to think about. But you know, dr Mann, I think it can be hard for especially us Southerners, right we're recording this from Alabama that it's hard to jump from a lot of our fried foods to a Mediterranean diet.

Speaker 3: 14:41

You know, after all, chick-fil-a is God's chicken, right? Oh yeah. So I just want to encourage our listeners, like I always like to, just from a health coach perspective just take some small steps in the right direction and make healthy substitutions. So it might be helpful to work with a good nutritionist like our friend Rachel Olson, who we've had on the podcast before. She's a wonderful wealth of knowledge, she's super nice. You can find her information under our guest biographies on mcminnmdcom. She's super intelligent, well-researched and she can get you really where you need to be.

Speaker 3: 15:12

And you know, before we move on from diet stuff, the Mediterranean diet can be great for so many people but maybe it's not for everyone. For instance, my hubby Tyler. He has some specific health issues which have responded better to a different diet. So it goes back to that concept of personalized medicine where you know there's the Dr McMinn diet, there's the Lindsay diet, there's the Tyler diet and we got to kind of hone in what works best for your body with whatever it is that you're dealing with, and nutritionists like Rachel can really help you if you need guidance in that area.

Speaker 1: 15:43

You know, coach, for instance, we're looking at this from the lens of cardiovascular health. There are other people who at certain points in their life, their main emphasis may not be cardiovascular health, but it might be gut health or dysautonomia or something else, and so they have to kind of have a diet that's really focused on their main thing at that time. But then things might change and someday they might find that a Mediterranean diet is right for them, but maybe not right now.

Speaker 3: 16:06

And I think that idea of whole, like nutrition's not static, because our life is not static. You know our needs in life are not static. You know we go through different seasons. We see that just in nature itself. So I think it makes sense that the diet needs to adjust to you and the season of life you're in.

Speaker 1: 16:23

Correct, it's not static and it's not one size fits all for sure. So, speaking of nutrition, coach, low vitamin D levels have also been linked to increased cardiovascular risk. A meta-analysis in the American Journal of Clinical Nutrition showed that individuals with the lowest vitamin D levels had a 52% increased risk of cardiovascular disease. Whoa, coach, that's huge.

Speaker 3: 16:42

Yeah, vitamin D super huge. And there was another randomized controlled trial that looked at supplementing vitamin D and K2 together and found that those two supplements had a 70% fewer adverse cardiovascular events for people taking them. 70%.

Speaker 1: 17:01

Yeah, that's really striking Coach. Yeah, it is. And so, and by the way, let me say, before you take any supplements, check with your primary care doctor or your cardiologist, because not everybody, for instance, can take vitamin K, and so, anyway, there are some, you know, supplement drug interactions and things like that that you'll have to check with your PCP on. So there are some other specific nutritional deficiencies that can also affect cardiovascular risk, as supported by scientific evidence, and these include things like B vitamin deficiencies, deficiencies in vitamin C, vitamin E, magnesium, calcium, potassium, zinc, iron and omega-3 fatty acids.

Speaker 3: 17:37

So the next risk factor on our list that we're going to discuss is obesity, and this is a significant problem in America and it is increasing. And this is a significant problem in America and it is increasing. It's getting worse. Projections suggest that about 60% of today's children will develop obesity by the age of 35. And that's sad. Obesity carries with it a significant increased risk for developing cardiovascular conditions.

Speaker 1: 18:05

Significant increased risk for developing cardiovascular conditions in addition to other diseases and problems, and studies show that for every five-unit increase in body mass index, the risk of coronary artery disease increases by approximately 20 to 30 percent. This happens via numerous different mechanisms, and these include things like increased strain on the heart, high blood pressure, unhealthy cholesterol, systemic inflammation, increased insulin resistance and type 2 diabetes. Increased risk of obstructive sleep apnea, increased risk of blood clotting, so that extra weight is not just about looking good in your favorite dress. It's about life and death.

Speaker 3: 18:37

Weight loss is a whole podcast of its own. It's a complex issue and we don't want to oversimplify it. There are so many factors that go into it, so you really need to work with your provider and consider working with a nutritionist or a health coach Whatever works for you in order to achieve your ideal body weight. Your health will improve in so many ways and you'll feel so much better as well.

Speaker 1: 19:02

Yeah, Now, Coach, just a brief word about hydration. There are a couple of studies which suggest that poor hydration can increase cardiovascular risk via several different mechanisms that I'm going to go into today. So the solution, of course, is just adequate fluid intake. And the next risk factor that we'll mention is metabolic syndrome. You can think of this as kind of like a pre-diabetes. It was always amazing to me how many patients came in with clear metabolic syndrome, but their doctors had never even mentioned it. The key here is that you don't have to wait to cross a line into diabetes before you start getting risk factors for badness. People with metabolic syndrome, even without diabetes, are two to three times more likely to develop cardiovascular disease compared to those without it, even without other traditional risk factors like smoking. So if you recognize and treat this early, then you can nip it in the bud and prevent some serious stuff like diabetes, heart disease and stroke.

Speaker 3: 19:54

So how does one recognize metabolic syndrome? According to the American Heart Association, there's five different criteria and if you have three out of five then you are considered to have metabolic syndrome. So those criteria are increased waist circumference, high triglycerides, low HDL cholesterol, increased systolic blood pressure that's that top number and increased fasting blood sugar levels. So they do have all those specific cutoff numbers. If you really would like to go look those up, you can. They're readily available online and we'll in fact have a summary posted of it on the metabolic syndrome document in the document section at mcminnmdcom. So we'll have that listed for you to look at.

