Risk & Reward

Win the battle with heart disease by knowing your risks and taking responsibility for your condition.
By Larry Trivieri JR.

Every 20 seconds, your blood completes a cycle through more than 60,000 miles of blood vessels (arteries, veins, and capillaries), circulating through every tissue and organ in your body. At the center of this vital process beats the powerhouse that is your heart.

A hollow muscle comprised of two side-by-side pumps, each side of the heart contains two chambers, the atrium and the ventricle. These pumps power the distribution system that supplies oxygen and nutrients to all of your body’s tissues and organs. It also pumps blood from the rest of your body to the lungs for re-oxygenation.

Weighing between 8 to 10 ounces on average, this miraculous organ beats around 100,000 times and pumps approximately 1,980 gallons of oxygen-rich blood through your body each and every day. Once the blood is ready to be reoxygenated, it moves through your veins back to your heart, and then on to your lungs. This process runs continuously each and every minute throughout your life.

Cued by the endocrine system, the heart reacts quickly to physical and emotional stimuli, helping us handle stress in the heat of the moment. It provides us with the strongest and most immediate feedback regarding our internal health, and yet for many Americans, heart disease seems to take them by surprise.

Fortunately, in recent years, researchers have gained new insights into why heart disease is such a major health scourge—including some major differences between the way men and women experience the disease. What that research shows is that most of the nearly one million deaths that annually occur in the US are preventable. In most cases, so is heart disease itself. The key to preventing heart disease lies in knowing what causes it, knowing your risks for developing it, and then doing all you can to reduce those risks. These same steps that reduce heart disease risk have also been shown to be highly successful for reversing heart disease, in many cases completely.

Looking Beyond Cholesterol
While keeping cholesterol levels within normal levels is still important for preventing and treating heart disease, doctors now know that this, alone, is not enough. According to integrative physician Kerry D. Friesen, MD, of Chattanooga, Tennessee, “In the last decade or so, there has been an entire paradigm shift in our understanding of the causes of heart disease.”

Among the research spearheading physicians’ new understanding of the causes of heart disease, Friesen says, are recent studies of patients considered at risk for heart disease using Electron Beam Tomography (EBT, an ultra-fast CT scan). “The EBT studies examined the coronary arteries of these patients, examining them for signs of heart disease, specifically atherosclerosis,” Friesen explains. Based on the old paradigm understanding of heart disease, patients with atherosclerosis should also have had elevated low-density lipoprotein (LDL), or “bad” cholesterol, levels. But what the EBT studies showed was that LDL levels did not correlate with atherosclerosis (hardening of the arteries caused by plaque buildup in artery walls).

“The EBT studies, as well as other studies, reveal that the widely held belief that LDL causes heart disease is inaccurate,” Friesen says. “In fact, elevated LDL cholesterol is such a poor marker for heart disease that 50 percent of patients with normal LDL levels still go on to develop heart disease. A much stronger indication of heart disease can be seen with low levels of highdensity lipoprotein (HDL), or ‘good’ cholesterol, and elevated triglyceride levels. This was noted years ago by Dr. William Castelli, who was the director of the Framingham Heart Study, but has been overlooked until recently.”

According to Friesen, few prescription drugs are available to treat the combination of low HDL and high triglyceride levels. “The good news is that there are a variety of natural self-care approaches that are effective for reversing this critical metabolic disorder,” he says.

Lesser-Known (But Telling) Risk Factors
In addition to elevated cholesterol and triglyceride levels, another equally important risk factor for heart disease is chronic low-grade inflammation. “This type of inflammation is often caused by infectious diseases,” Friesen says. Oxidative stress, which is often associated with chronic inflammation, is another major risk factor. Other risk factors include chronic emotional stress and unresolved emotional issues (especially anger), as well as the buildup of environmental toxins in the body.

“The role that environmental toxins, such as lead, mercury, and other heavy metals, play in heart disease is also overlooked by most physicians,” states Garry F. Gordon, MD, DO, medical director of the Gordon Research Institute in Payson, Arizona. “But in fact these toxins can be responsible or exacerbate other major risk factors associated with heart disease, especially inflammation, oxidative stress, and chronic infections. In my own clinical practice, I’ve found that, once these toxins are addressed through a properly supervised program of detoxification, the overall symptoms of patients with heart disease usually are reduced as well.”

