What is cardiovascular disease?
Cardiovascular disease (CVD) is the general term for blood vessel disease of the heart or body. CVD is the most common disease process in Western society and the financially well-off sections of developing countries.
Blood vessel disease, called atherosclerosis or atheroma, means a build up of fatty or calcific plaques along the arterial wall, which leads to narrowing or complete blockage. Significant narrowing reduces the amount of blood reaching an organ or body region and causes tissue ischaemia (lack of oxygen), reduced cell metabolism, and organ dysfunction
There are five main types of CVD, which cause ischaemia or a lack of blood flow.
- Ischaemic heart disease of coronary artery disease can cause a myocardial infarction or heart attack.
- Cerebrovascular disease (of the brain) can cause a stroke or cerebral infarct.
- Peripheral artery disease of the arms and legs can cause claudication (calf pain with walking), distal tissue atrophy, and in severe cases gangrene.
- Renovascular disease affects blood flow to the kidneys and can cause renal failure.
- Aortic disease can lead to narrowing of the main artery, called the aorta, from the heart or an aortic aneurysm or ballooning of the aorta. Atheroma can cause weakening of the artery wall and ballooning of the artery, called an aneurysm, which can rupture the artery causing fatal internal bleeding.
Atherosclerosis means thedeposition of atheromain the vessel wall of large and small arteries causing ischaemia, which means a lack of blood. Atheromatous plaques can contain fat, cholesterol, blood cells and fibrous tissue.
Coronary artery disease means a build up of atheromatous plaque within the coronary arteries, which provide the heart muscle with oxygenated blood and nutrients. If significant ischaemia results, a myocardial infarction or heart attack results. The damaged heart muscle can stop pumping leading to heart failure.
- During 2007–08, approximately 3.5 million Australians had a long-term CVD.
- Nearly 50,000 deaths were attributed to CVD in Australia in 2008 – more than any other disease group and 34% of the total.
- CVD was the main cause for 475,000 hospitalisations in 2007–08 and played a secondary role in a further 797,000.
- CVD accounted for about 18% of the overall burden of disease in Australia in 2003, with coronary heart disease and stroke contributing more than 80% of this burden.
- CVD remains the most expensive disease group in Australia, costing approximately $5.9 billion in 2004–05. Just over half of this money was from the cost of admitting patients to hospital for treatment.
The overall death rate for CVD has fallen by about 80% since the 1960s and continues to fall. Death rates from coronary heart disease, stroke, heart failure, rheumatic heart disease, and peripheral vascular disease, have all fallen markedly during the past 20 years. (Cardiovascular disease – Australian Facts 2011)
How do doctors treat ischaemic heart disease?
Ischaemic heart disease (IHD) or coronary artery disease is the most common form of atheromatous disease. Sudden death is the first indication of IHD in up to 40% of cases. IHD can cause a heart attack, or myocardial infarction, which presents as acute chest pain and arrhythmia, with cardiovascular decompensation. A person with IHD may experience recurrent angina with effort or congestive cardiac failure, which presents as shortness of breath on exertion and fluid retention, with or without angina
The two vital treatment goals in myocardial infarction and angina are to improve coronary arterial circulation and prevent any progression of atheromatous disease.
Medical interventions to treat IHD include:
- Thrombolytic therapyto dissolve thrombus, which must be performed within three hours of an acute infarction
- Coronary angioplasty to expand artery narrowing with or without stent insertion
- Coronary artery bypass surgery, to create a new blood vessel
- Coronary artery vasodilationusing short acting glyceryl trinitrate and long-acting nitrate drugs
- Beta-adrenergic blocking drugsto reduce myocardial oxygen demand, cardiac arrhythmia, andhypertension
- Angiotensin-converting enzyme inhibitors (ACE inhibitors)to improve myocardial contractile function and reduce hypertension
- Calcium-channel blocking drugsto stabilise myocardial contractility and improve coronary arterial perfusion, reduce occurrence of angina, and lower hypertension
- HMGCoA reductase inhibitor drugs (statins) to reduce cholesterol synthesis and inhibit progression of atheromatous plaque, and
- Platelet inhibitor drugs, such as aspirin, ticlopidine hydrochloride, dipyridamole, and abciximab (ReoPro) to inhibit platelet activation and aggregation, thereby reducing thrombogenesis and atheroma progression.
However, medical interventions seldom address the issue of revitalisation of damaged myocardium and, apart from the reportedly beneficial effect of ACE inhibitor drugs, their impact on long-term mortality remains questionable. Presumably, this lack of long-term benefit relates to progressive medication-induced alterations in cellular and systemic metabolism.
Treatments for ischaemic heart disease include lifestyle changes, medicines, and medical procedures.
Treatment goals aim to relieve symptoms and reduce a person’s risk factors to delay or even prevent further atherosclerosis. Surgical treatment can widen or bypass occluded arteries, while medication can lower the risk of blood clots and prevent complications of IHD.
