Cardiovascular Health

Despite advances in treatment and prevention, cardiovascular disease remains the leading cause of death worldwide. Here is some information on major risk factors which can cause cardiovascular disease and strategies to mitigate the risk.  

1. Hypertension

2. High cholesterol

3. Metabolic syndrome / toxemia

Hypertension - Don't just treat the numbers:

Most people know that hypertension or high blood pressure can lead to heart disease. What a lot of people do not know is that hypertension is often a sign of chronic and sustained underlying process which consists of inflammation, oxidative stress and vascular ageing. 

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Normal adult blood pressure is 120/80. There is a wide range of normal numbers based upon individual age, gender and additional factors. 

What strategies can lower inflammation, oxidative stress and improve vascular aging?

Following non-pharmacological strategies can help

  1. A healthy diet low in salt, saturated fats, caffeine and alcohol

  2. Sleep - 6 to 8 hours of uninterrupted and good quality sleep and

  3. Stress management can help mitigate inflammation.

In addition, several pharmacological methods including blood pressure lowering medications can mitigate three components of hypertension. 

FAQs about Diet and Blood Pressure: 

How does nutrition affect blood pressure?

  • Certain foods can increase blood pressure.

  • Certain foods can lower blood pressure.

  • Gaining weight can increase blood pressure.

  • Losing weight can reduce blood pressure.

What should I eat to control high blood pressure?

  • Eat foods lower in fat, salt, and calories.

  • Use spices and herbs, vinegar, lemon or fruit juices instead of salt to flavor foods.

  • Use less oil, butter, margarine, shortening, and salad dressings.

What are some of the foods I should eat?

  • Plant based or skim or 1% milk, greek yogurt, plant based yogurt.

  • Lean meat.

  • Plant based protein or skinless turkey and chicken.

  • Low-salt snack or cereals.

  • Cooked hot cereal (not instant).

  • Vegan cheeses or low-fat and low-salt cheeses.

  • Fruits (fresh, frozen, or canned without added salt).

  • Vegetables (fresh, frozen or canned, no added salt).

    • Richly colored green, orange, and red items are high in potassium and minerals that help lower blood pressure.

    • The goal is 5-9 servings of fruits and vegetables per day.

    • Unsalted seeds (pumpkin, squash, sunflower) and unsalted nuts are mineral-rich foods that lower blood pressure.

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What foods should I eat less of?

  • Butter and margarine.

  • Regular salad dressings.

  • Fatty meats.

  • Whole milk dairy products.

  • Fried foods.

  • Salted snacks.

  • Canned soups.

  • Fast foods.

  • Deli meats.

What's the difference between sodium and salt?

Salt is mostly sodium, a mineral that occurs naturally in foods. Sodium is the substance that may cause your blood pressure to increase. Other forms of sodium are also present in food. MSG (monosodium glutamate) is another example of a sodium added to food (common in Chinese food).

How does salt increase blood pressure?

When you eat too much salt, which contains sodium, your body holds extra water to "wash" the salt from your body. In some people, this may cause blood pressure to rise. The added water puts stress on your heart and blood vessels.

How much sodium is too much?

The American Heart Association recommends limiting daily sodium intake no more than 1,500 milligrams. (A teaspoon of salt has about 2,400 milligrams of sodium.) Most people greatly exceed these sodium guidelines.

How can I reduce my sodium intake?

  • Don't use table salt.

  • Read nutrition labels and choose foods lower in sodium.

  • Choose foods marked "sodium-free," "low sodium," and "unsalted."

  • Use salt substitutes (ask your healthcare provider first).

  • Don't use lite salt as a substitute.

  • Read content labels. (Contents are listed in order of greatest amount.)

  • Purchase sodium-free herbs and seasoning mixes like Mrs. Dash®.

What foods are high in sodium?

  • Processed foods such as lunch meats, sausage, bacon, and ham.

  • Canned soups, bouillon, dried soup mixes.

  • Deli meats.

  • Condiments (catsup, soy sauce, salad dressings).

  • Frozen and boxed mixes for potatoes, rice, and pasta.

  • Snack foods (pretzels, popcorn, peanuts, chips).

  • Pickled or marinated food in brine. (Vinegar- and lemon juice-based marinades are ok.)

What else should I do to change my diet?

  • Avoid alcohol.

  • Eat a variety of foods.

  • Eat foods high in dietary fiber (whole grain breads, cereals, pasta, fresh fruit, and vegetables).

 

Comparison of Sodium in Foods

Meats, poultry, fish, and shellfish

Fresh meat, 3 oz. cooked: Less than 90 mg

Shellfish, 3 oz: 100 to 325 mg

Tuna, canned, 3 oz: 300 mg

Lean ham, 3 oz.: 1,025 mg

Dairy products

*Whole milk, 1 cup: 120 mg

Skim or 1% milk, 1 cup: 125 mg

*Buttermilk (salt added), 1 cup: 260 mg

*Swiss cheese, 1 oz: 75 mg

*Cheddar cheese, 1 oz : 175 mg

Low-fat cheese, 1 oz.: 150 mg

*Cottage cheese (regular), 1/2 cup: 455 mg

Vegetables

Fresh or frozen vegetables, and no-salt-added canned (cooked without salt), 1/2 cup: Less than 70 mg

Vegetables canned or frozen (without sauce), 1/2 cup: 55-470 mg

Tomato juice, canned, 3/4 cup: 660 mg

Breads, cereals, rice and pasta

Bread, 1 slice: 110-175 mg

English muffin (half): 130 mg

Ready-to-eat, shredded wheat, 3/4 cup: Less than 5 mg

Cooked cereal (unsalted), 1/2 cup: Less than 5 mg

Instant cooked cereal, 1 packet: 180 mg

Canned soups, 1 cup: 600-1,300 mg

Convenience foods

Canned and frozen main dishes, 8 oz: 500-1,570 mg

*These can also be high in saturated fat, unless low-fat or reduced fat options are purchased.