Screening for and treating chronic infections, such as periodontal disease, should also be part of any comprehensive program for heart disease, Gordon says. “Infections are acquired through exposure to viruses, bacteria, fungi, and parasites that we come into daily contact with through other people, animals and our environment,” he explains. “Due to today’s devitalized food supply, stress, exposure to environmental toxins, and so forth, our bodies lose the ability to fight off these infectious invaders. Over time, this constant barrage wears down our immune system, allowing the infections to dig in even deeper. This leads to chronic inflammation which leads to many degenerative diseases, including heart disease.”

Allergies can be another risk factor for heart disease, especially among women aged 50 and younger, according to Andrew W. Campbell, MD, of The Woodlands, Texas, and a consultant to both the CDC and the National Institutes of Health (NIH). “Common allergic symptoms are significantly associated with an increased risk of coronary heart disease,” Campbell states. “There is a three-fold increased risk of heart disease with wheezing, and a 40 percent increased risk with runny nose and itchy eyes compared to no allergies.” Campbell has documented these increased risks in his own clinical practice and recommends that people who suffer from allergies be screened for heart disease as a precaution.

Another risk factor that has come to light in recent years is low testosterone in men. A recent study published in the medical journal Heart found that low testosterone is common among men suffering from heart disease and, if left untreated, can significantly interfere with recovery and increase the risk of death.

Other risk factors for heart disease include:

• A family history of heart disease

• Poor diet

• Poor lifestyle habits, such as smoking

• Lack of exercise

• Obesity

• Hypertension (high blood pressure)

• Diabetes

Knowing and addressing these risk factors is an important key for preventing heart disease, and also for helping to treat it.

Heart Disease Is Different For Women
Heart disease has traditionally been considered a disease that most commonly affects men. Most people also assume that cancer, not heart disease, is the number one killer of women in the United States. Both of these assumptions are false, and can be dangerous if believed. The following statistics bear this out:

• Approximately 8 million women in the US currently live with heart disease, including 10 percent of all women between the ages of 45 and 64.

• 43 percent of deaths in women in the US are caused by heart disease (approximately 500,000 deaths each year).

• Heart attacks kill six times as many women in the US each year as breast cancer.

• More women die from heart disease each year in the US than men.

• 62 percent of all deaths in the US each year caused by congestive heart failure occur among women.

Women who suffer a heart attack also have lower survival rates compared to men (38 to 25 percent), and are more likely to suffer from another heart attack within six years (35 to 18 percent). Female heart attack survivors are also more than twice as likely to be disabled due to heart failure within six years compared to men (46 to 22 percent), and nearly twice as many women as men die after bypass surgery. Making matters worse, most of the research conducted on heart disease today is focused on men, with women comprising only 25 percent of all participants in medical studies related to heart disease.

Compounding matters is the fact that women often do not experience symptoms of heart disease in the same way that men do, and therefore are more likely to not recognize what the symptoms mean, or to ignore them altogether. For example, while chest pain is the most common symptom of a pending heart attack, women are far more likely than men to not experience chest pain before a heart attack strikes. Women are also less apt to experience other common warning signs of heart disease, such as pain in the left arm and shortness of breath.

Instead of experiencing the most common warning signs of heart disease, women are more likely to experience what are known as “atypical warning signs.” Such symptoms include pain in the back, neck or jaw; nausea; vomiting; indigestion; weakness; unexplained fatigue; dizziness or lightheadedness; and sleep disturbances. Research has shown that 95 percent of women who suffered heart attacks first experienced one or more of these atypical symptoms rather than common warning signs. In the majority of cases, they did not recognize the symptoms for what they were. Had they done so, the majority of them might have avoided heart attacks by receiving medical attention in time.

