Overview of Cardiovascular Risk Factors 1 Cardiovascular Biomarkers 2 Did You Know?

Sugar May Be Too Sweet For Your Heart 3 DHEA Deficiency & Cardiovascular Risks 3 5 Superfoods For A Strong Heart 4 Heart Healthy Recipes 5

February 2013

Cardiovascular Health
Cardiovascular Biomarkers

Overview of Cardiovascular Risk Factors

Coronary heart disease develops when main arteries that supply the heart with blood become constricted and narrow. As the arteries remain constricted, they become inflamed and damaged by oxidative stress to decrease the amount of blood flowing to the heart. This impairs the hearts pumping ability. Various cardiovascular risk factors are related to the formation of heart disease. When you think of cardiovascular risk factors, do you think of high blood pressure, diabetes, cholesterol imbalances, obesity, and smoking? If so, you are correct, but you may also be missing another important cause related to heart disease inflammation. Certain inflammatory markers, including white blood cell count, C-reactive protein, fibrinogen, and albumin can be measured to determine the development of plaque and risk of myocardial infarction.

HEART DISEASE HAS BEEN CONSIDERED A WIDELY PREVENTABLE DISEASE; YET, IT STILL CONTINUES TO BE THE MAIN CAUSE OF FATALITY FOR MEN AND WOMEN IN THE UNITED STATES BY CLAIMING APPROXIMATELY ONE MILLION LIVES EACH YEAR. Do you know the cardiovascular risks and biomarkers associated with this
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disease? Recognizing cardiovascular biomarkers and knowing what can be done to lessen your susceptibility to heart disease can help you maintain optimal cardiovascular function. What does it take to have a healthy heart? Common answers may include regular exercise, healthy eating, and stress management, but there are several factors associated with cardiovascular health that should be taken into consideration. Last month, we reviewed the role and development of good and bad cholesterol. This month, we take a closer look at other cardiovascular risk factors and measurements associated with heart health. We also look at the relationship between a DHEA deficiency and cardiovascular ailments. Nutritional recommendations and heart-healthy recipes are also included to help you recognize what steps can be taken to keep your heart content.
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Cardiovascular Biomarkers

commonly related to stroke in men and coronary heart disease in women. Lifestyle modifications that are used to reduce cardiovascular risks, such as lowering cholesterol, losing weight, and not smoking, will also lower fibrinogen levels.7

While several risk factors can be controlled or modified, there are some risks that are unable to be altered, such as age, gender, and family history.2 As we age, the heart can undergo physiological changes arteries can become less pliable and the heart may relax less between beats to decrease the hearts efficiency. Among men and women, men are more susceptible to heart disease. However, as women reach menopause their risk of heart disease and stroke becomes similar to men. One of the reasons for this factor is that estrogen, which helps to protect the heart, declines making women more susceptible to cardiovascular risks. If your family has a history of heart disease and stroke, you have a greater predisposition to heart ailments most likely because unhealthy lifestyle behaviors are passed through generations. 3, 4

High Sensitivity C-Reactive Protein

C-reactive protein (CRP) is an inflammatory marker produced by the
A CLINICAL ASSESSMENT OF VARIOUS CARDIOVASCULAR BIOMARKERS IS CONSIDERED A USEFUL EVALUATION FOR MANAGING PATIENTS HEART DISEASE RISKS. Through simple serum

liver that is continually related to heart disease, stroke, and certain cancers when it is elevated.8 CRP tends to be found in high concentrations among individuals who are overweight or obese. One study showed that people who are overweight have C-reactive protein levels that are 51% higher than normal, while those who are obese have levels that are 75% higher.9 Furthermore, individuals with excess body fat and elevated C-reactive protein levels are shown to have a greater risk of heart attack and stroke.10, 11 Elevated C-reactive protein levels have been related to a 2.3 to 4.8-fold increase in the risk of cardiovascular disease, as well as considered a risk for stroke and peripheral arterial disease.12 Interleukin-6, an inflammatory compound that activates the production of C-reactive protein in the liver, can also be measured to determine cardiovascular risks. A diet high in saturated fat and high-glycemic carbohydrates can increase C-reactive protein levels in your body. In contrast,
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tests an individuals vulnerability to cardiovascular ailments can be identified. These measurements include fibrinogen, high sensitivity C-reactive protein, homocysteine, hemoglobin, and lipoprotein levels.

high in whole foods and fiber can reduce C-reactive protein levels.14

Prothrombotic Factors (Fibrinogen)

Fibrinogen is a protein produced by the liver to form blood clots and stop bleeding. Levels of fibrinogen tend to be elevated when inflammation occurs from atherosclerosis. This protein increases cardiovascular risks by affecting blood circulation, platelet aggregation, plasma viscosity, and fibrin formation. Individuals that have
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Homocysteine Levels
Homocysteine is an amino acid found in the blood that is necessary for manufacturing protein. When homocysteine levels become too high, it can damage blood vessels, promote excessive blood clotting, and create oxidative stress to increase heart attack, atherosclerosis, and heart disease risks.15, 16, 17 It is necessary to have some homocysteine in the blood, but an excess reduces blood flow and blood vessel flexibility. A ten-year study found that middle-aged men with the highest homocysteine levels were twice as likely to have cardiovascular disease risks.18 Additionally, homocysteine levels can

high concentrations of fibrinogen tend to have a risk of cardiovascular disease that is 1.8 times greater than those with lower levels of fibrinogen in their plasma.6 Fibrinogen levels tend to be higher in smokers and are more
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a diet that is low in saturated fat and