Nutritional medicine treatment of cardiovascular disease
An effective, integrated dietary and nutritional program improves myocardial cellular metabolism, cardiovascular function, general health An effective, integrated dietary and nutritional program improves myocardial cellular metabolism, cardiovascular function, general health status, and long-term mortality. Nutritional therapy needs to be integrated with medical interventions, with a focus on improvement of clearly identified metabolic mechanisms. Keeping your heart healthy will also have other health benefits, and help reduce your risk of stroke and dementia.
An integrated diet and nutrient supplement program, tailored to individual nutrient needs, is crucial to optimise myo¬cardial function and cardiovascular integrity. This program is based on detailed assessment of a person’s nutritional and metabolic status, including medical treatment.
You can take action to prevent of delay coronary artery disease by reducing the number or risk factors that apply to you. If you smoke, it’s time to quit. Make time for regular physical exercise. Change to a healthy diet that includes a variety of fruits and vegetables.
Thorough clinical history
A thorough history, dating back to infancy, including a detailed family history, should be taken with particular emphasis on the following:
- Current symptoms of cardiovascular disease, including: ischaemic pain (angina at rest or with effort, referred cardiac pain in neck, shoulder or epigastrium and peripheral claudication); exercise tolerance and symptoms of cardiac failure; palpitations and cardiac arrhythmias; hypertensive symptoms; cerebrovascular insufficiency (transient episodes of dizziness, fainting, confusion, disorientation, paraesthesia and paresis).
- Family history of heart disease, diabetes, obesity and hypertension may be related to a genetic susceptibility to insulin resistance and/or abnormalities of lipoprotein or homocysteine metabolism and would strongly suggest appropriate tests for this condition, which will have a strong influence on the type of diet required.
- History of recurrent respiratory tract, gastrointestinal symptoms or overt allergic disease may indicate the presence of previously unidentified food sensitivity and/or a chronic infectious process with intracellular organisms such as Mycoplasma, Chlamydia, rickettsiae or viruses. These patients would require thorough testing of immunological function including: IgE and IgG allergy testing; measurement of gluten anti-bodies; estimation of high-sensitivity C-reactive protein (CRP) and cytokine levels, such as interleukin-2 and interleukin-6; serology or preferably PCR (polymerase-chain reaction) testing for infectious organisms.
- Recurrent antibiotic therapy or an episode of intensive antibiotic therapy may indicate the presence of bowel dysbiosis, particularly if easy bruising is present with unduly compromised hepatic detoxification, thereby reducing tissue glutathione and CoQ10 capacity and increasing demand for antioxidants such as ascorbate, Vitamin E and selenium.
- Current or past smoking – cigarette smoking undoubtedly contributes to development of CHD. Importantly, regular smoking of marijuana is equally as detrimental as cigarettes, excess alcohol consumption and long-term drug use (prescribed medications included).
- A history of chronic stress-reactions and/or depression may relate to long-term high nutrient demand that induces tissue insufficiency.
- Current exercise – frequency, intensity and duration and exercise capacity.
Dietary history look for:
- High-level consumption of saturated fats and/or low-level consumption of seafood may indicate omega-3-FA insufficiency and blood lipid abnormalities
- Low consumption of fruit, vegetables and whole grains (dietary fibre) may suggest inadequate cholesterol excretion with or without adequate fat absorption; may suggest bowel dysbiosis; inadequate antioxidant intake (ascorbate, Vitamin E and flavonoids); increased insulin response to dietary carbohydrates (hyperinsulinaemia).
- High level consumption of processed foods may suggest an excessive intake of: refined carbohydrates, exacerbating insulin responses and contributing to insulin resistance; hydrogenated/saturated fats, contributing to adverse blood lipid metabolism; high dietary salt/potassium ratio and a corresponding low intake of: dietary fibre; antioxidants and other vitamins; essential fatty acids; magnesium and zinc.
- Overweight and obesity – increased BMI indicates increased risk of insulin resistance, particularly when the umbilical:hip ratio exceeds 0.9 in men or 0.8 in women.
- Body composition – a lean weight less than 85% of the minimum weight for height may suggest a protein depletion state secondary to inadequate dietary intake, impaired digestion or impaired protein synthesis due to B6/zinc insufficiency or low anabolic hormone status.
- Signs of essential fatty acid imbalance and antioxidant insufficiency.
- Signs suggestive of mild or early nutrient inadequacy, e.g. Vitamin B6, zinc, magnesium, calcium etc, and
- Signs suggestive of food reactivity, impaired digestion and bowel dysbiosis.
Physical examination and nutritional assessment
A thorough physical and examination and nutritional assessment is important. Clinical examination should focus on assessment of both cardiovascular and nutritional status. Cardiovascular assessment includes recording of pulse rate, pulse rhythm and blood pressure, peripheral perfusion, arterial murmurs (bruits are indicative of widespread arteriosclerosis) and cardiac pump inadequacy (cardiac failure).
Nutritional assessment focuses on: