Heart disease

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 mg/dL.
• 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/ L.

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.

We’re always happy to welcome new patients to our medical clinic in Yarmouth, Maine, for those who can make the trip. Click here for information about making an appointment.

Related to this article:

References & further reading on heart disease risk factors

 

Original Publication Date: 02/21/2005
Last Modified: 01/11/2008
Principal Authors: Marcelle Pick, OB/GYN NP & Dixie Mills, MD