When people think of preventing heart disease, the first thing that comes to mind is lowering cholesterol. However there is much more to the story of cardiovascular health than just one lab value. Let’s dive into the role of cholesterol in cardiovascular health and what we can do to keep our hearts healthy and happy.
Contrary to popular belief, high cholesterol, while important to monitor and sometimes treat, is not the cause of heart disease and stroke. Instead, cholesterol is a relatively innocent bystander to an inflammatory process happening inside one’s artery walls.
Imagine a busy freeway with 6 lanes. Every car or truck is an LDL (low density lipoprotein, often referred to as your “bad” cholesterol) particle filled with cholesterol. Some of the cars are big, some are small, and in a healthy body they are just driving smoothly through your arteries shuttling cholesterol and other nutrients to tissues around your body that need it. Now imagine that there is construction work happening along the outer edges of the freeway. That repair work is causing all kinds of havoc on the freeway, and unfortunately some of those LDL particles are getting pulled in. It isn’t the particle’s fault, but if there are very many of them on the freeway it does make it harder to get by without getting stuck. When they get stuck, this is the start of the formation of a plaque. As the plaques grow they leave less and less room for blood and other proteins to pass through, leading to conditions (like a blood clot) that can cause a heart attack or a stroke.
From this example you can see that it isn’t the cholesterol itself, but the repair work on the side of the road, combined with the NUMBER of cholesterol particles, that leads to plaques. This is important because typically in conventional medicine doctors look at the AMOUNT of total cholesterol that is inside the particles with a lab value called LDL-C. But, new research has shown that it is actually the NUMBER of cholesterol particles that is more predictive of coronary events than the amount of cholesterol in those particles. This is measured by a value called LDL-P. To go back to our analogy, LDL-C tells us the number of people inside the cars, but what really matters is how many cars are on the road, which is the LDL-P. People can have high LDL-C and low LDL-P, and not be at a greater risk of heart disease, or they can have low LDL-C and high LDL-P, and therefore be at greater risk for a cardiovascular event, but sadly would not have that awareness because this isn’t a value that is traditionally looked at. At The Women’s Vitality Center, we often test LDL-P in addition to LDL-C so that we can accurately assess risk.
Besides the number of LDL particles, we also want to consider their size and density. Smaller, denser particles are more likely to be taken up into a plaque than large buoyant ones. They are also more easily oxidized (we’ll talk more about this later). LDL particle size is something we also look at when we are doing a detailed cardiovascular work-up. Going back to our analogy, it is better to have fewer large cars carrying more cholesterol than to have many small cars carrying less cholesterol. Rather than Total Cholesterol or LDL-C, the number often looked at by conventional doctors, what we really want to know is the number of small LDL particles and their size.
Inflammation and plaque formation
You might be asking: Why is all this repair work happening in the first place? In our analogy, the repair work represents the body’s attempt to fix damage that has occurred in a blood vessel. Blood vessels can become damaged or inflamed by high blood pressure, infection or autoimmune conditions, high blood sugar, fried/barbequed/charred foods, refined vegetable oils, environmental pollutants, heavy metals, or deficiency of antioxidants and protective nutrients. Once damaged, the body attempts to repair the damaged vessel, bringing white blood cells to the area, which create more inflammation and attract LDL cholesterol. LDL particles, especially small, dense LDL, become lodged in the vessel. There can also be oxidative damage to your LDL cholesterol and these oxidized LDL are more likely to be taken up into a plaque. To make matters worse, when there is damage to the artery walls it can result in an inflammatory cycle that reduces the vessel’s ability to dilate, making the highway even more narrow, and more dangerous if a plaque does break loose and form a clot. (The more repair work on our freeway, the more cars might get stuck, and then there is even less room for the cars to get by).
To see if this might be happening in a patient, one inflammatory marker we can assess in bloodwork is called Cardiac C-reactive Protein (cardiacCRP), also known as High Sensitivity CRP (hsCRP). If CardiacCRP is high we know there is an inflammatory process happening in your body- it is not specific to the arteries, but CRP levels do predict atherosclerosis, cardiovascular disease, and deaths from cardiac events. In addition to CardiacCRP, we can measure oxidizedLDL to see how much of your LDL is being oxidized during this inflammatory process, and your increased risk because of that oxidation.
What you can do to support your blood vessels.
The good news is that we can do many things to prevent damage that occurs in the blood vessel. Additionally, if there is already high LDL-P, CardiacCRP, or oxidized LDL, we find that these values will go down with a good treatment plan provided by a Naturopathic Doctor.
1 – Reduce your inflammation, manage your blood sugar, and increase your antioxidants.
Eat a whole foods diet with mostly plants. Avoid sugar, alcohol, and caffeine, and experiment with removing other foods that can cause inflammation in some people (such as gluten and other grains, dairy, or nightshades). Eat at the same times everyday, and have fiber and fat with your meals and snacks to keep a steady blood sugar. Eat as many colorful plants as you can – dark leafy greens, tomatoes, pomegranates, dark berries, citrus fruits, peppers, beets, carrots – these all bring much needed nutrients to your cells and mop up pro-oxidant molecules that come from inflammation. A great supplemental anti-oxidant that patients love is Wise Woman Herbals’ Mixed Berry Solid Extract (you can purchase from our online dispensary at https://womensvitalitycenter.com/supplements ). Non-caffeinated herbal teas are a great easy way to increase antioxidants… try chamomile, hibiscus, and hawthorne teas, or, if caffeine is a must for you, drink an organic green tea.
2 – Go see your Naturopathic Doctor.
It is important to find a doctor who will run screening tests and provide a science-based treatment plan if indicated. Testing for cardiovascular health may be individualized to the patient depending on their lifestyle, family history, and medical history, but baseline tests should at minimum include a CBC (complete blood count), lipid panel with ratios, lipid fractionation, oxidized LDL, blood sugar/hemoglobin A1c/fasting insulin, high-sensitivity C-reactive protein and homocysteine. Other possible tests would be Lp(a), myeloperoxidase, thyroid panel, 4-point cortisol, sex hormone testing, and a heavy metals panel. High blood pressure; inflammatory conditions such as endometriosis, crohns or ulcerative colitis, rheumatoid arthritis; infections, such as H pylori; and toxicity should all be ruled out and/or treated as they all are associated with increased cardiovascular risk. Your doctor should also address sleep, hormones, and emotional wellbeing, as all of these have a measurable impact on cardiovascular risk. Your individualized treatment plan might include diet and lifestyle recommendations, nutritional supplements, herbs, and if needed, pharmaceutical drugs.
Would you like help to explore and optimize your heart health? We warmly invite you to schedule a complimentary “Vitality Discovery Call” so we can get to know you and help you figure out your best next steps from here.