Speaker 1: 20:41

And treatment of metabolic syndrome usually starts with lifestyle changes. These include diet, exercise, all that kind of stuff. Consistent dietary changes and regular physical activity not only help manage metabolic syndrome, but also reduce its long-term health risks. Then, if lifestyle changes don't do the job, then medications may help. Again, the key is early recognition, and then the earlier the interventions begin, the more profound the benefits will be.

Speaker 3: 21:03

You know, my parents recently came into town. Dr Mack and dad was sitting at the table talking about chopping wood and he was talking about the importance of chopping it early after the tree fell versus waiting, and because if you wait longer that wood gets harder and if you chop it right away he described dad said it chops like butter, and I just think about that as a concept here with so much of this lifestyle medicine the longer you wait, the harder it will be.

Speaker 3: 21:30

So today is the day, today's the day Chop it like butter versus waiting until it gets harder and harder to do the next risk factor that we'll mention is diabetes, and sometimes, if you don't nip it in the bud like we're talking about, then prediabetes does turn into diabetes. The InterHeart study showed that diabetes doubled the risk of heart attack. Type 1 diabetes is considered to be an autoimmune disease. However, type 2 is more closely related to all these lifestyle factors. So attention to things like diet, exercise, weight management can really help prevent and, in many cases, really actually treat type 2 diabetes.

Speaker 1: 22:10

You know, another one of the core lifestyle factors that is, a cardiovascular risk factor that we often underestimate is restorative sleep. Poor sleep quality and quantity can eventually take a toll. A study in the European Heart Journal found that individuals sleeping less than six hours per night had a 48% increased risk of developing or dying from coronary heart disease. Sleep apnea, in particular, has been strongly linked to hypertension, arrhythmias and heart failure.

Speaker 3: 22:35

And speaking of sleep, another sleep-related issue is shift work. So numerous studies have shown that shift workers are at higher risk of cardiovascular disease events like myocardial infarction, stroke and coronary artery disease. Some meta-analysis showed that 15 to 20 percent there was a higher risk of cardiovascular events for shift workers compared to regular daytime work schedules. So, gosh, I'm so appreciative of night shift workers, especially in the hospital, dr Mack, and I know you took your fair turn of that, but the bottom line is it's we got to make sleep a priority and work with your provider if you need to check for sleep apnea as well. So, if you need more expertise, there's some excellent doctors who specialize in sleep medicine and we'll have a document for you again on McMinnMDcom, in the document section called McMinn Sleep Therapy Options.

Speaker 1: 23:30

In our neighborhood. I pass by a hospital frequently and every time I do I look up there and I think about all the doctors, nurses, orderlies, pharmacists and other fine folks that take care of us all night, and how grateful I am. And what would we do without them? And you know, that can be said for all the people who work nights I mean to fill up our grocery shelves or whatever. So I'm just so grateful for them. But it does take a toll on those people, yeah for sure.

Speaker 3: 23:56

Yes.

Speaker 1: 23:58

I can attest to that, after working 20 years of night shifts in the ER, I know you can yeah.

Speaker 1: 24:05

But the ears of night shifts in the ear. I know you can, yeah, but mental health also plays a role in heart health, Coach. There's an old saying that goes like this the body is a puppet of the mind. And I think there's a lot of truth to that saying, Coach. In other words, it's all linked together. If we're having troubles with our mind and that creates problems throughout our body, for instance, there's solid evidence that things like depression, anxiety, social isolation, instance, there's solid evidence that things like depression, anxiety, social isolation, loneliness, PTSD and emotional and psychological trauma are all linked to cardiovascular disease.

Speaker 3: 24:35

Meta-analysis published in the European Journal of Preventive Cardiology found that depression was associated with a 30% increased risk of coronary artery disease. And then there was another meta-analysis of 46 different studies that found that anxiety was associated with 41% higher risk of coronary heart disease and cardiovascular mortality.

Speaker 1: 24:54

Well, coach, those are huge numbers, aren't they?

Speaker 3: 24:56

They are, they really are, yeah, yeah, it's very significant, and I don't know very many people in my life that could say they don't have anxiety. You know, yeah, right.

Speaker 1: 25:04

These are anxious times we live in, aren't they?

Speaker 3: 25:06

Coach they are yes, sir.

Speaker 1: 25:08

Another meta-analysis published in the journal Heart in 2016 showed that social isolation and loneliness are associated with a 29% increased risk of coronary artery disease and a 32% increased risk of stroke. In fact, chronic loneliness has been compared to smoking 15 cigarettes a day in terms of its impact on health. Wow.

Speaker 3: 25:27

Wow, yeah, that's quite a statement, isn't that?

Speaker 3: 25:31

something. Moving on to stress, so extensive research has demonstrated that both acute and chronic stress can have detrimental effects on our heart health specifically. So some studies suggest that chronic stress may be associated with 50% excess risk for cardiovascular disease may be associated with 50% excess risk for cardiovascular disease. So managing that stress should be considered a very important component of cardiovascular disease prevention and treatment strategies. And again at mcminnmdcom you can find Dr Mack's stress management toolbox and his stress plan in the document section. So just you know, listeners, take a day sometime, peruse that website and hit the print button.

Speaker 2: 26:15

You know.

Speaker 3: 26:16

Print some of those resources out. They're free for you?

