Heart Disease: Causes, Prevention and Treatment

by Hans R. Larsen, MSc ChE

Cardiovascular disease is the major cause of death in the United States; it claims more
lives than all other diseases combined(1). Worldwide it is estimated that more than 12
million people die every year from cardiovascular disease(2).

What is cardiovascular disease?

Cardiovascular disease involves the heart and its two networks of blood vessels, the
system which circulates the blood throughout the body and the system which circulates
the blood through the lungs.

The heart, apart from what other mythical and emotional characteristics we may ascribe
to it, is basically a living pump. Its failure, for whatever reason, usually means instant
death. The heart is one of the hardest working organs in the body; it contracts and
expands about 100,000 times every day. It supplies a blood vessel network 96,000
kilometers long and pumps in excess of 10,000 liters of blood around the body every
single day.

The heart pumps returning "used" blood through the lung capillaries where waste gas,
primarily carbon dioxide, is expelled and fresh oxygen is taken up by the blood. From the
lungs the now oxygenated, bright red blood is pumped through the aorta into the smaller
arteries, the capillaries, where the actual nutrient and oxygen exchange with individual
body cells takes place, and then back to the heart through the veins. Immediately after
exiting from the heart the aorta branches off into the right and left coronary arteries which
supply the heart itself with fresh blood and the nutrients it needs. The coronary arteries
are attached directly to the wall of the heart and are squeezed and expanded 100,000
times a day. This constant stress makes them especially vulnerable to damage and
disease.

Coronary heart disease and stroke are the two major manifestations of cardiovascular
disease. In the United States, about 500,000 people die every year from coronary heart
disease and about 150,000 from stroke(3). The cost of treating cardiovascular disease
with surgery and drugs now exceeds $115 billion a year in the United States alone(4).
Cardiovascular disease is very much a disease of Western Civilization and its incidence
varies from almost 1,000 deaths per 100,000 population in Hungary to less than a third
of that in Japan(2).

Coronary heart disease strikes hardest at men in their mid-fifties while women usually
are spared until about age 65(5). Coronary heart disease is also known as ischemic
heart disease and its most common forms are myocardial infarction (heart attack) and
angina pectoris (chest pain).
Conduction disturbances, valve malfunctions, and arrhythmias are other common
manifestations of heart disease, but their significance pales in comparison with the
impact of coronary heart disease. Stroke, intermittent claudication (a peripheral vascular
disease) and macular degeneration (a leading cause of blindness involving the central
part of the retina) are cousins of coronary heart disease and all have one common
ancestor - atherosclerosis(3,5,6).

Atherosclerosis
Atherosclerosis is a disease of the arteries in which fatty, often calcified deposits develop
on the inside of the arterial walls and eventually cause blockages which lead to
cardiovascular disease. Atherosclerosis is the result of the body's attempt to patch up
injuries to the inside of the arterial walls. These injuries come about because of
weaknesses in the walls and because the walls are constantly exposed to mechanical
stress induced by the heart's pumping action. This stress is exacerbated by high blood
pressure (hypertension) and chronic emotional stress(3,5,7).

Free radical activity also plays a major role in the development and progression of
atherosclerosis both through the generation of oxidized, reactive lipoproteins
(compounds of proteins and fats which serve as carriers for cholesterol) and through
direct attacks on the DNA of the arterial wall cells(7-12).

The body attempts to repair the damage to the arterial walls by producing more smooth-
muscle cells in the area of the injury; these cells in turn tend to accumulate cholesterol
and oxidized lipoproteins and may also undergo calcification(3,5,10). As the deposits
grow they narrow the inside opening of the artery and eventually create a blockage. If the
blockage is in the coronary arteries angina pectoris may develop or a heart attack may
occur. If it is in the brain, a stroke may be the result and if the blockage is in the legs
intermittent claudication may occur.

It is interesting that cardiovascular disease is unknown among other mammals. Why are
humans the only species afflicted with this disease? Nobel laureate Dr. Linus Pauling
and Dr. Matthias Rath, MD, a German physician and leading expert in cardiovascular
disease believe that the root of the problem is our inability to produce vitamin C. Only
Homo Sapiens, primates and guinea pigs do not manufacture vitamin C internally. Drs.
Pauling and Rath believe that cardiovascular disease is a form of early scurvy and that
the vitamin C deficiency inherent in both diseases manifests itself by the development of
fragile blood vessels lacking in collagen - the reinforcing rods of arteries. They also
believe that we developed the artery wall repair mechanism thousands of years ago as a
compensation for our inability to produce vitamin C and sufficient collagen to maintain
strong, healthy arteries which would not be prone to tears and injuries(2,13,14).

