chd by batcagan0085

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Heart Disease          Coronary heart disease is the leading cause of
                       death in the United States.

 Definition            DEFINITION
                       Coronary heart disease (CHD) and its related
 Risk Factors          conditions are the most common cause of death
                       in the United States. Over 925,000 Americans
 Diet                  died of cardiovascular disease in 1995, account-
                       ing for 42% of all deaths (1). There are over
 Smoking Cessation     1.5 million heart attacks in the United States
                       each year with one-third of these patients dying
 Herbal Supplements    before they reach the hospital. The cost of lives
                       lost is high and so is the financial burden. Over
 Exercise              $100 billion is spent in the United States annual-
                       ly on cardiovascular related conditions.
 Yoga/Tai Chi/Qigong
                       The build-up of plaque, known as atherosclero-
 MindBody Therapies    sis, within the heart's arteries is responsible for
                       the morbidity and mortality related to this condi-
 Spirituality          tion. This plaque, made up of a lipid-rich core
                       and covered with a fibrous cap, can obstruct the
 Pet Therapy           heart arteries leading to heart-related chest
                       pain, also known as angina, shortness of breath,
 Music Therapy         or fatigue. The symptoms can vary widely
                       between individuals, especially women (2).
 Naturopathy           Rupture of this plaque may form a blood clot
                       which can obstruct the artery leading to death of
 Homeopathy            the heart muscle supplied by that artery. This
                       condition is known as a myocardial infarction
 Ayurveda              (MI) or more commonly, a heart attack.
RISK FACTORS                     years old) within siblings or    total cholesterol is less than
There are several risk fac-      parents which increases          200. Reducing cholesterol,
tors for the formation of ath-   the level of risk. There are     specifically the LDL choles-
erosclerosis. Those which        several risk factors that are    terol or "bad cholesterol,"
are not modifiable, include      modifiable including smok-       has been shown to lower
age, gender, race, and a         ing, hypertension, elevated      the risk of coronary heart
family history of premature      cholesterol, diabetes, obe-      disease (10).
CHD (3,4). The incidence         sity and physical inactivity.
of CHD increases with age                                         Diabetes is also a risk fac-
and men typically present        Smoking is one of the            tor for the development of
with symptoms of CHD on          greatest risk factors for        CHD regardless of whether
average 10 years earlier         CHD and its cessation is         it is juvenile onset or adult
than women. This "protec-        one the most effective ways      onset, insulin dependent or
tive effect" in women is felt    to reduce risk (6,7). Even       not (11). The risk of CHD
to be secondary to the hor-      within the first year of quit-   appears to be increased
monal state of women dur-        ting there appears to be a       approximately 3-fold in dia-
ing menses, however this         reduction in the incidence       betic men and perhaps even
advantage gradually fades        of CHD related events.           more in women (12-14).
in menopause leading to a        Switching to a low-tar or
similar incidence of CHD in      low-nicotine cigarette does      Obesity is associated with
the elderly. CHD rates are       not appear to be of benefit.     several other risk factors for
30 to 70 percent higher                                           CHD such as adult-onset
among blacks than among          Hypertension (elevated           diabetes, elevated choles-
whites of the same age up        blood pressure), is not only     terol, and hypertension. Its
until age 74 and the current     a risk factor for CHD but is     direct association with CHD
decline in CHD rates is          the most common cause of         is related to a certain pat-
much less apparent in            stroke. Hypertension can         tern of obesity known as
blacks than in whites (5).       be defined as a systolic         visceral obesity character-
The exact reason for higher      (upper number) of 140 or         ized by a protuberant
incidence of CHD in blacks       greater or a diastolic (lower    abdomen and a waist-to-hip
is not known, but perhaps        number) of 90 or greater         ratio greater than 0.9 in men
hypertension, more com-          (8). Its treatment leads to a    and 0.8 in women (14-16).
monly found in blacks, may       reduction in CHD.
play a role. Simply having a                                      While physical inactivity in
first degree relative with       Elevated cholesterol (total      and of itself is not consid-
CHD is not enough to be          cholesterol value of over        ered a risk factor for the
classified as having a family    200) has been consistently       development of CHD, a reg-
history of CHD. Since near-      shown to confer an               ular exercise routine
ly half of all Americans will    increase risk of CHD. This       appears to reduce the risk
develop cardiovascular dis-      risk appears to exist            of CHD and therefore the
