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CARDIOVASCULAR DISEASE (CVD)

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"More women are dying from Cardiovascular Disease (CVD) than breast cancer. In fact a women is five times more likely to die from a heart attack or stroke (22% chance) than from breast cancer (3% chance) (Leening, 2014).

For both men and women, statistics from the Australian Heart Foundation show that one Australian dies every 12 minutes as a result of CVD, and it is the leading cause of death in the western world" (WHO, 2012).

The latest research suggests that the current approach to preventing cardiovascular disease is not sufficiently effective, and we desperately need a new approach, particularly for women. Our Chinese medicine team follows and supports the latest research and is committed to working with clients to complement their doctor's treatment.

Following evidence-based medicine and using Chinese medicine diagnosis, our team provides assessment of CVD risk and advises on supplements, lifestyle changes, and acupuncture treatments. We address the underlying causes of CVD, as well as the symptoms. We offer discussion on best evidence medical research and an individualised treatment plan.

CVD is a term that encompasses a wide variety of diseases but primarily includes heart attacks, angina, and strokes. Heart attacks occur more often in men, while women tend to be more likely to suffer from a stroke.

Research suggests that a CVD episode in men is more often triggered by a highly stressful incident whereas episodes in women are more often the result of high levels of chronic ongoing stress (Leening, 2014). Two out of three people will experience CVD at some point in their life and our Chinese medicine team recognises the gender differences in assessing risk of CVD and adjust our assessment and treatment strategies accordingly.

The medical treatment of CVD for the last few decades has focused purely on elevated cholesterol and blood pressure as the main causes of CVD. Unfortunately, this approach has not significantly reduced CVD incidence or deaths.

The main treatment recommended for these conditions has been low fat diets and the use of cholesterol and blood pressure lowering medications. However, more and more research is debunking the premise behind these treatment protocols (Chowdhery, 2014; Fuller, 2015).

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Scientific research now suggests that, while high cholesterol and blood pressure contribute to CVD, there are a range of other factors that also significantly contribute to the condition.

These other factors include: systemic inflammation, oxidative stress, infections, immune dysfunction, nutritional deficiencies, and gut dysbiosis. Evidence suggests that prevention and treatment of CVD is best approached in an holistic way, encompassing and addressing causative factors and their effects.

As conventional medical drugs do not focus on the treatment of these underlying factors, they fail to significantly help prevent and treat CVD. Examples of this are the blood pressure medications that dilate the arteries to reduce blood pressure.

These blood pressure medications do not address the inflammation in the walls of the arteries that can be the key drivers of the blood pressure rising in the first place. So while blood pressure may go down, the CVD.

Some of the medications to prevent CVD also carry significant side effects, including an increased risk of developing diabetes, muscle fatigue, muscle and joint pain, and liver damage.

Statins for example, used to lower cholesterol, increase the likelihood of developing diabetes, and in turn diabetes is one of the highest risk factors for CVD. While statins are a good short term option, the benefits of long term use may seem counterintuitive.

Often, prescribed medications also reduce important vitamins and minerals that are essential in preventing CVD.

A good example is again the statin drugs, which reduce the production of CoQ10, a coenzyme that is actually important in preventing CVD. Additionally, statin use can negatively affect insulin levels, thus creating another risk factor for CVD. As such, it is vital to advise on a patient’s diet to maintain blood sugar levels and add appropriate supplements. Our holistic Chinese medicine practitioners can play a key complementary role in this area.

Research is now also revealing that standard lipid profiling (such as the basic cholesterol tests) is not as accurate an indicator for CVD risk as previously thought, and this is very concerning as these tests are often the main assessment used to diagnose early CVD risk.

Emerging evidence provides a greater understanding of how lipids contribute to CVD risk. However, this evidence is being ignored by most mainstream health practitioners (Houston, 2012). More detailed blood tests are required to give the full picture for CVD risk than the current LHL/HDL profile, because all LDL are not the same and it depends on whether the LDL has been modified or damaged as to whether it is atherogenic or not, and this is not investigated. Further blood tests that can provide a more extensive picture of the CVD risk include tests that look at the general level of inflammation (ESR and CRP) as well as identifying insulin resistance (fasting glucose and fasting insulin).

