You have seen firsthand the impact cardiovascular disease has on your patients’ health.
When treating a patient with cardiovascular disease, such comorbid conditions as obesity, non-alcoholic fatty liver disease (NAFLD), cancer, type 2 diabetes, metabolic disease, respiratory disorders, and dyslipidemias are commonplace.1
Such increases in morbidity come via risk factors such as increased fasting plasma triglycerides, high low-density lipoprotein (LDL) cholesterol, low high-density lipoprotein (HDL) cholesterol, elevated blood glucose and insulin levels, and high blood pressure.2 As heart disease is the leading cause of death for U.S. women and men, and over a third of U.S. adults are being classified as obese, a holistic approach must be considered.
The allopathic reaction to a patient with the aforementioned risk factors is to prescribe a statin medication (to lower cholesterol) and offer brief advice about eating less saturated fat and cholesterol. Statins proved to be an important group of drugs that researchers have shown to not only prevent but also regress coronary heart disease (CHD) via pleiotropic (non-lipid-lowering) effects.
Statins work by targeting the liver cells (hepatocytes) and inhibiting HMG-CoA reductase, the enzyme that converts HMG-CoA into mevalonic acid, a cholesterol precursor. Statins are effective in lowering blood cholesterol and reducing cardiovascular disease, thus making them one of the most prescribed drugs worldwide.3 However, because hypercholesterolemia and CHD are usually a lifelong conditions (co-occurring with other aforementioned health conditions), influenced by a plethora of modifiable factors, statin reliance must be explored further.
Cholesterol is an essential component of the human body: It’s required for constructing cell membranes, it assists in manufacturing sex hormones such as testosterone and estrogen, it’s a vital component of myelin sheath, it produces vitamin D, forms bile acids that aid in digestion and vitamin absorption, and it regulates inflammation via the formation of cortisol.4
Approximately 80 percent of the body’s cholesterol is produced in the liver, while the remaining 20 percent comes from the diet. Whole-body cholesterol metabolism is a state of delicate balance.5
Although it seems logical to assume that eating cholesterol contributes to elevations in blood cholesterol, this usually does not occur. For example, the average person has between 1,400 and 1,700 milligrams of cholesterol in their body daily. Cholesterol production is so tightly controlled in the body that when dietary cholesterol consumption decreases, bodily cholesterol production raises and vise-versa. This is significant because excess cholesterol in the body that is needed to be catabolized must be transported to the liver, secreted into bile and eliminated from the body by the intestines.
A worldwide crisis
Hypercholesterolemia, a key component of CHD, is a metabolic disorder characterized by high levels of serum cholesterol. Because cholesterol does not dissolve well in the blood, it needs to attach itself to a fatty protein to circulate through the body.
LDL is termed “bad cholesterol” because it deposits its cholesterol from the liver to the arterial walls. In addition, these easily oxidized cholesterol particles begin the fatty streak deposition that can lead to coronary artery disease (CAD).6 A significant risk factor that doctors routinely measure for heart disease is dyslipidemia.
Modifiable risk factors for CHD
- Elevated LDL
- Elevated triglycerides
- Low HDL
- Tobacco use
- Western diet
Although a therapeutic lifestyle change should be the primary focus in decreasing a patient’s health risk, doctors habitually opt for pharmacological agents first. Many state that the usual dietary modification and other non-pharmacological measures tend to be inadequate and do not sufficiently improve their patient’s blood chemistry enough.
Once the lipid-lowering agents (statins) lower the CHD risk, lifestyle modification assessment and follow up become almost non-existent. This means the critical element of lifestyle modification is reduced to taking a pill.
The focus here is on cholesterol, because there is a great class of medications for it, but it is only one of many factors that contribute to CHD. For example, systemic inflammation, its comorbidities, and the surge in inflammatory cytokines due to central adiposity are all factors.
Beyond normalizing lab values
Improvement in a patient’s dyslipidemia resulting in a better lipid profile is needed, but it’s also necessary to have greater control of blood pressure, fasting blood glucose, physical exercise, emotional state, adipose tissue, and food and alcohol habits. The current approach doctors take with CHD patients is to modify laboratory values but neglect to treat the actual cause of the dyslipidemia.
One study that demonstrates the magnitude of modifiable risk factors for heart disease, titled “Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study),” was published by The Lancet in 2004. In summary, nine easily measured risk factors were identified that are the same in almost every geographic region and every racial and ethnic group worldwide, and these are consistent in men and women of all ages.7
This was a landmark study not only because it identified the nine significant risk factors for heart disease and stroke but also because it set in place a preventive strategy to avert coronary heart disease worldwide. Medical providers now can clarify risk factors and target them with appropriate lifestyle modifications.
Science is catching on to prevention—many graduate medical education programs are developing curricula relevant to lifestyle medicine. Accredited preventive medicine residency training programs are now offered in 73 medical and graduate schools.8
Modifiable risk factors associated with myocardial infarction
- Raised ApoB/ApoA1 ratio
- History of hypertension
- Abdominal obesity
- Psychosocial factors
- Daily consumption of fruits and vegetables
- Regular alcohol consumption
- Lack of physical activity
A perfect fit
Chiropractors are the ideal health care providers to promote a preventive medicine lifestyle. The frequency with which they treat and evaluate their patients is unique and fosters a special rapport.
On the initial intake, the DC can assess the most recent laboratory results, anthropometric measurements (waist circumference, BMI), 24-hour food and drink log, social habits (exercise frequency, sleep quality, bowel habits), and a list of prescribed and over-the-counter medications taken. These are all the tools needed to implement a program to decrease a patient’s cardiovascular disease risk and comorbidities.
Dietary changes, supplementation, additional bloodwork (if needed), an exercise plan, and meditation with easy implementation steps can help your patients get healthy.
Louis Miller, DC, MS, is the owner and operator of Advanced Chiropractic of South Florida and Healthy Weight Solutions. He graduated from New York Chiropractic College in 2000. In 2015, he completed his Master of Science Degree in applied clinical nutrition. He is currently writing his first book regarding the many nutritional cases he’s been presented during practice. He can be contacted at 561-432-1399 or through healthyweightsolutions.org.
1 Morrison F, Shubina M, Turchin A. Lifestyle counseling in routine care and long-term glucose, blood pressure, and cholesterol control in patients with diabetes. Diabetes Care. 2012;35(2):334-41.