~Cardiovascular Disease Comprehensive 6 - Other Connections
THE LINK BETWEEN INFECTIONS AND INFLAMMATION IN HEART DISEASE
Infections are of particular interest because of the increasing attention paid to the role of inflammation in heart disease, according to David S. Siscovick, M.D., professor of medicine and epidemiology at the University of Washington. The data incriminate the infectious process in various phases known to contribute to heart disease. For example, current research suggests that infection may be an important determinant of fibrinogen levels, offering one possible explanation for the association between chronic or acute infection and vascular events (Woodhouse et al. 1997). Many researchers class inflammation as worse than cholesterol at triggering heart attacks. Note: Men with hypercholesterolemia and inflammation have a significantly higher risk of cardiovascular death (2.4) compared to those with only high cholesterol levels (1.4) (Engstrom et al. 2002).
Dr. Paul Ridker (Boston's Brigham and Women's Hospital) recently explained that everyone reaching middle age has some degree of fat buildup, that is, plaque in the vasculature. New evidence suggests the plaque becomes threatening if weakened by inflammation, which makes the buildup squishy and fragile. Even a small lump can burst, promoting the formation of a clot that in turn chokes off blood flow and causes a heart attack. Thus, reducing the inflammatory process is of equal importance to lipid monitoring in controlling the dangers of plaque (Associated Press 2002).
Researchers observed that mortality from ischemic heart disease markedly increases during the flu season, particularly among the elderly. One reason for this appears to be that patients with influenza A, a flu virus, tend to have much higher levels of CRP. Researchers at Rochester General Hospital and Rochester School of Medicine and Dentistry showed that CRP increased 370% during infection and that old age magnified the increase (Falsey et al. 2001; Horan et al. 2001).
A higher white blood cell count, common when the body is fighting off infection, is associated with an increased coronary risk by diminishing blood flow to the heart muscle and encouraging blood clot formation. The higher the white blood cell count, the greater the patient's risk of death from a heart attack or of developing congestive heart failure (Barron et al. 2000).
In fact, angina pectoris appears less a prognosticator of a forthcoming heart attack than a febrile (flu-like, feverish) infection prior to the attack. Peter Ammann, M.D. (Switzerland), stated that he has observed significantly higher numbers of myocardial infarctions among patients with febrile conditions, mainly of the upper airways, within 2 weeks prior to infarction (Ammann et al. 2000; Healthlink 2000).
Bacteria appear to gain entry into the heart via immune cells, most likely activated in the process of clearing infections from the respiratory passages. The bacteria most suspected of initiating coronary problems are Chlamydia pneumoniae, Pasteurella aerogenes, Enterococcus endocarditis, Staphylococcus aureus, Enterococcus faecalis, Candida albicans, and Viridan streptococcus. (Some researchers add H. pylori, a bacteria associated with duodenal ulcers, peptic ulcers, and chronic gastritis, to the list.)
Tissue specimens from patients who had undergone a carotid endarterectomy showed high levels of C. pneumoniae in 11 of 17 cases (64%). The American Heart Association also reported that C. pneumoniae was found in the infected arteries of autopsied cardiac patients. Dr. Tatu Juvonen (Oulu University Hospital in Finland) explains that C. pneumoniae is a specific microbial antigen that causes inflammation and atherosclerotic cells to proliferate (Juvonen 2000; Mosorin et al. 2000; Vink et al. 2001).
An alternative to this dismal situation may be antibiotic therapy, controlling the inflammatory process attacking the vessel wall. An American study of more than 16,000 British patients showed that people treated with two types of antibiotics had a significantly reduced risk of heart attack. Those treated with tetracyclines were at 30% less risk than patients not given antibiotics, while those who took quinolones (antimicrobials) had a 55% reduced risk. It appears antibiotics may act in the same fashion as anti-inflammatory drugs, reducing inflammation in the arteries (BBC News 1999, 2002a).
Inflammation appears to be an independent risk factor that may explain cardiovascular disease in the presence of normal cholesterol, blood pressure, and coronary arteries. MINC patients, individuals experiencing a myocardial infarction with normal coronary arteries, should be at lower risk for a cardiac event because they most often have normal electrocardiograms, higher HDL levels, and no significant impairment in LDL cholesterol. Dr. Ammann believes the trigger may be systemic inflammation or specific infective agents, advancing a benign complaint to a life-threatening condition. Interestingly, migraine headaches have also been observed as forerunners to a heart attack in otherwise healthy individuals (Ammann et al. 2000; HealthLink 2000).
IS ATRIAL FIBRILLATION PREDICTIVE OF CARDIAC MORTALITY?