ease, it is the premature        throughout the whole range       lack of physical activity
onset of CHD (defined as a       of elevated cholesterol val-     should be considered a
male less than 55 years old      ues and not just those near      modifiable risk factor (17).
or a female less than 65         the top (9). A desirable         It is also worth noting that
regular exercise promotes a     If drugs are prescribed by a      major dietary factors which
healthy weight, a reduction     medical provider remain           contribute to high blood
in blood pressure, an           compliant with their use rec-     cholesterol (5). They are
increase in HDL or "good        ognizing that holistic            a high intake of saturated
cholesterol," and reduces       approaches serve as an            fat and/or dietary choles-
the risk for the development    adjunct to treatment and not      terol, and an imbalance
of adult-onset diabetes (18-    a substitution for well-          between caloric intake and
21).                            researched, thoroughly-test-      energy expenditure. In
                                ed, FDA-approved thera-           order to meet appropriate
Great strides have been         pies. This is not to belittle     dietary guidelines of this
made in the past 20 years       the potential benefit of holis-   expert panel, two diet plans
developing better prescrip-     tic approaches, but simply        are suggested, with the
tion drugs for the treatment    to acknowledge the role           Step I diet being less strin-
of modifiable risk factors.     they play in CHD or any           gent and the Step II diet
As a result, if the medica-     other medical condition.          plan being more stringent.
tion is taken as prescribed,
an individual at risk for CHD   DIET
or already having CHD can       Eating right may reduce                    For every
reduce their chance of
experiencing a heart attack,
requiring coronary bypass
surgery, or even dying of
                                your risk of a heart attack.
                                Most of the dietary recom-
                                mendations for reducing the
                                risk of CHD relate to the
                                                                  “        1% reduction in
                                                                        total cholesterol, a
                                                                        2% reduction in the
cardiovascular disease.         reduction of cholesterol
                                within the bloodstream. As              risk of Coronary
                                a result, they will not all be
                                                                         Heart Disease
                                repeated here, but visit our
                                sections on Cholesterol and              is realized.
 often serve best
                                Dietary Therapies under
                                Conditions, as well as our
                                Nutrition section under
                                Therapies for more in-depth
                                                                  The Step I diet is a low fat
                                                                  diet with no more than 30%
                                                                  of total calories coming from
 in addition to                                                   fat. Saturated fat such as
                                                                  animal fat can be no more
 traditional medical            Lower fat intake. The             than 8 to 10% of calories
 treatment, NOT                 National Cholesterol              and dietary cholesterol is
                                Education Program (NCEP),         recommended at less than
 as a substitution              under the auspices of the         300 mg. If after 3 to 6
 for well-researched            National Institutes of Health     months, target cholesterol is
                                (NIH) set-out to establish        not achieved, the Step II diet
 therapies.                     dietary guidelines for reduc-     should be tried. In this more
                                ing high cholesterol. The         stringent plan, saturated fat
                                second report of this expert      is kept to 7% of total calo-
                                panel, published in 1993,         ries, and dietary cholesterol
                                identifies three                  is held at 200 mg.
A low-fat diet can make a         Hypertension is a major risk
difference? The predicted         factor for the development of       A recent study
reduction in total cholesterol    CHD and diets composed                  found a
from the Step I diet is 5 to 7    largely of vegetables have          44% reduction
percent and progressing to        been demonstrated to signif-
the Step II diet should yield     icantly lower blood pressure.
                                                                        in cardiac
an additional 3 to 7 percent.     For instance, the DASH                events by
Response varies and can be        (Dietary Approaches to Stop         increasing the
quite dependent on dietary        Hypertension) diet study
                                                                        quantity of

