Atherosclerotic Heart Disease:

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Atherosclerotic Heart Disease

• A Practical Approach
• for prevention and treatment
• Kevin Logan, M.D.
• 10/20/08

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Inflammation

• The common pathophysiologic cascade that causes
• Heart Attack Stroke Cancer and
• all Degenerative Diseases
• Atherosclerosis An Inflammatory disease (NEJM
  Jan 99)

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Causes of Inflammation and the Effects of
Oxidative Stress

• Free Radicals are caused by Radiation, Cigarette
  smoke, Heavy metals including IRON.
• Oxidative Stress increases endothelial
  permeability, oxidizes lipids and creates a
  tendency to clot

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Immunologic Sources that contribute to
Inflammation

• Infections
• Bacterial Chlamydia, pneumonia,
  H.pylori
• Viral CMV, HSV, Hep A
• Antibodies to these infections were more accurate
  predictors of Heart Disease than Hyperlipidemia,
  Diabetes, Hypertension and Obesity.
• Clinical Cardiology June 2000

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Metabolic Factors are the most common contributor
to Atherosclerosis and Inflammation in the US

• Diabetes affects 1 of every 16 people
• 40 of America have some degree of Insulin
  Resistance and predisposition to Diabetes
• Insulin is an inflammatory molecule and also
  raises blood pressure
• Insulin can promote Atherosclerosis before it
  causes frank Diabetes

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What is Insulin Resistance?

• A Dysfunction in Metabolism whereby the body is
  not responding to the normal actions of Insulin

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Insulin-counterregulatory overdrive in the
metabolic syndrome A vicious cycle

• INCREASED
• INSULIN
• Increased fuel storage Increased circulating
  glucose Physiologic Effects
• Increased lipogenesis Carbohydrate insulin
  resistance Dyslipidemia
• Increased basal lipolysis Visceral obesity
• High Blood pressure
• Increased resting heart rate
• Decreased heart rate variability
• INCREASED Glucose intolerance
• COUNTER- Endothelial dysfunction
• REGULATORY
• ACTIVITY
• Increased Glucocorticoids, Catecholamines,
  Glucagon, Free fatty acids

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Insulin Resistance Leads to the Metabolic
Syndrome

• Abdominal Obesity
• Hypertension
• Decreases HDL
• Increases LDL, apo B
• Elevated Insulin
• Polycystic Ovarian Syndrome (Anovulation)
• Elevated insulin levels and impaired glucose
  tolerance
• Low Thyroid Function

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Does Stress Play a Role?

• Type A personality at higher risk for heart
  attack
• Patients with Depression are also at Higher Risk
• Most Heart Attacks occur in the morning when
  stress hormones are highest

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• Stress
• Cortisol Adrenaline Insulin
• Glucose

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Chronic Stress Leads to

• Insulin Resistance
• Metabolic Syndrome
• Eventual Adrenal Fatigue, Difficulty with
  Menopause, Sleep Disturbances, Low Testosterone
• And Dyslipidemia

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Is Cholesterol the evil molecule that Pfizer and
Merck and manufacturers of cholesterol lowering
medications might lead us to believe?

• Cholesterol is critical for every cell membrane
  in our body
• Cholesterol is the precursor to all steroid
  hormones including cortisol, testosterone,
  estrogens, progesterone, etc.
• Cholesterol is THE precursor to Coenzyme Q10, the
  most important antioxidant in the mitochondria
• Cholesterol is an antioxidant
• Cholesterol is the precursor to formation of bile
  salts which are vital for assimilation of fats
  and detoxification of fat soluble toxins

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So should we try to lower our cholesterol to the
levels currently recommended?

• 60 of all Heart Attacks occur in people with
  normal cholesterol
• Longevity studies show low cholesterol a risk
  factor for increased mortality
• ENHANCE Study recently showed Zetia when lowered
  cholesterol to same levels as Lipitor showed No
  changes in cardiac mortality

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What types of lipids should we pay attention
to?
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Homocysteine

• Toxic to blood vessel lining, increases clot
  formation, decreases nitric oxide, increases Risk
  for Alzheimers, contributor to osteoporosis
• Easily treatable with B6, B12 and Folate

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Lipoprotein a (Lp a)

• With High Levels it is associated with inability
  to break down clots
• Treat with Vitamin C, Lysine, Niacin and CoQ10
• Decreases with increased intake of Saturated
  Fatty Acids

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Lipid Peroxidation

• Measure at specialized Lab
• Metamatrix [phone]
• Marker for oxidized lipids which create Free
  Radical Damage and activate the immune system
• Lipid Peroxides are quenched by fat soluble
  antioxidants Vit A, D, E, K and CoQ10

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• What other markers
• should your Doctor
• be paying attention to?

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Cardio CRP (C Reactive Protein)

• Increase clotting
• Identifies risk of an Acute event
• (ie Heart Attack)
• If elevated investigate for causes of
  inflammation infection, toxic, metabolic, immune

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Fibrinogen

• Causes platelet aggregation and increase blood
  viscosity and thus clot formation
• Increase with age, smoking, obesity, Diabetes and
  LDL-C
• Decreased with Exercise, HDL and Alcohol

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Ask your Doctor for these tests

• Lipid Panel
• Homocysteine (12 Hour Fast)
• Cardio (HS) CRP
• Fibrinogen
• Lp (a)
• Ferritin
• Fasting Glucose/Insulin
• 2 Hour post prandial Glucose and Insulin
• Free Testosterone (Men)

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• Nutrient Dense Foods,
• as Defined by Dr. Price,
• are the key to prevention of
• Insulin Resistance, Inflammation and Infections
  that lead to Heart Disease

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Fat Soluble Vitamins

• Vitamin A
• Key Antioxidant to prevent Lipid Peroxidation
• Protects mucous membranes against invading
  infections
• Vitamin D
• Increases insulin secretion
• Vitamin E
• Intracellular Antioxidant, Increases insulin
  Sensitivity
• Vitamin K
• Maintains Calcium in Bony tissue thus prevention
  extra osseous calcification in Blood vessels
• Coenzyme Q 10
• Key Mitochondrial Antioxidant
• Critical in all energy production in the body
• Decreased by Statin Drugs

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Important Fatty Acids found in Higher
concentrations in Grass Fed Animals/Wild Caught
Fish

• EPA/DHA the Omega 3s increase insulin
  sensitivity at the cell membrane
• CLA
• works at the nuclear level to stimulate genes
  that improve fat metabolism and increase insulin
  sensitivity
• CLA also has anticancer activity
• Grass Fed Animals posses 10 times as much of CLA
  as grain fed animals
• Phosphatidyl Choline (Lecithin) Fat burning
• Carnitine aids in Fatty Acid transport into the
  mitochondria and glucose transport

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Trace Minerals found in Organ Meats, Broths and
Fruits/Vegetables grown in Healthy live soil are
critical as well

• Chromium Increases Glucose tolerance Factor
• Vanadium Increases insulin sensitivity
• Zinc Critical for Healthy immune function and
  to quench oxidized cholesterol
• Manganese Critical mineral for production of
  Insulin
• Iodine Important for thyroid Hormone
  production, Increased Metabolism and Decreased
  Glucose/Triglycerides

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Other Factors

• B Vitamins cofactors in cellular energy
  production
• Biotin A B-vitamin that decreases insulin
  resistance
• Lipoic Acid, N-Acetyl Cysteine and Taurine help
  improve pancreatic production of insulin and
  maintain healthy cells via their Antioxidant
  capability

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You Are In Control of your HealthSo Be Proactive

• Eat Nutrient Dense Foods
• Exercise
• Reduce Stress
• Have Fun