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Cardiovascular Health: Cholesterol, Inflammation & Hormones

Updated: Feb 18


Heart disease and stroke are the most common cardiovascular diseases. They are the first and third leading causes of death for both men and women in the United States, accounting for nearly 40% of all annual deaths. More than 910,000 Americans die of cardiovascular diseases each year, which is 1 death every 35 seconds. Heart disease and stroke are also a major cause of disability.


There are many different forms of heart disease. The most common cause of heart disease is narrowing or blockage of the coronary arteries, the blood vessels that supply blood to the heart itself. This is called coronary artery disease and happens slowly over time. It's the major reason people have heart attacks.


Although these largely preventable conditions are more common among people aged 65 or older, the number of sudden deaths from heart disease among people aged 15–34 has increased dramatically.


Coronary heart disease is a leading cause of premature, permanent disability in the U.S. workforce. Stroke alone accounts for disability among more 1 million Americans. More than 6 million hospitalizations each year are because of cardiovascular diseases.


According to Dr. Mark Houston, the most common underlying reasons for dyslipidemia are:


  1. Chronic inflammation

  2. Immune dysfunction

  3. Oxidative stress of the vascular system

These are all corrective protective/defense mechanisms and the most common reasons for these vascular responses:


  • Chronic inflammatory macro- and micro- nutrient intake.

  • Chronic infections (all types including bacteria, virus, fungi, TB and parasites)

  • Toxins, POPs (persistent organic pollutants) and heavy metals



Understanding cholesterol


Cholesterol is the type of fat that is most often associated with the risk of heart disease. High blood levels of cholesterol, low density lipoprotein cholesterol (LDL-C) in particular, have been associated with increased risk.


It is important to note that more than half of heart attacks occur in apparently healthy men and women with average or low levels of plasma LDL-cholesterol.


LDL is the lipoprotein particle that is mostly involved in atherosclerosis. LDL particles exist in different sizes. On one hand there are the large, fluffy, cotton-ball like molecules, and on the other hand the small dense molecules. Many recent studies have looked into the importance of LDL-particle size.


Studies show that people whose LDL particles are predominantly small and dense, have a threefold greater risk of coronary heart disease. Furthermore, the large and fluffy type of LDL may be protective. However, it is possible that the association between small LDL and heart disease reflects an increased number of LDL particles in patients with small particles. Therefore, the number of LDL particles could be more important in terms of risk than particle size in itself.


Know your numbers!!


Advanced lipid testing offers greater insight into assessing your risk of cardiovascular disease than a basic lipid panel. The markers tested on advanced lipid panels can vary based on which lab you are using, but in general they will have significantly more markers than a basic lipid panel and should include many of the markers listed below. Here are the optimal values you are looking for to minimize your risk:


Optimal Values - Advanced Lipid Testing

  • LDL-P: < 900 nmol/L

  • Apo B-100: <80 mg/dl; < 70mg/dl for high risk

  • Non-HDL-P: < 800 nmol/L

  • Dense LDL III: < 300 nmol/L

  • Dense LDL IV: < 100 nmol/L

  • Lp(a): < 30 mg/dl

  • VLDL: <85 nmol/L; < 30 mg/dl

  • RLP: <150 nmol/L

  • HDL2b: > 1500 nmol/L

  • hs-CRP: <1.0 mg/dl

  • Homocysteine: <7-10 mg/dl

  • HS-Omega-3 Index: >8%

  • Fasting Insulin: 7-9  µIU/ml


Inflammation and CVD


Plaque build up in the arteries is considered a chronic inflammatory disease. The immune system plays a significant role in both causing plaques the progression of cardiovascular disease (CVD). Damage to the lining of blood vessels triggers an immune response - an attempt to "fix" the damage. The problem arises when the "fix" actually causes thickening of the blood vessel wall, and the "glue" starts to attract more and more cholesterol, platelets and fibrinogen. In an attempt to heal the blood vessel lining, the body has created a different problem - plaque formation.


Things that can trigger inflammation in the lining of blood vessels can include:

  • elevated cholesterol

  • oxidized LDL

  • uncontrolled high blood pressure

  • high blood sugar

  • toxins

  • infections

  • eating a diet high in saturated animal fat

  • eating a diet high in simple carbohydrates

  • eating a diet low in plant fiber and phytonutrients


Hormones and the Heart


The heart both is regulated by hormones and secretes hormones to maintain homeostasis and in response to stressors. Hormones that regulate cardiac function include DHEA, estrogen, progesterone, testosterone, cortisol, insulin, free T3, reverse T3, epinephrine and norepinephrine. The heart is regulated by hormones minute by minute, and these hormones can either improve cardiac function or create stress on the heart muscle.


In recent years, the heart has been recognized as an endocrine secreting organ - meaning that the heart actually secretes hormones to regulate its function - and to communicate with our other organs. For example, when blood pressure elevates, the heart send out Atrial Natriuretic Peptide to the kidney to manage shifts in salt/water balance!!


B-Type Natriuretic Peptide is secreted by the heart in response to stress and increases cortisol, epinephrine and norepinephrine. These hormones increase heart rate and blood pressure. When an individual is under frequent physical stress, these hormones can cause persistent dysregulation of the sympathetic nervous system and even contribute to hypertension, enlargement of the left ventricle, anxiety, sleep disturbance and weight gain.


Recognizing the role of hormones in regulating heart health, and overall well being, is an essential step in maintaining a healthy cardiovascular system.


What can you do to ensure a health heart?


First - make sure to work with a Precision Medicine provider that can provide you with the best testing available to assess your risk. Consider both genetic testing and advanced blood work to ensure you are not missing anything that could have fatal consequences. Make sure to examine inflammatory markers, hormone levels, advanced lipid panel and nutrient levels.


Second - make sure to move daily. Whether you are walking, biking, doing yard work or running a marathon, get your movement groove and keep it up daily in some way.


Third - eat the rainbow! Make sure to get in at least 6 servings of vegetables and two fruits daily. Try to have at least one day a week with no animal products (including butter, dairy, eggs).


Finally - Manage your stress response. Find a hobby! Find activities that you enjoy. Learn to let go of aggravations, work with a therapist, have a close friend to talk with, get outside. These key strategies can help you regulate not only the stress signal sent TO your heart, but can decrease the stress signals sent FROM your heart!


References


Henein MY, Vancheri S, Longo G, Vancheri F. The Role of Inflammation in Cardiovascular Disease. Int J Mol Sci. 2022 Oct 26;23(21):12906. doi: 10.3390/ijms232112906. PMID: 36361701; PMCID: PMC9658900.


Aortic Atherosclerosis and Complications, Editor(s): Dylan V. Miller, Monica P. Revelo,

In Diagnostic Pathology, Diagnostic Pathology: Cardiovascular (Second Edition),

Elsevier, 2018, Pages 306-311, ISBN 9780323595605,


Harvard Heart Letter - HDL: The good, but complex, cholesterol - Published: March, 2010


<https://www.cdc.gov/cholesterol/ldl_hdl.htmMaturitas. 2018;107:97-102. - Vitamin D Linked to Metabolic Syndrome, high triglycerides, and low high-density lipoprotein (HDL) cholesterol in Postmenopausal Women. 


Hernáez A, Castañer O, Elosua R, et al. Mediterranean diet improves high-density lipoprotein function in high-cardiovascular-risk individuals: A randomized controlled trial. Circulation 2017; 135:633-643.


Rader DJ. Mediterranean approach to improving high-density lipoprotein function. Circulation 2017; 135:644-647.

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