Speaker 1: 26:19

Yeah, they are free. Research has consistently demonstrated a strong link between emotional and psychological trauma as an increased risk factor for cardiovascular disease. These folks have a 27 to 44% higher risk of cardiovascular disease, even after accounting for lifestyle and medical factors, and this increased risk applies to both acute and chronic trauma. Interestingly, severe childhood adversity in particular puts people at risk with a 50% higher risk of developing cardiovascular disease later in life. You know, coach, there's an interesting phenomenon that I saw back in my ER days called broken heart syndrome. It's also known as takotsubo cardiomyopathy or stress cardiomyopathy. It usually affects women, typically postmenopausal women, and these women would have a sudden heart attack due to severe acute stress.

Speaker 3: 27:05

Really, literally dying of a broken heart, like it's called broken heart syndrome Broken heart, like it's called, broken heart syndrome. Last on our list of mental health-related cardiovascular risk conditions is post-traumatic stress disorder, or PTSD. Individuals with PTSD unfortunately have a 49% increased risk of coronary heart disease and cardiovascular mortality. Cardiovascular conditions resulting from PTSD also include high blood pressure, AFib, heart failure, stroke, coronary heart disease and heart attack itself.

Speaker 1: 27:39

Now, anybody can have PTSD under the right circumstances or I should say the wrong circumstances but we often see in our brave veterans who have made so many sacrifices for our country. These folks should be closely monitored for cardiovascular risk factors and complications and, interestingly, women are more at risk than men for PTSD. An interdisciplinary approach involving mental health professionals and a cardiologist may be beneficial for optimal care for these folks.

Speaker 3: 28:05

So when we're looking at these effects of depression, anxiety, loneliness, social isolation, stress, emotional and psychological trauma like PTSD, the bottom line is clear there's a direct heart-brain connection and we need to take care of our mental and spiritual health and stay social, really in order to reduce our cardiovascular risk.

Speaker 1: 28:28

Now let's move on to another one of our key lifestyle factors related to cardiovascular risk, and that is exercise. According to the American Society of Preventive Cardiology, physical inactivity is a major risk factor for cardiovascular disease, leading directly or indirectly to 10% increase in premature mortality. And yet only 50% of adults get sufficient physical activity. Worldwide, approximately 3.9 million premature deaths could be prevented every year just by getting adequate physical activity 3.9 million.

Speaker 3: 28:59

Yeah, that's a lot of folks in it, you know. I'd like to point out that it's not just the classic cardio exercise that could help, but also strength exercise or resistance training can have a really significant positive impact on cardiovascular risk. Studies show that engaging in weight training can be as effective as aerobic exercise for improving blood pressure and your lipid profiles, and strength training is also linked to a lower risk of cardiovascular events and mortality, specifically in older adults. Risk of cardiovascular events and mortality, specifically in older adults. So the combination of using resistant training with the aerobic training may provide greater benefits for reducing certain cardiovascular disease risk factors like obesity, diabetes, hypercholesterolemia versus just doing one of those types of exercise alone, but doing that combination resistance and aerobic training.

Speaker 1: 29:54

Well. So, coach, that begs the question how much exercise is enough? Well, the answer is somewhat debatable, but many experts recommend that we get at least 150 minutes of moderate intensity physical activity per week, or greater than 75 minutes of vigorous, intensive physical activity per week. However, if you can't reach these goals, then it's worth noting that any exercise is better than none. Another thing, coach I think that it's worth noting that if you sit for 10 hours a day, you can't overcome that, really, with exercise. I think there's this old saying that sitting is the new smoking. You've heard that, right, yes, I have heard that.

Speaker 1: 30:27

I think when you're at work, if you can have a standing desk or if you can get up once an hour and move around, all that stuff is quite helpful as well. Due to the emerging data as far as strength training that you talked about a little bit earlier, Coach, the American Heart Association is now also recommending that we combine cardio and strength exercise.

Speaker 3: 30:46

And I want to emphasize that you don't have to go to the gym or buy a bunch of expensive equipment to really harness this benefit. The Harvard alumni study found that men who just walked regularly had a significantly lower risk of coronary heart disease. And there was a large the Nurses' Health Study that found that women who walk briskly for at least 30 minutes a day had a 30% lower risk of developing heart disease. So no equipment needed, except maybe the good pair of old-fashioned walking shoes. And for the strength training. Really people can do those old-fashioned things like push-ups and pull-ups, squats and lunges. You don't have to make it so complicated that you end up not doing it. I think sometimes that's the barrier in itself.

Speaker 1: 31:32

Yeah, start easy, and you know, I have begun to realize, Coach, I think the key is consistency. Really Make it a lifetime habit, you know. Just plan it into your day. Okay, when am I going to get exercise? Am I a morning exerciser? Or I know my wife, Dr Cheryl. She likes to exercise in the morning. I'm not a morning guy, so I do it before dinner, but I do it consistently almost every day, and so I think that's the key. Next on the list is smoking, and smoking. Tobacco significantly increases your chances of developing cardiovascular disease. Smoking damages and narrows the arteries through a number of different mechanisms, but the good news is that after quitting smoking, health benefits such as improved circulation usually happen relatively quickly, coach.

Speaker 3: 32:14

Quitting can be difficult, though, and it can be hard to do it by yourself, so there's many tools in the smoking cessation toolbox, so work with your provider to get on a program, and the first step is just really to make up your mind that it's important enough for you to do it.

Speaker 1: 32:31

You know, one good way to get them in to quit coach, is to tell them that smoking is terrible for erectile function and knowing that, right there, we'll get a lot of guys to kick the habit.

Speaker 3: 32:41

You know it's funny. I was talking to someone last night who was sharing the story that there was a man that was diagnosed with prostate cancer and he decided he was going to quit smoking because of that. And you know, I mean I'm sure there's some correlation there, but of course the correlation would be, a stronger cancer for something else but that was the. You know that was the domino that helped him stop it.

Speaker 1: 33:03

Well, you can tell them that smoking, tell the guys that smoking causes cardiovascular disease and it's not going to change their mind. But if you tell, them that it causes erectile dysfunction, then for sure they'll quit. So anyway, that's motivating. Yeah, that's right, that's right.

Speaker 3: 33:18

So maybe sometime we can do another podcast on that. Dr Mack Smoking cessation.

Speaker 1: 33:23

Yeah, yeah.

Speaker 3: 33:23

But next on the list is socioeconomic status, and you know we're not surprised here that people who have a lower socioeconomic status are at a greater risk of developing cardiovascular disease, and the reasons for this are multiple and complex. Diet is generally considered to be one of the biggest reasons. People from a higher socioeconomic background usually have greater access to more nutritionally balanced diets. Background usually have greater access to more nutritionally balanced diets. And then, on the other hand, people with that low socioeconomic status often live in places called food deserts where they're not having access to food that is more healthy for you and then just factually, it costs money to eat. Well, organic food is more expensive than processed foods and less readily available.

Speaker 1: 34:17

Another factor is that people with lower socioeconomic status have a higher exposure to toxins. We'll dive into the toxin issue in just a bit. But think about it You'll never find a chemical factory or a polluting oil refinery in an affluent community. They're always located in communities of color and where you'll find a lot of poor people always located in communities of color and where you'll find a lot of poor people.

Speaker 3: 34:38

So let's kind of also mention ethnicity. The terms race and ethnicity are often used interchangeably, but ethnicity really has a broader context. Race is primarily a social construct, historically based on physical characteristics such as skin color, facial features, hair texture. It has often been used to classify people into broader categories like Black, White, Asian, whereas ethnicity refers to shared cultural factors language, religion, ancestry, traditions, cultural practices. So it's more about the person's cultural identity than a physical appearance.

Speaker 1: 35:11

So, for instance, statistics suggest that people who are of Caribbean descent have a greater risk of developing cardiovascular disease, regardless of their race. Another example for instance, a white person who lives in the American South, who eats the classic Southern diet, which is terrible for your heart, may have a different cardiovascular risk profile, say, compared to a white person who grows up in Japan, where he or she is exposed to a diet rich in omega-3s, along with vegetables, soy, green tea, and a low consumption of saturated fats and processed foods.

Speaker 3: 35:49

Menopause has long been thought of as a non-modifiable risk factor. However, times have changed and in these days where we have hormone replacement therapy as an option for these women, we can kind of start to think of menopause, possibly even as a more modifiable risk factor to some extent.

Speaker 1: 36:01

Now I'm going to use the abbreviation HRT for hormone replacement therapy, and for many years HRT was thought to cause an increase in cardiovascular risk. This was mainly due to a study called the Women's Health Initiative Study, which was back in the 90s, and it was very misleading in this regard. Women in the study who took Primpro had more heart problems than women in the study who did not. A more in-depth breakdown, however, of the WHI data and more recent studies have challenged that notion. The problem was in those early studies like the WHI, they used the wrong hormones.

Speaker 1: 36:34

The primrin used in the Women's Health Initiative study is not the same as a woman's own natural estrogen. The estrogen in primrin comes from a pregnant horse. It's basically horse estrogen, not human estrogen. It's not the same. They have a different chemical composition and even a slight change in chemical composition can create different outcomes. Also, they gave it orally and we know now that oral estrogens cause more blood clots and cardiovascular risk, whereas transdermal estrogens do not. Likewise, the Primpro uses a progestin called Provera, which is not the same as a woman's natural progesterone, and in hindsight, the data suggests that the Provera was definitely a culprit when it comes to cardiovascular risk. Also, in some of these studies, the HRT regimen was started at an older age, many years after menopause, which skews the results towards cardiovascular badness. However, we now see, with some excellent large studies, that a well-designed HRT regimen with bioidentical hormones, used the right way at the right time, can actually reduce cardiovascular risk.

Speaker 3: 37:34

For instance, the Danish osteoporosis prevention study with over a 10-year follow-up found that early initiation of HRT reduced cardiovascular mortality and did not increase stroke or thrombolytic events.

Speaker 1: 37:51

Another study called the E3N study, a large study out of France with over 100,000 women specifically examined transdermal estrogen with a bioidentical micronized progesterone, and they found a lower risk of cardiovascular disease compared with other HRT types and also compared to neurohormone replacement therapy at all. These studies illustrate what I've been saying on the podcast for many years when it comes to HRT, it matters what you use and how you use it, and when it comes to cardiovascular disease, it also matters when you use it To reduce cardiovascular risk. Hrt works best if it started within 10 years of menopause. Also, you'll want to use a transdermal estrogen along with a bioidentical progesterone. If you do that, then the data is crystal clear. There is no increased risk of clotting and HRT can significantly reduce cardiovascular risk. So work with a qualified provider who specializes in HRT to get on a customized program, and this can help you in many ways, including heart protection.