Many scientific studies have shown that a lack of vitamin C and other antioxidants
increases the risk of heart disease and stroke(2,15-23). Other major risk factors for
cardiovascular disease are smoking, a high level of cholesterol and lipoproteins,
diabetes, hypertension (high blood pressure), obesity (especially around the
abdomen) and lack of exercise(3,5,24,25,26). Genetic predisposition can also be a
factor in the development of heart disease, but some experts downplay its
importance(3,5,25).

Excessive exposure to free radicals generated through contact with pesticides,

chlorinated water, air pollutants and other toxic chemicals is a strong risk factor for
cardiovascular disease(7,10). Chronic emotional stress is also a significant risk factor
and acute emotional or physical stress may precipitate a heart attack(3,24,27,28). Stress
not only raises the blood pressure and constricts the arteries, it also generates large
quantities of adrenalin which the body converts to adrenochrome - a potent free
radical(29).

The role of alcohol in the development of cardiovascular disease is controversial.

Recent research has shown that consumption of moderate amounts of wine, especially
red wine, actually reduces the risk of developing heart disease; other studies dispute
this. The consensus of opinion now seems to be that a couple of glasses of wine or a
beer or two a day will not promote heart disease and may even help to prevent it. Heavy
drinking, however, is still considered a potent risk factor for heart disease(30-33).

Iron has recently been implicated in heart disease(34,35). Researchers at Harvard

University now conclude that it is not the overall iron intake which increases the risk of
heart attack, but rather the intake of heme iron as found in red meat. The Harvard
researchers found that men who ate beef four times or more per week had a 38%
greater risk of having a heart attack than did men who ate beef once per month or
less(36). More recent studies show that the body is remarkably efficient in keeping the
blood's iron content within safe limits(37).

Cholesterol is an important intermediary in the production of many vital hormones. The

liver supplies all the body's needs (about 3000 mg/day) and any excess dietary intake is
unnecessary and harmful(24,25).

A high overall cholesterol level and a high level of LDLs (low density lipoproteins) are
strong risk factors for cardiovascular disease in men. One recent study found that men
with cholesterol levels higher than 6 mmol/l (240 mg/dl) have a three times higher risk
than men with a level below 5 mmol/l (200 mg/dl)(3). Another study found that men who
had a high cholesterol level in their youth are twice as likely to develop heart disease as
are men with a low to normal level(38).

Cholesterol risk factors are different for women. The high density lipoprotein (HDL) level
and the level of triglycerides are far more important risk factors for women than are total
cholesterol and LDL levels. Women with low levels of HDL have a three times higher risk
of dying from cardiovascular disease than do women with higher levels. Women with a
low level of HDL and high levels of triglycerides have a death rate almost eight times
greater than women with normal triglyceride levels and low HDL levels(39,40).

Recent research has shown that a high level of the amino acid, homocysteine, in the
blood increases the risk of cardiovascular disease very significantly(41-44). Finnish
researchers have discovered that mercury is a potent initiator of heart disease and other
researchers have found that the risk rises with the number of amalgam tooth fillings(45).
The Helicobacter pylori bacterium has also been implicated in the development of
coronary heart disease(46).

The prevention of heart disease and stroke is synonymous with the prevention of
atherosclerosis. Atherosclerosis can be prevented by developing strong artery walls, by
controlling the factors which cause injuries to them and by minimizing the level of fats,
lipoproteins, cholesterol and homocysteine in the blood.

Part 2 - Prevention

A healthy diet is the strongest protection against cardiovascular disease. A heart-healthy

diet is rich in fruits and vegetables and low in saturated fat, cholesterol, meat, and
sugar(2,3,24,25,47-49).