The latest research assessing high blood pressure monitoring has also raised new concerns because current guidelines were found to be inadequate.

SPRINT (Systolic Blood Pressure Intervention Trial), a trial that was published in 2015 in the New England Journal of Medicine (Group, 2015), was a large randomised controlled trial whose aim was to identify the optimal level of blood pressure control for those suffering from high blood pressure (HBP) and at high risk of CVD.

The results were critical as the study found that the risk of dying was reduced by 27% if participants were treated with blood pressure medication that targets their systolic blood pressure (the upper reading) to bring it below 120 millimetres of mercury. Currently, medical protocol recommends that the target systolic blood pressure be 140, however researchers found this systolic level left people at high risk.

Low blood pressure, which is often overlooked is also of concern, and a recent study at Johns Hopkins University has identified that a low diastolic blood pressure (the bottom number on a blood pressure reading) can also predict increased risk of heart attack and stroke. (McEvoy, 2016).

The study found that low diastolic blood pressure can be an indicator of stiffening arteries with the added risk of reduced blood flow to the heart muscle that can lead to damage. In particular a reading of below 60 was found to cause a very high risk. Low blood pressure can be an indicator of the long term impact of stress on the system as well as elevated cortisol levels.

The Johns Hopkins study also revealed concerns about current high blood pressure treatment protocols, because it was revealed that an overly aggressive treatment of high blood pressure without regular monitoring can also increase CVD.

Of particular concern in patients receiving aggressive blood pressure medication to reduce systolic blood pressure (the upper number in the blood pressure test), is the impact on the diastolic levels (the bottom number in the blood pressure tests) falling too low. This study identified that diastolic levels below 70 millimetres of mercury increased the risk of CVD and that levels below 60 were of very high concern.

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Atrial Fibrillation

Of further concern to our team is the increasing number of people presenting at our clinic with undiagnosed atrial fibrillation, an abnormal heart rhythm that can cause blood to pool in the left atrium of the heart, causing clots to develop that may lead to a stroke.

Symptoms of atrial fibrillation include breathlessness, chest discomfort, and palpitations and although these symptoms can be mild, the condition still poses a significant risk of stroke.

Our team are concerned because of the high incidence of people under 40 we see who have already experienced a stroke as a result of this condition being left undiagnosed. While Professor Simon Stewart at the Mary MacKillop Institute for Health Research at the Australian Catholic University estimates that up to 10% of the population over 65 suffer from atrial fibrillation and that this rises to about 20% for those over 80 (Stewart, 2015), we feel these figures may easily be higher in a younger population that is not being monitored.

This is because the pattern we have observed in our clinic is all too consistent with increasing high levels of anxiety in younger people who also experience palpitations and chest pain.

Our team's holistic approach to reducing the risk of CVD involves addressing causative factors such as oxidative stress, immune issues, stress, pain, digestive issues, and all factors that increase inflammatory processes. Regularly monitoring blood pressure, heart rate, and the latest recommended blood tests are also part of our holistic protocol in complement with specialists in this field.

Addressing the causative factors that contribute to elevated cholesterol levels and inflammatory processes associated with atherosclerosis and irregular heart rates, using acupuncture and Chinese herbal medicine has shown promising results and may more safely prevent CVD (Lu et al. 2008; Luo J, Xu H., 2012; Qiu et al. 2012; Tachjian et al. 2010). Our practitioners are able to discuss simple nutritional deficiencies, mitochondrial function, and systemic inflammation and how they might be addressed through diet, exercise, supplements, and Chinese medicine. These are powerful tools in reducing cardiovascular disease in complement with medical protocols.

