Natural Therapies
In today's high tech computer world it is difficult to believe that the simple things such as diet, lifestyle changes and exercise could represent the real answer to the management of heart disease. There is no question that such simple things start early in life can prevent and reverse heart disease. Dr. Dean Ornish in his book Reversing Heart Disease, illustrated how a vegetarian diet, meditation and exercise in the form of yoga could reverse angiographically documented coronary artery blockages. The medical literature also indicates that management of hostility and behavioral problems as well a good exercise program are some of the most important aspects to the management for heart and blood vessel disease. For the modern physician though it is very difficult with as many patients to sit down and start talking about diet and lifestyle changes. However, the real answer does lie in this area.

Risk Reduction
Here the management of modifiable risk factors sill remains to be the most important area in the management of cardiovascular disease. The major modifiable risk factors are smoking, sedentary lifestyle, high cholesterol, hypertension, diabetes and obesity. All of these can be managed with an intensive program. Unfortunately, where is the reimbursement for sitting down and counseling a patient on exercise, diet and weight reduction? It simply does not exist and here lies the answer to why heart disease remains so prevalent.

Avoid or Minimize Drug Therapy
Major advances have been made in the development of cardiac drugs for hypertension, clotting disorders and lipid disorders. These drugs, although important, when there is presence of more advanced disease frequently carry unfortunate side effects. For example, many hypertensive drugs effect male and even female sexual function, cholesterol lowering drugs can cause liver damage and muscle injury and drugs for clotting abnormalities can cause bleeding problems. In my practice there is a tendency to use natural therapies, although the holistic cardiologist for the 21st century, must use a combination of drugs and vitamins and supplements along with diet and exercise. There is no question that when one is dealing with severe coronary artery disease or impaired left ventricular function in the form of cardiomyopathy, intensive drug therapy in conjunction with vitamins, minerals, amino acids and herbs.

Avoid Invasive Testing
With the modernization of the cardiac catheterization laboratory, it has become evident that one of the main diagnostic areas for cardiac disease is the use of coronary angiography. I have found that this is a markedly overused procedure and it appears that most cardiologists that are involved in angiograms will do a stress test. It may have minimal changes, however, angiograms will be advised. In my practice I do recommend angiograms but only for the most severe patients when all other methods are not safe and when the patient is at risk of having a severe heart attack or stroke.

Avoid Invasive Surgery
Surgical intervention and now very prevalent coronary angioplasty and coronary stent implantation are really performed throughout the country in a massive number of patients. Many of these revascularization procedures can be avoided with the use of intensive medical management, diet, exercise and drug therapy. I do recommend patients for revascularization when they are at a severe risk for developing a heart attack or stroke. Coronary angioplasty has been one of the major failures in the management of heart disease with our third of all angioplastics being closed at the end of six months. And now stent implantation I believe will eventually be shown to be just as much of a devastating failure as the plain coronary angioplasty. Many patients, after undergoing angioplasty, will find themselves being recatheterized on two to four occasions because of repeated blockages. The continued intracascular manipulation causes progressive cartial wall injury and irreparable damage.

Nutri-pharmacology
Last month in New Life Magazine I presented an article on the natural therapies for hypertension and cholesterol problems. Nutri-Pharmacology or the new area of what I call "cardio nutrition" has been well documented in the nutritional literature for the management of all cardiovascular related problems. Just as Ginkgo is used for memory, glucosamine for arthritis and ginseng for energy, there are many vitamins, minerals, herbs and amino acids that are effective for cardiovascular related problems such as: angina, hypertension, arrhythmia, hypercholesterolmia, elevated triglycerides, obesity, insulin resistance, fatigue, diabetes and peripheral vascular disease. These most likely will be discussed in future articles.

Arteriosclerosis Reversal
Arteriosclerosis has been definitely been found and reported widely in the medical literature to be a reversible disease. Approximately 3 years ago the opening of the American Heart Association meeting started with the lead speaker indicating that the cure for heart disease has been found but it is not being utilized. It is once again much to frequent where patients are pushed into invasive procedures without trying intensive medical management andartiosclerosis reversal. Arteriosclerosis reversal has been once again as noted above to be reported by Dr. Dean Ornish and there are many articles in the medical literature indicating how intensive lipid lowering can reverse arteriosclerosis. New guidelines established by the National Cholesterol Education Program indicate that LDL cholesterol must be lowered to be below 100 for those individuals with established heart disease. When these levels and possibly levels even lower are maintained, arteriosclerosis reversal or the actual reopening of narrowed blood vessels will occur. Symptomatic improvement will improve after six months. In my practice intensive lipid lowering is used through the use of diet and when necessary drug therapy. Another extremely important part of the arteriosclerosis reversal process is preventing thrombosis with the use of high levels of antioxidants including the newer types of antioxidants such as lipoid acid, co-enzyme Q10, grape seed extract and soy products which have been proven now to have an antioxidant effect including many other antioxidants. This too can be discussed in future articles. In a good arteriosclerosis reversal program, chelation therapy could also be considered. In a good arteriosclerosis reversal program, chelation therapy could also be considered. This has been shown in many patients to improve symptoms, and I believe when used in conjunction with other modalities, will aide in the management of heart and blood vessel disease.

Control Insulin Resistance
The so called "insulin heart disease connection" is quite well documented now. Recently an article in the American Heart Journal Circulation indicated that insulin levels were just as important as cholesterol for heart disease. In my practice I found that there has been an epidemic of insulin resistance. This syndrome occurs as a metabolic/genetic abnormality in patients with abdominal obesity, hypertension, glucose intolerance and lipid disorders especially high triglycerides. Most type II diabetics are insulin resistant and many patients with heart disease and obesity have insulin related problems. Insulin itself is a growth factor that causes and acceleration of the arteriolerotic process. It also causes, in insulin resistance, thrombotic or clotting abnormalities and it causes elevated sodium levels through renal changes causing hypertension. The fact that diabetics have 5-10 times the degree of heart disease is an indicating factor of the importance of insulin in heart and blood vessel disease. The management of insulin resistance and more details on this subject will be following in this series of articles.

The Body/Mind Connection
Very frequently behavior modification is easily forgotten in the management of heart disease, but when one studies trigger heart attack, one of the greatest triggers along with physical activity is emotional stress, hostility or anger. Part of the Dean Ornish program seriously addresses this in the form of behavior modification and these emotional changes with their concurrent vasconstrictive problems as well as causing an increase in rapid heart rate which can cause plaque rupture and thrombosis must be addressed and are an important part in the management of heart disease.