A recent study carried out in Germany showed that the death rate among male
vegetarians due to cardiovascular disease was only 39% of that of the general
population while the death rate of female vegetarians was only 46%(50). Other studies
have shown that high fat diets significantly increase the risk of cardiovascular
disease(3,47). Trans-fatty acids found in hydrogenated vegetable oils are particularly
harmful(51,52). A recent study at the Harvard Medical School found that people who had
a high intake of margarine had more than twice the risk of having a heart attack than did
people with a low intake(53). Another study found that women who had changed from
butter to margarine to lower their cholesterol and avoid heart disease actually had a 67%
higher incidence of heart disease than did women who had not made this switch(54).

The fat content of the average American diet is 40-50% of calories consumed and is
mostly saturated fats(24,25,55). The World Health Organization recommends that dietary
fats should only supply between 15 and 35% of daily energy intake with 30% being the
maximum for sedentary individuals. Less than 10% of the daily energy intake should be
in the form of saturated fat and the daily cholesterol intake should not exceed 300 mg
(one egg)(56).

Leading experts in the prevention and treatment of cardiovascular disease go even

further in their dietary recommendations. Dr. Dean Ornish, MD recommends a diet
containing no more than 20% of calories from fat with the fat source being mostly
polyunsaturated or mono-unsaturated. Dr. Ornish also recommends no more than 10 mg
of cholesterol per day(24). To put these recommendations in perspective consider that
just one "Quarter Pounder" hamburger with a side order of french fries provides about
30% of total daily energy intake, contains 100 mg of cholesterol and is loaded with
saturated fat and trans- fatty acids; definitely not a heart-healthy meal(24,55).

Other researchers recommed an increased intake of non-contaminated fish as an

effective way of reducing the risk of cardiovascular disease(57-60).

Most medical experts agree that a high total cholesterol level is a critical risk factor for
cardiovascular disease and that a reduction in overall cholesterol levels is an important
measure in preventing and treating atherosclerosis(3,5,24,25,61). There are, however,
dissenters who provide compelling evidence that reducing total cholesterol levels has
little if any effect on the progression of atherosclerosis and does not lower overall
mortality or even mortality from cardiovascular disease(62-64). It may well be that a high
cholesterol level is relatively unimportant in comparison to the major risk factors of
hypertension, smoking, obesity, diabetes, and physical inactivity(65). Whatever the truth,
there is now a growing consensus that a concerted effort should be made to lower
cholesterol levels by dietary changes before considering drug therapy(3,66,67).

A significant increase in the intake of fruit, vegetables, grains and legumes and a drastic
reduction in the consumption of saturated fats, cholesterol, meat and sugar are the
cornerstones in any cholesterol reduction program. There is extensive evidence that
such dietary modifications on their own can bring about impressive reductions in overall
cholesterol levels(24,25,55,61,62,67-70). Very effective cholesterol-lowering programs
have been developed by Dr. Julian Whitaker MD, Dr. Dean Ornish MD, and Dr. Hans
Diehl. These programs are based on low fat diets, exercise and stress reduction. They
not only lower cholesterol but actually reverse blockages in the arteries(24,25,55).
There are many specific dietary components and supplements which are highly effective
in lowering cholesterol levels. Among them are wheat germ, oat bran, soy protein,
calcium, green tea, nuts, garlic, and omega-3 fatty acids specifically fish oils and flax
oil(71-84).

Cholesterol levels can also be lowered by the use of pharmaceutical drugs(3,5).

However, there is considerable controversy as to the overall benefits of this
approach(85,86). Niacin (vitamin B3) is equal or superior to pharmaceutical drugs in its
ability to lower the "bad" cholesterols and increase the "good" (HDL) cholesterol(87-90).

Some researchers believe that low levels of HDL (high-density lipoprotein) are even
more detrimental to cardiovascular health than are high total cholesterol levels and high
LDL levels. HDL cholesterol counteracts the effects of low density cholesterol by
scavenging excess cholesterol from the walls of the arteries and taking it to the liver
where it is broken down and excreted(5). Exercise, dietary modifications, weight control
and niacin therapy are effective in raising the blood levels of HDL cholesterol(3,47,87-
90).