habits prior to initiation of     examined 459 patients eat-
the diet plan. A reduction in     ing one of three diets (24).
total cholesterol does corre-     While no patients lowered
spond to a decrease in your       their blood pressure that ate
risk of developing heart dis-     high fat diets, those on a
ease. In fact, for every 1%       near vegetarian diet noted             in the diet
reduction in total cholesterol,   significantly improved blood
the risk of developing heart      pressure. The average drop    muscle cell membranes, as
disease is reduced by 2%          in systolic and diastolic     well as brain, nerve and eye
(22). Other studies, such as      blood pressure was 6 points   tissue. Their deficiency in
those conducted by Dr.            and 3 points respectively.    the diet can actually con-
Dean Ornish have examined         The mechanism for this        tribute to obesity, adult
the response to a very low        reduction is felt to involve  onset diabetes, hyperten-
fat diet on regression of         increased potassium con-      sion and coronary heart dis-
coronary artery disease. His      sumption from fruits and      ease (26). Diets low in
approach to cardiovascular        vegetables (25). A second     omega-3 fatty acids may
health has also been shown        contributing factor may be    actually lead to a reduced
to reduce the incidence of        increased fiber intake by     HDL cholesterol and high
heart disease (23).               vegetarians, which is also    triglycerides. In those who
                                  felt to lower blood pressure  consume fish oils on a reg-
Increase fruits and vegeta-       (11). Caution in consuming    ular basis, there has been
bles. Any diet should contain     extra fruits and vegetables   an evident decrease in
the necessary nutrients to        should be exercised in those  triglycerides (up to 43%)
meet the Recommended              individuals taking potassium  and raised HDL cholesterol
Dietary Allowances (RDA).         sparing diuretics such as     (up to 18%) (27,28). In
See page five for the list of     spironolactone (Aldactone),   addition, a recent study
common RDA's.                     or those with kidney failure, examining the health bene-
                                  either of which could lead to fits of increased fish intake
Fruits and vegetables are         dangerously high levels of    found a 44% reduction in
healthy sources of fiber, folic   potassium.                    cardiac events such as
acid, vitamin C, vitamin A                                      heart attack and heart relat-
and many other minerals, all      Fish contain polyunsaturated ed chest pain in the individ-
of which promote a healthy        fatty acids, particularly the uals who consumed the
cholesterol or provide anti-      omega-3 form, which is        largest quantity of fish in
oxidant properties.               important in building healthy their diet (29). In this study,
 Recommended Daily Allowances (RDA) for common supplements

    Supplement                Women                  Men

    Protein                    44 g                 56 g

    Vitamin A                800 mcg             1000 mcg

    Vitamin D            7.5 mcg (300 IU)     7.5 mcg (300 IU)

    Vitamin E             15 mg (250 IU)       15 mg (250 IU)

