Cardiovascular Disease. You Can t Beat a Healthy Heart. Presented By: Jonothon Mainland BA, BSc, ND. Medical Director AOR. AOR.ca

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1 Cardiovascular Disease You Can t Beat a Healthy Heart Presented By: Jonothon Mainland BA, BSc, ND Medical Director AOR AOR.ca

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3 Cardiovascular Disease You Can t Beat a Healthy Heart By: Jonothon Mainland BA, BSc, ND Medical Director - AOR Cardiovascular System Includes the heart and blood vessels Main Functions Deliver O 2 and nutrients to tissues Remove CO 2 and waste products The Heart The most efficient muscle in the body 2.5 billion beats per human lifetime 100,000 beats per day 7200 Litres of blood pumped per day 1

4 The Blood Vessels Arteries, arterioles, capillaries Transport blood from the heart Veins Return blood to the heart Cardiovascular Disease (CVD) Diseases affecting the heart and blood vessels #2 leading cause of death in Canada, behind Cancer 22% of all deaths in 2010 One death every 7 minutes One heart attack every 7 minutes The Stats Costs the Canadian economy more than $22.2 billion every year Leading cause of hospitalization in Canada, accounting for 16.9% of total hospitalizations Canadians (90%) have at least one risk factor for heart disease or stroke 2

5 Cardiovascular Disease (CVD) Six major types Ischemic Heart Disease Cerebrovascular Disease (Stroke) Peripheral Vascular Disease Heart Failure Rheumatic Heart Disease Congenital Heart Disease Ischemic Heart Disease Most common type of CVD Blocked arteries reduce blood flow to the heart Results in heart attack Cerebrovascular Disease Blocked arteries reduce blood flow to the brain Results in a stroke 3

6 Peripheral Vascular Disease Reduced circulation in the legs Caused by blockages or clots in blood vessels Leg pain Large-vessel PAD increases mortality from cardiovascular disease significantly. PAD carries a greater than "20% risk of a coronary event in 10 years Heart Failure Results from damage to the heart Heart attack Heart muscle disease Heart unable to supply adequate blood/oxygen to the body Rheumatic & Congenital Heart Disease Difficult to prevent Childhood bacterial infection or birth defect Damage to heart valves or heart structure Prevention: Aggressive treatment of strep throat (with antibiotics) and of rheumatic fever (should it occur) 4

7 Risk Factors for CVD Lifestyle Factors Smoking Inactivity Unhealthy Diet Stress Flossing? Risk Factors for CVD Health Factors High Cholesterol High Blood Pressure Diabetes Risk Factors of CVD Lifestyle risk factors often linked to health risk factors Lifestyle Health Problems Cardiovascular Disease 5

8 Lifestyle Factors These Factors are modifiable with lifestyle changes Smoking Reduces O 2 levels in the blood Increases heart rate Increases blood pressure Contributes to arterial plaque Smoking Doubles the risk of stroke 70% greater chance of dying from heart disease Causes 40-45% of heart disease in people under the age of 65 Quitting reduces the risk of CVD by 50% in one year, and to normal levels in five years 6

9 Smoking Rates PROVINCE BC 15% 14% 16% 15% 16% 16% MB 21% 20% 20% 22% 19% 21% ON 17% 18% 17% 16% 20% 20% AB 20% 21% 21% 21% 20% 20% NS 20% 20% 22% 21% 20% 22% PEI 19% 18% 19% 20% 21% 21% SK 20% 24% 24% 22% 21% 24% NL 20% 21% 22% 21% 22% 23% QC 19% 22% 20% 22% 22% 25% NB 20% 21% 23% 22% 24% 24% Inactivity Regular exercise keeps the heart healthy 50% of Canadians report being inactive Inactivity doubles the risk of heart disease Exercise also reduces other CVD risk factors Unhealthy Diet High in: Salt Saturated fat Cholesterol Refined Sugar Low in: Fibre Nutrient density 7

10 Unhealthy Diet Percentage of Americans with Inadequate Intakes from Food Based on the Estimated Average Requirements Salt Prior to refined salt: ~768 mg per day Today: 4000 mg per day 90% of salt in US diet is added Excessive sodium in diet is linked to high blood pressure and increased risk of CVD Fat Get the right kind of fat Diets high in cholesterol, saturated fats and transfat are linked to an increased risk of heart disease Polyunsaturated fats can help lower the risk 8

11 Sugar Empty calories Lowers the nutrient density of the diet Contributes to obesity and poor control of diabetes Stress High stress levels increase blood pressure Increase risk of heart disease and stroke Stress Positive ways to cope with stress Exercise and physical activity Harmful ways to cope with stress Alcohol Smoking Unhealthy food 9

