Cardiovascular Disease
What are High Blood Pressure and Cardiovascular Disease?

Cardiovascular disease (CVD) is the term for all types of diseases that affect the heart or blood vessels, including coronary heart disease, heart arrhythmias, heart failure, cerebrovascular diseases such as strokes, and more. "More than 800,000 people die of CVD every year in the United States". (1) This translates into one person dying every 34 seconds in this country from CVD. (2)

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Two of these conditions that make up CVD, namely coronary heart disease and cerebrovascular diseases, are listed as the first and fifth leading causes of death in the United States respectively. (3) But these problems extend far beyond the United States. In fact, the leading cause of death globally is CVD, with an estimated 17.9 million people dying from this in 2019. That represents 32% of all global deaths! And a staggering 85% of these having been due to heart attack and stroke. (4)

Types of Cardiovascular Disease

There are 11 types of CVD, the first 8 of which are considered types of heart disease:

Coronary Heart Disease (CHD), which is the most common type of heart disease in the United States, (5) is also known as 'Coronary Artery Disease' (CAD), 'Ischemic Heart Disease', or 'Coronary Atherosclerosis'. When people talk about 'heart disease' they often mean CHD. As the leading cause of death for men and women in the United States, about 697,000 died from it in 2020 - which is 1 in every 5 deaths. (2)
Heart Arrhythmias are irregular heartbeats, often due to mishaps in the electrical impulses generated by the heart.
Heart Failure, which includes Congestive Heart Failure (CHF) among others, occurs when the heart cannot pump enough blood and oxygen to support other organs in body. This is a serious condition but does not mean that one's heart has stopped beating.
Valvular Heart Disease is when any valve in the heart has damage or is diseased, preventing it from opening or closing fully. Varieties of valvular heart disease include 'regurgitation', 'prolapse' and 'stenosis'. This can occur in any heart valve, but the aortic valve is the most commonly affected. (6)
Pericardial Disease is when there is fluid or other pathology between the heart and the pericardium, which is a thin fibroelastic sac composed of two layers that separate the heart from the surrounding chest structures. Such heart diseases can present clinically as acute pericarditis, pericardial effusion, cardiac tamponade, or constrictive pericarditis.
Cardiomyopathy represents a group of diverse conditions that have in common effects on the heart muscle, with many different causes, symptoms, and treatments. When cardiomyopathy occurs, the normal muscle in the heart can thicken, stiffen, thin out, and no longer pumps the blood as well as it did before. This can lead to irregular heartbeats, the backup of blood into the lungs or rest of the body, and heart failure.
Congenital Heart Disease presents when there are defects with the structure of the heart. 'Congenital' means that that the problems are present at birth. These defects happen when a baby's heart doesn't develop normally during pregnancy and are among the most common types of birth defects.
Rheumatic Heart Disease is a systemic immune condition that occurs as a complication of rheumatic fever. This occurs after a streptococcal infection of the throat and is a significant form of acquired heart disease among children and adults worldwide.
Cerebrovascular Disease "includes all disorders in which an area of the brain is temporarily or permanently affected by ischemia or bleeding and one or more of the cerebral blood vessels are involved in the pathological process. Cerebrovascular disease includes stroke, carotid stenosis, vertebral stenosis and intracranial stenosis, aneurysms, and vascular malformations". (7)
Peripheral Arterial Disease (PAD), also known as 'Peripheral Artery Disease' or 'Peripheral Vascular Disease', is a narrowing of the distal arteries that carry blood away from the heart to other parts of the body. The most common type is lower-extremity PAD, in which blood flow is reduced to the legs and feet. Upper-extremity PAD is less common and both are primarily caused by the buildup of fatty plaques in the arteries, which is called atherosclerosis.
Venous Thromboembolism (VTE) is a term used to describe two closely related conditions: Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). DVT is a blood clot, or 'thrombus', which forms in a non-superficial vein, most commonly in the leg. But they may develop in the arm or other part of the body. Part of the clot, called an 'embolus', can break off and travel to the lungs. This is a PE, which can cut off the flow of blood to all or part of the lung. A PE is an emergency and may cause death.

Risk Factors for Cardiovascular Disease

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Though the term "risk factor" is used to indicate some quality or circumstance that is associated with a given outcome, a risk factor is not necessarily a cause. The term risk factor includes surrogates for underlying causes; however, "[a] risk factor has a causal effect on a disease when the disease would not have occurred in the absence of the risk factor". (8)

There are some risk factors we can change and influence, and others we cannot. These can be categorized as 'modifiable' or 'non-modifiable' risk factors. Many of these risk factors are of particular concern because they themselves are risk factors for TWO types of CVD, namely CHD and cerebrovascular disease. Of such concern are high blood pressure/hypertension, high blood cholesterol/hyperlipidemia, diabetes, smoking or exposure to second hand smoke, obesity, unhealthy diet, and physical inactivity. "Stress has been identified as a risk factor for various diseases, including CVD. ... One of the adverse outcomes of persistent stress is on cardiovascular health ... equivalent to the primary risk factors associated with CVD". (9) This is because stress itself can lead to many risk factors including high blood pressure/hypertension, smoking, unhealthy diet, physical inactivity and even high blood cholesterol/hyperlipidemia associated with a chronic and longterm elevation in cortisol levels. Other risk factors include race or ethnicity, age, gender, and genetic factors.