Avoidance of smoking and secondhand smoke vie with dietary modifications as the
single-most effective measure in avoiding cardiovascular disease. Smoking kills over
400,000 Americans every year and over 125,000 of them die from cardiovascular
disease(3,91). Women smokers who also use oral contraceptives increase their risk of
heart attack substantially(3). Smoking also aggravates angina(92). Secondhand
(passive) smoking increases the risk of heart disease and may aggravate existing angina
pectoris(93). The benefits of quitting smoking occur fairly quickly. Smokers who quit
lower their risk of stroke by 27% two years after stopping. Their risk reaches the level of
non-smokers after about four years(94).

Antioxidants are very effective in preventing atherosclerosis. They work by deactivating

free radicals and peroxidized fats and thereby prevent them from adhering to existing
deposits on the artery walls(15,23,95-100).

Vitamin C helps to strengthen the artery walls by building up their collagen content.
Numerous studies have found that vitamin C or vitamin C- rich foods help prevent heart
disease(2,25,101,102). A low vitamin C intake has also been linked to an increased risk
of heart disease and stroke(103- 105). A recent study showed that vitamin C
supplementation helps protect the blood against oxidation and another showed that
antioxidants protect fats in the blood against harmful peroxidation(95,105). Vitamin C
helps thin the blood, regenerates vitamin E and lowers blood pressure(2,7,25,98,107).
Vitamin C is safe and free of side effects even at high concentrations(108).

Vitamin E prevents cardiovascular disease in several different ways: by protecting low

density lipoproteins from oxidation, by inhibiting smooth muscle cell proliferation (a major
cause of atherosclerosis), by reducing platelet adhesion (an important factor in the
formation of blood clots), and by increasing the concentration of "good" cholesterol
(HDL) in the blood(7,8,25,109-115). The evidence of the protective effect of vitamin E is
impressive and growing daily. Two large studies carried out at the Harvard Medical
School concluded that people who had taken 100 IU of vitamin E for two years or more
had a 40% lower incidence of coronary heart disease and a 30% lower incidence of
ischemic stroke. The studies involved over 125,000 nurses and other health
professionals(8,22,116). Other studies have shown that men who took 100-250 IU per
day of vitamin E had a 44% lower risk of coronary heart disease than did men who did
not supplement. The decrease in risk was only observed in men who supplemented; a
high intake of vitamin E-rich foods did not decrease the risk significantly(116). Vitamin E
is also useful in preventing diabetes which often leads to heart disease(117).

Vitamin E is entirely safe in dosages up to 1000 mg/day (1000 IU/day) and no toxicity
has been observed with dosages as high as 3200 IU/day(108,118,119). Medical advice
should, however, be obtained before starting a supplementation program in the case of
individuals who have a vitamin K deficiency, a tendency to prolonged bleeding or who
are taking anticoagulants like warfarin(108).

Beta-carotene is another fat-soluble antioxidant which is highly effective in protecting

against free radical damage. Beta-carotene is particularly effective in protecting smokers
from lipid peroxidation and thereby lowering their risk of heart disease(22,120). Several
studies have found that people with a low level of beta-carotene in their blood have an
increased risk of developing coronary heart disease(16,17,23,102).

Beta-carotene is approved by the U.S. Food and Drug Administration as a dietary

supplement and is considered safe even in large intakes. Yellowing of the skin may
occur in people taking more than 30 mg/day for extended periods. This condition,
however, is entirely benign and disappears when supplementation is discontinued(108).

The importance of selenium as a dietary antioxidant is becoming increasingly clear.

Selenium is a component of the body's natural antioxidant, glutathione peroxidase, and
also plays an important role in combatting the toxic effects of mercury(121). A low
content of selenium in the blood has been linked to an increased risk of cancer and heart
disease(122,123). A daily intake of 50-200 micrograms is safe and adequate(123).

Some very recent research has shown that Ubiquinol-10, the reduced form of
ubiquinone-10 (coenzyme Q10) is even more powerful than vitamin E and beta-carotene
in protecting low-density lipoproteins (LDLs) against peroxidation(124-127). It is,
unfortunately, only found in very low levels in LDLs, but its concentration can be
significantly increased by supplementing with coenzyme Q10(109,127). Coenzyme Q10
is relatively free of adverse effects in daily intakes as high as 300 mg/day(128).