Physicians, too, can fail to detect heart disease in women. One reason this is so is because women aren’t as likely to have fatty plaque buildup in their arteries compared to men. This is especially true among younger women. In addition, women typically develop heart disease an average of 10 to 15 years later than men do. Researchers attribute this delay to two factors: menstruation, which helps to thin blood, making it easier for the heart to pump it; and the rich supply of female hormones that are produced prior to menopause, which have heart-protecting properties. Once menopause sets in, however, women who previously exhibited no signs of heart disease might quickly develop them, but because of their health history, their doctors might fail to screen for them.

Prevention and treatment of heart disease also differs between men and women. For example, one of the most commonly prescribed measures to prevent a heart attack is taking an aspirin once a day. However, research has shown that aspirin does not help to prevent heart attacks in healthy women to the same extent as it does in healthy men. In addition, once heart disease is detected, men are more likely to receive the appropriate medical care, including cardiac catheterization, a minimally invasive surgical procedure often used by cardiologists to determine the extent of damage to the heart and arteries, as well as the best treatment options. Women with heart disease are far less likely to receive this procedure than men unless they specifically request it.

All of the above facts make it essential that women become proactive when it comes to heart disease. This means knowing the different and atypical warning signs of heart disease that most commonly affect them, and making sure to request a thorough screening process for heart disease from their doctors, especially once they enter into menopause.

Screening Tests for Heart Disease
In addition to blood tests that monitor HDL, LDL, and triglyceride levels, Drs. Campbell, Friesen, and Gordon agree that other blood screening tests are also important for determining heart disease risk. To screen for inflammation, they use blood tests to measure levels of C-reactive protein (CRP), homocysteine, and fibrinogen. Levels of ferriten, a marker for oxidative stress, should also be screened for.

Dr. Friesen also typically screens his patients using advanced lipid profile tests instead of standard lipid tests, especially if they have a family history, or are in the early stages, of heart disease. “Advanced lipid profiles help determine the quality of a patient’s cholesterol in addition to its quantity,” he explains. “Most doctors and patients do not realize that standard lipid profile tests don’t measure cholesterol directly, only their approximate level based on a mathematical formula. The advanced lipid profile test that I use can directly measure and differentiate between five subtypes of HDL, seven subtypes of LDL, triglyceride levels, and intermediate molecules known as VLDL and ILDL, plus the dangerous hereditary molecule Lp(a), which can mimic another molecule in the body that can trigger a fatal blood clot.”

Another test these doctors recommend is the PLAC test, which measures lipoprotein phospholipase A2 (Lp-LPA2). This test measures free radical damage and inflammation inside blood vessels, and can be used to determine levels of existing plaque in arteries. “I frequently use the PLAC test to monitor the effectiveness of my patients’ treatment regimen,” Friesen says. Other tests he recommends are the VAP or Berkley Heart Lab test (both blood tests your doctor can order). He also suggests you become aware of your family’s health history to have a better idea of the health risks you may have inherited from your parents.

Dr. Gordon also recommends that patients have their doctors determine how thick or thin their blood levels are. This can be done through blood viscosity testing. Thin blood is easier for your heart to pump, Gordon explains, reducing how much arteries have to stretch to accommodate healthy blood flow, and also reducing the risk of arterial injury. “The thicker the blood is, the higher the correlation for heart disease there is,” he says, adding that elevated LDL levels, as well as obesity and smoking, are some of the risk factors that can cause blood to thicken.

Dr. Campbell adds that analyzing hair samples for levels of the stress hormone cortisol is also important. “Elevated cortisol found in hair samples has been shown to be a significant predictor of a heart attack,” he says. “We all know that stress is a risk factor in heart disease but previously doctors had to rely on what their patients told them about stress, whereas with hair analysis we now can measure stress levels accurately and objectively.”

Campbell also recommends two other tests that may soon be commercially available. The first is known as the f-TFPI (free tissue factor pathway inhibitor) test, and the second is called vWF (Von Willbrand factor). “Combined, these tests provide doctors a precise predictor of heart disease risk, as was shown in a study published in Circulation, the journal of the American Heart Association,” Campbell says.

Taking Matters Into Your Own Hands
When it comes to heart disease, the more proactive you are, the better. There is much that you can do on your own to dramatically reduce your risk for heart disease, as well as to help manage and reverse your symptoms if you already have it. Dr. Campbell recommends you start by following the American Heart Association’s Life’s Simple 7, a series of guidelines established by the AHA to help people achieve healthy heart function. These include:

• At least 150 minutes of moderate exercise, or 75 minutes of intense exercise, per week.