    Vitamin C                 75 mg                90 mg

    Thiamine                  1.1 mg               1.5 mg

    Riboflavin                1.3 mg               1.7 mg

    Niacin                    14 mg                19 mg

    Vitamin B6                 2 mg                2.2 mg

    Folic acid               400 mcg              400 mcg

    Vitamin B12               3 mcg                3 mcg

    Pantothenic acid         4 - 7 mg             4 - 7 mg

    Biotin                 100-200 mcg          100-200 mcg

    Calcium                  1000 mg              1000 mg

    Phosphorus               700 mg               700 mg

    Magnesium                255 mg               255 mg

g=grams, mg=milligrams, mcg=micrograms, IU=international units
thre was a significant rise in
                                  Soy lowers cholesterol by (36):
their HDL cholesterol as well.
Current dietary recommen-         * decreasing its absorption
dations are to consume
0.65 grams per day of             * increasing LDL receptor activity and thus increasing its
omega-3 fatty acids, which          uptake from the bloodstream
corresponds to 20-62
                                  * increasing bile acid excretion leading to elimination of
grams of fatty fish (30).
                                    cholesterol into the gut
Fish highest in omega-3 fatty
acids include mackerel, her-      * stimulating thyroid hormone production and a resultant
ring, sardines, salmon, tuna        fall in cholesterol
and trout. While these cold-
water fish may be high in fat  vation, known as the "French             drinking a glass of red
as well, they are packed with  Paradox," has been attrib-               wine each night may be
omega-3 fatty acids. If        uted to a rise in HDL choles-            good for heart health (35).
unable or unwilling to con-    terol afforded to those who              Of course, one should not
sume 3 ounces of fish 3-4      consume alcohol on a regu-               consume more than 2
times per week, consider       lar basis, particularly red              alcoholic beverages per
supplemental gel caps con-     wine (32). Trans-resveratrol             day. Keep in mind that
taining omega-3 fatty acids.   is a naturally occurring                 one drink of alcohol equals
Most supplements also con-     antioxidant found in red wine            12 oz of beer, 4 oz of wine
tain high amounts of vitamin   that inhibits production of fac-         or 1 1/2 oz of hard alcohol.
A and D as well.               tors within the blood that may           Excessive alcohol has
                               damage artery walls or pro-              been linked to elevated
The French have long been      mote clotting (33,34). It                bloodpressure as well as a
known to have less heart dis- seems that intake is inversely            host of other deleterious
ease than Americans despite correlated with the develop-                effects. It is also worth
their diet containing high-fat ment of CHD, and therefore,              noting that a 4-ounce glass
food (31). So far this obser-                                           of wine contains approxi-
                                                                        mately 80 calories and
  Fish            Omega-3 Fatty Acid Content (18)                       therefore even modest
                                                                        daily use can lead to grad-
                                                                        ual weight gain.
  Mackerel                       1.8-5.3 grams
                                                                        Soy may do the heart
  Herring                        1.2-3.1 grams
                                                                        some good. Foods rich in
                                                                        soy protein are becoming
  Salmon                         1.0-1.4 grams
                                                                        increasingly recognized as
                                                                        heart healthy. Several
  Tuna                           0.5-1.6 grams
                                                                        mechanisms, including
                                                                        cholesterol reduction, have
  Trout                          0.5-1.6 grams
                                                                        been touted for the role of
                                                                        soy in decreasing the risk
  Halibut                        0.4-0.9 grams
                                                                        of coronary heart disease.
The FDA has now approved         Finland had developed heart
the following health claim for   disease while only 5% of the        While the available
soy protein: "Diets low in       Japanese had developed
saturated fat and cholesterol    heart disease. Most impres-         research still
that include 25 grams of soy     sive were the Greeks from
protein per day may reduce       the island of Crete. Only 2%        remains
the risk of heart disease.       had developed heart disease
One serving of [name of          after 10 years and none of
food] provides ____ grams        them had died. What makes           for those who
of soy protein" (37). Soy        this even more notable was
protein bars, soy flour, or      that the Greeks were eating         enjoy
black or green soybeans          almost as much fat as the
offer a healthy source of soy    Finns, but far less saturated       tea, drink green or
protein.                         fat. Therefore, this diet plan
                                 is worth a look, but careful        black tea as
The Mediterranean diet has       attention to total fat intake is    part of a heart
become increasingly popular      especially important. If
as a heart healthy style of      prone to weight gain, be            healthly diet.
eating. Olive oil and whole-     especially cautious.
grain bread alone can                                                It can't hurt and it
account for up to 50-60% of      A Harvard study examined
total calories, however this     the potential association           may just be
diet is also rich in beans,      between egg consumption
fresh fruits, and vegetables     and heart disease (40).
                                                                     good for you!
(38). Much of the fat from       They found that eating one
this diet plan is monounsatu-    egg per day-that's seven           disorders, and even pre-
rated fat from olive oil which   eggs per week-did not              vent tooth decay. Black,
appears to raise the level of    increase the risk of heart         green, and oolong tea all
HDL. Perhaps the benefits        disease or stroke for healthy      contain antioxidants such
of this diet plan are best       adults who did not have dia-       as polyphenols. However,
illustrated by a study con-      betes.                             only green tea contains a
ducted by Dr. Ancel Keys                                            specific antioxidant known
and his wife nearly 50 years     Next to water, tea is the          as catechin which is felt to
ago and known as the             most commonly drank bever-         play a role in the preven-
Seven Countries Study (39).      age in the world. Tea is high      tion of plaque formation
This study included partici-     in specific anti-oxidants          within the heart arteries
pants from the United            called polyphenols which           (41,42). Milk inhibits the
States, the Netherlands,         make up 30% of its dry             effect of catechins and
Japan, Italy, Finland, Greece    weight. Tea has been touted        therefore its addition to
and Yugoslavia. It was           for its potential ability to       green tea should be avoid-
based upon the simple            reduce the risk of heart dis-      ed. Black tea has also
observation of the develop-      ease and cancer, decrease          been found to be beneficial
ment of CHD. At 10 years,        blood pressure, sooth              in preventing heart dis-
28% of participants from         headaches, treat stomach           ease. At a presentation of
the Society of Medicine

