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Real Risk Factors for Heart Disease and Why You Can't Wait to Make Changes

Heart disease is just a thing old dudes worry about... right? Sorry, pal. It's actually everywhere. Statistically, you know someone with cardiovascular disease (even if you don't know they have it). It's also likely you're very aware of someone in your family is struggling with heart health. It may sound small like, meh... he has high cholesterol, or it may be as serious as a heart attack. "But... I can basically ignore it until I'm old, right?" DOUBLE sorry, pal. Heart disease, strokes, heart attacks, high blood pressure, high cholesterol, etc. don't just magically appear one day. The universe doesn't pick a day and declare "TODAY is the day you'll start eating dinner at 4:30 pm, watching 'stories' on the TV, and start thinking about your heart health." That fun diagnosis all the "old" people receive has been in the works for YEARS by the time a doctor actually finds it. Let me explain why and how to prevent heart issues now, and the REAL risk factors you should be looking for (hint: your doctor might be a liiiiittle out of touch).  

Ideally, we'd all be on board with the "prevention" mindset, 100% of every day. I'm in that mindset when I can be (my kid gets fruit in fancy shapes instead of a sugar-laden birthday cake) but sometimes I just... can't (i.e. I'm not even the one to put the fruit into fancy shapes, and the amount goldfish crackers in the back seat of my car resembles the number of fish in the actual ocean). But, whenever possible I like to put the best of intentions and effort into healthy living before disaster or disease strikes. 

Or.. you could do the OPPOSITE. You could wait until that “holy shit”-revolution-spurring-terrifying moment kicks your health into gear. Fear becomes your motive when you realize: “my dad just had a heart attack”, “my brother passed out while mowing the lawn, and has to see a specialist for months”, “my aunt had a stroke while riding her bike (ironic if it was this ride)."  I'm begging you, don't wait until something serious hits close to home before you start asking about prevention. Because guess what? You have SO much control over your health right. now.

There's a chance you fit this profile:

  • Hard working
  • Kinda stressed
    • No matter how much you love your job or even love the pressure it brings. Not to mention you may have a spouse always on your tail about being more "social" or helping around the house, yadda, yadda, yadda...
  • You’re a dad (or mom)… or have something else causing your sleepless nights. WHO IS ACTUALLY GETTING 8 HOURS?
  • You enjoy some grown up beverages and other occasional carbs on the couch
    • Because that’s when you actually get time chill out, or have a real conversation...
  • Your prior fitness routine has come undone
    • You fell-off-that-wagon so hard that you're going to have to start paying some dude to yell at you move heavy stuff from one spot to another.
  • Your time for rest…. Wait… who has time to rest?
  • Your diet actually has gotten better compared to the college days, but work trips, happy hours, and lunch meetings are putting unfavorable notches in your belt.

You might think, "eh, that all sounds fine to me..." but even average people like us are being told that our bad cholesterol is rising, our good cholesterol is falling, and blood sugar levels are increasing, along with our blood pressure.

Part of this is on you (ahem, us), but part of this is on your doctor. The traditional medical community might give you a "plan" that includes the following:

  1. Take 100mg of a statin drug for your cholesterol. If that doesn't work, we'll up your dose next time. In a few months if your blood pressure doesn’t come down too, we’ll add a blood pressure medication.
  2. Drink more water
  3. Get more sleep
  4. Lose 15 lbs (ya know, the gym?)
  5. See you back next year unless something terrible happens before then.

Cool. NOT super helpful.

It's not that water, sleep, and weight loss aren't good suggestions, it's just that if you aren't doing them now, a 5 second suggestion from your doctor probably isn't going to revolutionize your life. Remember-- time, work, nachos, and life happen all the time, causing the work-life-health balance to become….unbalanced.

What risk really looks like...

What I want to encourage is a more accurate way of assessing your risk of having a stroke or heart attack. Most doctors focus on weight, blood pressure, and a blood lipid panel to asses your heart health however, these are really bad at predicting risk for cardiovascular disease. Did you know over 50% of men and women showing up the emergency room with a CONFIRMED stroke or heart attack have had normal blood pressure, and normal cholesterol their entire life?

But wait… that means, the other 50% have been diagnosed, are being treated, AND ARE STILL HAVING A STROKE OR HEART ATTACK. What gives?

Let me repeat... half the people with stroke/heart attack have had normal blood pressure, and normal lab results and normal weight? They weren't assessed for actual risk.

The top three risks I like to focus on with my patients are the three biggest insults to the heart and arteries.

The 3 Big Cardio Risk Factors:

  1. inflammation
  2. oxidative stress
  3. a weak immune system

Honestly, it’s a combination of variables that impact our ability to have a healthy heart. These 3 risk factors are causing weak blood vessels and weak hearts. The good news is they can be evaluated if your doctor is open to a different approach to lab testing. Instead of going straight to the medication when your cholesterol panel looks ugly, your doctor could dig a little further and evaluate your risk. To save those 50% of people with normalab test results, let's dig a little further and evaluate risk for them too. That way we can truly know when to make lifestyle modification instead of waiting until it's too late. It'll make more sense after you read this:

This is BIG: Here's Why Medicating for Cholesterol Levels Gives us False Hope

Once a person is medicated for cholesterol, a harsh reality is covered up:

