Heart disease is the leading cause of death in both men and women in the United States. Every 34 seconds someone passes away from cardiovascular disease, placing the death toll in 2020 at around 697,000 according to the CDC. A common misconception about cardiovascular disease is that it impacts males at a much higher rate, when the reality is that over 45% of the total deaths from heart disease are females. Men are screened early and often for heart disease, as they are well aware of the statistics, while only about half of women recognize that heart disease affects them at nearly the same rate!
The term ‘heart disease’ encompasses a wide variety of heart conditions with the most common being coronary artery disease. Other diseases that fall under this umbrella include irregular heartbeats or arrythmias, heart valve dysfunction, disease of the heart muscle such as cardiomyopathy, and other blood vessel diseases such as atherosclerosis.
Causes
There are three responses in the body that lead to the development of heart disease: inflammation, oxidative stress, and immune dysfunction. The cause list is not that short, although focusing on foundational health can address the majority of triggers leading to those three responses. The most common causes of heart disease include central obesity, diabetes, poor diet, excess alcohol intake, a sedentary lifestyle, and chronic emotional stress. Additional causes, often less focused on yet just as important when discussing heart health, include poor dental health (link – separate article?), sleep apnea or other sleep disorders, dehydration, chronic infection, poor gut health, hormonal imbalances, and environmental toxin or heavy metal toxicity. All of these factors are known to cause excess inflammation, oxidative stress affecting the lining of the blood vessels, and immune dysfunction leading to heart disease if unaddressed.
Inflammation
Inflammation is defined as a set of changes in the tissue as a response to immune system activation from pathogens, toxic chemicals, environmental agents, trauma or overuse. This is the first change seen in the tissue, long before any direct heart disease processes start taking place. Inflammation isn’t always a negative response. Without inflammation our body wouldn’t be able to heal from illnesses, scrapes on our skin, or even workouts. Inflammation becomes an issue when the drivers are repetitive or long-standing, such as smoking cigarettes or eating fast food for lunch every day. Chronic inflammation weakens the tissue’s ability to heal itself and can lead to cardiovascular disease if not addressed.
Oxidative stress
Caused by an imbalance between production and accumulation of reactive oxygen species (ROS) and the production and consumption of antioxidants to neutralize the ROS. Reactive oxygen species are naturally produced during metabolism (energy creation) in every cell, but exposure to heavy metals, radiation, environmental toxins, increased blood glucose, and may other factors drastically increase the body’s burden of ROS. Our cells are equipped with enzymes to produce our own antioxidants to combat normal ROS production, but these processes require specific vitamins and minerals as co-factors. Excess oxidative stress damages the lining of the blood vessels, exposing them to additional ROS. This can lead to arterial wall build-up and is a factor in the development and progression of cardiovascular disease.
Immune dysfunction
Immune Dysfunction is when the immune system doesn’t work the way it should. This includes overactivity, underactivity, sensitivity, insensitivity, autoimmunity, and many more. The main pieces to consider when discussing the immune system’s function is exposure to antigens or triggers, the availability of building blocks to create immune system cells and signalers, the co-factors needed for proper function (vitamins, minerals, nutrients), the down-regulation system, and the ability to recover and repair the tissue. If the immune system is dysfunctional in any of these areas, chronic inflammation can occur. Chronic inflammation is a leading cause of cardiovascular disease, especially atherosclerosis.
Symptoms
Most people know if they start to experience chest pain or pressure, they need to seek urgent medical care to rule out a heart attack. Less obvious symptoms may be pushed to the wayside without any further thought leading to late detection and poor outcomes.
Additional signs and symptoms of cardiovascular disease:
- Neck and upper back pain
- Jaw pain
- Cold sensation in the legs or arms
- Shortness of breath with low exertion activities, such as household tasks or walking up stairs
- Cramping in the calves while walking
- Weakness or fatigue in the legs
- Erectile dysfunction or female sexual arousal disorder
- Elevated resting heart rate
Diagnostic Tests
When discussing heart health, it is essential to understand the difference between biomarker testing and endpoint testing. Biomarker testing is a key tool in prevention, early detection, and risk stratification of heart disease. A biomarker is a compound commonly measured through the blood which is indicative of how the body is currently functioning. For example, biomarkers such as blood glucose, insulin, and hemoglobin A1c can be used to detect blood sugar dysregulation even before a person develops diabetes. An increase in these numbers would show your body may be headed down the wrong path. Focusing more on dietary changes and stress management would be beneficial in preventing diabetes, which is a driver of heart disease.
Another helpful biomarker test to stratify risk is an Omega-3 Index. Omega-3 fatty acids, such as EPA and DHA, play a vital role in inflammation control, cell membrane health (think cell-to-cell communication), blood viscosity, tissue repair and cholesterol regulation. Having a healthy omega-3 status reduces factors, such as inflammation, that lead to the onset of cardiovascular disease and has been shown to slow progression if cardiovascular disease is diagnosed.
