The 8 Disease States
Years ago, after researching cardiovascular disease information from the perspective of multiple medical disciplines, it became apparent to me that cardiovascular disease is multi-faceted and centers around inflammation. There are 8 primary disease states that together create inflammation that attacks the blood vessels and target organs. For years, many physicians have thought that they could fix the patient's lipids and that would fix the patient's cardiovascular disease but nothing could be further from the truth. Until physicians cast a wider net and look past the patient's lipid status, we will never see meaningful progress in cardiovascular disease event reduction.
Diabetes
Insulin resistance is, in my opinion, the most common reason people have cardiovascular disease. According to the the CDC, 64% of adult patients > 20 years of age are insulin resistant. Through work done at my office on my patients, I have learned that insulin resistant patients cannot eat > 25 grams of carbohydrates within a 4 hour period without causing a 4 day inflammatory response from the liver, pancreas, and intraabdominal fat cells. Exceeding the 25 gram carbohydrate limit also causes the insulin resistant patient's liver to synthesize sd-LDL-C for 4 days. The excess circulating sd-LDL-C and excess circulating inflammatory factors that occur over a 4 day period as a result of overeating carbohydrates contributes to significant impact on each patients cardiovascular system. Every patient has a carbohydrate capacity that can be exceeded, including a non-insulin resistant patient, albeit the difference between carbohydrate capacities are vastly different for a non-insulin resistant patient vs an insulin resistant patient. Read More
Hyperlipidemia
Many physicians and patients falsely believe that if you fix the lipids, you eliminate cardiovascular risk - nothing could be further from the truth! I am not implying that treating the lipids is not an important part of preventative care though, because treating the lipids is vital to disease state containment and plaque regression. Circulating lipids lead to the development of plaque that can ultimately lead to clogged arteries or ruptured plaque. It is important to understand that the circulating lipids do not cause problems without an invitation from inflammatory factors contained within the endothelium of blood vessels. Inflammatory factors within the blood vessel endothelium secrete "chemokines" that lure the LDL-P to attach to the vessel and then cholesterol from the LDL-P is deposited into the posterior endothelial wall. Once LDL-P deposits the cholesterol into the blood vessel wall, LDL-P then returns to the liver to pick up more cholesterol with plans for revisiting other areas in the circulation that have inflammatory factors secreting chemokines. Read More
Hypertension
It's been known for years that uncontrolled hypertension patients have higher rates of strokes, heart attacks, and cardiovascular mortality. The patient with uncontrolled hypertension tends to have elevated levels of angiotensin which leads to inflammation showing up whereever blood vessels exist. The elevated levels of angiotensin also efftects target organ damage through inflammatory insults, specifically attacking the kidneys and the heart. With uncontrolled hypertension's effect on an enlarging and thickening heart, levels of aldosterone tend to increase exponentially getting as high as 90 fold of the normal levels of aldosterone in a normotensive patient. Thus uncontrolled hypertension, through various inflammatory insults, leads to the gamut of cardiovascular problems showing up including strokes, heart attacks, congestive heart failure, end stage kidney disease, and peripheral arterial disease. Read More
Sleep Disorders
Sleep disorders are a very common cause of cardiovascular disease as the sleep disorders create a proinflammatory state that is causing an inflammatory response 24/7 whereever blood vessels are found. There are 3 primary sleep disorders that include obstructive sleep apnea (OSA), restless leg syndrome (RLS), and narcolepsy. Each of these sleep disorders make it difficult for the patient to have any stage 3 and 4 sleep (AKA N3 sleep), the stages of sleep where brain chemicals are made. The purpose of sleep is for the synthesis of brain chemicals within the brain, as these brain chemicals are generally used up during the course of a day. A healthy sleeper goes to bed tired due to the lack of brain chemicals in their respective neurons and this healthy sleeper wakes up refreshed due to an abundance of chemicals present within the brain - enough chemicals to sustain all of the activity and stresses of the upcoming day. Patients with sleep disorders go to bed tired due to the lack of brain chemicals, but usually wake up tired due to a serious deficiency of brain chemicals still existing because the sleep disorder disturbed the brain's ability to make brain chemicals due to ineffective sleep. When a patient's brain is deficient of neurochemical, this patient will have to circulate very high levels of adrenaline (AKA epinephrine) that will help keep the neurons functional. Read More
Chronic Kidney Disease (CKD)
Chronic Kidney Disease (CKD) usually occurs as a result of chronic inflammation that ultimately damages the kidneys glomerular filtration system, which essentially is a modified form of blood vessel within the kidneys that perform numerous functions. It is uncertain why the chronic inflammation seen in some patients leaves the patients untouched while other causes of chronic inflammation cause significant CKD but there clearly is a relationship between the inflammation and CKD. Once CKD develops, it becomes a source of chronic inflammation, partly due to the decreased effectiveness of eliminating impurities. CKD also causes indirect problems with inflammation such as the problems associated with decreased production of erythropoietin which ultimately causes prolonged anemia issues. When a person is significantly anemic for even one year there is a 33% occurrence of left ventricular hypertrophy in that person.
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Mental Health Disorders
Mental health disorders are very common within the United States and they could be worsening due to more complex lifestyles that may include long work hours. There are numerous levels of mental health disorders that might start with problems such as generalized anxiety disorder. We can then move up the mental health ladder with panic disorders, post-traumatic stress disorder, depression, bipolar disorder, and schizophrenia. There are other medical conditions that may associate with these mental health disorders such as fibromyalgia and chronic fatigue syndrome. It is clear from multiple studies, that people with undertreated or untreated depression or bipolar disorder have an approximate 45% increase occurence rate of heart attacks and strokes. To make matters worse, if depression has causation participation in heart attacks and strokes, the survival rate of the event significantly decreases. Read More
Genetic Disorders
Historically both physicians and patients would reason that a person's genetics are simply a part of who they are and that there is nothing we can do about this genetic situation. Since the Human Genome project was completed in the late 1990's, we have learned quite a bit more about genetic disorders and how they work. When the United States government provided 3 companies one billion dollars each to diligently research genetic information, we have been receiving regular genetic information that is filling in the pieces to many puzzles. We are beginning to have medications that alter the genetic expressions of certain diseases (i.e. Actos has the ability to enter the nucleus of the insulin resistant cell and down-regulate the genetic expression of that cell). We have other medications that simply bypass the problem caused by the genetic condition (i.e Deplin is the L isomer of methylfolate, capable of overriding much of the problems caused by the genetic lack of the enzyme, methylenetetrahydrofolate reductase, in MTHFR genetic abnormality patients). Read More
Autoimmune Disorders
Autoimmune disorders are related to cardiovascular disease for fairly obvious reasons in that they each cause an immune attack on a body part that ultimately causes increased inflammation within the circulatory system. Autoimmune conditions known to increase cardiovascular disease include Rhumatoid Arthritis, Lupus, Crohn's Disease, Ulcerative Colitis, and Celiac Disease. It is important that we pay special attention to our patients with autoimmune conditions as these patients can have a rather bad outcome if we don't emphasize cardiovascular risk reduction within their plan of care. Often times patients with autoimmune conditions have problems with entering a state of remission that I believe relates to the other inflammatory conditions that patients simultaneously experience. Read More
