Risk factors for heart disease
by Marcelle Pick, OB/GYN NP & Dixie Mills, MD
There is no single cause of heart disease, but there are several conditions and
habits that increase our chances of developing a cardiovascular condition. Understanding
these heart disease risk factors is an important step in preventing heart disease.
The best approach to heart health is to minimize all of the risk factors as best
we can, rather than focusing on just one.
Let’s look now at the early signals of heart disease as a way of understanding
its true causes.
Early signals of heart disease: cholesterol, homocysteine, and inflammation
Our understanding of cardiovascular disease is growing rapidly, but one thing seems
clear: inflammation has as much to do with heart disease and stroke as cholesterol
— maybe much more. We also know that cholesterol does not act alone but is
linked to our metabolism and the levels of insulin and acids in our blood, which
in turn affect inflammation. Think of it as the chicken or the egg: we don’t
know yet which comes first. But we can tell what we should do to have healthy hearts.
Cholesterol: When we talk about cholesterol levels, we
are really talking about lipoproteins. Cholesterol is an essential lipid, or fat,
that is both consumed in food and produced by the liver, and circulates in the blood.
It is vital to building cell walls and making hormones. It’s the foundation
of hormonal and metabolic balance.
Lipoproteins are proteins in your blood that transport
and store cholesterol as complexes. LDL (low-density lipoproteins) is considered
the “bad” cholesterol. It transports cholesterol around your body for
use, depositing the excess along artery walls, and is associated with a build-up
of plaque, or atherosclerosis. HDL’s (high density lipoproteins) are “good”
cholesterol. They transport cholesterol out of the bloodstream and back to the liver
where it is broken down.
In this way, a high cholesterol count is not necessarily bad if you have a high
proportion of HDL to LDL. It appears to be the relationship between the two that
matters. Recently, a whole new “fractionated” reading of LDL’s
has become popular. This further breaks down these proteins in the hope of explaining
why some people can maintain high levels of LDL without getting plaque. But we still
don’t understand this process entirely.
Homocysteine is an amino acid created in your blood when
you digest protein. It’s usually converted into other less caustic amino acids
with the help of B vitamins and folic acid. If you don’t have enough B vitamins
or folic acid to help this process, your homocysteine levels rise and irritate your
blood vessels, which is one form of inflammation.
Essential fatty acids are helpful in offsetting high levels of blood acid
and reducing inflammation. Generally speaking, current science best supports supplementing
the diet with omega-3 fatty acids to reduce inflammation and prevent diseases, since
the other forms — omega-6’s and omega-9’s — tend to be overabundant
in the modern diet.
Other possible causes of a high homocysteine level include low levels of thyroid
hormone, kidney disease, psoriasis, some medicines, and genetic deficiencies in
the conversion enzyme known as 5–methyltetrahydrofolate, which is used to
process homocysteine in the body. A cardiovascular genetic profile is now available
to test for this deficiency, which affects a significant number of people. You can
ask your practitioner for this test.
Metabolism/insulin resistance: Evidence is mounting that
high levels of insulin in the blood are related to chronic inflammation and cardiovascular
disease. As a precursor to obesity, type 2 diabetes and high blood pressure,
insulin resistance clearly plays a role in fat storage and cholesterol function.
Since metabolism involves hormonal function, it’s possible that there’s
an association between insulin resistance and the estrogen loss and lower HDL levels
that occur after menopause. For this reason, it’s always a good idea to eat
foods that have a low to moderate reading on the glycemic index scale — and
avoid those with high readings, such as sugars and simple carbohydrates.
Inflammation: Systemic or chronic inflammation is being
linked to obesity, cancer, type II diabetes,
irritable bowel syndrome (IBS), rheumatoid arthritis and other autoimmune
diseases, Alzheimer’s disease — and heart disease. But this may still
be news to you. A recent cover article on heart disease in Parade magazine
failed to mention it at all.
