Cardiovascular disease, encompassing vascular and structural types, continues to be the most common chronic disease. For the past 50 years, cardiac disease consistently remained a number one cause of death in both men and women. Despite ongoing successful efforts in reducing mortality from cardiovascular disease, current preventive and treatment strategies failed to stem the rise in its prevalence. Fueled by the obesity and diabetes epidemic, compounded by the exposure to environmental toxins, and disruption in our responses to stress, cardiac disease continues to grow in numbers. From the economic perspective, cardiovascular disease outpaces all other chromic diseases. It also exerts a substantial emotional and financial toll by impacting many patients during their most productive years.
Traditional risk factors for heart disease, defined through Framingham Heart Study, identified age, gender, hypertension, dyslipidemia, smoking, diabetes and family history as contributors. However, these factors combined account for approximately 50-70% of cases of heart disease. Up to 50% of patients with first myocardial infarction do not have any of the traditional risk factors.
It is well known that lifestyle intervention is highly effective in preventing, and treating chronic cardiac disease. Up to 80% of heart disease events, including heart attacks and strokes, may be prevented through a lifestyle approach. This approach emphasizes whole and natural foods, plant-based diet, healthy oils, stress management and physical activity. Exemplified by Dr. Dean Ornish program, this approach emphasizes prevention over medication and procedures.
Functional and Integrative Therapies Based on Genome, Environment, Nutrition, Exercise and Supplements
Rapid advances in vascular biology identified endothelium, a one cell thick inner lining of the blood vessels, as critical interface that plays a pivotal role in formation and progression of vascular plaques. The molecular mechanisms shaping endothelial function include inflammation, oxidative stress and autoimmunity. Subsequent clinical research highlighted the impact of inflammation by demonstrating an increased cardiovascular risk in patients with systemic inflammatory conditions, such as lupus and rheumatoid arthritis, chronic infections such as human immunodeficiency virus, and those with disrupted metabolism, such as seen in metabolic syndrome, diabetes and obesity.
At the same time, ongoing efforts in sequencing of the human genome, and refinement of the sequencing techniques, made it possible for patients to inexpensively obtain access to their single nucleotide polymorphism (SNPs) for genes guiding energy utilization and toxic substance removal, and even some disease-specific genes. These genes, involved in methylation, folate, trans-sulfuration, nitric oxide and gluthatione production cycles, are closely involved in regulating levels of vascular inflammation, thus impacting our endothelial and metabolic health.
These developments created a remarkable opportunity. For the first time, we may be able to deeply personalize lifestyle interventions to help patients across a spectrum of vascular diseases by focusing on how their genome is interacting with multiple factors, all contributing to inflammation, oxidative stress and autoimmunity that affect endothelial lining, a pivotal interface in initiation and progression of vascular diseases.
Functional and Integrative Therapeutics based on Genome, Environment, Nutrition, Exercise and Supplements (FIT in Your GENES®) program provides a personalized lifestyle intervention plan for any patient at risk for or suffering from cardiovascular diseases. The program is based on identifying SNPs that underlie each patient metabolic imbalances, and applying foundational and condition-specific lifestyle interventions to minimize their influences thereby pushing down on inflammation, oxidative stress and autoimmunity affecting vascular lining. The pillars of the program are seen in the diagram below:
Case Presentation
A 57 y/o woman presents seeking treatment for early carotid artery disease and elevated cholesterol. She experienced menopause early, in her late 40s. Despite being physically active, and eating organic food, she has a self-described “sweet tooth”. Her job as a school teacher is stressful at times. Her spouse is supportive. She suffers from bouts of anxiety and gastrointestinal distress. She is not overweight, and her body composition parameters are all within normal range for age and gender: weight 120.6 lbs, height 5’5”, BMI 26.9, percent body fat at 22.2%, and visceral fat at 5%. Her initial blood work was notable for elevated total cholesterol (263 mg/dl), with elevations in direct LDL (169 mg/dl), elevated Lp(a) (at 117 mg/dl), and elevated markers of inflammation with hs-CRP at 1.4 and fibrinogen at 389 mg/dl. Based on her clinical parameters, the ACC/AHA Lipid Guidelines estimated risk of atherosclerotic coronary vascular disease was calculated as <5% over 10 years, placing her not in statin benefit group. Her Reynolds Risk calculator, accounting for the hsCRP, places her in low risk group as well. However, projecting 10 years forward, to the age of 67 years old, her risk of cardiac events rises 300% if she were to continue with the current levels of risk factors. She suffers from osteoarthritis, and during her pre-operative assessment, she underwent a carotid Doppler evaluation that disclosed early atherosclerosis in both carotid arteries.
Patient was interested in preventing further progression in her early vascular disease, in addition to addressing her fatigue, anxiety, and gastrointestinal discomfort. She underwent a 6 month FIT in Your GENES® Program with all phases summarized below.
At 6 month follow up, her metabolic parameters have improved significantly as seen in the table below.
Her Reynolds Risk score also showed a 3-fold drop in 10 year risk if she were to maintain her current level of metabolic improvement. Even more importantly, her vascular function, measured as endothelial reactivity in the brachial artery (Endothelix, Inc) improved dramatically as seen in the diagram below, with vascular reactivity index moving well into the optimal (green) region.
Conclusion
FIT in Your GENES® Program is a multi-faceted approach based on functional medicine that allows effective personalized lifestyle intervention for patients with cardiovascular risk factors and diseases. At the Holistic Heart Centers of America, we provide patient care, professional education, and access to our proprietary programs and practitioner network to create a vibrant community of patients and practitioners achieving optimal wellness.
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