Let’s Have a Heart to Heart: Find Out Your Real Cardiovascular Disease Risk

Here’s some fresh and helpful information on extending your life, and reducing your real cardiovascular risk. Although 2100 people die in the U.S. every day from heart disease/heart attacks, and strokes, more women than men die of heart attacks, because the way they present their symptoms are very different than men’s. This largely preventable disease is still misunderstood by many family doctors, internists and cardiologists. In order to do something to lower your risk of heart disease, you need to get some information; that is find out where you are, and subsequently where you’re headed if you are doing well, or if not doing well, where you’re going to wind up if you don’t get motivated to change things. Before I go into detail, take heart, at almost any juncture along a vascular disease continuum, much of the damage can be managed or reversed without medication, or in combination.

The old model of heart disease was based on a “lipid”, or blood fat; cholesterol model. HDL, high density lipoproteins were “good” and LDL, low density lipoproteins were “bad.” Simple, right? If you got the volume of each measured, and got the HDL up and LDL down, you were good to go. If you couldn’t; voila, statins. Wrong! Not so simple. More on statins later and the risks associated with taking them.

A new era in preventing, managing and reversing cardiovascular and metabolic disease has arrived. Heart disease is multifactoral. Half the people who have a heart attack have normal cholesterol. Are your levels really “normal”? We have to look more closely. When it comes to measuring blood lipids,“size matters.” Its the small dense particles that plaque your arteries and lead to heart attacks.

Heart disease starts earlier in life than we thought, and is a progressive disease driven by inflammation and the immune system. Many things cause insults and damage to the inner lining of the blood vessels, called the “endothelium.” The way our bodies naturally respond to these continued insults, that are like little “scratches” on the inner vessel, is by becoming inflamed, patching things up, and then developing plaque.

Certain kinds of lipids are more likely to be “oxidized”, and turn into foam cells and later plaque that will eventually narrow your blood vessels. This can in turn lead to high blood pressure among other things, and is hard on your kidneys. In the presence of some other chemicals floating around, the “toxic brew” that joins the foam cells grows behind the inner vessel membrane, and once it becomes plaque it develops a “cap” that forms around the plaque. An enzyme from white blood cells called myeloperoxidase, oxidizes HDL and apolipoprotein A, and can destabilize the membrane that caps the plaque. If it dissolves the plaque and ruptures into the blood vessel turning into a clot, it will plug a blood vessel somewhere. If it’s in the heart; that’s a heart attack, in the brain, a stroke.

Not all women have the same warning symptoms as men; such as chest pain, arm pain, shortness of breath and tend to ignore their symptoms. Cold sweats, dizziness, extreme fatigue, sleeplessness, and stomach symptoms mistaken for indigestion are more typical of how a female’s impending cardiac “event” shows up. She might take antacid instead of calling her doctor or 911. That could be a fatal mistake.

Because most cardiologists have been trained to look at the 5 major risk factors; obesity, smoking, elevated cholesterol, diabetes mellitus and treat those risk factors with medication; there’s still a gap where not all of them recognize or treat the inflammation that’s driving this thing. Quitting smoking and getting your body composition at about 23% fat with a waist of 30 or under for women, is part of the equation, but there are “skinny fat people” out there whose pathology (and inner vessel “marbling”) is overlooked. They don’t look typical of the red faced, type A, balding 40-something male with a big belly. You could be a normal weight woman, with low pulse rate, and normal blood pressure with “normal” cholesterol levels, and still be at risk. Statins alone only reduce your overall risk of a heart attack by 36%. Statins interfere with your mitochondria, the little energy manufacturing cells within your cells themselves. Also they need CoQ10 to manufacture energy and statins knock that down. The mitochondria account for 40% of the heart’s actual weight, and take up 70% each heart muscle cell. Not only do people taking cholesterol lowering medication feel brain fog, they also hurt all over, and start losing muscle mass. Recent studies have shown the how statins interfere with the mitochondria not only leads to fatigue, but interferes with glucose metabolism, and causes many people to go on to develop type 2 diabetes who never had a familial risk.

Women deposit fat more symmetrically. This subcutaneous fat is more ‘friendly’ than belly fat. That gained around the abdomen, has macrophages, a type of white blood cell, so it is inflammatory in nature, think-angry fat, and more dangerous to your heart and brain. Belly fat is also a sign of insulin resistance or metabolic syndrome, caused by high sugar/carbs in your diet. Your labs would probably show a high fasting glucose, and high triglycerides which will raise your LDL. If you measure the size of your LDL particles, and it is composed of more small dense particles, plus you have hsCRP levels over .2 showing the inflammation, you could be making plaque right now.