As mentioned before, there are three responses in the body leading to heart disease: inflammation, oxidative stress, and immune dysregulation. Talking with your provider about monitoring biomarkers related to these three responses can greatly improve overall health, while guiding your lifestyle changes to further support heart disease prevention and healing.
Endpoint testing is used to diagnose and monitor heart disease progression. Diagnostic tests for heart disease will vary based on what the initial symptoms are or what the previously diagnosed heart disease is. The most common diagnostic tests for acute cardiovascular symptoms are blood tests and an electrocardiogram (ECG or EKG). When there is a damaging event to the heart muscle, such as a heart attack, there are chemical compounds excreted into the blood measurable via blood testing to track the extent of damage. An electrocardiogram is an in-office test that attaches wires to points on the chest, arms and legs. This test reads the electrical impulses coming from the heart and is useful in diagnosing a heart attack and other heartbeat irregularities (arrythmias).
Coronary artery calcification testing can be a useful tool if coronary artery disease is suspected. This test utilizes computerized tomography (CT) to detect calcium build-up within the arteries of the heart. The higher the score, the higher the risk of narrowing of the arteries and chances of experiencing a heart attack.
If your provider is suspecting dysfunction of the heart valves or is concerned about the strength of contraction, they may recommend an echocardiogram. An echocardiogram utilizes ultrasound to better visualize the function of the valves and to determine if blood is flowing properly through the chambers of the heart.
Diagnostic testing is a great tool to have access to; however, always remember it is one piece of a complex puzzle and there are many other factors when looking at overall cardiovascular health.
Diet
As the saying goes “you are what you eat.” If you eat poor-quality fats, your cells will be made with poor-quality fats. What we put into our bodies on a daily basis is one of the easiest yet most neglected changes we can make to positively affect our heart health. More than two-thirds of heart disease-related deaths worldwide can be linked to food choices according to a study published in 2020. Start with healthy, nutrient-dense additions, and once those become a part of your routine choose another change that you are going to focus on. The easiest addition to make is adding two servings of non-starchy vegetables with each meal. Vegetables are a great source of antioxidants that help to neutralize oxidative stress – one of the main responses leading to heart disease. They also contain fiber which slows the absorption of carbohydrates in the intestines to promote proper blood sugar regulation along with being a food source for the healthy bacteria found in our intestinal tract. Vegetables are loaded with vitamins and minerals which are important for heart health, such as magnesium, potassium, folate, and vitamins A, C, and K.
Eliminating sources of inflammatory fats in the diet is another foundational change to be made. Start with changing out the oils you cook with. Instead of reaching for the poor quality canola, peanut, corn, and seed oils, choose anti-inflammatory promoting oils such as avocado or olive oil. Unsaturated fatty acids, such as those found in avocado and olive oil, promote lowering of total and LDL cholesterol lowering the risk of developing heart disease. Another important role unsaturated fats have is increasing the fluidity of cell membranes, which promotes elasticity of the arteries. Arterial stiffness is an independent predictor of heart disease and can play a role in the development of high blood pressure. Ensuring you are eating an adequate amount of unsaturated fatty acids and reducing your intake of poor quality saturated fats will improve the health of each individual cell and play a role in overall cardiovascular well-being.
Exercise
The average American sits for 12 hours per day. Those with a sedentary lifestyle have a 147% higher risk of experiencing a heart attack. Movement has benefits long past what we can discuss in this section, but let’s go over the basics. There are two main categories of exercise that can be performed, aerobic and anaerobic, each having their individual benefits. If you are looking to improve your cardiovascular health, your routine should include some form of both.
Aerobic exercise is consistent movement while relying on the oxygen you bring in through breathing to fuel the activity. This category includes activities such as walking, running, swimming, cycling, rowing, and others. Aerobic exercise has been shown to increase antioxidant enzymes in the body, lower both systolic and diastolic blood pressure, and increase nitric oxide production. Nitric oxide’s most important function in the body is vasodilation, expanding of the blood vessels, to increase circulation and oxygen delivery.
Anaerobic exercise is a form of exercise that relies on the energy (carbohydrates) stored within the muscles. This category of exercise includes weight lifting, high-intensity interval training (HIIT), Pilates, yoga and other forms of strength training. Anaerobic exercise has been shown to lower body mass index (BMI), fasting blood glucose levels, and total cholesterol. Engaging muscle fibers during exercise is one of the only ways to uptake glucose (sugar) from the blood completely independent of insulin. Exercise is a great way to naturally lower blood glucose levels! A combination of aerobic and anaerobic exercise should be done for 30 minutes minimum, 5 days per week to improve cardiovascular health.
