Cardiovascular Disease: Beyond Cholesterol

By Alan S. Weiss, MD

In the United States, cardiovascular disease is the leading cause of death in men over 50 years old and in women over 55.. Nearly 1 million Americans will die of heart disease this year; 2400 will die each day of cardiovascular disease, an average of 1 death every 36 seconds. Clearly this is an area that is of concern to each of us.

Heart attacks usually result from the rupture of a plaque composed of cholesterol particles and inflammatory cells. When this rupture happens, the plaque expands to occlude a coronary artery, blocking the flow of blood to the heart muscle. Many of these ruptures happen in coronary arteries which were only minimally blocked by the plaque prior to the rupture. When the coronary blood flow is blocked, the heart muscle is starved of oxygen and the tissue dies—a myocardial infarction. Obviously a person cannot survive if so much heart muscle dies that the heart cannot adequately pump blood to the rest of the body.

Many risk factors which favor the development of cardiovascular disease have been reported. These include a family history of premature coronary artery disease, tobacco smoking, hypertension, diabetes, obesity, and most famously, elevated cholesterol levels.

As many as 50% of people who have their first heart attack have a normal level of cholesterol, so it is now clear that there are factors other than cholesterol which can lead to cardiovascular disease.

Important but lesser known risk factors in the development of heart disease are inflammation, infections, diet, and lifestyle.

C reactive protein is a marker for inflammation in a person’s body. An elevated CRP is an important risk factor for heart disease, and reducing an elevated CRP can reduce the likelihood of a heart attack even more so than lowering cholesterol.

A typical American diet rich in saturated fats and high glycemic foods, as well as tobacco use, obesity, and insulin resistance, can cause the CRP be elevated.

Chronic hidden infections in the body can also raise the CRP level. Infections which have been linked to the development of cardiovascular disease include periodontal gum disease, respiratory infections including influenza, stomach infections (H Pylori) and even urinary infections.

Interventions to lower CRP include dietary modification, the use of Omega 3 fatty acids (fish oil), exercise, treating chronic infections, aspirin therapy, and statin drugs, which not only lower cholesterol but also reduce inflammation.

Finally there is recent evidence that using hormone replacement in the time around onset of menopause may help reduce development of coronary artery disease in women. This is important given that heart attack risk for women begins to rise after menopause to meet that of men.

For many people, lifestyle and nutritional interventions can substantially reduce cardiovascular risk even without the use of more aggressive pharmacological treatments. Though the heavily marketed cholesterol lowering drugs can be life saving there are other important safe and effective ways to reduce the risk of heart disease.