Cardiovascular health

• Will examine what we know re CV health and Coronary heart disease (CHD)

• American and Canadian info & resources, mostly allopathic, some web-based

• Then look at integrative approaches relying on text chapter 18 as framework

Cardiovascular health

• CV disease is now “the major cause of death and disability and of rising health care costs in Canada”

• In groups of 5, record what you know about CV disease / health and what you know re treatment / prevention – allopathic & less conventional or “alternative”

CHD ~ what is it ?

• Narrowing of coronary arteries• Atherosclerosis vs arteriosclerosis• Angina (lack of oxygen induced) to

full blown heart attack• Cholesterol, vital to hormone &

vitamin D production, bile to digest fat etc present everywhere

• Excess cholesterol is issue re athero etc

CV Disease Deathsby sex, Stats Can,1994

Risk Factors in General

• smoking • high blood pressure • high cholesterol • physical inactivity • obesity • diabetes

Risk Factors and CHD

The risk factors that you cannot  control include:

• Age (45 years or older for men; 55 years or older for women)

• Family history of early heart disease (father or brother affected before age 55; mother or sister affected before age 65)

Risk Factors and CHD

The risk factors that you can control include: • High blood cholesterol (high total cholesterol and

high LDL ("bad") cholesterol) • Low HDL ("good") cholesterol • Smoking • High blood pressure • Diabetes -- if you have diabetes, your risk for

developing heart disease is high, as high as a heart disease patient's risk for having a heart attack; need to lower cholesterol under medical supervision, in much the same way as a heart disease patient, in order to reduce high risk of getting heart disease.

• Obesity/overweight • Physical inactivity

What makes cholesterol hi or low ?

• Your blood cholesterol level is affected not only by what you eat but also by how quickly your body makes LDL ("bad") cholesterol and disposes of it

• In fact, your body makes all the cholesterol it needs, and it is not necessary to take in any additional cholesterol from the foods you eat

Benefits of cholesterol - lowering

• Huge risk reducer (lots of evidence) both for people with high cholesterol & those with avg levels

• Studies use ‘statins’ (discussed in your text) as cholesterol lowering drugs – longitudinal studies in Scotland etc showed dramatic reductions in incidences of CHD, 20-37% reductions

• *** See notes re studies in ‘Handout’ format below this slide***

What makes cholesterol hi or low ? – Factors re LDL levels:

• Heredity • What you eat • Weight • Physical activity/exercise • Age and sex • Alcohol • Stress • *** see definitions in Handout format

below this slide ***

Framingham Heart Study

• huge study, “best” one re mass of data on cholesterol reductions

• 0n web site; *** see material below this slide re Framingham

Types of Blood Pressure Medications

• Diuretics • Beta-blockers • ACE inhibitors • Angiotensin antagonists • Calcium channel blockers (CCBs) • Alpha-blockers • Alpha-beta-blockers • Nervous system inhibitors • Vasodilators• *** see definitions of each below this

slide ***

Integrative medicine re CHD

• “when applied to CV disease, preventative medicine in Western society is a concept most people accept, few people practice, and almost no one pays for” [ text 409 ]

• Most of the $200 billion annual US price tag is spent on the treatment of symptomatic disease & end-organ failure

Integrative medicine re CHD

• Reliance on therapeutic vs preventative strategies fosters a “magic bullet” mentality in N America

• No single strategy, medication, or intervention program guarantees avoidance of ‘negative cardiac events’

Integrative medicine re CHD

• Huge sums of $$$ to conquer a largely behavioural disease thru pharmacology, surgery, catheterization-based interventions & genetic engineering

• So, what are the integrative suggestions from your text and elsewhere ???

Integrative CV Health

• CHD as a complex of genetic, environmental, cultural, and behavioural factors

• Text notes that “genetic markers,” that is, risk factors we can’t control, are important (lipid metabolism, diabetes, hypertension), CV health / prevention of CHD is remarkably variable

• Non-allopathy here is predominantly diet and lifestyle interventions - * consider these as primary or at least adjunctive treatments for CHD and CV health

Text & CV Health

• Diet – goes thru studies re epidemiological links, avocados, Mediterranean-style diets (mono-unsat fats), and serial monitoring of types of fat intake & body weight/BMI

• Exercise – evidence also strong here• Alcohol – red wine vs beer vs hard

liquor – what does evidence say ?

Text & CV Health

• Dietary Supplements & Herbs~ digoxin (also called

digitalis, both derived from plant foxglove) vs angiotensin inhibitors

~ plant-based diets re antioxidants and antiinflammatories [ purslane ] ~ garlic and teas, hawthorn berries rich in flavinoids (anti-inflam), folic acid, Vitamin E-rich foods

Text & CV Health

• Note the crystal clear summary pp 410-411 esp tables 18-1, 18-2, and 18-3 * what makes this “alternative” is the element of informed, evidence-based choice *

• Also, difference betw choices in acute coronary syndromes vs chronic stable CHD vs at-risk

• Emphasis is on delay and avoid

Last 3 classes:

• Tuesday: chronic fatigue & GI system

• Thursday: oncology * start wrap-up

• Tuesday 11th, last class, synthesis & yes, chapters 31 & 33 are required re this unit

Evidence ~ MC Exams

• Multiple multiples NOT when they’re logic, don’t test knowledge

• So, no more than 8 on exam, and only if content, not logic-based

• # of alternatives evidence – 4 good ones better than 5th bad one so I’m going to do that too