The B-vitamins are receiving increasing attention as important factors in the prevention
of cardiovascular disease. Folic acid, vitamin B6 and vitamin B12 are all required for the
metabolism of homocysteine and supplementation with 400 micrograms/day of folic acid
is effective in normalizing homocysteine levels(41,42). Supplementation with niacin
(vitamin B3) reduces the risk of developing diabetes(129). Larger amounts of niacin are
also very effective in lowering cholesterol levels(87-90).

A magnesium deficiency is closely associated with cardiovascular disease. Lower

magnesium concentrations have been found in heart attack patients and administration
of magnesium has proven beneficial in treating ventricular arrhythmias(3,130-138). Fatal
heart attacks are more common in areas where the water supply is deficient in
magnesium and the average intake through the diet is often significantly less than the
200-400 milligrams required daily(130).

Omega-3 fatty acids found in flax oil and fish oil are all powerful preventers of heart
disease(57,60,81-84). Recent research has shown that supplementation with 3 grams of
fish oil per day lowers blood pressure substantially in people with borderline
hypertension(139).
Garlic lowers cholesterol levels and blood pressure; it also prevents clotting and plays a
significant role in the natural "digestion" of blood clots (fibrinolysis)(80,140). Flavonoids,
found in onions, tea and red wine, also lower the risk of coronary heart disease
significantly(78,141).

Potassium, calcium, and magnesium are all very effective in the treatment of
hypertension, one of the major risk factors for cardiovascular disease(142-146). A high
intake of dietary fiber (24 g/day or more) lowers high blood pressure(143).

Regular exercise is one of the most important measures in the prevention of heart
disease, stroke, hypertension, obesity, and diabetes(3,24,25,147-154). It is also effective
in increasing the blood level of good HDL cholesterol(3,47). British researchers conclude
that frequent, regular walking plus participation in a recreational activity or sport once a
week lowers the risk of heart attack and stroke by over 50% in middle-aged men(152).
Another study shows that men who bicycle to work (6 km round trip) every day are half
as likely to suffer a heart attack or a stroke as those who chose a less strenous way of
getting to work(153). Recent research has shown that postmenopausal women can cut
their risk of a heart attack in half by going for a 30-45 minute walk three times a
week(154). Studies have also shown that men and women who exercise at least once a
week lower their risk of developing diabetes by 30%(151).

Avoidance of excessive stress is another important weapon in the fight against

cardiovascular disease. A recent study by the Harvard Medical School found that men
with a high anxiety level had a two to three times higher risk of dying from coronary heart
disease than did men with a low level of anxiety(27). Another study showed that men
with a high anxiety level have twice the risk of developing hypertension than do men with
a low anxiety level(155).

Exercise, tai-chi, qi gong, meditation, long walks, indulging in a hobby, listening to music
or relaxation tapes, and making a conscious effort to reduce one's exposure to stress all
go a long way towards reducing the risk of cardiovascular disease.

It is clear that there are many, many things we can do to effectively prevent
cardiovascular disease. However, these diseases take a long time to develop and for
many people it is too late to consider prevention; treatment and in many cases, urgent
treatment is required.

Part 3 - Conventional Treatment

As is the case with most degenerative diseases there are two avenues of treatment -
conventional (allopathic) and alternative (natural) treatment. Conventional medicine
employs surgery and drugs to treat the symptoms of cardiovascular disease but rarely
gets to the root cause of the disease. Alternative methods, on the other hand, bolster the
body's innate healing powers and focus on removing the cause of the disease rather
than on treating its symptoms. Both types of treatment have a place in the fight against
cardiovascular disease.

Conventional medicine has the edge when it comes to the diagnosis and treatment of
acute, life-threatening events. Alternative therapies, on the other hand, are gentler, have
far fewer side effects, and are capable of actually reversing heart disease and regaining
full health.

Searching through your herb book, cutting out the fat in your diet or swallowing a handful
of vitamins is not the answer when a heart attack or stroke strikes. This is a case where
conventional medicine is very much needed. Well-equipped ambulances, trained
paramedics and a smoothly functioning emergency department and intensive care unit
can mean the difference between life and death when it comes to an acute myocardial
event (heart attack) or a stroke.