February 2013 CARDIOVASCULAR HEALTH

be high among individuals with kidney disease.19 Individuals who smoke have been shown to have high homocysteine levels and a risk of cardiovascular disease that is 12 times greater than nonsmokers.20 Increasing your intake of B-vitamins, B6, B12, and folate, can help reduce homocysteine levels, as individuals with low levels of B vitamins often have high levels of homocysteine in their body. By lowering homocysteine levels, deep vein thrombosis (blood clots), heart disease, and heart attack risks are significantly reduced.
21, 22

Hemoglobin
Hemoglobin is a protein found in red blood cells that helps to carry oxygen from the lungs for delivery to the peripheral tissues. The hemoglobin A1c serum test is used to assess glucose levels and to determine the formation of glycation that leads to premature aging and disease risks.23, 24 Advanced gycation end-products (AGEs), which form when sugars bind with proteins in the body, have been linked to heart disease and the aging process. AGEs cause blood vessels to be inelastic and create chronic inflammation. By

monitoring hemoglobin levels, glycation formation and cardiovascular risks can be identified.25

Lipoproteins
Lipoproteins are molecules composed of proteins and lipids that transport cholesterol through the blood. All of our cells rely on fats and cholesterol to form membranes that control internal water content and organize internal structure/ proteins. However, high levels of lowdensity lipoproteins (LDL) and low levels of high-density lipoproteins (HDL) are considered cardiovascular risk factors.26

Did You Know? Sugar May Be Too Sweet For Your Heart

to develop greater inflammation, but simple carbohydrates (bread, pasta, cereal, rice, potatoes, etc.) can increase insulin, triglycerides, and blood pressure levels, as well as fat cells in your body. Researchers observed that regular consumption of sweetened beverages can increase risks of coronary heart disease in women even after other unhealthy dietary and lifestyle factors were recognized.28 Another study found that sugar-sweetened beverages were associated with an increase in triglycerides, inflammatory markers, and leptin.29 Added consumption of sugar and carbohydrates can also increase biomarkers related to cardiovascular risks, including raised LDL and reduced HDL cholesterol levels, among adolescents.30

DHEA Deficiency & Cardiovascular Risks

As a precursor to other hormones, including testosterone and estrogen, DHEA is known as one of the most abundant steroid hormones in the body. Between the ages of 25 and 75 years old, DHEA levels decline by approximately 80% leading to a deficiency that weakens immunity, inhibits cognitive health, and decreases mood, while increasing fatigue, body fat, and anxiety.

MOST PEOPLE CONSIDER SATURATED FAT A PRIME TRIGGER FOR HEART DISEASE, BUT A LESS APPARENT HAZARD FOR MANY IS HIGH-GLYCEMIC FOODS AND SUGAR.27 Sugar contributes to

inflammation in the artery walls. You dont need to eat a spoonful of sugar

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DHEA also increases the incidence of agerelated illnesses, including cardiovascular dysfunction.
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Researchers have observed that a decline in DHEA is related to an increase in cardiovascular risk factors. DHEA supplementation has been shown to aid cholesterol, insulin, and glucose levels after
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administration for 40 days.34 DHEA has also been suggested to improve arterial health and improve endothelial cell formation.35, 36, 37

High insulin and cortisol

levels, related to a DHEA deficiency, can affect cardiovascular health.

5 Superfoods For A Strong Heart

Feeding your heart requires eating foods that are rich in vitamins, nutrients, and antioxidants. Focusing on a diet rich in whole grains, fresh vegetables and fruit, lean protein, fish, and good fats can be pleasing to your heart. Here are five honorable mentions to add to your heart-healthy diet. Blueberries These small berries pack a punch of nutrients, including anthocyanins, vitamin C, and fiber. Salmon - Rich in omega-3 fatty acids, salmon is a great source of protein that is easily digested and full of various nutrients, including vitamin D and B12. Spinach High in potassium, B-vitamins, calcium, fiber, and several nutrients that benefit your heart. Nuts Walnuts, almonds, pecans are all rich in monounsaturated fats that benefit your heart and low in saturated fat. Plus, they are a great source of fiber and protein. Legumes Black beans, lentils, aduki, pinto beans, and a variety of legumes are high in fiber, low in fat, and a good source of flavonoids.

Heart-Loving Nutrients
THE HEART DEMANDS ATTENTION, WHICH IS WHY SPECIFIC HEART-HEALTHY NUTRIENTS ARE BENEFICIAL TO SUPPORT THE ENERGY PRODUCTION NEEDED FOR THE CARDIOVASCULAR SYSTEM TO FUNCTION OPTIMALLY.

