HEART DISEASE

ItS THE BIGGEST KILLER IN THE UNITED KINGDOM. It claims one adult life every three minutes, and nearly two-fifths of the deaths in people age 75 and under can be blamed on it. However, that doesn't mean we completely understand this major killer known as heart disease. So here's a brief tour of the terminology used to describe the things that can go wrong with the human heart.

Atherosclerosis is a condition in which fatty deposits called plaques accumulate on the walls of the arteries, the blood vessels that carry oxygenated blood to the body's tissues. Think of plaques as biological shingles. As they gather into clusters and adhere to the interior of arteries, they narrow the diameter of the arteries to the point where the blood supply becomes inadequate and tissue damage occurs.

Plaques can stick to the walls of any artery. When they build up in coronary arteries, which carry oxygen to the heart, heart disease is the result. Symptoms of heart disease include angina (or chest pain), poor tolerance for exercise, weakness, dizziness, fatigue and eventually heart attacks. But by the time these symptoms occur, heart disease is usually well advanced.

Atherosclerosis is a complex process. It appears to begin in childhood and progress with ageing. Elevated blood cholesterol is an important contributing factor, but it is not the whole story. Two main types of cholesterol exist in the bloodstream: LDL (low-density lipoprotein, or 'bad' cholesterol) and HDL (high-density lipoprotein, or 'good' cholesterol). The 'bad' LDL tends to accumulate in damaged areas of arteries, while the 'good' HDL tends to protect against this process.

Platelets also play an important role in heart disease. When platelets clump together, they release compounds - including prostaglandins - that significantly contribute to plaque formation.
Though all this may seem complicated, it is important to understand why atherosclerosis happens. Then you can appreciate the ways that herbal and nutritional treatments can help to prevent and treat heart disease.

Based on what is known about heart disease, treatment should focus on:
* Decreasing total cholesterol and LDL while increasing HDL cholesterol
* Preventing and healing arterial injuries that lead to the accumulation of plaque
* Preventing platelet aggregation
* Shrinking plaques that are already present
* Dilating coronary arteries
* Strengthening the heart muscle in general, especially by boosting its efficiency in using energy and oxygen

If you have a strong family history of heart disease or have elevated cholesterol, it's never too early to start preventive strategies. Begin eating a heart-healthy diet, quit smoking and add exercise to your daily routine - now, not tomorrow.

DON'T SELF-TREAT HEART DISEASE
Heart disease is a very serious, potentially life-threatening illness. You must continue to see your doctor or a cardiologist on a regular basis. If you are taking medications for heart disease, you should work with your doctor and possibly with an experienced herbalist to construct an individualized programme, because many herbs interact with heart medications. Never stop taking your prescription medications without consulting your doctor.

Drug treatment of heart disease is complex and depends on a variety of factors. They include whether high blood pressure, heart rhythm irregularities or congestive heart failure is present and whether other disease, such as asthma, is present. Many patients require more than one drug.

Herbs that have an effect on the health of the circulatory system take time - weeks to months - to do their work. Be patient. Most important: heart disease is not a condition to take lightly. Consult your doctor about any symptoms of heart disease and be completely honest with him or her about herbs you plan to take. Do not change your regimen of prescription or other pharmaceutical drugs without your doctor's supervision.

FIRST THINGS FIRST
Even though conventional medications and herbal remedies can help heal heart disease, the best treatment is prevention: in other words, exercise and good diet. If you have heart disease, your commitment to an exercise programme and a good diet helps determine your ability to recover from it. Work with your doctor to make these important lifestyle changes safely.
To prevent future heart disease, here are the steps to take:
· What should your cholesterol levels be? Agencies and researchers are continually revising their guidelines. Check with your doctor for the most current ones.
· Get up and sweat. Regular exercise helps lower cholesterol and strengthens the heart. Any kind of aerobic exercise will work, but never exercise to the point of angina (chest pain) or exhaustion, which can damage your heart. If you are currently sedentary, start slowly, gradually increasing your pace and distance. Walking is an excellent exercise for this purpose.
· Don't smoke; if you do, quit. Even if you've been a lifelong smoker, it's never too late to realise the health benefits of quitting.
· Open your heart. This vital organ isn't merely a machine that pumps blood - the metaphor of the broken heart is not an empty one. Many scientific studies have implicated stress, loneliness and isolation in the development of heart disease. If you are isolated, connect with others through your place of worship, volunteer activities, classes or other hobbies. If you are stressed, a variety of meditation and relaxation techniques can help ease the effects of stress on your body.
· Eat better. Western diets, with high animal fat and low vegetable fibre content, are predisposing factors in the development of heart disease. Many good books and classes are available on heart-healthy diets.