Scientists are in the process of discovering a disturbing relationship between high
LDL cholesterol and chronic inflammation. While no one knows for sure, it’s
possible that excess LDL feeds inflamed arteries, coating the walls and hardening
into plaque. Or it may be that inflammation is exacerbated by preexisting blockages.
Either way, inflammation of the arterial wall creates high levels of a liver secretion
called C-reactive protein (CRP). Inflamed plaques are
highly unstable and prone to rupture, which can then cause a blood clot and heart
attack or stroke. More than half of all sudden heart attacks are caused by inflamed
plaque. Because women have higher levels of LDL’s after menopause, they are
at a higher risk for this kind of inflammation–related crisis.
You may be surprised to learn that your dentist can play a role in assessing your
risk for heart disease. Recent studies show a striking association between cardiovascular
disease and the presence of certain periodontal bacteria. which caused inflammation
of the gums. These bacteria are harbored in the gums and pump high levels of pro-inflammatory
toxins into the blood stream, where they can travel to other organs, including the
heart, and cause damage.
Decoding your blood test results
When you have a blood test, ask to see the results! Here’s what we look for:
- LDL: Standard optimal levels for women are 70–100
mg/dL. But we’ve seen healthy patients with higher levels.
- HDL: Standard optimal levels for women are 70–80
- VLDL: Very low-density lipoproteins that carry triglycerides
(dietary fat) but convert to LDL after they deposit their store. The lower the ratio
of VLDL to HDL, the better.
- CRP: In the test we use at Women to Women, the optimal
range is <1mg/L. Called a high-sensitivity C–reactive protein test (hs–CRP),
it is ultra-sensitive. This test is not yet widely used. For more information, visit
the website of Genova Diagnostics.
- Fasting glucose: Tests blood sugar levels and insulin
sensitivity. Optimal range is 75–80.
- Homocysteine: Our optimal range is 5–8 µmol/
One of the cleanest indicators we have for potential heart disease is a high level
of cholesterol (above 240 mg/dL) in the blood, where the ratio of “bad cholesterol”
(LDL) outweighs the “good cholesterol” (HDL). This is again an oversimplification
that doesn’t explain why over half the people who have heart attacks have
normal cholesterol levels — it may turn out that high cholesterol levels have
little to do with heart disease — but it may prove a good indicator of inflammation.
What’s most important here is the overall relationship between all of these
elements. Recent studies prove that even slightly elevated levels of CRP in the
blood (over 1 mg/L) combined with high LDL levels nearly triple the risk of contracting
a heart condition.
But heart disease isn’t just a matter of lab test results. We learned long
ago that "type–A personality" was a risk factor.
At Women to Women we know that personality type is just one aspect of the role emotions
play in heart health.
The emotional root of heart disease
(or, What’s love got to do with it?)
Your heart responds to how you feel. It jumps for joy, it pounds with anxiety, it
breaks with emotional pain. A recent report verified that a sudden emotional shock,
with its surge of adrenaline, can trigger heart attack–like symptoms of chest
pain and fluid in the lungs, a condition called “broken heart syndrome.”
Notably, only women were affected.
It’s not a huge leap to accept that your cardiovascular system may also react
to unresolved emotional conflicts by gradually weakening. Stress and emotional difficulty
create a “fight or flight” response that in time creates
adrenal fatigue, boosts cholesterol levels, and weakens the immune system,
making it more prone to infection and inflammation.
A recent study looked at men in several European countries and concluded that being
depressed increases the odds of developing CHD by 50%. Inflammatory markers such
as CRP rise in conjunction with feelings of depression and stress.
Targeting emotional health is a new experience for most conventional doctors, but
more of them are coming around to it. New programs like the HeartMath System teach practitioners from all backgrounds
how to work with patients to give them daily tools that help reduce stress, channel
their anger, and achieve emotional balance.
This process is something Eastern doctors have been doing for millennia. In Chinese
medicine, the heart is the organ associated with joy. A healthy heart is one in
which the expression of joy is balanced and fed by a strong life force, or Qi.
