More people die prematurely from diseases of the heart and arteries than anything else – 150,000 a year in England alone, roughly half from heart attacks and a quarter from strokes, according to current statistics from the British Heart Foundation.
It used to be many more men than women that died from heart disease, but in recent years the numbers have evened out, with more women than men dying from strokes. At least 20,000 deaths occur prematurely in people under the age of 75.
In the UK, there are an estimated 2.6 million people living with the condition and angina (the most common symptom of coronary heart disease), which causes a tightness across the chest, affects 2 million people. Worldwide, over 8 million women die every year from heart disease. Yet both heart attacks and strokes are largely preventable diseases with highly familiar risk factors, such as poor diet, smoking, obesity and lack of exercise.
The combined strategy of changing your diet, improving your lifestyle, and taking the right supplements is likely to be far more effective than taking prescribed drugs – for both preventing and reversing cardiovascular disease – without the side effects.
What really increases risk of heart disease and how to reduce your risk
There’s a difference between actual risk factors and exaggerated risk factors designed to sell drugs. While having a raised cholesterol level is a predictor of risk on its own, it’s not a very good one.
Total cholesterol is but one of a number of fat-like substances in the blood that you want to know about. Others are your low density lipoprotein (LDL), high density lipoprotein (HDL), lipoprotein(a), triglycerides, HbA1c (glycosylated haemoglobin) and homocysteine.
It’s really important to test these other factors since the odds are that if you have a heart attack you won’t have high cholesterol.
On its own, homocysteine is the single best predictor of heart disease in older people but before we go into that it’s good to understand more about the other important measures.
‘Lipo’ means fat or lipid and in the world of cholesterol one wants to have a low LDL, nicknamed the ‘bad’ cholesterol, and a high HDL or ‘good’ cholesterol, and lower triglycerides. Triglycerides are actual fats in the blood and go up when you eat a lot of sugar, fat or drink alcohol. Lipoprotein(a) is something your body makes in response to a lack of certain key nutrients.
Most people wrongly think that cholesterol levels in the blood are a reflection of eating fat or cholesterol. Neither of these myths are true. Cholesterol is produced by the body when your blood sugar and insulin levels rise. So, losing blood sugar control is a major driver of high cholesterol, and controlling your blood sugar with a low GL diet is the main way to reduce it. Soluble fibres also help remove excess.
Reducing fat in your diet doesn’t reduce heart disease risk unless you replace animal fats with fish. If you replace fat with carbs, which is what most so-called low-fat foods do, your risk can actually go up. Also, reducing your cholesterol intake by eating fewer eggs makes absolutely no difference. If your doctor recommends you to eat fewer eggs, ask them for the evidence to support this advice.
Niacin vs statins for lowering cholesterol
For decades now we’ve been told to take cholesterol-lowering statin drugs despite the fact that they are remarkably ineffective unless you are a man and have already had a heart attack.
Niacin (vitamin B3) is available on prescription in high doses of 500mg. It is by far the most effective cholesterol-lowering substance because it not only lowers the ‘bad’ LDL, it also lowers triglycerides and lipoprotein(a) – all by about a quarter, and it raises the good HDL. No drug does all this. It also reverses atherosclerosis (arterial thickening) and risk of cardiovascular events.
Niacin is usually given in a dose of 1,000mg a day (500mg twice a day) although slightly better results are achieved with 2,000mg a day. Most trials have been on a slow-release form called Niaspan. Niacin also works but makes you blush for up to 30 minutes. Niacinamide does not. Inositol hexanicotinate, the non-blush form, should work but there’s no definitive trial on it.
Lipoprotein(a) and vitamin C – Linus Pauling’s legacy
Working with Matthias Rath, Dr Linus Pauling’s last discovery was that lipoprotein(a) is an independent predictor of heart disease. They proposed that when the arteries become damaged, the body makes more of a protein called apoprotein(a), which attracts fat and becomes lipoprotein(a), which then sticks to damaged areas in the arteries –effectively repairing the damage.
They proposed that a lack of vitamin C was one cause of increasing lipoprotein(a), called Lp(a) for short, and showed that giving high dose vitamin C (eg six grams a day) together with the amino acid lysine (three grams a day) could lower Lp(a) and heart disease risk.
High dose vitamin C also makes a lot of sense not only because it lowers Lp(a) and cholesterol, but also because it is an anti-inflammatory. A recent study in Stroke, of almost 60,000 people in Japan, reports that vitamin C intake is strongly associated with a reduced risk of heart disease, especially in women, cutting risk by a third.
Homocysteine – the single best predictor in older people
Having a high blood level of homocysteine is a risk factor for heart disease quite independent of cholesterol. In fact, studies have found that homocysteine is a better predictor of cardiovascular problems than either cholesterol, blood pressure or smoking.