Speaker 3: 38:45

And let's transition to also cover the issue of infectious disease. So certain infectious diseases do increase the risk of infectious disease. So certain infectious diseases do increase the risk of cardiovascular disease. So, for instance, viral infections, hiv, influenza, chronic hepatitis C, covid-19, and bacterial infections like chlamydia, pneumonia, streptococcal infections, as well also chronic infections of the gums in our mouth, those can increase the risk of cardiovascular disease. Got to also mention parasitic infections like the Chagas disease and chronic gut infections like H pylori are linked to cardiovascular disease. So the solution here is of course to avoid or properly treat these infections when they come up.

Speaker 1: 39:34

There are also certain medications that may increase the risk of cardiovascular disease. For some folks, these include the chronic use of non-steroidal anti-inflammatory drugs, which we also call NSAIDs, such as Motrin and Naproxen. Also, there's a certain class of NSAIDs called selective COX-2 inhibitors, such as Celebrex, that are particularly associated with an elevated risk of blood clotting, which can lead to things like heart attacks and strokes.

Speaker 3: 39:57

Other medicines that can increase the risk of cardiovascular disease include oral contraceptives, antipsychotics, chemotherapy, immunosuppressants and some diabetes medications, and then stimulants like amphetamines, either prescribed or recreational, like cocaine and meth.

Speaker 1: 40:15

Other medications that impact cardiovascular risk include Phentermin, which is a weight loss drug we don't use that much anymore, but we used it back in my early career Certain anabolic steroids, some antidepressants, such as tricyclic antidepressants, corticosteroids like prednisone, and drugs that cause what we call QT prolongation, which would include some antiarrhythmics, some antibiotics, some antifungals and anti-nausea drugs. So you'll certainly want to work with your prescribing provider if you're taking any of these medications in order to mitigate your cardiovascular risk.

Speaker 3: 40:46

The next risk factor that we'll mention on our daggers of cardiovascular disease is toxins. This significantly contributes to cardiovascular risk, and we feel that the adverse medical impact of toxins really is grossly underestimated by the medical community. When is the last time your cardiologist tested for, or even mentioned toxins? I'll bet the house that the answer is never. However, recent scientific evidence strongly supports the link between the exposure of environmental toxins, particularly toxic metals so lead, cadmium, arsenic with an increased risk of cardiovascular disease. Even low-level chronic exposure to these metals can increase your risk by 15 up to 85 percent. So if you think you are not exposed, then you really are underestimating our world today. We live in a world full of toxins, and it's not an exaggeration to say that you'll find toxins in the food that we eat, the water that we drink and the air that we breathe, and we just kind of need to accept that and then make a strategy.

Speaker 1: 41:58

Right, right, right right, and some are more contaminated than others. Like you know, you have the Dirty Dozen and the Clean 15, you know when it comes to foods, and so, with the Dirty Dozen, definitely want to buy those organic, don't you? So efforts to reduce exposure to toxins, both as an individual and as a society, could play a major role in reducing cardiovascular disease. These include wisely choosing the food that you eat, and, of course, organic is best in this regard, especially for the dirty dozen foods. Also, be careful about the lotions and the cosmetics you put on your skin and drink filtered water. However, unless you move to Mars, it's hard to control the air that you breathe. Air pollution is not just down the street from the factory. They have found toxins in the air as far away as the South Pole and even on top of the Swiss Alps. The air pollution has been proven to be a significant risk factor for cardiovascular disease, with both long-term and short-term exposure contributing to increased morbidity and mortality.

Speaker 3: 42:50

So we did take a deep dive into the toxin issue before in the podcast back in 2021. So you might want to scroll back and check that out. You know microplastics are the latest hot topic when it comes to toxins these days.

Speaker 1: 43:05

Yeah, that's in the news a lot these days, coach, and there's a landmark study actually on that issue, published in March of 2024 in the Harvard Heart Letter, and they found that microplastics were present in the coronary artery plaques of a significant number of patients, and the presence of these microplastics in arterial plaques is associated with a higher risk of serious cardiovascular events.

Speaker 1: 43:26

What they found was that patients with detectable microplastics in their coronary arteries had about a 4.5 times chance of having a heart attack and stroke or of dying of any cause during the study period. One more thing, before we move on from toxin issue, coaches, is the issue of mycotoxins, which come from mold and they can also contribute to cardiovascular disease. So work with your provider to test for mold and treat if needed. And, by the way, you may have to go and find a functional medicine doc or a clinic that specializes in mold in order to get proper testing and treatment for mycotoxins. This is just not on the radar of most regular doctors. So check out our podcast on toxins if you'd like to learn more about this important topic.

Speaker 3: 44:14

And next up on the list of cardiovascular risk factors is immune dysregulation, which significantly impacts the risk of cardiovascular disease. So extensive research has demonstrated that chronic activation of our immune systems is a major contributor to the development and progression of numerous cardiovascular diseases, including heart attack, stroke, hardening of the arteries, heart failure and atrial fibrillation.

Speaker 1: 44:32

A couple of the immune-mediated diseases that present cardiovascular risk include rheumatoid arthritis, an autoimmune disease in which patients have a 48% higher risk of cardiovascular events compared to the general population, and inflammatory bowel disease, which is linked to about a 24% higher risk of heart attack and stroke. So aggressively treating these diseases, especially from the focus on reducing inflammation, can help reduce cardiovascular risk.