12 Health Factors These Factors modifiable through changing lifestyle factors High Cholesterol LDL Cholesterol Bad Contributes to atherosclerosis HDL Cholesterol Good Low HDL increases risk of heart attack and stroke Oxidized LDL Damages arteries Contributes to atherosclerosis Inflammation vs Cholesterol? Link between elevated CRP levels and heart disease has been demonstrated repeatedly Some evidence that CRP may be a more important indicator of heart disease risk than high LDL ("bad") cholesterol. Eight-year study involving 27,939, women more than half of the women who eventually developed heart disease had high CRP levels even though their LDL levels were not considered high. 10

13 Atherosclersis Build-up of plaque in the arteries Leads to reduced blood flow and blockages May rupture and cause a blood clot Heart Attack Stroke Pulmonary Emboli High Blood Pressure (BP) BP > 140/90 mm/hg is considered high Over 4 million in Canada have hypertension (19%) (aged >12yo) Many are unaware they have it High BP damages blood vessels and can lead to atherosclerosis Diabetes 1/16 Canadians have Diabetes Diabetes Increases the risk of hypertension, coronary artery disease and stroke Excess sugar in the blood damages blood vessels Thickens Vessels & makes them less elastic Especially dangerous if poorly controlled 11

14 Take Steps to Protect your Heart In North America the greatest threat to heart health are diet and lifestyle choices In most cases chronic diseases are preventable, your health is up to you Eating fresh, unprocessed foods, exercising regularly and supplementing your diet can help protect your heart Nutrients to Help the Heart Magnesium Antioxidants Co-Enzyme Q10 Vitamin E Hydroxytyrosol Polyphenols Fish Oils Hawthorn Arjuna Curcumin Nitric Oxide Magnesium Essential mineral for heart health and function Involved in over 300 biochemical reactions in the body Up to 75% of us are deficient Deficiencies linked to many CVD risk factors 12

15 Magnesium Choosing the right kind Magnesium Orotate Orotic acid improves cardiac function Better bioavailability than inorganic Mg salts Magnesium Taurate Amino acid taurine regulates heart beat Cardioprotective Better bioavailability than inorganic Mg salts Magnesium How much to take?? When?? Co-Enzyme Q10 Effective adjunct treatment for heart failure Improves overall heart function Clinical trial involving 2664 individuals showed improvement in heart rate, blood pressure and arrhythmia 13

16 Co-Enzyme Q10 Involved in cellular energy production Protects the Heart Antioxidant Prevents LDL oxidation Stabilizes platelet cell membranes Co-Enzyme Q10 After treatment, angina pectoris (9.5 vs. 28.1), total arrhythmias (9.5% vs. 25.3%), and poor left ventricular function (8.2% vs. 22.5%) were significantly (P < 0.05) 05) reduced in the coenzyme Q group than placebo group. Total cardiac events, including cardiac deaths and nonfatal infarction, were also significantly reduced in the coenzyme Q10 group compared with the placebo group (15.0% vs. 30.9%, P < 0.02). Vitamin E Getting the right Vitamin E is important Complex of 8 Vitamin E molecules Tocopherols Tocotrienols High α to γ-tocopherol balance in heart failure patients 14

17 Vitamin E Tocotrienols lowered cholesterol levels by 31% in four weeks γ-tocopherol regulates fluid pressure around cells High fluid pressure leads to hypertension Fish Oils Treatment 1 gram per day of Omega3 fatty acids reduced the occurrence of: Death (20%) Cardiovascular death (30%) Sudden cardiac death (45%) Hawthorn Contains beneficial flavonoids Help for a damaged heart Treatment for ischemic heart disease 15

18 Hawthorn Results in 1000 patients with heart failure Lower blood pressure and heart rate Increased exercise performance Improved heart function (ejection fraction) Reduction in other common symptoms (nocturia and shin edema) Hawthorn One study found that hawthorn extract (900 mg/day) taken for 2 months was as effective as low doses of captopril (a prescription heart medication) in improving symptoms of heart failure. Niacin Human trial 8341 men who had already suffered a heart attack were assigned to receive one of four different cholesterol drugs, or niacin, or a dummy pill Niacin therapy cut the rate of nonfatal heart attacks by 27%, and stroke by 26%, over the course of the trial Men taking niacin supplements were 11% less likely to die from any cause compared to the placebo group 16