DRUG TREATMENT

Nitrates
Glyceryl trinitrate (under-the-tongue tablets or spray), glyceryl trinitrate ointment (Percutol), isosorbide dinitrate (Angitak, Isordil, Sorbitrate, Sorbichew), isosorbide mononitrate (Imdur, Ismo, others).
Function: reduce angina by relaxing smooth muscles in the coronary blood vessels. Side effects: headache, slight decrease in blood pressure.

Beta Blockers
Propranolol (Inderal), metoprolol (Betaloc, Lopresor), labetalol
(Trandate), others. Function: decrease the heart's oxygen consumption by reducing blood pressure, heart rate and the strength of contractions. Side effects: heart failure, too-low heart rate, shorthess of breath, decrease in HDL cholesterol, cognitive problems, problems with memory and concentration, depression, sexual dysfunction, altered sleep, fatigue.

Calcium-Channel Blockers
Nifedipine (Adalat, Cardilate MR, others), diltiazem (Adizem, Dilcardia SR, Tildiem, others), verapamil (Cordilox, Securon), others.
Function: inhibit calcium transport into cells, leading to dilatation of coronary vessels and reduced demands for oxygen by the heart.
Side effects: flushing, low blood pressure, dizziness, swelling, headache, heart failure, heart rhythm irregularities.

Aspirin
Function: decreases risk of heart attacks by preventing platelets from sticking together. Side effects: heartburn, indigestion, stomach irritation, mild nausea or vomiting.

VITAMINS FOR HEART HEALTH
Diet is crucial to a healthy heart, but supplementation is the best kind of insurance, especially because switching to healthier foods is usually a long process for most people. Here are some supplements you may want to investigate if you have heart disease or are at risk for it.
· L-Carnitine. This amino acid is involved with energy metabolism at the cellular level. It increases the efficiency of the heart muscle, reduces cholesterol metabolism and prevents plaque formation. Typical dosage: 500 to 1,500 milligrams per day.
· Coenzyme Ql0. This vitamin-like antioxidant helps cells make energy and improves cholesterol levels. It decreases the frequency of angina and improves exercise tolerance. Typical dosage: 100 to 150 milligrams per day.
· Niacin. This B vitamin lowers cholesterol, but doses tend to be limited by the uncomfortable flushing that it can cause. Sustained-release or long-acting forms of niacin produce less flushing but may damage the liver. An appropriate alternative is inositol hexaniacinate, a niacin precursor that does not cause flushing even at high doses and is harmless to the liver. Studies show this form of niacin to be as effective as other forms, with no side effects reported. Typical dosage: 50 to 100 milligrams three times per day.
*Vitamin E. There are many kinds of vitamin E. The tocotrienol form may be especially helpful in lowering cholesterol. It actually inhibits cholesterol production, a feature that makes this form a good choice for people whose bodies make higher than normal amounts of LDL cholesterol, despite changes in diet. Typical dosage: 25 to 100 milligrams per day.
· itamin B6. Deficiency of this key B vitamin appears to be a major cause of heart disease. It can be taken as part of a good quality multivitamin or a B-complex combination. Typical dosage: 25 to 50 milligrams of B6 per day.
· Magnesium. Many studies link magnesium deficiency with heart disease, sudden cardiac death, heart attacks and dangerous irregular heart rhythms. This mineral may help decrease plaque formation, lower total cholesterol, raise `good' HDL cholesterol and inhibit platelet aggregation. Typical dosage: 500 to 1,000 milligrams per day. Caution: if diarrhoea occurs, reduce the dose.
· Bromelain. Made from proteolytic enzymes found in pineapple, this supplement has anti-inflammatory effects and inhibits platelet accumu­lation. It has been shown in clinical studies to break down plaques and ease angina. Typical dosage: 250 to 500 milligrams three times per day on an empty stomach. Caution: occasionally, bromelain causes upset stomach.

HERBAL REMEDIES

Garlic (Allium saliva) and Onion (A. cepa)
Both of these delicious, aromatic herbs contain substances that prevent platelets from sticking together, lower total cholesterol and triglycerides (a type of blood fat), and increase 'good' HDL cholesterol. Garlic also promotes the breakdown of certain types of blood clots and lowers blood pressure. If you like these fragrant foods and want to include them in your diet rather than take a supplement, eat at least one garlic clove or half a small onion a day. Typical dosage: capsules that provide at least 10 milligrams of allicin per day (your garlic capsules should specify how much allicin they contain). Caution: some people cannot digest garlic or onions; the result is upset stomach, bloating and wind. If you experience a mild form of this side effect, try the culinary trick of adding lots of fresh parsley to a dish made with garlic or onions.

