On a class reunion trip this summer I was saddened
to learn that a classmate's brother died following a heart attack. A 52 year-old
man is not unusual as a victim of premature death from coronary artery
disease. Sedentary lifestyles, overly rich diets, highly stressful
careers and family lives, daily exposure to chemicals and toxic elements,
periodic bouts of upper respiratory and gastrointestinal infections,
and cardiovascular risk factors undoubtedly play a major role in acute
death from myocardial infarct. Despite a growing public consciousness
of high cholesterol and hypertension, too many middle-aged individuals
only realize their risk of mortality after being surprised with "bad
numbers" after a routine medical exam. Clearly the coronary artery
disease did not develop overnight – atherosclerosis has been
progressively clogging the arteries since teenage years. Unfortunately
teenagers and young adults are not receptive to preventing cardiovascular
risk.
In a move that has perplexed patients, the Board of Cardiology has established
remarkably lower numbers in 2003 for defining normal blood pressure. Whereas
140/90 had been considered the benchmark for high blood pressure in years past,
now a reading of 110/70 is held as the optimal blood pressure for adults of
all ages. A blood pressure of 130/80 is considered to be high blood pressure
and a reading of 140/90 is considered a very elevated blood pressure reading.
For many adults, these new standards are difficult to achieve without the use
of medication and probably multiple medications. It is not unusual for elderly
adults to have readings that are now considered dangerously elevated. One cardiologist
stipulates
that patients with such blood pressure elevations require the use of a beta
blocker, ACE inhibitor, and/or diuretic at minimum, to achieve normal blood
pressure readings. With family practitioners and cardiologists administering
more intensive medication regimens to hypertensive patients, there will be
more frequent incidence of adverse effects. Still it will be very difficult
to justify avoidance of such medications, if one were unable to achieve the
newly defined normal blood pressure reading with herbals and vitamins/minerals
alone. A reasonable period of time would be justified to attempt lifestyle
and herbal programs for hypertension control. At the end of the day, when a
patient fails to control hypertension with natural means, medication is justified
and should not be withheld. One must remember that the purpose of alternative
medicine is to accomplish a goal that simply cannot be met by conventional
medicine approaches. One needs to be circumspect in deciding that alternative
medicine works superiorly to conventional medicine for control of hypertension.
Another bone of contention has been the control of cholesterol. In this publication
and elsewhere the cholesterol-controlling drugs have been derided as unnecessary,
risk-producing, and fraught with adverse effects. This reasoning is reasonable
except for one minor observation: ongoing studies with "statin" drugs
have established preliminary evidence that statins do reduce inflammation in
the cardiovascular process and may show low-grade reversal to the atherosclerotic
plaque process. More work needs to be done to confirm that "statins" reverse
atherosclerosis but the early evidence is highly suggestive that high and moderate
risk cardiovascular patients would benefit from the use of "statin" drugs.
It is now incumbent for physicians in natural medicine who oppose "statin" drug
use to develop provable protocols which lower LDL cholesterol, reduce C-Reactive
protein, and reverse atherosclerotic plaque. This is a major challenge and
there may be valid natural protocols. We know that Vitamin C, niacin, red rice
yeast extract, policosanol, citrus pectin, guggulipid herbal, and other herbals
play a role in lowering cholesterol. However, many patients complain about
the administration of such natural product protocols. There is difficulty in
tolerating high dose niacin. While red rice yeast extract and policosanol seem
to lower cholesterol, expense is an important concern. There is difficulty
in achieving compliance when too many supplement pills are required each day.
This issue of the Townsend Letter explores alternatives in the prevention and
treatment of coronary artery disease and angina. Undoubtedly, the alternatives
play a vital role in cardiovascular risk prevention, in improving lifestyle,
lowering stress, and enabling individuals to experience higher quality of life.
We need to consider both conventional and alternative approaches in use – the
drug agents to control hypertension and/or cholesterol as well as the herbal
and vitamin/mineral factors which naturally support cardiovascular health.
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