Arjuna
An Indian shrub, known as arjuna, has been mainly used in Ayurvedic medicine to support cardiovascular health.38 This extract contains a variety of flavonoids and polyphenols, which help reduce

inflammation that causes plaque in the arteries.39 It also supports healthy lipid profiles.40 cellular energy and cardiovascular function. A deficiency can form as CoQ10 levels decline with age. CoQ10 supplementation can restore serum levels and support cardiovascular health

CoQ10
Coenzyme Q10 is a strong antioxidant naturally found in the body to support

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by inhibiting cholesterol oxidation, reducing inflammation in blood vessels, and maintaining healthy blood pressure levels.41, 42, 43, 44

Hemoglobin
Hemoglobin is a protein found in red blood cells that helps to carry oxygen from the lungs for delivery to the peripheral tissues. The hemoglobin A1c serum test is used to assess glucose levels and to determine the formation of glycation that leads to premature aging and disease risks.xix,xx Advanced gycation end-products (AGEs), which form when sugars bind with proteins in the body, have been linked to heart disease and the aging process. AGEs cause blood vessels to be inelastic and create chronic inflammation. By monitoring hemoglobin levels, glycation

formation and cardiovascular risks can be identified.

Hawthorn Extract
Hawthorn extract is rich in polyphenols and flavonoids and is considered a cardiovascular benefit to help reduce risk factors related to heart disease. This extract has been shown to support oxygen consumption, heart rate, blood pressure, and heart muscle contractions.47, 48 Endothelial cell health and inflammation reduction in the blood vessels has also been observed with hawthorn.49, 50

Fish Oil
Fish oil is a supplement that has gained massive popularity for its many health benefits. High in omega-3 components, EPA and DHA, fish oil helps to lessen inflammation and improve artery elasticity. It can also benefit cardiovascular health by reducing excessive triglyceride levels in the blood by as much as 25 to 50% after one month of treatment with 3 to 4 grams/day of fish oil.45, 46

Heart Healthy Recipes

Low cholesterol recipes can add new flavor to a traditional dish, as they reduce your consumption of saturated fat and cholesterol. When you use herbs and spices, you have a greater opportunity to get creative with recipes and experience new tastes

Slow-Cooker Wild Rice Soup

Ingredients: 2 medium carrots, peeled and chopped (1 cup) 2 stalks celery, chopped (1 cup) 3/4 cup uncooked wild rice, rinsed and drained 1 medium onion, chopped (1/2 cup) 1 small sprig fresh rosemary 2 bay leaves 1 teaspoon finely shredded lemon peel 1/4 teaspoon ground black pepper 3 chicken breast halves with bone (about 2 1/4 pounds total) 3 14-ounce can reduced-sodium chicken broth 1/2 cup snipped fresh parsley In a 4- to 4 1/2-quart slow cooker, combine carrots, celery,
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wild rice, onion, rosemary, bay leaves, lemon peel, and the 1/4 teaspoon pepper. Top with chicken breast halves. Pour chicken broth over all. Cover; cook on low heat setting for 6 to 6 1/2 hours or on high-heat setting for 3 hours. Remove chicken and cool slightly. Discard rosemary sprig and bay leaves. Cut chicken from bone; discard bones. Chop chicken and return to soup along

Roasted Beet, Goat Cheese, & Fennel Salad

Ingredients: 2 large beets (1 pound) 1/2 teaspoon salt (divided) 1/2 teaspoon ground black pepper (divided) 2 medium fennel bulbs, cored and very thinly sliced 8 cups torn butterhead (Boston or bibb) lettuce 1/4 cup chopped walnuts, toasted 4 ounces crumbled goat cheese (chevre) 2 tablespoons snipped fresh chives Preheat oven to 400 degrees F. Prepare Lemon Vinaigrette; cover and set aside. Scrub beets. Wrap each beet in foil and place on a baking sheet. Bake 1-1/2 hours or until a knife can be easily inserted into beets. Cool 20 minutes or until able to handle. Trim off stem and root ends of roasted beets. Peel and cut into 1-inch pieces. In a medium bowl combine beets, 1/4 teaspoon salt, 1/4 teaspoon pepper and 3 tablespoons of the vinaigrette. In another medium bowl combine fennel, 1/4 teaspoon salt, 1/4 teaspoon pepper, and 3 tablespoons of the vinaigrette. Line 8 salad plates with lettuce. Drizzle with remaining vinaigrette. Layer with beets, walnuts, fennel, goat cheese, and chives. Makes: 8 servings Serving size: 1/2 cup

Lemon Vinaigrette
Ingredients: 3 tablespoons lemon juice 1 tablespoon finely chopped shallot 1 1/2 teaspoons Dijon-style mustard 1/2 teaspoon finely shredded lemon peel 1/2 teaspoon honey 1/3 cup olive oil In a medium bowl whisk together lemon juice, shallot, Dijon-style mustard, lemon peel, and honey. In a steady stream, slowly whisk in olive oil. Makes 2/3 cup
Recipes obtained from Heart Healthy Living www.hearthealthyonline.com

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