19 Niacin Randomized, controlled comparison with lovastatin Niacin lowers LDL to a similar degree (23% (niacin) vs 32%(statin)) Elevated HDL considerably more (33% vs. 6%) Niacin lowers lipoprotein(a) (Lp[a]) by an astounding 35%, while lovastatin therapy has no effect Terminalia Arjuna Clinical trials with demonstrated benefits for congestive heart failure Increases cardiac muscle capacity Increases blood-pumping activity of the heart by 10% and ability to empty the left ventricle by 20% Reduces angina attacks by 2/3 in stable angina Reducing Cholesterol & Protecting the Heart Curcumin: Reduces CRP (inflammation) 1 study, HDL (29%) Total Cholesterol (11%) Polyphenols: l Helps prevent oxidation of LDL Apolipoprotein B-100 Hydroxytyrosol: Found in Olive oil Study reduction of oxidized LDL & BP 17

20 Reducing Cholesterol & Protecting the Heart Berberine: 18% in Total Cholesterol, 21% in LDL Artichoke Leaf: 18.5% in Total Choleserol, l 22.9% in LDL L Theaflavin (from Green & Black Tea) 11% in Total Cholesterol, 16% in LDL Planet Sterols: Lowers LDL Cholesterol by 15% with a healthy diet The Power of Nitric Oxide Dramatic blood pressure lowering effects have been associated with dark leafy vegetables, like beetroot, spinach and lettuce, which are high in nitrate content. Nitrates Nitrites Nitric Oxide (NO) Beetroot juice, which is very high in nitrates: decrease systolic blood pressure by as much as 10.4mmHg reduce diastolic blood pressure by as much as 8.1mmHg effect becoming noticeable just one hour after consumption. How do Nitrates benefit the Heart Reduce Blood Pressure Vasodilation of blood vessels Improves Blood vessel function Prevents damage/plaque formation Improves Platelet function Prevents stickiness Reduces harmful effects of ischemia Reduces lipids and triglycerides 18

21 Conclusion Nutrients important for heart health Magnesium Niacin Antioxidants (Vitamin E, Co-Enzyme Q10, Hydrotyrosol, Polyphenols) Fish Oils Curcumin Nitric Oxide Nutrients for a damaged heart Co-Enzyme Q10 Hawthorn Arjuna Exercise and a healthy diet!! Selected References Geiss KR, Stergiou N, Jester, Neuenfeld HU, Jester HG. Effects of magnesium orotate on exercise tolerance in patients with coronary heart disease. Cardiovasc Drugs Ther Sep; 12 Suppl 2: McCarty MF. Complementary Vascular-Protective Actions of Magnesium and Taurine: A Rationale for Magnesium Taurate. Medical Hypotheses (1996) Finckenbeg P, et al. Magnesium supplementation prevents angiotensin II-induced myocardial damage and CTGF overexpression. J Hypertens 2005 Feb;23(2): Tomeo AC, Geller M, Watkins TR, Gapor A, Bierenbaum ML. "Antioxidant effects of tocotrienols in patients with hyperlipidemia and carotid stenosis." Lipids Dec; 30(12): Ohrvall M, Sundlof G, Vessby B. "Gamma, but not alpha, tocopherol levels in serum are reduced in coronary heart disease patients." J Intern Med Feb; 239(2): Baggio E, Gandini R, Plancher AC, et al. Italian multicenter study on the safety and efficacy of coenzyme Q10 as adjunctive therapy in heart failure. Mol Aspects Med. 1994; 15(Suppl): Singh RB, Wander GS, Rastogi A, Shukla PK, Mittal A, Sharma JP, Mehrotra SK, Kapoor R, Chopra RK. "Randomized, double-blind placebo-controlled trial of coenzyme Q10 in patients with acute myocardial infarction." Cardiovasc Drugs Ther Sep; 12(4): Rissanen T, Voutilainen S, Nyyssonen K, Lakka TA, Salonen JT. Fish oil-derived fatty acids, docosahexaenoic acid and docosapentaenoic acid, and the risk of acute coronary events: the Kuopio ischaemic heart disease risk factor study. Circulation Nov 28; 102(22): McLennan P, Howe P, Abeywardena M, Muggli R, Raederstorff D, Mano M, RaynerT, Head R. The cardiovascular protective role of docosahexaenoic acid. Eur J Pharmacol Apr 4; 300(1-2): Pitler MH, Guo R and Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev. 2008; 23(1): CD Leifert WR and Abeywardena MY. Cardioprotective actions of grape polyphenols. Nutr Res. 2008; 28(11):

22 Thank You Questions: 20

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