Encouragingly, according to the INTERHEART study, which examined CVD risk factors in 51 countries, nine out of the ten strongest risk factors are modifiable by changes in diet and lifestyle (Yusef, 2004). These are key areas that our experienced team can discuss and address.

Research also strongly suggests that there are three key nutrients involved in CVD risk reduction. These are fish oils, Coq10, and magnesium. These nutrients have been shown to improve endothelial function, which are the cells that line the arteries as well as help reduce systemic inflammation, oxidative stress, and insulin resistance, all of which are key drivers of CVD. (Marchioli, 2002; Mortenson, 2014; Maier, 2012).

In summary, CVD is the leading cause of death in the western world and the latest research recommends prevention along a more holistic model, with closer monitoring of high as well as low blood pressure, comprehensive blood test assessments, and adequate addressing of inflammatory processes that are the key drivers of CVD.

There is significant research to indicate that an holistic approach to CVD can provide powerful reductions in CVD risk markers as well as CVD outcomes. Some of the best outcomes for patients can be achieved when conventional medical treatments are combined with acupuncture and Chinese herbal medicine treatments.

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References

  1. M.J.G.Leening et all (2014) Sex Differences in lifetime risk and first manifestation of Cardiovascular Disease: prospective population based cohort study. The British Medical Journal: 2014; 349: g5992.
  2. World Health Organisation - The top 10 causes of death - http://www.who.int/mediacentre/factsheets/fs310/en/
  3. Chowdhury, R. et al (2014) Association of dietary, circulating, and supplemental fatty acids with coronary risk: a systematic review and meta analysis. Internal Medicine 160(6): 398-406.
  4. Fuller, NR et al (2015) The effect of a high egg diet on cardiovascular risk factors in people with type 2 diabetes: a three month randomised controlled trial. The American Journal of Clinical Nutrition 101(4): 705-13.
  5. Houston M, MD, IFM Annual International Conference 2012, Scottsdale, AZ.
  6. Group S R, Wright J T Jr., Williamson J D, et al; for the SPRINT Research Group. (2015) A randomized trial of intensive vs standard blood-pressure control. New England Journal of Medicine. 2015; 373: 2103-2116. doi: 10.1056/ NEJMoa1511939.
  7. McEvoy J W, Chen Y, Rawlings A, et al. (2016) Diastolic blood pressure, subclinical myocardial damage, and cardiac events. Implications for blood pressure control. Journal of the American College of Cardiology. 2016. doi: 10.1016/ j.jacc.2016.07.754.
  8. Stewart, S. (2015) Health Report: Atrial Fibrillation in Australia.
  9. Yusef. S et al (2004) Effect of Potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case control study. The Lancet: 2004: 364: 937-95.2
  10. Marchioli. R et al (2002) Early protection against sudden death by n-3 Polyunsaturated Fatty Acids after myocardial infarction. Time course analysis of the results of the GISSI. Circulation 105: 1897-1903.
  11. Mortenson. SA. et al (2014) The Effect of Coenzyme Q10 on Morbidity and Mortality in Chronic Heart Failure: Results from Q-Symbio: A Randomised Double Blind Trial. The Journal of the America College of Cardiology 2014: 2: 641-649.
  12. Maier. JAM. (2012) Endothelial cells and magnesium: implications in atherosclerosis. Journal of Clinical Science 122: 397-407.
  13. Lu et al, Effects of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction. American Journal of Cardiology. 2008; 101 (12): 1689-1693.
  14. Luo J, Xu H. Outcome measures of Chinese herbal medicine for coronary heart disease: an over view of systematic reviews. Evidenced based complementary and alternative medicine. 2012; 2012:9 page 927392.
  15. Oiu et al, Traditional Chinese Herbal products for coronary heart disease: an overview of Cochrane reviews. Evidence-based, complementary and Alternative Medicine. 2012; 2012:5 pages 417387.
  16. Tachjian et al, Use of herbal products and potential interactions in patients with cardiovascular diseases. Journal of the American college of cardiology. 2010; 55 (6): 515-525.

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