Find Out if You Are at Risk of Cardiovascular Disease

Heart disease is the leading cause of death in north america, so yeah, it’s important part of your health! You have probably been to your Primary Healthcare Provider and had your lipids tested. If you have elevated cholesterol they probably told you you need to start a statin like Lipitor. But did you know that 50% of people who have a heart attack have normal cholesterol levels? Or that taking a statin reduces your risks of having a cardiovascular event by 1% over 10 years? Did you know that statins deplete CoQ10, an essential nutrient your heart muscles need to operate? Did you know that taking CoQ10 with Selenium has been shown to cut yours risks down by 50% (read more here). It’s time to rethink the statin strategy, and get the whole picture. So what does it mean to really asses your risks for cardiovascular disease? It’s alot more involved then just looking at your cholesterol and lower it. There are four main areas to focus on in testing when assessing your cardiovascular health:

1. Inflammation & Plaque stability: hs-CRP, Homocystein, Fibrinogen, MPA, LpPLA
2. Genetics: Lp(a), MTHFR, Clotting factors
3. Lipid profile: HDL, ApoA, LDL, sdLDLs, Cholesterol, Apo B, TG
4. Metabolics: HbA1C, insulin, C-peptide, fasting glucose

*More information on these tests here.

External factors that play a big role at influencing the above internal factors are of course: (see info-graph here.)

1. Smoking
2. Weight- more over weight a person is the higher the risk.
3. Activity level: minimum 30 minutes daily.
4. Stress
5. Diet: can drastically change your lipid profile alone.
6. Alcohol intake: 3 drinks or less per week.
7. Blood pressure: ideal is 120/60

Besides eating healthy, not smoking, maintaining a healthy weight and exercising regularly there is lots you can do maximize your cardiovascular health. Maintaining healthy hormones is a big part of that. For women estrogen play an important role, and for men testosterone does. (See my blog here for more on Testosterone role in cardiovascular health).

Estrogen is Cardio-protective in Women

Before menopause women have a lower risk of cardiovascular disease then men the same age, after menopause we have an increased risk. Estrogen replacement therapy has been shown in numerous studies to reduce cardiovascular mortality by 40-50% in post-menopausal women. Seem how women are much more likely to die of cardiovascular disease then breast cancer (read about estrogen and cancer risks here) that is something to consider. Here is how estrogen can prevent cardiovascular disease:

• Improved lipid profile (lower LDL, Lp(a) & TG, increases HDLs by 10-15%)
• Lower accumulation of lipids in the arteries
  Stimulates endothelial NO production = vasodilation (less pressure in system)
• Increase mitochondrial efficiency and reduces oxidative stress
  Reduces vascular oxidative stress (less inflammation = better health of vessels)
• Limits the progression of fibrofatty and atherosclerotic plaques formation
• Improves endothelial growth and repair, and reduces thickening of the intima
• Lowers blood pressure (ACE inhibiting, down regulates constriction and increase vasodilaiton)
• Transdermally it acts as an anti-inflammatory

Oral Estrogen & Clotting

The form of estrogens make a big difference in their safety, oral synthetic estrogens like birth control pills and Premarin increase clotting. In the Womens Health Initiative study they found an increased risk of cardiovascular disease, mostly relating to clot formation- strokes, embolism, and other forms of clots, in this study they used Conjugated Equine Estrogens (CEE). These are a from of oral estrogens and oral (Bio-identical or not) have a long list of side effects that are very hard on your health and cardiovascular system including:

• Increase blood pressure
• Increased 4-OH estrone production (the “bad” estrogen)
• Hard on the liver
• Increases clotting factors
• Increases inflammatory marker CRP
• Increases cravings for carbs (which usually results in eating more carbs and sugar, which creates more inflammation).

When a hormone is taken orally it is metabolized through the first pass in the liver, during this process they are broken down into metabolites that can increase clotting and inflammation resulting in many of the above concerns. This is why doctors always ask you before taking the birth control pill if you have a family history of blood clots or if you are a smoker. We know oral estrogens have this risk, so it’s no surprise in the WHI study they saw an increase in cardiovascular events like clots, strokes and embolism. When estrogen is taken topically in a cream or vaginally this first pass metabolism doesn’t happen and many of the above risks are negated. I don’t recommend women take any kind of estrogen orally! This includes the oral birth control pill. Endogenously produced, topical and vaginal estrogens are very safe and are cardio-protective. Here for more information on the cardio-protective effects of estrogen.

Naturally Reduce your Risks for Cardiovascular Disease

• Enjoy a Mediterranean style diet- avoiding saturated fats, trans fast, refined sugars, processed foods, fried foods. Inlcude more salmon, olive oil, olives, coconut, plant based fats, colorful fruits and veggies, nuts and seeds, turmeric, garlic and ginger.
• CoQ10, Selenium and Vitamin E
• Maintain healthy levels of vitamin D (50-90 in blood)
• Methylation factors to keep homocysteindown: B12, methyl-folate, B6, TMG
• Magnesium
• Mitochondrial support: L-Carnitine, CoQ10, D-Ribose, Niacinamide (niacin, NAD).

Overall

When estrogens are produced naturally in the body, or taken as a bio-identical topical cream, or vaginal suppository they have a very beneficial and protect effect on the cardiovascular system, and your heart. It’s important to be informed about the form of estrogen your taking, the mode of delivery, and have your estrogen metabolites measured. Estrogen metabolites will let you know how you’re breaking down your estrogens, as some estrogen metabolites are not good for you (for more info on estrogen metabolism click here)

If you are wanting to have your hormones tested or want to have your cardiovascular health assessed, Dr. Escobedo can help. We work with Boston Heart and Cleveland Heart labs- two of the leading cardiovascular labs in the country, with some of the most sensitive markers for assessing cardiovascular health. Book your free 15 minute phone consult today.