Speaker 3: 44:56

And speaking of inflammation, that's another huge cardiovascular risk factor, really kind of getting more at the root of the situation, right, if we're finding that as a common theme in many of these things. So it plays a pivotal role in the development of the hardening of the arteries which we call atherosclerosis, and that's the primary underlining cause of most cardiovascular events. So research has shown strong and consistent relationships between markers of inflammation and a risk of future cardiovascular events.

Speaker 1: 45:30

Some studies have shown that for patients with hardening of their arteries and systemic inflammation, there is a 30% higher rate of major adverse cardiovascular events like heart attack or stroke, a 24% higher rate of heart failure hospitalizations and a 35% higher risk of death.

Speaker 3: 45:46

A high-quality study called the CANTOS trial demonstrated that targeting inflammation, even without changing cholesterol levels, can significantly reduce the risk of subsequent heart attacks, stroke and the need for major cardiac interventions.

Speaker 1: 46:02

So identifying inflammation and aggressively treating it can definitely impact cardiovascular outcomes. We did an entire podcast on the subject back in 2023, so if you're interested in this, you might want to go back and check that out. I'll also have a document for you at mcminnmdcom on the causes of inflammation.

Speaker 3: 46:18

Our next cardiovascular risk factor is allergies, and this also has a significant impact on your risk. Several studies have found an association between allergic disorders, high blood pressure and coronary heart disease. This may be mediated by a couple of mechanisms that we've already talked about, like immune activation and inflammation. So avoidance and treatment with a qualified allergist would be mainstays as part of a cardiovascular prevention program.

Speaker 1: 46:50

And similarly, sensitivities such as gluten sensitivity are associated with increased cardiovascular risk. This is not a true allergy, but it's a sensitivity or intolerance. It's estimated that celiac disease is associated with a 27 to 44 percent higher risk of cardiovascular disease, after accounting for various lifestyle, medical and other cardiovascular risk factors. In order to reduce cardiovascular risk, a gluten-free diet would need to be initiated and maintained in these patients.

Speaker 3: 47:15

You know, there's a song I've heard and it's Dem Bones and that musically describes the connection between all the bones of the body. Sometimes my kids like to make it like the head bones connected to the knee bone but that you know that doesn't work that way, but you know the head bone and the clavicle and the shoulders.

Speaker 3: 47:32

So, but the idea being that everything in the body truly is connected and each organ counts on the other organs to keep it healthy, it's a harmony, it's a symphony of sorts, and the heart is no exception to this. So, for instance, when we have a chronic kidney disease, then there is a significant increased risk of cardiovascular disease, including coronary artery disease, heart failures, arrhythmias, sudden cardiac death, stroke and also peripheral artery disease. Everything's connected.

Speaker 1: 48:06

In fact, studies have shown that patients with chronic kidney disease have nearly double the risk of coronary artery disease compared to those without chronic kidney disease, and cardiovascular mortality accounts for about 40 to 50 percent of all deaths in patients with advanced kidney disease, compared to 26 percent in those with normal kidney function.

Speaker 3: 48:24

Also, liver disease significantly affects cardiovascular risk. For instance, people with non-alcoholic fatty liver disease have nearly double the risk of coronary artery disease compared to those that don't have liver disease at all. And liver disease is actually much more common than you might think. Many people don't even know they have it until it really gets severe. Yet it affects the heart in its early stages. So the solution to the problem is early detection and then appropriate management of liver disease, as well as just a multidisciplinary approach involving a liver specialist and a cardiologist. Those kind of big picture outlooks can be really helpful when you're thinking about this.

Speaker 1: 49:07

There are some other organs Coach which affect heart health, and these include the brain, the lungs, the pancreas, the thyroid and the adrenal glands, the gut, the muscles, the fat tissue, endocrine system and bone marrow. Disorders affecting blood cell production can indirectly impact cardiovascular health, but in the interest of time we won't go into this in detail.

Speaker 3: 49:24

And our next cardiovascular risk factor is sarcopenia, and that's the loss of muscle mass. So multiple studies have demonstrated a significant association between sarcopenia and higher cardiovascular disease risk. It's associated with a faster progression of cardiovascular disease and a higher risk of mortality. So screening for sarcopenia in proper intervention may be crucial in preventing or delaying the progression of cardiovascular disease.

Speaker 1: 49:54

Now, if you've been listening to our podcast for any length of time, then you'll know that we are bullish on the microbiome.

Speaker 3: 49:59

That's right.

Speaker 1: 50:00

And when it comes to the gut microbiome, studies show that alterations in the gut microbiome can significantly increase heart attacks, strokes, peripheral artery disease, hospitalizations and death.

Speaker 3: 50:10

Interestingly, we see the oral microbiome also playing a role here. Several studies have identified specific oral bacteria associated with increased cardiovascular disease, like a longitudinal study that was over 18.8 years. Have identified specific oral bacteria associated with increased cardiovascular disease, like a longitudinal study that was over 18.8 years. Found that good oral hygiene, like brushing and flossing, was associated with a 51% reduction in cardiovascular disease mortality. Get out the floss, folks.

Speaker 1: 50:39

Well, isn't that fascinating. I think most folks are pretty clueless to that fact.

Speaker 3: 50:44

Yes, yeah, I know I was Teeth bones connected to your heart muscle.

Speaker 1: 50:49

There we go there we go, and some studies actually have linked frequent mouthwash used to increase cardiovascular risk, especially with the antibacterial mouthwashes containing something called chlorhexidine. There are several mouthwash brands out there that are not antibacterial and you can do a web search on those. I use one called Tom's of Maine I like quite a bit and my wife, Dr Cheryl, says my breath is not terribly bad, just moderately bad. So the bottom line is that good oral hygiene is in order and aggressive treatment of periodontal disease and targeting oral dysbiosis may be helpful to reduce cardiovascular disease.

