Heart Disease

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          Disorders of the heart and blood vessels account for the largest numbers of deaths in our population. It has been the number one cause of death in all areas, and has recently become the leading cause of death in women. The number of persons with diagnosed heart disease is upwards of 23 million, over 11 %.  The number of office based physician visits in 2002 was over 20 million, and it has become the most expensive collection of diseases to treat. Literature over many years has commented on the need to prevent heart disease, and the fact that it is preventable, yet it doesn't seem to be happening.

            It is imperative that we understand the totality of our heart risk and take steps to change them as early as possible to be able to remain healthy. There should be far more preventative testing for the number one killer in our society.

            There are many causes of heart damage and degeneration. The most prevalent of which concerns blockage of blood vessels great and small. Called Atherosclerosis, Arteriosclerosis, and plaque in general, these describe a phenomenon of blood vessel lining inflammation, degeneration and deposition of a variety of substances. This can effectively decrease blood flow and oxygen/nutrient/hormone delivery to cells in various places including heart muscle. Cells that are deprived of these essential factors begin to die a progressive and horrible death. Cardiac muscle and nerve tissue can be effected so quickly that it can cause function to cease.  To put a very complex picture into perspective and as a result of brilliant research over the years we now can put together an understanding of the most significant risk factors and the overall plaque process.

            We have known for years that cholesterol, triglycerides and elevated blood sugars, can deposit onto the wall of the blood vessel. The inner lining is called the intima. We have also known that an abnormal clotting mechanism may also contribute to this process. Hence, we test for fibrinogen and platelets. (Here we are told to take a baby aspirin to thin the blood. Nutritional physicians usually recommend Vitamin E and Fish Oil). Over many years, and through continued research we also know that elevated homocysteine, and c reactive protein may also quicken the progression of plaque.
(Homocysteine can be controlled easily by correcting levels of vitamin B6, B12 and Folate). Elevated C reactive protein can point us to look for infection as a contributor. Autopsy research has described that there were a variety of organisms found at the base or beginning of plaque on the lining of coronary blood vessels. Some of these organisms include Epstein Barr virus, Cytomegalovirus, Mycoplasma, Chlamydia among others. Heavy metal exposure can contribute to damage, as well as circulating free radicals creating oxidation. (Literature has described the importance of taking antioxidant vitamins to disable free radicals). As blood vessels " tighten" or become much less stretchable, blood pressure tends to increase. As cholesterol and triglyceride increases, usually contributed to by excess carbohydrate intake, plaque becomes more prevalent. Small pieces of unstable plaque can break free with the normal pulsation of blood flow and clog vessels down the line. This can cause heart attack, stroke, or death. A great deal of this is preventable.

          Many medications used to try to change the circumstance only temporarily help, or can create harm in their use. Agents that interfere with the production of cholesterol can also dramatically reduce the production and availability of Co enzyme q10. This is essential in contraction of heart muscle, among other things. In studies, patients given certain cholesterol lowering drugs had a decrease in cardiac out put and contractility. Diuretics have been given for those people with hypertension; some of these actually decrease levels of magnesium and potassium. It has been described that deficiency of these minerals can contribute as a cause of hypertension.

           The best of all approaches to this scenario involves a comprehensive approach to each patient. Because all people are individual, protocols must be tailored to the specific causes of disease in each person. An interview must be thorough, learning about dietary, family, social, prescription, exercise, and medical history. To be complete, and depending on history, testing should cover all of the following:

  1. Blood count – (CBC, Differential)
  2. Chemistry – Liver , kidney , electrolytes, Cholesterol profile, Iron profile
  3. Hormones – DHEA, Cortisol, Growth Hormone, Thyroid profile, Insulin Response, Testosterone, Estrogen/Progesterone, LH/FSH
  4. Nutritional – Vitamins and Minerals
  5. CV risk – Homocysteine, Apolipoprotein, Fibrinogen, C reactive protein, Cardiolipin antibodies, Troponin
  6. Digestive – Heidelberg Gastric analysis
  7. Infectious Disease – Bacteria, Virus, Parasite , Fungal infection
  8. CV eval – EKG, Vascular Sonography ( Echocardiogram , Carotid and Lower Extremity duplex, Abdominal vessels)
  9. Ultrafast Cat scan – Coronary calcium score.

Stress testing: The more that we know, and understand, the more able we are to make change.


Dr. Calapai