• Having a body mass index (BMI) of less than 25.

• Being a nonsmoker for at least one year.

• Keeping total cholesterol below 200 mg/dL

• Maintaining blood pressure below 120/80

• Having a fasting blood sugar level below 100 mg/dL

• Meeting 4 out of 5 of the AHA’s key components for a healthy diet (4-7 servings of fruits and vegetables per day, unrefined whole grains, eating fish at least twice a week, eating lean meats and skinless poultry, reducing foods prepared in or containing trans-fatty acids).

Additional self-care steps you can take include the following:

Diet: Eat a Mediterranean-style diet, which, according to Dr. Friesen, is scientifically documented as being helpful for preventing and reversing heart disease. “This type of diet is also rich in polyphenols, compounds that give the skin of fruits and vegetables their rich color,” Friesen points out. “A growing body of research is establishing that polyphenols are not only good for your heart, but also your brain and many other health functions.” The Mediterranean diet contains an abundant supply of fruits, vegetables, and nuts, along with fish and poultry as its primary protein foods, and a plentiful supply of olive oil. Such a diet is also rich in healthy fats, antioxidants, anti-inflammatory fatty acids, and heart-healthy spices such as garlic, as well as low in sugar, saturated fats, and refined carbohydrates.


Nutritional and Herbal Supplementation:
“Omega-3 fish oils are a very important factor for lowering cholesterol and protecting against inflammation, and one of the few supplements where more is better,” Dr. Campbell says. He also recommends co-enzyme Q10 (Co-Q10) and alpha lipoic acid (ALA). Dr. Friesen adds that turmeric, which is rich in curcumin, and boswellia extract are both excellent herbs for protecting against chronic low-grade infection.

Exercise: “Ideally, you should try to get at least 30 minutes of exercise each and every day,” Dr. Friesen says. “Aerobic exercise is especially good, and includes activities such as walking, cycling, jogging, and swimming. I also recommend t’ai chi, due to the many benefits I’ve personally received from my many years of practicing it.” If you are unused to exercising, be sure to consult with your doctor so that the two of you can work together to create an exercise program that is most appropriate to your specific needs.


Lifestyle: If you are overweight, work with your doctor, who can help you devise a program for losing excess weight. If you smoke, seek help so that you can quit. It is also important that you get a good night’s sleep for at least 7 to 8 hours every evening.


Stress Management: Given how closely linked chronic stress is to heart disease, it’s important that you take time each day to “de-stress” yourself. Useful ways for doing so are meditation, deep breathing exercises, regularly engaging in hobbies and other enjoyable activities, and spending time with loved ones. If stress continues to be a problem in your life, consider working with a health professional who specializes in stress relief.


For most people, heart disease is largely the result of long-standing unhealthy habits. By following the above recommendations, you can go a long way toward preventing and reversing heart disease, both on your own and, if necessary, by working with your doctor. The most important key is to get started now.

Larry Trivieri Jr. is recognized as a lay-expert in health and healing and has authored more than a dozen books on the subject over 30 years.


Are you at risk?

Your risk for heart disease is greater if any of the following factors apply to you:
>> You have a family history of heart disease

>> You are a smoker

>> You weigh 10 pounds or more than your ideal body weight and/ or have a body mass index above 24

>> You have high blood pressure

>> Your total cholesterol is above 200 mg/dL

>> You suffer from chronic stress

>> You live a sedentary lifestyle

>> You have type-2 diabetes
If you have any of these risk factors, consult with your physician.


The cost of heart disease
Since the beginning of the 20th century, heart disease in the United States has been our nation’s number one killer, a position it still holds today. Presently, heart disease kills more than one out of every four Americans (26 percent), and costs our nation $316.4 billion in 2010, alone.

Once mistakenly thought to primarily affect men, approximately 50 percent of all deaths caused by heart disease in the US each year are among women. The CDC estimates that someone in the US has a heart attack every 34 seconds, and someone dies from heart disease every single minute!