Diagnosis and Conventional Treatment

In many cases the first indication of cardiovascular disease is a sudden heart attack.
There are more than 1.5 million heart attacks in the United States every year and 30% of
them are fatal within the first month(5,24). As one popular medical textbook puts it:
"Sudden death is the first and only manifestation of coronary heart disease in about 25%
of patients."(5)

The most useful non-invasive tests for diagnosing early heart disease involve
electrocardiograms taken at rest and during exercise and continuous cardiograms
taken over a 24-hour period using a portable Holter monitor. These tests are particularly
indicative in people with a number of risk factors for coronary disease (smoking,
diabetes, obesity and hypertension); they will also show if a patient has already suffered
a mild heart attack without noticing it. Norwegian researchers recently discovered that
people whose blood pressure rises significantly during exercise have double the risk of
eventually having a heart attack(156).

Radioisotope studies are useful in spotting inadequate blood flow in and around the
heart. Echocardiography is another non-invasive technique which is useful in
evaluating the heart's performance. Newer techniques for studying heart function without
invasive procedures include positron emission tomography (PET scanning), CT
scanning, and magnetic resonance spectroscopy.

Coronary arteriography is an invasive technique used to determine the extent and

location of blockages in coronary arteries. It is normally used as a prelude to heart
surgery such as angioplasty or bypass surgery. It is less useful and not recommended
for diagnosing angina pectoris(5). Angiography is not very accurate in determining the
extent of blockage and is a relatively dangerous procedure(5,25). It is, unfortunately, a
favourite with cardiologists and heart surgeons. A recent study concluded that 80% of all
angiograms may be unneccessary and often lead to further dangerous and
unneccessary procedures like angioplasty and bypass surgery(157).

The two most common indications of cardiovascular disease are angina pectoris (chest
pain) and myocardial infarction (heart attack). The pain felt in angina pectoris occurs
because blocked arteries prevent an adequate supply of oxygen and nutrients from
reaching the heart. Stable angina is brought on by increased physical effort, emotional
stress, exposure to secondhand smoke, or even by certain meals or weather changes.
Unstable angina can occur during rest or even while sleeping and is often considered to
be an intermediate condition between stable angina and a full blown heart attack. Angina
is treated medically with nitroglycerin, beta- blockers or calcium entry blockers.
Nitroglycerin is often used to combat acute attacks and works by relaxing the heart
muscle. Beta-blockers (propranolol, nadolol) reduce the heart's oxygen demand by
slowing it down while calcium entry blockers (verapamil, diltiazem) also work by dilating
the large arteries. Both types of drugs thus lower the demand on the heart, but of course,
do nothing to treat the atherosclerosis causing the angina. Neither beta-blockers nor
calcium entry blockers significantly reduce mortality or prevent a future heart attack and
both have serious side effects(5). Beta-blockers are a poor choice for patients engaging
in vigorous exercise(158).

A heart attack involves the death of part of the heart's muscle tissue (ischemic necrosis)
caused by a sudden disruption in the blood flow to the area. About 25% of all heart
attacks are immediately fatal(5). If the patient makes it to the hospital the chances of
survival go up considerably; injections of magnesium sulfate within the first three hours
of the attack has been found to increase survival by over 20%(131-138).

The medical treatment of heart attack survivors is aimed at preventing a second attack
and daily intake of relatively small amounts of aspirin has been found quite
effective(5,159). Arrhythmias are common complications of heart attacks and other heart
problems. They are often treated with antiarrhythmic drugs like digoxin, verapamil and
amidarone; these drugs however, have serious side effects and often do more harm than
good(160,161).

A stroke (cerebral infarction) is similar to a heart attack except that it occurs in the brain.
When brain tissue is deprived of blood and oxygen it is destroyed within a few minutes.
Atherosclerosis is by far the most common underlying cause of a stroke. Most strokes
occur when loose atherosclerosis plaque or clotted blood block a brain artery already
narrowed by atherosclerotic build-up. Strokes can also be caused by the rupture
(aneurysm) of an artery in the brain most often in connection with hypertension. There is
no therapy which will restore the function of brain tissue destroyed in a stroke so medical
treatment essentially consists of rehabilitation and measures to avoid a second stroke.

Intermittent claudication involves pain in a muscle to which the blood supply has been
restricted due to atherosclerosis. The pains occur with exercise and subside within a
couple of minutes once the exercise is stopped. Conventional medical therapy includes
an emphasis on daily walks, weight reduction, and total avoidance of smoking.

