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For Optimal Heart Health, Look Beyond Cholesterol - By Dr. Vivian Kominos


For the last several decades cardiology has concentrated on the treatment of high cholesterol, specifically LDL cholesterol, for the prevention of heart disease. It is true that high cholesterol is a risk factor. For people at high risk for heart disease, drug therapy with statins decreases heart attack and stroke risk. However, For the last several decades cardiology has concentrated on the treatment of high cholesterol, specifically LDL cholesterol, for the prevention of heart disease. It is true that high cholesterol is a risk factor. For people at high risk for heart disease, drug therapy with statins decreases heart attack and stroke risk. However, about one-half of patients who have heart attacks have normal or low LDL cholesterol levels. Risks beyond cholesterol need to be considered to help prevent and reverse heart disease. Two of these risks are inflammation and calcification.


Inflammation: With injury or infection, inflammation is the mechanism by which the body heals: chemical messengers recruit white blood cells that attack and repair damage caused by infection or injury. In fact, inflammation that is appropriately targeted and short-lived is necessary for survival and health. But when inflammation goes unchecked and persists, it increases the risk for heart disease and many other chronic diseases including dementia, arthritis and some cancers. There are ways to measure inflammation with a simple blood test called C reactive protein, or CRP. The results of a large placebo-controlled trial, JUPITER, showed that even with normal cholesterol levels, a high CRP was associated with an increased risk for heart attacks and strokes. Your doctor can order a CRP to check for inflammation. A level below 1 mg/dL is associated with low cardiovascular risk while levels above 3 mg/dL confer high risk.

What causes inflammation and what can you do to reduce it? Inflammation can result from many insults: environmental exposure to toxins (e.g., smoking, pesticides), high emotional stress, autoimmune diseases, and poor nutrition to name a few.


Inflammation can be reduced naturally through lifestyle. Clinical studies have shown that both the Mediterranean and DASH diets reduce the inflammatory chemicals that damage the lining of blood vessels. Stress reduction techniques such as breathwork, meditation and yoga not only reduce inflammation and stress, but also prevent and treat high blood pressure, high cholesterol and obesity! Supplements such as turmeric and fish oil also lessen inflammation. But before taking supplements, check with your physician to make sure they are safe and do not interact with any medications.


Calcification: Calcium, the most abundant mineral in the body, may collect on the lining of blood vessels as a response to injury. This interferes with the normal function of the blood vessel and over time, the calcium build up can cause a blockage that limits blood flow. It is easy to quantify the amount of calcium in the heart’s arteries with an ultrafast CT scan of the chest. This yields a number called a “calcium score.” This score is then compared to people in the same age group. A high calcium score, or high calcium for age, predicts an increased risk for heart attack and stroke. But this test is not for everyone: there is some radiation exposure; if there is a history of coronary artery disease or other vascular disease, the test does not add any prognostic value; similarly if a high risk for heart disease is already present, the test may not be of value since it may not change treatment. The purpose of any test is to provide useful information that will aid in a treatment plan. Ask your physician if this test is right for you.


What causes calcification of arteries? A complex milieu that includes some of the same risks that cause heart disease: high blood pressure, smoking, high cholesterol, diabetes, and genetics. Unlike high cholesterol, there is currently no drug that treats or reverses calcification. Minimizing or reversing risks will also prevent calcification.


It is never too late to obtain optimal heart health. There is ample clinical evidence that heart disease can be reversed with lifestyle, appropriate medications and a healthy physical and emotional environment.


Vivian A. Kominos, MD, FACC, ABOIM is a fellowship trained integrative medicine doctor and cardiologist. She is an Assistant Professor of Medicine at the Andrew Weil Center for Integrative Medicine, University of Arizona School of Medicine and has a clinical practice in West Long Branch, NJ. She utilizes the best of conventional and integrative medicine to personalize approaches to overall wellness besides heart health.


This article appears in the February 2020 issue of Natural Awakenings Monmouth/Ocean edition