Atrial fibrillation, a condition shared by over 2 million Americans, occurs when the atria, the upper chambers of the heart, beat faster than the lower two chambers, the ventricles. Many problems can cause atrial fibrillation, including a leaky heart valve, hypertension, obesity, stimulants (including caffeine and alcohol), medications (such as sumatriptan, a headache drug), and thyroid disorders. Dr. Robert Atkins, M.D., adds that patients should be evaluated for heavy metal intoxication and mycoplasmal infections, factors also capable of provoking atrial fibrillation.
Although not immediately life-threatening, atrial fibrillation may cause up to a 30% reduction in cardiac output, resulting in shortness of breath, fatigue, and reduced exercise capacity. In fact, the American Heart Association no longer regards atrial fibrillation as a benign disorder. About 75,000 strokes related to atrial fibrillation occur each year in the United States. Up to 23% of such patients die, and 44% experience significant neurologic deficits. (The mortality rate from other causes of stroke is about 8%.) Nonetheless, Dr. H.J. Crijns (University Hospital Gr鰊ingen, the Netherlands), declares that even patients with heart failure should not be in greater danger because of atrial fibrillation if the condition is well managed (Kennedy 1999; Alpert 2000; Crijns et al. 2000).
Blood thinners are often prescribed for atrial fibrillation, but a program based in natural medicine is also helpful. While full correction of the chaotic rhythm associated with atrial fibrillation is often difficult to achieve, nutritional supplements can lessen the risk of a blood clot. Dr. William Campbell Douglass, M.D., states that vitamin E (800 IU daily), cod liver oil capsules (4 daily), olive oil (1 tbsp daily), and bromelain (about 750 mg 3 times a day on an empty stomach) have similar action to Coumadin and aspirin, thinning the blood and reducing the risk of a thrombotic event (Douglass 1996). Other heart nutrients such as CoQ10, hawthorn, carnitine, taurine, magnesium, and ginkgo biloba are also important. To read more about the supplements recommended for atrial fibrillation, please consult the Therapeutic section of this protocol.
Conversely, in chronic aortic regurgitation, a number of compensatory adjustments occur, rendering aortic regurgitation less dangerous. In fact, the majority of patients remain asymptomatic through this compensated phase, which may last for decades. With time, the left ventricle progressively enlarges and depressed myocardial contractility increases. This can progress to the extent that the full benefits of surgical correction, that is, recovery of left ventricular function and improved survival, are no longer possible.
The results of several studies, involving 490 asymptomatic patients with chronic aortic regurgitation who were followed for an average of 6.4 years, give a brief history regarding the developmental patterns of the condition.
Are Artificial Valves as Good as Natural Valves?
- The rate of progression to symptoms and/or left ventricle dysfunction averaged 4.3% a year. (As the left ventricle goes, so goes the heart.)
- Sudden death occurred in six of the 490 patients (an average mortality rate of < 0.2% a year).
The replacement of diseased natural heart valves with artificial valve can be life-saving, but the replacement valves are never considered as good as healthy natural ones. There are two general types of valves: mechanical and bioprosthetic (usually taken from pigs). The mechanical valves last longer but require the patient to take anticoagulants. The bioprosthetic valves do not require long-term anticoagulation therapy, but they frequently must be replaced after about 10 years in adults. Their replacement comes quicker in children and persons on kidney dialysis. The major risk of prosthetic heart valves is stroke. Those taking anti-coagulants reduce the incidence of stroke, but the risk is not totally eliminated.
The following natural products may be of value to patients with valvular disease. The herbs profiled have one or more chemicals that convey the biological property delineated and are subsequently not equal in therapeutic strengths (Duke Database). Researchers state that carnitine may provide independent benefit in ischemia when used as monotherapy, or additional benefit when used in combination with conventional beta-blockers or calcium antagonists (Jackson 2001). To learn more about the following supplements, please consult the Therapeutic section below.
Continued . . .
- Vasodilators. Angelica, garlic, ginger, ginkgo biloba, hawthorn, magnesium, niacin, and olive leaf
- ACE inhibitors. Angelica, garlic, ginger, ginkgo biloba, grape seed, green tea, hawthorn, olive leaf, procyanidins, and taurine
- Calcium blocking properties. Angelica, garlic, ginger, ginkgo biloba, grape seed, green tea, hawthorne, magnesium, and olive leaf
- Digitalis-like activity. Bugleweed and taurine
- Diuretic activity. Angelica, bugleweed, curcumin, garlic, ginger, grape seed, green tea, hawthorn, olive leaf, taurine, vitamin B6, vitamin C, and vitamin E
- Anti-inflammatories. Angelica, bromelain, bugleweed, chondroitin, curcumin, DHEA, EFAs, garlic, ginger, ginkgo biloba, grape seed, green tea, hawthorn, olive leaf, and vitamin C
- Beta-blocking activity. Grape seed, green tea, hawthorn, magnesium, and taurine
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