Many cases of coronary heart disease (angina and heart attack) are ultimately treated
with surgery. The two most common procedures are angioplasty (percutaneous
transluminal coronary angioplasty) and bypass surgery.

In angioplasty a small balloon is guided on a wire into the blocked artery. It is positioned
at the blockage and inflated. This causes the arterial wall to stretch and may also
dislodge part of the plaque deposit thus resulting in a widening of the artery. Angioplasty
is often used in the treatment of an acute heart attack. Over 300,000 angioplasty
operations were performed in the United States in 1990 with an approximately equal
number done in the rest of the world(5). Angioplasty is dangerous; it is estimated that
2.5-5% of patients undergoing this operation have a heart attack during or after the
surgery and that 2.5-5% require immediate coronary bypass surgery for complications.
The overall mortality rate is 0.5 to 1% and highly dependent on the skill of the
surgeon(5).

Although angioplasty has proven successful in many cases of stable angina it is often a
temporary measure only. About 30 to 45% of patients undergoing angioplasty reform the
blockage within six months and are then back to where they started or in need of another
angioplasty operation(162).

In bypass surgery sections of a vein from the leg are grafted on to the coronary artery
in such a way as to bypass the blockages created by atherosclerotic deposits. Bypass
surgery is most commonly used when three or more arteries are blocked (triple or
quadruple bypass operation). When only one or two blockages are involved angioplasty
is preferred. Bypass operations often reduce angina pains and improve survival after a
heart attack, however, they are dangerous and temporary in nature. Surgical mortality
rates are between 1 and 3% but can go as high as 10%. The operation accelerates
atherosclerosis in and around the grafts and its benefits rarely last more than five or at
the most ten years(5). About 380,000 bypass operations were performed in the United
States in 1990. According to some experts half of them were unnecessary or of no
benefit(157).

Part 4 - Alternative Treatment

Conventional (allopathic) therapy is largely aimed at ameliorating the symptoms of

cardiovascular disease and providing temporary relief of pain and improvement in quality
of life. Alternative treatments, on the other hand, aim at containing and reversing the
underlying cause of cardiovascular disease, ie. atherosclerosis. They are generally
based on the principles which also guide prevention.

Diet and lifestyle changes are perhaps the most important tools in the natural
treatment of cardiovascular disease. Dr. Dean Ornish, MD has developed a
comprehensive program which effectively reverses atherosclerosis in a relatively short
time. Dr. Ornish's program focuses on stress management, development of greater
intimacy and increased social contact, a diet devoid of animal products (except egg
whites and nonfat dairy products) and very low in fats and cholesterol, and a program of
moderate exercise. The overcoming of smoking and other addictions is also a key
component in the program. Scientific evaluations of Dr. Ornish's program have shown
that participants who follow the program for just 24 days reduce their chest pain by over
90%, improve their exercise capacity by 55%, and reduce their cholesterol levels by
21%. Patients who followed the program for a year reduced their coronary artery
blockages by significant amounts and also reported a much improved sense of well-
being. Dr. Ornish's program has proven so successful in reversing heart disease that
major insurance companies now cover the cost of it as an alternative to angioplasty or
bypass surgery(24).

Dr. Julian Whitaker, MD operates the Whitaker Wellness Institute in California. Dr.
Whitaker's program also emphasizes dietary and lifestyle changes and is highly
successful in reversing heart disease(25).

Antioxidants and other supplements can be of great benefit in the treatment of heart
disease.

Vitamin C lowers blood pressure and cholesterol levels, helps prevent heart attacks and
strokes by thinning the blood and protects the lining of the arteries against further
atherosclerotic build-ups(2,7,25,98,107). Vitamin-C also increases the production of
HDL-cholesterol which removes deposits from artery walls(2). Dr. Mathias Rath, MD
provides convincing evidence that a supplementation program based on vitamin-C,
vitamin-E, B vitamins and the amino acids l-lysine and l-proline can reverse
atherosclerosis(2).
Vitamin E is highly effective in preventing abnormal blood clotting, it increases the level
of HDL and together with selenium has been found useful in reducing angina pain(25).
Long term (3 months or more) supplementation with vitamin-E reduces the leg pain in
intermittent claudication and improves exercise tolerance(25,116,163-165). A recent
study concluded that men who supplemented with over 100 IU per day had a significant
reduction in the progression of their atherosclerosis as measured by angiography(116).
Vitamin E in combination with niacin and colestipol is also effective in reversing
atherosclerosis(166). It is also noteworthy that vitamin E supplementation markedly
reduces the tendency of arteries to close up again (restenosis) after angioplasty(116).