  • It's true that with the help of medicine, LDL or "bad" cholesterol will go down. We think, "yay!" until we realize it's not that easy. 
  • Keep in mind: we need and use cholesterol to make hormones that protect the body from aging (think protection against MS, Parkinson's, Dementia, etc.), so we want to have cholesterol in our body if it's not a risky type.
  • There's good and bad cholesterol: HDL is the "good" kind, LDL is the "bad" kind
  • LDL/"bad" cholesterol comes in different sizes.
    • Small LDLs are linked to a greater risk (and therefore a better predictor) of stroke and heart attack. Although they are small, they are dense and heavy.
    • Large LDLs are fluffy and light, are less likely to make plaque in arteries, and therefore pose less risk. 
  • Your doctor is likely testing LDL-C, just checking for overall levels of cholesterol. Instead, they should be testing LDL-P (think P for "particle size") would measure the actual total number of particles AND break them down by size. IMPORTANT:
    • Cholesterol medications can lower the big fluffy LDLs but NOT the small dense LDLs, but on a test it still looks like the total number of LDL/"bad" cholesterol went down. THIS MEANS - if you didn't test the sizes, you have no idea if your risk went down at all.
    • If the number of small dense LDL particles isn't going down, then the risk for heart attack and stroke hasn't gone down either (... the original point of medication!)

BUT, I'm not on medication because my cholesterol test came back normal.

Again, if your doctor tested LDL-C (probably) instead of LDL-P (unlikely) you might not be in the clear with "normal" results.

  • Your "normal" LDL levels could be composed of entirely small/dense/plaque-forming particles, and hardly any large and fluffy particles -- explaining why "normal" cholesterol levels may still put you at a very high risk for heart attack or stroke!
SO - your regular 'ol cholesterol test could be very deceiving, even detrimental. Additionally, overall health may go down, as statin medications (for cholesterol) deplete the body of a nutrient called CoQ10 which protects the heart.  

    In a few years, many of those patients will also have to add a blood sugar medication, hormone help (testosterone, estrogen, etc.) and more, because they're not only losing nutrients from the first medication, but they don't have enough cholesterol in their body to produce hormones that regulate blood sugar.  It’s a vicious cascade. 

    So what else should be tested?

    1. Request that your doctor order an LDL-P test rather than LDL-C, and if they give you a puzzled look... go find a doctor who knows how to read LDL-P test results.

    2. Inflammation and oxidative stress can be evaluated by testing your levels of CRP (C-reactive protein) and Homocysteine. Another option may be for your doctor to run a test called an ESR especially if he or she suspects an autoimmune disorder. Bonus: If your doctor knows functional medicine, they'll be able to order this specific oxidative stress test

    3. Immune system strength can be tested by having even a basic test like a CBC (any doctor runs these all the time). Other options would be a "complement assay". One clue to a weak immune system, even if you aren't testing for it? -- You catch nearly every cold, cough, flu that goes around. 

    What DOES fix risky lab results?

    Lifestyle. It's not the easy answer, but it's the most effective. The following changes in lifestyle help reduce ALL bad cholesterol, inflammation, oxidative stress, and immune system overload by 80%!

    • Supplementing nutrients like B3 and Omega 3 fatty acids
    • Getting MULTIPLE vegetables (harsh, right?) and good sources of protein throughout the day.  If you have questions on protein, read here, and look here for veggie inspiration!
    • Optimize exercise. Both resistance training + aerobic exercise 3-4days/week can help. Even sneaking in a quick 20 minutes is great!
    • Cut out processed carbohydrates.. like pasta, bread, cake, and cookies. Not forever, but you shouldn't be eating these every day.
    • Good sleeping patterns. Shoot for 7-8 hours per night. This give your blood pressure time to lower at night which typically only happens while sleeping. To help this, shut your phones, computers, and ipads off by at least an hour before your goal bed time (tis science).
    • Maintain your mental mo-jo. Mend or eliminate stressful relationships where you can. It may involve distancing from a needy friend, or re-evaluating your mindset and approach. Keep in mind that saying "no" politely can do wonders for your stress levels. You can always use this meditation when you need to take 5.
    • If you still need it, ask for a better medication. Medications that target LDL-P levels are called "Fibrates" - this request should only be asked of a doctor who is familiar with or trained in functional medicine.

    Nutrition for a Healthy Heart

    Sometimes you just want the short and sweet "what do I need to take now"... here it is:

    • OMEGA 3's: I suggest a minimum 3-4 grams if you have a family or personal history of high blood pressure or heart disease.
    • COQ10: it limits damage to your heart especially as we age, and exercise.  (I suggest 50-100mg/day if you're not currently on a statin, and 100-300mg/day minimum if you are on a statin (or a exercise fanatic).
    • Power Antioxidants: control oxidative stress (the stress that damages your cells) to help them live longer and function better.
    • Seem like a lot? Consider having a functional medicine provider test for what your unique body needs. I especially love tests through Genova Diagnostics, or Spectracell!

    The Bottom Line

    Don't wait until it's too late. Your 20's, 30's, and 40's are the time to take care of yourself before you get slapped with a diagnosis in your 50's. If you're already in your 50's, work smarter not harder by finding a practitioner that's up to date with accurate and effective lab testing, and treatment.


    Disclaimer: this post does not take the place of a visit with your health care provider, and these statements have not been evaluated by the FDA. 

    Calla Kleene
    Calla Kleene