Speaker 3: 51:24

Next let's take a look at clotting disorders. So there's a whole host of clotting disorders, often caused by genetic alterations or autoimmune issues. But these disorders can increase cardiovascular risk through different mechanisms, primarily by promoting clotting, increasing inflammation and influencing atherosclerosis development, which again, that's the hardening of the arteries. So a tailored approach for these patients can certainly reduce their risk of adverse cardiovascular events, and a team approach with a hematologist and cardiologist would be your best bet if you have a clotting disorder like this.

Speaker 1: 52:04

And then we move on to excessive alcohol consumption. It's another cardiovascular risk factor. It significantly affects cardiovascular health by increasing the risk of high blood pressure arrhythmias, heart attack, stroke, heart failure and enlargement of the heart muscle itself.

Speaker 3: 52:19

Unfortunately, we do see a lot of sexism in our world today that we live in, and we find that alcohol picks more on women than men. So women who consume eight or more alcoholic beverages per week, calculating that out, just one a day, right.

Speaker 1: 52:33

Yeah, just about one a day coach.

Speaker 3: 52:35

For us ladies, that gives us a 45% higher risk of heart disease compared to those with a low intake, which is really significant. Dr, Mack can't ignore that.

Speaker 1: 52:45

Well, coach, I have a confession to make. I went to my excellent new primary care doctor I won't mention her name, but anyway about a year ago and it's my first visit to her, and she asked me if I drink alcohol. I told her that I did. She asked how much and I smugly told her well, just one drink per night and thinking I would get a real gold star for being a good boy.

Speaker 1: 53:03

But no, I was busted coach. She told me that I needed to cut back. I was shocked, quite frankly. But you know what? She was right. She's up on the latest literature and the recent studies are suggesting that no amount of alcohol is really good for you. All that stuff about red wine being healthy is really kind of now down the drain. So I have a cutback coach and, by the way, I found a pretty good non-alcoholic beer that's really not all that bad. It's a brand called Athletic. This is not a commercial I have no financial relationship, but just giving you all some tips and it also happens to be gluten free. I think it's only like 45 calories, but it's not bad. So I made a simple substitution and now everyone's happy, my primary care doctor's happy and I'm happy because it's still good to have my beer at night.

Speaker 3: 53:44

There you go. So let's take a look at some lab work and labs that signal an increased cardiovascular risk. So let's start with homocysteine levels. So elevated homocysteine levels may be connected to the MTHFR genetic mutation or other factors like nutritional deficiencies, kidney dysfunction or other lifestyle factors in general. However, in all honesty, the cardiovascular benefits of lowering your homocysteine levels are still being debated, and also exactly how low that homocysteine should be is a controversial topic. So many experts tend to start with a heavy emphasis on lifestyle changes first.

Speaker 1: 54:26

Another lab coaches uric acid. These are also associated with increased cardiovascular risk. Uric acid is thought to be a gout-related lab, but there are also strong associations with cardiovascular disease. However, there's an ongoing debate about whether uric acid is actually a causal factor or simply a marker of other metabolic abnormalities. To lower uric acid levels, start with a low-purine diet, drink plenty of water, maintain your ideal body weight, and even drinking a bit of coffee may be helpful. There's an excellent book on this subject by Dr David Perlmutter called Drop Acid, which we highly recommend, and along with any of his other books they're all quite excellent.

Speaker 3: 55:08

C-reactive protein is the next lab up that we'll mention, so the CRP is considered to be a great marker for systemic inflammation, which we have discussed in this podcast. Studies have consistently found that higher CRP levels are a strong and independent predictor for an increased risk of heart attack, stroke and cardiovascular death, and those studies are also showing that lowering CRP, especially in higher risk individuals, is associated with improved cardiovascular outcomes. A comprehensive strategy combining lifestyle medications and risk factor management is your best bet for maximizing cardiovascular health with getting your CRP down.

Speaker 1: 55:46

High fibrinogen is considered an independent predictor of cardiovascular events, including coronary artery disease, peripheral artery disease and ischemic stroke, due to its role in clot formation, inflammation and atherosclerosis. Lowering fibrinogen can potentially reduce cardiovascular risk. Again, your first-line treatment is going to be diet, along with exercise and maintaining a healthy weight. If that doesn't do it, then a visit to your good hematologist may be in order to get on some meds. A high ferritin level may also suggest increased cardiovascular risk. High ferritin is associated with an iron storage disease which adversely affects the heart.

Speaker 3: 56:21

And that brings us to the elephant in the room, which is the issue of cholesterols, also known as lipids, and certainly lipids are related to cardiovascular risk. We're not going to deny that. But this subject is super complex and somewhat controversial too. So it seems like a lot of our cardiologist friends would like to err on the side of putting statins in the water supply, but we kind of are thinking not so fast on that.

Speaker 1: 56:47

And if we're really to do justice to the lipid issue on today's show, we'd have to lengthen the podcast by like half hour or so. So it's just too much to get into here today. But I'm going to promise to do a separate special podcast on the topic of lipid management in relation to cardiovascular risk in the near future.