Coenzyme Q10 improves the exercise capacity of patients with angina pectoris(167).
Oral supplementation has also been used with good success in patients suffering from
congestive heart failure and essential hypertension(168-171). Research is ongoing to
evaluate the benefits of ubiquinone supplementation prior to cardiac surgery and
preliminary results are promising(172,173). There is also evidence that coenzyme Q10 is
useful in the treatment of mitral valve prolapse and ventricular arrhythmias(174-176).
Most treatment protocols use between 30 and 100 mg daily(128).

Magnesium is proving to be very important in the maintenance of heart health and in the
treatment of heart disease. Magnesium, calcium, and potassium are all effective in
lowering blood pressure(142-146). Magnesium is useful in preventing death from heart
attack and protects against further heart attacks(131-138). It also reduces the frequency
and severity of ventricular arrhythmias and helps prevent complications after bypass
surgery(177).

Fish oil supplementation lowers blood pressure, helps prevent heart attacks, and
reduces the extent of restenosis (reclosing) of arteries which have been unblocked with
angioplasty(139,162,178). Alpha-linolenic acid, a major component of flax oil and
purslane, helps prevent a second heart attack(82).

Niacin (vitamin B3) lowers the level of "bad" cholesterol and raises the level of "good"
cholesterol; it also helps reduce atherosclerotic plaque(87-90). Niacin is also effective in
the treatment of atrial fibrillation and helps prevent diabetes, a major risk factor for heart
disease(29,129). Thiamine (vitamin B1) has been found useful in the treatment of
congestive heart failure(179).

Gingko biloba is effective in the treatment of intermittent claudication and improves the
blood supply to the brain(180).

Hawthorn (Crataegus oxyacantha) has long been used in Europe as a heart medicine. It
is used in the treatment of arrhythmias, is non-toxic, and has also been found to improve
cardiac performance in general(181-183).

Exercise is an important component in the rehabilitation of heart disease patients. Light

exercise is just as effective and less dangerous than high intensity training in
rehabilitating heart attack victims(184). Moderate exercise decreases platelet
adhesiveness while vigorous exercise may actually increase it(185). Regular exercise
helps prevent obesity and diabetes both important risk factors for heart disease and has
also been found to enlarge existing arteries and help build new ones(25).

Chelation therapy is the alternative equivalent of heart surgery. It is an established

medical practice for the removal of lead and other toxic materials from the body and is
now being used to an increasing degree for the removal of calcified atherosclerotic
deposits(7,186).

Chelation therapy is performed on an out-patient basis and usually involves about 20

treatments each lasting 3 to 4 hours. The patient sits in a comfortable position while
receiving an intravenous infusion of EDTA (ethylene diamine tetraacetic acid), vitamins
and minerals. The therapy is usually combined with a program of dietary and lifestyle
modifications. Chelation therapy restores blood circulation and can help to avoid
angioplasty and bypass surgery. It is also used in treating arrhythmias, intermittent
claudication, and macular degeneration(186,187).

Chelation therapy is safe, is used by thousands of doctors all over the world, and has by
now been used to successfully treat many hundreds of thousands of patients(186).
Danish doctors report beneficial results for 80-91% of patients treated for
atherosclerosis. An astounding 89% of patients scheduled for heart surgery were able to
avoid it after chelation therapy. Among patients suffering from intermittent claudication,
82% showed significant improvement(188).

Oral chelation agents are used to reduce atherosclerosis and cholesterol levels. They
are, however, not a substitute for intravenous chelation as they are less effective and act
considerably slower(186).

It is clear that there is an enormous range of alternative therapies and natural

supplements which are highly effective in both preventing and treating cardiovascular
disease. These alternative methods deserve thorough evaluation and trial before
submitting to a lifelong dependency on pharmaceutical drugs or dangerous, short term,
surgical solutions.