What if you have an autoimmune illness, like Sjogren’s Syndrome, or Lupus? Having an autoimmune condition like those,or rheumatoid arthritis, scleroderma or celiac disease, the constant inflammation from autoimmunity in your system can upregulate your genes to start switching on less beneficial ones that will have you headed to heart disease, rather than switching them off. What else ramps up your risks? Anything else that causes inflammation. Allergies, stress, the Standard American Diet; too much refined grain ( bread, pizza, cake, crackers, pasta, rolls i.e. starch) sugar, salt, saturated and trans-fats, meat, deep fried food, fast foods, additives, sodas, alcohol, coffee, and unfortunately not enough omega 3 fatty acids, olive oil, fish, vegetables, soy products, fruits, and whole grains.

Stress, sleeplessness, negative emotions and thoughts, fears, isolation and loneliness all affect the heart and blood vessels too. Low grade infections left undetected and untreated contribute to the mix, like H. Pylori which causes stomach ulcers, Chlamydia, gum problems, an infected tooth and chronic dental disease. Heavy metal toxicity (lead, cadmium, mercury, aluminum) is associated with heart disease, cancer, retinopathy and dementia. Get those infections treated, take care of your teeth and gums, and have the metal levels checked with blood and urine testing; then use natural methods to get rid of them.

Taking a closer look at multiple “biomarkers” that are more sensitive to your genetic inherited risks is required to know your real risks. Measuring the actual particle size of HDL and LDL, which tells us whether yours is likely to plaque artery walls, or instead is large and fluffy, floating through nicely and not turning into plaque is very important. Inflammatory markers of advancing disease should be part of the panel.

So then how do we detect your risk? Refer to the list of labs below and find a Metabolic Cardiologist, or an Integrative Cardiologist or heart center in your area. Look for a chiropractor, internist, general practitioner, or naturopath who belongs to the Institute for Functional Medicine, and has taken the Institute for Functional Medicine’s Applied Functional Medicine in Clinical Practice course, and/or has recently attended the IFM’s annual symposium which started on May 31st; A New Era in Preventing, Managing, and Reversing Cardiovascular and Metabolic Function. Any one of the above mentioned doctors would be able to order the labs, interpret them and explain them to you, and immediately get you started on the right dietary, exercise program, stress reduction techniques, and lifestyle changes that can start changing your “numbers” within hours of getting started on a new path to truly intelligent wellness. Doctors who practice this way you’ve heard of and seen in the media, like Dr. Oz, Dr. Hyman, Dr. Lipman. IFM is shining a light on the way we need to take back our health and use community based programs to support one another in getting healthy and staying that way, without relying on doctors and medication.

Here’s a list of a few things you’ll want your doctor to add to your lab slip. Be prepared, that not every doctor likes a patient to assert herself, and may not agree that you need that particular test performed.

Apo A 1 and B
COq 10
Serum Ferritin
MPO myeloperoxidase
Total Cholesterol
and particle size and number of both of the above
Non-HDL Cholesterol
fasting glucose
fasting insulin
Small-dense LDL ( sdlDL)
Lipoprotein (a), Lp(a)
Urinary Microalbumin; random
Most standard lab req slips are not going to have these things on them. You may need to go to someone who uses specialty labs, like the Berkeley Heart Lab, the Cleveland Heart Lab, Genova Diagnostics or Spectracell Laboratories. Some of these measure risks of plaquing, chronic inflammation, the breakdown of important organ tissue in multiple systems, others measure oxidative stress from poor lifestyle choices showing your increased long-term risk for heart disease. The things that drive heart disease also age us faster, and are linked to type 2 diabetes, cancer and dementia. This had to be a long article to make a complex issue understandable, without being a 300 page book.

Barbara Streisand just raised and donated id="mce_marker"0,000,000 to the Cedars-Sinai Women's Heart Center, which is to be named for her. She and Bill Clinton noted the inequality in funding for research on women's heart health. She said that any inequality rankles with her, and she took these steps to improve womens' health by holding a fundraiser and calling on friends like Donna Karan and others to donate a million each.

Having just watched Dr. Mertz's presentation about this very issue on Ted Talks a few weeks ago, I thought this was all quite timely.


Watch for my next article “Are You On Fire?; Getting rid of Inflammation” that’s where I’ll hit all the dietary, stress reduction, and lifestyle changes that will empower you to take back your health. Now let me know what you’re doing right now to detect your risks, and get moving on the healthy solutions. I’d like to hear from you. So post me a comment.


Dr. Karen J. Krahl, D.C.  owner/doctor Synergy Health Group.  The link to one of my blogs is www.synergyhealthgroup.com, click on "Health News" on the banner at the top of my home page and pick a topic.


In order to comment on BlogHer.com, you'll need to be logged in. You'll be given the option to log in or create an account when you publish your comment. If you do not log in or create an account, your comment will not be displayed.

Recent Posts by Dr Karen Krahl D.C.