Speaker 3: 57:04

Of course, you should work with your provider on this lipid issue, and let me clearly state that there are many people who do need to be on statins. These drugs save lives, no doubt. However, we feel that there's a lot of people on statins who have dealt with a lot of the side effects and really won't receive a lot of clinical benefit or no clinical benefit, and so there are others who are not on statins who really also need to be on it. So we kind of see both sides of the fence here.

Speaker 1: 57:37

Yeah, coach, there's an interesting statistical concept in medicine called NNT, which means number needed to treat, and when it comes to statins, for the general population the NNT is over 400.

Speaker 1: 57:47

So what this means is that you would have to treat over 400 people, who get no benefit and have to put up with the costs and the side effects of statins, in order to prevent a heart attack in one person for the next five, 10 years, and so that's pretty good return on investment for the drug companies. But in all fairness, it's also important to realize that as you're dealing with sicker patients, then the NNT goes down and, as we said, it's a complicated issue and it's worth noting that for people with mild to moderate elevation, there are some other options besides statins to bring down cholesterols. We've posted on the website for you at mcminnmdcom, under the documents menu, a summary called Natural Ways to Balance Lipids. The document starts appropriately with lifestyle recommendations and also mentions some non-drug alternatives which may be considered. But at the end of the day, it's between you and your provider to get on the right program for you.

Speaker 3: 58:38

I remember an herbal cocktail that we'll mention here called Heart Savior, and we've used this on hundreds of patients with measured lipids before and after taking this supplement and have found it to be quite effective in bringing down cholesterol levels in many patients, and also don't really recall a single patient with any adverse side effects, which is kind of nice. So you can find that on Amazon and, by the way, we don't have any financial connections to this company at all.

Speaker 1: 59:08

So, wrapping things up, coach, there are a few other supplements that we've not mentioned so far which have some supportive evidence of beneficial effect for cardiovascular disease, and these include the olive oil we talked about, garlic, magnesium, zinc, l-arginine and L-citrulline, cocutin, the catechins, like ECGC, which is found in green tea, and D-ribose for congestive heart failure.

Speaker 1: 59:29

Some of the latest studies suggest that fish oil only helps people really with existing heart disease, although there may be some other benefits of fish oil beyond the heart, like the brain, for instance. Otherwise, Coach, that about does it for a discussion of the modifiable risk factors for cardiovascular disease? And let me summarize from a functional and integrative medicine point of view, the best way to approach cardiovascular disease, especially from a preventive point of view, is to look at modifiable risk factors, which is the root cause of the problem. We recommend close monitoring and advanced and personalized prevention in order to minimize the risk of poor health or death due to the number one killer of men and women, and I have a document at mcminnemdcom called McMinn Cardio Wellness Plan to summarize my suggestions for you.

Speaker 3: 1:00:13

As we wind down today, I'd like to ask you to please take a moment to rate us on iTunes. I'd like to ask you to please take a moment to rate us on iTunes. The reviews make a difference for us. And also, if you'd like, if you enjoy this podcast, then please do share out with a friend. Tell them about it. So thanks so much for helping us spread the word. You won't find a more evidence-based, unbiased podcast on wellness anywhere out there on the web, and we do our homework on these important topics and we want to shoot straight to you, so we're not trying to sell you things.

Speaker 1: 1:00:45

If you'd like to reach out to us and comment on the show or make recommendations for future topics, you can do so at drmcminn at yahoocom. Well, coach, can you leave us with another one of your brilliant Coach, lindsay pearls of wisdom.

Speaker 3: 1:00:58

Oh, thanks, dr Mack. You know this podcast has made me really think about one of my favorite health topics, the good old blue zones. And, listeners, if you're not familiar, there have been identified regions around the globe that are known for their exceptionally high life expectancy in the populations, and so there's five main regions that have been identified, in that One's Okinawa, japan, sardinia, italy, there's one in Costa Rica and Greece and then Loma Linda, california. So these are places where, again, the populations are the healthiest and they live the longest, or you have the most centenarians, people over 100 years old, and wouldn't you know it, dr Mack, they also have significantly lower rates of cardiovascular disease in those areas, which makes sense. So, for example, let me just tell you some of these stats In Okinawa, there's an 80% lower risk of cardiovascular rates than in the US 80% that's significant.

Speaker 3: 1:01:57

In Greece, we see that 20% of the individuals who are 80 to 90 plus years old have zero clinical signs of cardiovascular disease. And then in the Nequia Peninsula, there's 25% lower risk of dying from heart disease compared to non-blue zone regions in the world. So certainly there's things in these regions that people are doing right, and I think it lines up when you've, if you're familiar with the blue zones, then you've heard a lot of the themes which we've mentioned in our podcast today. So much of that lifestyle medicine, like just incorporating physical activity in your everyday life and just walking, gardening, those types of things, eating that Mediterranean diet I mean, here we're talking about Greece, right so those things ring familiar and I think lifestyle medicine is just never to be underestimated.

Speaker 1: 1:02:47

You know, coach, we've talked about a lot today and I think on first glance it could be overwhelming. However, I think, just think about what might apply to you. And again, the first step is always lifestyle medicine and work with your provider to maybe do a thorough workup and identify some of the risk factors that might apply to you. And on one of our handouts I mentioned, I actually have some advanced testing that can be done and I talk about that as well. So, anyway, don't freak out about this. It's not too much, but it's super important. Again, the number one killer of men and women. So we all need to sort of just look at those risk factors and do what we can to mitigate those, but anyway thank you so much for listening.

Speaker 3: 1:03:33

This is Dr McMinn and this is Coach Lindsay. Take care and be well.