Three of the leading risk factors for CHD and cerebrovascular disease, namely high blood pressure/hypertension, high blood cholesterol/hyperlipidemia, and diabetes, are also risk factors for arteriosclerosis (ART), a group of conditions which cause the arteries to become thick and stiff. There are five types of arteriosclerosis, however, the most notable is atherosclerosis. "Atherosclerosis, the major cause of CVD, is a chronic inflammatory condition with immune competent cells in lesions producing mainly pro-inflammatory cytokines. Dead cells and oxidized forms of low density lipoproteins (LDL) are abundant. The major direct cause of CVD appears to be rupture of atherosclerotic plaques". (10)

With atherosclerosis identified as "the dominant cause of CVD", it then becomes the most prominent force behind strokes, heart failure, and other causes of death including 'heart attacks', more formally known as 'myocardial infarctions', as they mostly result from CHD. (11) And worldwide, myocardial infarctions remain the most common cause of heart failure. (12)

As plaque builds up in the arteries of a person with heart disease, the inside of the arteries begins to narrow, which lessens or blocks the flow of blood. Plaque can also rupture (break open). When it does, a blood clot can form on the plaque, blocking the flow of blood.

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High Blood Pressure/Hypertension: A CVD Risk Factor of Special Concern

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Hypertension itself is a risk factor for multiple forms of CVD including CHD, cerebrovascular diseases as strokes, heart attacks, and heart failure.

High Blood Cholesterol/Hyperlipidemia: A CVD Risk Factor of Special Concern

Elevated blood cholesterol has long been recognized as a significant risk factor for CVD in general, as well as specifically for CHD and strokes. However, there is so much more to this topic.
There was even a study back in 2009 which reviewed over 100,000 hospitalized cases and found nearly half of all heart attack patients did not demonstrate prior risk which would indicate they were heading toward an attack. (14) This helped spur more advanced cholesterol testing.
It has been shown that several markers including LDL particle number (LDL-P) and apolipoprotein-B 100 (apo-B), are better predictors of CVD risk than the longtime used LDL cholesterol (LDL-C)!! Also, other tests can look at the health of blood vessels and inflammatory risk factors.
Sadly most clinicians still do not take advantage of these insights and continue to order the same less helpful markers as were used over twenty years ago.
We have written in-depth blogs on theses topics! Follow the links to learn more: "Cholesterol, Carbs, and Eggs", "Heart Disease Risk? The Lipid Panel does not 'measure up'", "Heart Disease - The Risk Factors Your Cardiologist Didn't Test You For", Have a heart to try acupuncture.

Diabetes: A CVD Risk Factor of Special Concern

Diabetes itself is a known risk factor for many aspects of CVD, including high blood pressure/hypertension, high blood cholesterol/hyperlipidemia, CHD, stroke and heart failure.
"People with diabetes are twice as likely to have heart disease or a stroke than people without diabetes"!! (15)
We have written in-depth information about multiple forms of diabetes! Follow the link to learn more: Diabetes, Prediabetes and Natural Diabetes Remedies.
We have written in-depth blogs on theses topics! Follow the links to learn more: "Have You Met Diabetes Type 1.5", "Diabetes Healthy Eating Tips and Strategies for the Holidays",

Why use integrative medicine
to treat High Blood Pressure and Cardiovascular Disease?

With more than 877,500 Americans dying of CHD, stroke or other CVDs every year, (15) it would seem the conventional medical approach to these conditions are wildly underwhelming. The economic costs associated with CVD are just as mind-blowing as the morbidity and mortality statistics: CVD costs the United States $216 billion in health care system costs and $147 billion in lost productivity on the job from premature death! (15) Clearly we need a new 'normal' here in the USA.

Many conventional doctors may suggest dieting, decreasing consumption of salt, exercise and stopping smoking, all of which may be beneficial. But these rote suggestions are often not accompanied with a substantial game plan to help a person accomplish lifestyle transitions. Instead, inevitably the emphasis in those visits often comes to prescribing medications, some with potentially copious side effects.

However, people deserve more than lifelong medication recommendations!