Since the early 1950s, largely due to the Framingham Heart Study, which began in 1948 and established a link between high cholesterol and heart attacks, it has been an accepted fact that elevated levels of LDL (bad) cholesterol were the primary risk factor for heart disease. This belief led to a sharp rise in the amount of statin drugs and other cholesterol-lowering medications that are prescribed in the US each year, to the point where statins are now the most prescribed class of drugs in the country. Once prescribed, patients tend to stay on these drugs for years, if not for the remainder of their lives. In 2010, more than 255 million prescriptions were dispensed at a cost of $18.7 billion.

Common symptoms of heart disease
The following warning signs are typical for heart disease. If you experience any of them, seek prompt medical help.
>> Chest pain

>> Shortness of breath

>> Pain in one or both arms (especially the left arm)

>> Pain in the upper back, neck, shoulder blade or jaw

>> Sweating

>> Fatigue

>> Indigestion or vomiting for no apparent reason

>> In men, inability to achieve or maintain a firm erection

Treating Chronic Inflammation
Chronic low-grade inflammation, often stemming from infectious diseases, is a very important risk factor to consider when evaluating risk for heart disease, according to Garry F. Gordon, MD, DO, medical director of the Gordon Research Institute in Payson, Arizona.

“It is clear to most scientists that inflammation is a major contributor to degenerative diseases, including heart disease,” Gordon adds. “This includes periodontal disease, which is proven to directly contribute to our bodies’ pathogen burden, causing some doctors to look at the mouth when treating cardiovascular disease. Researchers now are also reporting that virtually everyone today has some level of cytomegalovirus (CMV) present in their body, and that CMV is found in plaque and is contributing to the rise in hypertension among people today.

“However, most doctors ignore the total body burden of pathogens and the role they play in causing chronically elevated levels of inflammation. Instead of treating causes, they may use medications to try to lower inflammation, but this approach is only addressing symptoms, and usually is unsuccessful. I believe the reason most cardiologists fail to address chronic infection is because doing so would mean they would have to move beyond their cholesterol fixation and learn to help the body deal with these infections. That starts with detoxification, including reducing the burden of environmental toxins in the body, since infectious pathogens tend to thrive where such toxins are present. It also means improving patients’ nutritional status.”

In order to address such infections, Gordon recommends the use of vitamin C, which he says “will stop every infection in its tracks without needing to use antibiotics,” when given in the proper dosage range. Depending on the severity of infection, vitamin C administered through an IV may be necessary, he says. If this is the case, it should only be done by a properly trained physician. Gordon also recommends high doses of vitamin A for a few days, along with aged garlic extract, such as Kyolic.

Types of Heart Disease
There are over 50 different types of heart disease. The most common is coronary artery disease (CAD). Also known as coronary heart disease or ischemic heart disease, CAD is characterized by hardening and narrowing of the arteries, which cuts off blood flow to the heart and can cause a heart attack.

Other common types of heart disease include:

Angina, which is characterized by discomfort or pain in the chest or throat, often with accompanying shortness of breath.

Arrhythmia, which affects the body’s electrical system and can result in irregularities in heartbeat rhythm. Heartbeat that is too fast is called tachycardia; heartbeat that is too slow is called bradycardia. Arterial fibrillation is another type of arrhythmia.

Atherosclerosis, which is characterized by hardening of the arteries due to plaque buildup.

Cardiomyopathy, also known as congestive heart failure, which is characterized by blood congestion in the heart, which can lead to heart failure.

Congenital heart disease, a genetic condition that can affect any part of the heart, as well as blood vessels.

Endocarditis, which is an inflammation of the inner lining of the heart and valves, and pericarditis, an inflammation of the heart’s outer lining.

Heart atack, also known as myocardial infarction (MI), which occurs when the flow of blood and oxygen to a part of the heart is blocked.

Myocarditis, which is an inflammation of the heart muscle.

Stenosis, which is characterized by a narrowing of one of the heart’s valves. There are various types of stenosis, such as aortic valve and mitral valve stenosis.