Emotional difficulties can be traced back to a blockage in a particular organ or
hub of energy, called a chakra. The fourth chakra, the heart chakra, is the seat
of love — for others and ourselves. Relationships and self-acceptance are
deeply tied to this organ, as is compassion, integration, and centeredness.
Remember that your emotional outlook affects your health just as surely as it affects
your life. It’s no coincidence that studies of people who live to be a hundred
show that they share a positive outlook. Other studies confirm that people who are
always negative have more long-term health problems. We’re not saying you
should be chipper even when life is rotten; we just saying don’t get stuck
in a bad rut.
Oxytocin, the brain chemical involved in lactation during nursing, uterine contraction
in birth, sexual orgasm in both men and women, and the chemical basis for human
attachment, is produced by the heart. To have an abundance of this chemical, your
heart needs to function efficiently. Because women tend to pour their hearts out,
giving much more comfortably than they receive, many of their health concerns can
be traced emotionally back to a closed or exhausted heart. But so many of us don’t
realize what is happening until we enter menopause.
Menopause and the heart
Like peeling a rug off the floor to reveal the underlying patina,
menopause curtails the protective, softening effects of estrogen in our
bodies. While this may cause temporary symptoms of hormonal imbalance, it is also
a kind of gift — just as a diagnosis of heart disease can serve as a wake-up
call. It allows us the opportunity to examine what is really going on in our bodies
and our lives so we can make the necessary changes.
After menopause a woman is at much greater risk of developing heart disease. The
reason for this is still murky. It may be that estrogen loss lowers levels of HDL,
but we don’t know. One study has suggested that metabolic changes in menopause
transform the effect of estrogen from a dilator of blood vessels to a constrictor,
and lack of nutrients may exacerbate this effect. If true, that would explain why
the WHI studies showed equine/synthetic HRT (e.g., Premarin) to increase heart disease
in post-menopausal women. Other studies indicate that bioidentical hormones like
estradiol and progesterone appear to be safer. Hormones are a vital, complex part
of your underlying physiology, so it’s highly likely that they influence all
of the risk factors. We need to learn more.
New insight into aspirin use again shows us that women are different from men. Here’s
what the Women’s Health Study found:
- Otherwise healthy women over 45 experienced a moderate reduction in their
risk for suffering an initial stroke (approximately 17%) with daily aspirin use,
though aspirin did not reduce their risk of myocardial infarction (MI) or death.
- For women over 65, on the other hand, daily aspirin use was found to significantly
reduce (by 26%) the risk of a first major cardiovascular event (nonfatal MI, nonfatal
stroke, or cardiovascular death).
This is important because for women, strokes are more common cardiac events than
MI’s. The risks of aspirin therapy (bruising, GI bleeding, and stomach ulcers)
can outweigh its potential benefits, however, so be sure to discuss this with your
healthcare provider before beginning a regime of regular aspirin use. For this reason
I generally advise healthy women under age 65 to skip the daily aspirin —
but to be sure and take high-grade, lead-free fish oil daily instead.
For right now, how you handle the changes that take place during menopause will
strongly impact your overall heart health. Listening to your body’s unfiltered
signals could inspire you to delve into your past, fix your relationships (including
loving yourself more!), reshape your work, and alter your lifestyle. Your heart
will benefit in every aspect.
Reducing your risk
Understanding the factors that indicate risk of heart disease is a good first step
in achieving heart health — but don’t stop here! The really heartening
news is that most heart disease risk factors are within your control. For information
about what you can do to protect yourself, read our article on
heart disease prevention.
Our Personal Program is a great place to start
The Personal Program promotes natural hormonal balance with nutritional supplements,
our exclusive endocrine support formula, dietary and lifestyle guidance, and optional
phone consultations with our Nurse–Educators. It is a convenient, at-home
version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at
1-800-798-7902. We're here to listen and help.
Related to this article:
References & further reading on
heart disease risk factors
Last Modified Date: 04/20/2011
Principal Authors: Marcelle Pick, OB/GYN NP & Dixie Mills, MD