Naturopathic Approach to High Blood Pressure/Hypertension and Cardiovascular Disease

Yet it is in helping to restore the body to balance and proper function that we see the most favorable outcomes. Coordinating successful lifestyle medicine is part of this process. And this has been shown in the peer review literature. One study that included over 18,000 participants found "...post–myocardial infarction (MI) patients who reported adherence to just 3 healthy lifestyle habits at 30 days post–hospital discharge—smoking cessation, regular exercise, and healthy eating—demonstrated a 3.8-fold decreased risk of death, re-infarction, and stroke after 6 months as compared with those who adhered to none of these behaviors". (16, 17)

Naturopathic physicians take an oath upon receiving their diploma and completing four years of rigorous education; this oath has at its base six Principles of naturopathic medical practice. These Principles serve as the foundation of naturopathic medical education and naturopathic patient care. They include, as outlined by the American Association of Naturopathic Physicians: (18)

The Healing Power of Nature (Vis Medicatrix Naturae): Naturopathic medicine recognizes an inherent self-healing process in people that is ordered and intelligent. Naturopathic physicians act to identify and remove obstacles to healing and recovery, and to facilitate and augment this inherent self-healing process.
Identify and Treat the Causes (Tolle Causam): The naturopathic physician seeks to identify and remove the underlying causes of illness rather than to merely eliminate or suppress symptoms.
First Do No Harm (Primum Non Nocere): Utilize methods and medicinal substances which minimize the risk of harmful side effects, using the least force necessary to diagnose and treat as well as avoid when possible the harmful suppression of symptoms.
Doctor as Teacher (Docere): Naturopathic physicians educate their patients and encourage self-responsibility for health. They also recognize and employ the therapeutic potential of the doctor-patient relationship.
Treat the Whole Person: Naturopathic physicians treat each patient by taking into account individual physical, mental, emotional, genetic, environmental, social, and other factors. Since total health also includes spiritual health, naturopathic physicians encourage individuals to pursue their personal spiritual development.
Prevention: Naturopathic physicians emphasize the prevention of disease by assessing risk factors, heredity and susceptibility to disease, and by making appropriate interventions in partnership with their patients to prevent illness.

What this translates into during patient care is an emphasis on lifestyle support and the factors that precipitated the body's imbalance. Nutrient deficiencies which could be compounding symptoms should be identified and considered. Patterns of eating and hydration, as well as the quality of exercise investment need all be considered for fruitful management of these heavily lifestyle-driven conditions. Assessment and management of stress and inflammation need also be considered when addressing the whole person.

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Support for patients with High Blood Pressure and Cardiovascular Disease

Evidenced-based herbal medicine

Different botanical medicines have been used for centuries to help aid cardiovascular conditions. Some herbal treatments, including Crataegus oxycantha (hawthorn), have been used for their ability to increase the integrity of the blood vessel wall and improve coronary blood flow, with positive effects on oxygen utilization. (19) An even wider variety of botanical medicines have been used to support different aspects of high blood cholesterol, including Monascus purpureus (red yeast rice), Trigonella foenum-graecum (fenugreek), and Citrus bergamia (bergamot) with some very impressive results. When selecting herbal medicines, it is important to identify as fully as possible the underlying cause for the imbalance, as this will lead to different choices for treatments. If the goal is to support cardiac function, we would choose cardiotropic and/or vasodilatory herbs. If the goal is to decrease inflammation, then we would select anti-inflammatory or immunomodulating botanicals. Or if stress management options are being sought, there are many botanicals classified as nervines which can be supportive to this end. Thus a good treatment should be quite individualized.

Advanced specialty and nutrient deficiency testing

Multiple types of nutrients have shown to have been of keen concern for CVD but conclusions have not always been unanimous. Deficiencies of specific minerals, notably magnesium, have shown to be risk factors for increased atherosclerosis, coronary artery disease, arrhythmias, and heart failure. (20) However, that has not translated into magnesium supplementation always showing curative benefits. (21) Part of magnesium's therapeutic benefit is suspected to be related to its effects on potassium. "Potassium and magnesium deficiencies, particularly those induced by conventional loop and thiazide diuretic therapy, have been linked in clinical studies to an increased frequency in serious arrhythmias and mortality in acute myocardial infarction. Magnesium repletion has been shown not only to increase magnesium levels, but also to increase muscle potassium and to decrease the frequency of ventricular ectopic beats." (22) What's more, some researchers have also reported on increased risk of CVD by having higher levels of other minerals like calcium. (23)

Beyond minerals, other nutrients to consider regarding heart health include several fatty acids, vitamins and amino acids. When it comes to testing minerals, local laboratories can be helpful and offer some degree of functional testing assessment; however, they often do not have advanced methods for testing vitamins and amino acids, if any at all. So other options for testing may be preferable in some cases and these collection methods can include nutrients being tested in multiple ways including blood, urine, or hair.