Stress
It is no surprise that the majority of Americans are under an immense amount of stress. Our country thrives on a go-go-go mentality and neglects the negative effects of stress on our bodies, specifically our cardiovascular system. Stress hormones, such as cortisol and adrenaline, are released by our adrenal glands in response to physical, chemical or mental/emotional stressors. Once these hormones have been released, they signal to increase blood pressure, increase heart rate, increase respiratory rate with shallow breaths, decrease digestion, and decrease sex hormone production. If the stressor were to go away, the body would come back to homeostasis (balance) and all would be functioning in harmony again. However, we know the stressors rarely go away in today’s world. As one stressor passes, another comes into play and the same cycle starts over. This leaves a population with high blood pressure, poor oxygen delivery, elevated resting heart rate, poor nutrient status, and hormone imbalances – all of which can lead to heart disease. Stress relief practices, including meditation (link), prayer, light movement, deep breathing, and stretching should be added into daily routines for a healthy heart.
Sleep
One of the first questions everyone should ask themselves is, “Am I waking up feeling well-rested most of the time?” If the answer is no, something needs to be changed. Untreated sleep apnea increases the risk of heart failure by 140% and the risk of coronary heart disease by 30%. This statistic alone should explain how important sleep is to the cardiovascular system. During sleep our body is able to decrease inflammation and clean up the affected tissues, increase antioxidant production, and re-regulate immune system signaling. These address all three of the responses leading to heart disease.
The first step should be to ruling out any underlying sleep disorder, such as sleep apnea. The next step is to take into account these five factors to improve the quality of your sleep (link – separate article): regularity, temperature, darkness, location of wakefulness, and food or drink intake. To achieve enough high-quality sleep to benefit your heart health, allocate 7-9 hours per night in a dark, cool room.
High Blood Pressure
Among the many known causes of heart disease, high blood pressure has shown the strongest evidence of causation. High blood pressure has been implicated in heart failure, atrial fibrillation, chronic kidney disease, heart valve diseases, aortic syndromes, and dementia. High blood pressure causes excess stress on the heart muscle which can lead to inflammation of overuse. It can damage heart valves and the aorta by the shear force exerted on them. High blood pressure can also damage small blood vessels, especially capillary beds, where the majority of oxygen and nutrient exchange happens, hence its relationship to dementia and chronic kidney disease. Addressing the underlying cause of high blood pressure should be a top priority in reducing risk or extent of cardiovascular disease.
Supplements
Electrolytes
Electrolytes – sodium, potassium, calcium, magnesium, chloride, and phosphate – are minerals in the body that carry either a positive or negative charge. They play a key role in many bodily functions, including the contractility of the heart muscle. Choosing a high quality electrolyte supplement, which does not contain cane sugar or other added sugars, is a great way to promote healthy blood viscosity (thickness), controlled contractions of the heart muscle and regulate fluid balance for optimal blood pressure.
CoQ10
CoQ10 is an antioxidant naturally created in the body but has been shown to decrease with age. Cholesterol lowering medications, such as statins, shut down the enzyme responsible for this creation pushing your body to rely on dietary sources or supplementation of this antioxidant. Whether or not you are currently on a statin medication, CoQ10 is a low-risk supplement shown to positively affect energy production of the heart muscle, assist in healing post-ischemic event (stroke or heart attack), reduce oxidative stress levels, and promote exercise tolerance improving cardiovascular health in the long run. CoQ10 assists energy production through a process within the mitochondria, the powerhouse of the cell. The heart contains more mitochondria per gram than any other tissue in the body, which is why CoQ10 is such a powerful nutrient.
Omega-3 Fatty Acids (EPA-DHA)
As discussed previously, high-quality fatty acids are essential for heart health. Omega-3 fatty acids from fish and algae sources have been shown to improve arterial elasticity, reduce LDL cholesterol, reduce inflammatory markers, and improve cell-to-cell signaling which naturally decreases with age.
Heart Healthy Lifestyle
As we’ve learned, the cardiovascular system is affected by practically everything we do on a daily basis – sleeping, eating, hydration, exercising, stress, and the list keeps going. Sleeping 7-9 hours per night, eating a nutrient-dense diet, drinking half your body weight in ounces, exercising at least 150 minutes per week, learning stress management, and building a community around you who support your goals, share your values, and allow you to feel heard are all the foundational pieces to work on before jumping into the weeds on the specifics. As always, find a provider who listens to you and helps guide you toward your goals in reaching optimal heart health.
References:
https://www.cdc.gov/heartdisease/facts.htm
https://www.cdc.gov/heartdisease/women.htm
https://pubmed.ncbi.nlm.nih.gov/23415455/
https://thrivemyway.com/sitting-statistics/
https://www.sleepfoundation.org/sleep-apnea/sleep-apnea-linked-heart-disease
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