Among elderly people cholesterol is a very poor predictor of cardiovascular disease death, as is a widely used index of conventional risk factors called the Framingham risk score. According to a study published in the British Medical Journal the best predictor by far is your homocysteine – a level above 13 predicted no fewer than two thirds of all deaths five years on.
However, quite a few studies giving homocysteine lowering B vitamins have failed to reduce risk of a second heart attack in those with cardiovascular disease, despite clear evidence that high homocysteine is a very good predictor of risk. Why? The explanation could be surprisingly simple; lowering homocysteine prevents platelets sticking, which stops blood clots – something aspirin also does – so if people in the trials were already taking aspirin there would be no extra benefit in lowering homocysteine with B vitamins. Aspirin was in fact widely used by participants in the trials because they were mainly conducted in patients who had already had a heart attack or other cardiovascular diseases. Unlike aspirin, which damages the gut, the potential side-effects of B vitamins include better memory and mood.
Lowering high blood pressure with vitamin B, C and magnesium
High blood pressure is both a risk factor for a heart attack and also an indicator of cardiovascular disease because it either means the arteries are already becoming restricted or are harder, possibly due to muscular contraction. Magnesium helps muscles relax.
A study, published in Angiology, shows that magnesium lowers high blood pressure by about 10%, Research published in Scientific American, demonstrates that magnesium reduces cholesterol and triglycerides as well. A lot of us are deficient in magnesium: the average intake in the UK is 272mg, while an ideal amount is probably 500mg, especially if you have high blood pressure. The richest source of this mineral is dark green vegetables, nuts and seeds, especially pumpkin seeds. These are all good foods to eat, but if you have high blood pressure or any type of heart disease we recommend supplementing 300mg of magnesium a day. A good multivitamin might give you 150mg so you’ll need at least an extra 150mg. It is cheap, safe and highly effective.
Vitamin C also works. A meta-analysis of twenty nine trials confirms that a mere 500mg of vitamin C a day lowers high blood pressure by 5 points in eight weeks. This study, published in the American Journal of Clinical Nutrition, confirms this important effect of vitamin C. However, higher doses may be even better. In one study, those given 2 grams of vitamin C a day for 30 days had a 10 point drop in systolic blood pressure. This is comparable to the effect you can get with hypertensive drugs such as ACE inhibitors and diuretics.
Although I haven’t seen too many studies on this, in my experience, people with high blood pressure and high homocysteine invariably get a rapid reduction in their blood pressure when supplementing high dose B vitamins – necessary to lower homocysteine (principally folic acid, B12 and B6). A low GL: diet is probably the most important way to bring down high blood pressure.
Omega 3 fats halve you risk
Having a couple of servings (ideally three) of oily fish a week could halve your risk of a heart attack. Two long-term studies, published in the Lancet, comparing the effects of giving patients with heart failure cholesterol-lowering statin drugs or omega 3 fish oils found that those taking one gram a day of omega 3 fats cut their premature death risk by 9% and risk of admission to hospital by 8% compared to placebo. Those taking statins had no reduction in risk. According to the lead researcher Dr Philip Poole-Wilson from Imperial College, London “The results should humble researchers and remind them that medical decisions should be guided by science, and not strongly held opinion.”
There are plenty of other studies that show benefits from eating fish and supplementing fish oils high in EPA and DHA. So much so that the UK’s National Institute of Clinical Excellence recommends all doctors prescribe one gram of fish oil a day to patients who have had a heart attack for a six month period – after that the budget runs out! The American Heart Association (AHA) has recommended that all adults eat fish (particularly fatty fish) at least twice a week, as well as vegetables containing omega 3 fats. Walnuts, chia and flax seeds are the best sources. They also suggest that patients with documented coronary heart disease consume approximately one gram of EPA and DHA (combined) per day, from oily fish or fish-oil capsules. This means either eating a serving of oily fish, or taking two fish oil capsules. This is especially effective in lowering the high triglycerides that are one of the risk factors that are becoming increasingly common as obesity levels rise and are often found with lowered HDL. Statins have no effect on them.
Having a high intake of omega 3’s is also associated with a low homocysteine level, so there is this wonderful weave of effects of vitamin C, omega 3’s and B vitamins – with extra B3 (niacin) if your cholesterol is high, and extra B6, B12 and folic acid if your homocysteine level is high – improving so many of the known risk factors.
Another vital fat for reducing heart disease risk is vitamin D. It might explain why cardiovascular disease risk increases dramatically the further North you go. Exactly how vitamin D protects the heart is not clear yet but one way is probably by keeping the endothelium (the very fine lining of blood vessels) flexible, making you less likely to suffer high blood pressure.
If you’ve had a heart attack or have very high blood pressure, I am not suggesting you throw your drugs away. If your blood pressure reduces and normalizes with nutritional changes let your doctor know and discuss lowering your medication.