Ginkgo (Ginkgo biloba)
Much scientific research has confirmed the traditional value of ginkgo in the treatment of heart disease. It's antioxidant, enhances heart efficiency, increases blood supply to the extremities and has a tonic effect on blood vessels, gradually improving their health. It also prevents platelets from sticking together. Ginkgo may be particularly helpful if atherosclerosis has affected brain function or arteries in the arms or legs. It is common for people with coronary artery disease to have plaques in arteries throughout the body. Typical dosage: 40 to 80 milligrams of capsules standardised to 24 per cent heterosides three times per day. Caution: rare cases of gastrointestinal upset, headache and dizziness have been reported by people who use ginkgo.

Hawthorn (Crataegus spp.)
We know that hawthorn leaves, flowers and berries dilate coronary arteries, thus increasing blood supply to the heart. Hawthorn benefits heart health in other ways as well. It improves metabolic processes in the heart, including oxygenation and energy production. It also decreases lactic acid, the waste product of exertion that causes muscle pain, and strengthens artery walls. It's antioxidant, anti­inflammatory and reduces cholesterol. Typical dosage: 1 cup of tea three times per day (simmer
1 teaspoon of dried berries or steep 1 teaspoon of leaves and flowers in 1/4 litre of hot water for 10 to 15 minutes); or 1/2 to 1 teaspoon of tincture three times per day; or 100 to 250 milligrams in capsules
standardised to 20 per cent proanthocyanidins three times per day.

Ginger (Zingiber officinale)
This aromatic herb lowers cholesterol and prevents platelets from accumulating by decreasing the absorption of dietary cholesterol, and by stimulating its excretion in bile - one of the primary ways the body removes excess cholesterol. Ginger works best if eaten fresh and taken on an empty stomach. Typical dosage: up to a 6-millimetre slice of an average-sized root per day; or 250 milligrams per day of freeze-dried fresh root in capsules. Caution: ginger may cause upset stomach in some people, especially at higher doses.

Alfalfa (Medicago sativa)
The leaf from this grain decreases cholesterol levels and shrinks plaques that are already present. Often available in powdered form, it is to be taken according to package directions. Typical dosage: up to eight or nine 400- to 500-milligram capsules per day; or 15 to 30 drops of tincture four times per day.

Bilberry (Vaccinium myrtillus)
With a well-deserved reputation in the treatment of eye diseases, bilberry has significant potential benefits for cardiovascular disease as well. It is rich in anthocyanosides, which help it prevent the damage to the interior of blood vessels that allows narrowing to begin. Bilberry inhibits atherosclerosis, protects the heart during exertion, decreases inflammation and strengthens artery walls - all of which means that bilberry does for blood vessels what spinach did for Popeye; it simply does so more slowly. Typical dosage: 80 to 160 milligrams in capsules standardised to 25 per cent anthocyanidin content per day.

Yarrow (Alchillea millefolium)
Yarrow dilates arteries and helps to lower cholesterol. It is considered a blood-vessel tonic, improving arterial health in general. Typical dosage: 1 to 3 cups of tea two or three times per day (steep 1 teaspoon of dried herb in1/4 litre of water for 10 to 15 minutes); or 1/8 to 1/2 teaspoon of tincture two to three times per day. Caution: do not use if you are pregnant.

Motherwort (Leonurus cardiaca)
Another traditional heart tonic, motherwort is known to lower cholesterol, reduce platelet accumulation and generally strengthen the heart. It also slows a too-rapid heart rate, especially when anxiety is a contributing factor, because it relaxes the nervous system in general. Typical dosage: 1 cup of tea two or three times per day (steep to 1 teaspoon of herb in 1/4 litre of - hot water for 10 to 15 minutes); or 1/4 to 1 teaspoon of tincture two or three times per day.

Siberian Ginseng (Eleutherococcus senticosus)
This herb works by acting on the adrenal glands, the primary stress­managing glands in the body. It tends to correct disease-producing processes in the body. In people with heart disease, it appears to lower cholesterol and reduce blood pressure. It is especially appropriate when long-term stress is part of the picture. Typical dosage: up to nine 400- to 500-milligram capsules per day; or 20 drops of tincture up to three times per day. Caution: at high doses, Siberian ginseng may cause insomnia, irritability or anxiety. If these occur, reduce the dosage.

BERRY GOOD FOR THE HEART
Blueberries have chemical compounds similar to those of the more medicinal bilberry. They may have similar benefits for the heart, too, so you have a good excuse to include these delicious berries in your diet.
The pie crust that often accompanies them, however, is not part of a heart-healthy diet! Try eating these berries with low-fat ice milk, or by adding them to unsweetened, non-fat yoghurt with a dash of maple syrup. Or add them to porridge, bran flakes or a similarly fibre-rich cereal.