*High in saturated fat.

About these foods

  1. They lower blood pressure from 15 - 20 mmHg when combined with healthy lifestyle and low sodium diet.

  2. Greens are always great

  3. Leave the sugar behind when eating that dark chocolate

  4. Make garlic your friend

  5. Berries are good with portion control

  6. One banana a day is just ok

  7. Red beets have additional benefits

  8. Walnuts work on brain as well

  9. Just eat a serving of pomegranate as whole fruit

  10. When eating some of these delicious fruits, keep total daily carbs in check. Do not overdo carbs. Instead mix and match these foods and keep it fun 

Non pharmacologic device to lower blood pressure:

Resperate is an FDA approved device and can lower blood pressure by 10 - 15 mm Hg. More information can be found at www.resperate.com

                                             

Cholesterol:

Normal cholesterol should be below 200 mg/dl. However, there are many details to it. LDL should be low. HDL should be high and total cholesterol levels should be factored into the overall cardiovascular risk. In other words, if you have multiple risk factors for cardiovascular disease, it is recommended to maintain a even a lower cholesterol level.  That being said, cholesterol plays key functions in the body including synthesis and metabolism of several hormones and neurotransmitters. Therefore, it is important to keep the levels within an optimal range. 

Non - Pharmacological strategies to help regulate cholesterol 

1. Eat a healthy fiber and plant rich diet.

2. Obtain essential fatty acids from dietary sources such as nuts and seeds, olive oil, avacado oil, murine oil etc. 

3. Add omega-3 fish oil supplements with a balanced EPA and DHA ratio if it is hard to get essential fats from food. 

4. Supplements such as red yeast rice and plant sterols can lower choletserol to some degree.

5. Exercise regularly 

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Important points to keep in mind when using pharmacologic methods to lower cholesterol 

1. Pharmacologic methods (medicines) only play a partial role. A healthy diet and lifestyle should still be incorporated. 

2. Certain medications such as statins, deplete body of essential nutrients such as Co-enzyme Q10, zinc, magnesium etc. Therefore, it may be necessary to monitor their levels. 

Do I really need to take cholesterol medicine?

Check your risk of developing heart disease using the formula on the following website. If your risk is over 10% in the absence of diabetes or over 7.5% with diabetes, a cholesterol lowering medication must be considered. 

www.cvriskcalculator.com

Metabolic Syndrome or Metabolic Toxemia: 

Metabolic syndrome or metabolic toxemia refers to metabolic derangement which occurs as a result of lifestyle factors, environmental exposure and genetic predisposition. When all these factors work against our metabolism, oxidative stress, inflammation and vascular aging start to occur. One example of such state is metabolic syndrome which is a combination of 1) abdominal obesity, 2) elevated blood pressure, 3) abnormal cholesterol and 4) insulin resistance. While all these 4 are independent risk factors for cardiovascular disease, together these augment the devastating effect of each other and therefore must be controlled to the best of our abilities. 

Labs and tests to do to monitor cardiovascular health:

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Intervene here 

Not just here 

Bio-metrics 

  1. Blood Pressure

  2. Body Mass Index

  3. Diet 

  4. Exercise and fitness routine

Blood Tests

  1. Lipid panel

  2. C Reactive Protein

  3. Homocysteine 

  4. Uric acid

  5. HgbA1C

  6. Metabolic panel

Functional Tests

  1. QSART

  2. ANS with ABI

  3. Sudomotor 

  4. Vascular age

Structural Tests

  1. Echocardigram

  2. Coronary artery calcium score

  3. Coronary angiogram

Key Points to Remember and Follow:

If you have any of the above conditions, such as hypertension, high cholesterol or metabolic syndrome, use the following approach to improve your health.

  1. Diet & Lifestyle,

    1. Recommended diet advice mentioned above. That is, a diet low in salt, processed foods, unhealthy fats and high in green leafy vegetables, fruits and lean sources of proteins.

    2. Exercise at least 150 minutes a week.

    3. Use stress reduction techniques such as yoga, meditation etc.

    4. Improve sleep quality and aim to achieve sufficient amount of sleep .

  2. Take medications if/as prescribed.

  3. Use non-pharmacologic approaches such as supplements if appropriate.

  4. Based upon how well your condition is controlled, schedule follow up visits approximately once every 3-6 months.

  5. Consider getting advance level tests such as Coronary Artery Calcium Score (CAC score), Carotid ultrasound, Echocardiogram, Stress tests, advanced lipid panel and tests mentioned under metabolic syndrome. These tests help determine how well your conditions are controlled and if further therapeutic interventions are warranted.