Linus Pauling’s Theory of Heart Disease
As the only person besides Madame Curie awarded more than one Nobel Prize, the late Linus Pauling, PhD (Chemistry in 1954, Peace in 1962), contributed to the understanding of heart disease through research into the health benefits of vitamin C and devised a “Heart Cocktail” that he believed would eradicate heart disease.

Pauling was one of the first scientists to work in the fields of both quantum chemistry and molecular biology. He was also a major pioneer in promoting the use of nutritional supplements for treating and preventing disease, including heart disease.

He was a long-time advocate of daily supplementation of vitamin C at doses far beyond the Recommended Daily Allowance (60 mg/day). Based on his research, as well as his extensive study of published scientific studies, Pauling recommended daily supplementation of a minimum of 2,000 mg to as much as 6,000 mg of vitamin C (taken in divided doses of 2,000 mg three times per day), and much higher doses during times of illness, including colds and flu. Much of the last 25 years of his life was spent researching the role nutrients play in maintaining and achieving good health.

As a result of his research, Pauling regarded atherosclerosis (hardening of the arteries) as a form of “low-grade scurvy.” This view has since been confirmed by published scientific research. Atherosclerosis is caused by the buildup of plaque in the walls of the artery, causing arteries to stiffen and narrow. Cardiologists today often recommend statin drugs as a means of preventing and controlling plaque buildup because of the drugs’ ability to reduce levels of LDL (“bad”) cholesterol, one of the substances that is deposited in plaque. But Pauling pointed out that many published studies by numerous researchers show that a different type of cholesterol known as lipoprotein A, or Lp(a), is another major risk factor involved in plaque buildup and therefore heart disease. Neither statins nor any other class of drugs have been found to reduce Lp(a).

Like other forms of cholesterol, Lp(a) is manufactured by the liver and is used by the body to repair fissures (tears) that can occur in artery walls as a natural consequence of aging, or because of free-radical damage and other factors. Cholesterol in general is also used for this repair process. All forms of cholesterol are well suited for this task because they are sticky and therefore capable of easily attaching themselves to arterial walls to patch up fissures. But Lp(a) is much more potent than other types of cholesterol in its patching ability. Because of its high degree of stickiness, it has a tendency to attract other Lp(a) particles. Over time, this collection of Lp(a) forms the plaque that can result in heart attacks and stroke.

Researchers, including Pauling, discovered that Lp(a) levels higher than 20 mg/dl (deciliter) in blood causes Lp(a) to begin forming plaque, leading to atherosclerosis. Knowing this, Pauling used his expertise in biochemistry to explore which nutrients would best work to prevent this process. He decided on a combination of vitamin C and the amino acid lysine. Lysine residues are present in the wall of arteries and bind Lp(a) to cause plaque buildup. To counteract this, Pauling recommended that lysine be taken with vitamin C to both prevent and help reverse atherosclerosis. Both nutrients form collagen in high amounts and collagen needs to be replenished in blood vessels to keep them healthy and plaque-free.

Supplementing with lysine, Pauling explained, increases the amount of lysine molecules in the bloodstream where they then compete with the lysine residues found in the arterial walls. This prevents excess Lp(a) from attaching to the arteries and also pulls Lp(a) from the walls loose, destroying plaque. Shortly before his death in 1994, Pauling stated, “I think we can get almost complete control of cardiovascular disease, heart attacks, and strokes by the proper use of vitamin C and lysine,” adding that everyone who was at risk for heart disease “had better be taking vitamin C and lysine.”

Since his passing, numerous published studies and genetic testing have confirmed the role that Lp(a) plays in heart disease, and a growing number of integrative physicians now endorse Pauling’s nutritional heart cocktail, because of its ability to strengthen and heal blood vessels, lower LP(a) blood levels, and inhibit the binding of LP(a) molecules in the walls of blood vessels. Additional research has also confirmed that “high intake” of vitamin C (700 mg/day or higher) reduces the risk of coronary artery disease.

You can determine your own Lp(a) blood levels with a simple blood test. However, you will likely have to request it from your doctor, since it is not given routinely by most physicians. As Pauling pointed out, blood levels above 20 mg/dl are unhealthy, and optimal levels should be below 14 mg/dl.