More testing options to consider when gaining insight into cardiovascular health include advanced risk factor testing, often not even sought out by cardiologists. Such tests include lipoprotein fractionation, apoproteins, homocysteine, and several inflammatory markers such as Lp-PLA2 activity and hs-CRP. We have written in-depth blogs on theses topics! Follow the links to learn more: "Cholesterol, Carbs, and Eggs", "Heart Disease Risk? The Lipid Panel does not 'measure up'", "Heart Disease - The Risk Factors Your Cardiologist Didn't Test You For".

and CVD. For example, coenzyme Q10 is a fat-soluble compound with a chemical structure similar to vitamin K and has been shown to improve stroke volume (SV), cardiac output (CO), ejection fraction (EF), and cardiac index, among others. (24, 25) Taurine, an amino acid, was used among patients with CHF secondary to ischemic or idiopathic dilated cardiomyopathy, whose ejection fraction assessed by echocardiography was less than 50% and was shown to provide a significant treatment effect in systolic left ventricular function after 6 weeks. (26) More specific to high blood pressure, a meta-analysis of fifteen controlled trials concluded "[p]otassium supplementation is associated with reduction of blood pressure in patients who are not on antihypertensive medication, and the effect is significant in hypertensive patients". (27)

Attempting to restore balance to our bodies in the least invasive manner possible is part of the philosophic approach of naturopathic physicians. Thus we often seek to use the body's constituents to see if better health can be achieved, especially in light of findings from advanced nutritional testing. These may include vitamins, minerals, amino acids, fatty acids, supplemental hormones and more.

Don't get stuck not trying acupuncture

There are 12 classical meridians in Traditional Chinese Medicine (TCM). Acupuncture is based on the ancient Chinese theories of the flow of qi (a fine, essential substance which nourishes and constructs the body) through distinct channels that exist in and around us. Imbalance and obstruction to this flow correlates with disease; acupuncture is a tool used for millennia to correct health problems by regulating this flow properly.

Acupuncture has been used for treating heart failure in China since the Han Dynasty and can be applied to many diseases, according to the World Health Organization (WHO) recommendations. (28) The heart meridian travels the length of the inner arm. Several of the acupoints are indicated for palpitations, chest pain, a sense of fullness below the heart or local concerns to where the acupoints are found. "Many animal experiments have explored the mechanism of acupuncture in the treatment of heart failure [and] ... [m]any studies have shown that the acupuncture effect is closely related to the sympathetic nervous system, which is believed to play an extremely important role in the multipathway and multitarget [ways] acupuncture ... can simultaneously intervene in multiple cardiac function-related indicators". (29)

We have written in-depth blogs on theses topics! Follow the link to learn more: Have a heart to try acupuncture!

Therapeutic lifestyle modification

"If you want to go fast, go alone. If you want to go far, go together." – African Proverb

The dietary and lifestyle problems related to high blood pressure/ hypertension, high blood cholesterol/hyperlipidemia, and CVD are complex and can have multi-faceted repercussions on our bodies, with many different organ systems affected. It is no surprise then that more has to be done than just taking pills or injections and being advised to 'minimize dietary salt'.

Enter lifestyle medicine programs which have been shown to clinically reverse blood glucose concerns, cardiovascular disease, hypertension, elevated cholesterol, and obesity. These are implemented over 14 weeks. Why 14 weeks? Because social and psychological studies have shown that the median time for developing a habit is 66 days, and developing good habits is exactly what people need when focusing on what they eat, how they exercise or sleep, and stress management. We use combinations of a modified Mediterranean diet, body composition testing, and meal planning while taking a multi-faceted approach to a person. This treatment plan creates a balanced and manageable healthy lifestyle to clearly identify and overcome causes of ill health and improve total body function naturally by nourishing, balancing, and revitalizing a person's metabolic health. Our aim is to decrease body fat, increase lean muscle mass, lower fasting insulin and blood glucose levels while decreasing symptoms as fatigue, joint pain and digestive issues, among others, by unlocking the power of clinical nutrition!

Also of note is the other half of that recommendation to 'minimize dietary salt'. It has been reported that there is "... strong evidence of a negative association between dietary potassium and blood pressure, and some evidence ... of negative associations between dietary potassium and CVD (particularly stroke and CHD)...". Blood pressure lowering is particularly associated with high potassium and low sodium diets." (30)

So if you are seeking guidance, support or treatment, consider contacting our clinic at the number above.

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The content and any recommendations in this article are for informational purposes only. They are not intended to replace the advice of the reader's own licensed healthcare professional or physician and are not intended to be taken as direct diagnostic or treatment directives. Any treatments described in this article may have known and unknown side effects and/or health hazards. Each reader is solely responsible for his or her own healthcare choices and decisions. The author advises the reader to discuss these ideas with a licensed naturopathic physician.