Conference in London in
July of 1999, drinking at
least one cup of black tea
per day was found to reduce
the risk of heart attack by
44% (38,43). It didn't
appear to matter if it was hot          basic principles to quit smoking*
or cold, with or without milk.
In five studies conducted to        1. Set a stop date
examine the protective role
of flavonols in cardiovascu-        2. Involve other people
lar disease, three have sug-
gested a benefit, while one         3. Switch to a less appealing brand and begin to taper
showed no benefit and one
                                    4. Take it one day at a time
suggested perhaps even an
adverse association
                                    5. Change your routine
between tea consumption
and coronary heart disease          6. Alter your surroundings
(43). Therefore, the avail-
able literature on tea con-         7. Time the urge
sumption and the prevention
of cardiovascular disease           8. Practice positive thinking
has not yet led to a definitive
                                    9. Consider using aids such as nicotine gum
recommendation. However,
for those who enjoy tea, at         10. Do your homework first
least one cup of either black
or green tea per day may be
included in a heart healthy       each year and negatively          (LDL). It also inhibits the
diet.                             impacts nearly all the organs     aggregation of platelets,
                                  in the body (45). For smok-       which are small blood com-
SMOKING                           ers the risk of developing        ponents that build up on
Smoking is the single most        CHD is 2.8 times that of a        plaque within the heart
important preventable cause       non-smoker (46).                  arteries, form blood clots,
of death and disability. It       Fortunately by quitting, the      and can lead to a heart
doesn't matter if it is ciga-     risk of having a heart attack     attack (49). Based upon
rettes, cigars or a pipe. It      is lower within 2 years (47).     the above mechanisms,
doesn't matter if it is low tar                                     selenium is hypothesized
or not. Approximately 50          HERBAL SUPPLEMENTS                to be protective against the
million Americans still smoke     Selenium is an antioxidant        development of plaque for-
and annually 23 billion dol-      that regulates important          mation within the heart
lars is spent in related med-     enzymes that protect against      arteries, but this has not
ical costs (44). Smoking kills    oxidized molecules such as        been established in clinical
at least 400,000 Americans        low density lipoproteins          trials. Until more research
is available, selenium sup-      folic acid, vitamin B6 and B12     or diabetes mellitus.
plementation is not advised      treatment for people with ele-     Participants who took 100
for CHD. Keep in mind            vated homocysteine levels          IU (International Unit) of
that selenium may still play     may reduce heart attacks and       vitamin E daily for at least
a role in other cardiovascu-     other cardiovascular events, it    two years had a 39%
lar conditions involving         has yet to be demonstrated in      reduction in heart disease
heart muscle disorders not       any clinical trials. Based         or cardiovascular surgery
involving coronary heart         upon what is currently known,      (56). The US Nurses'
disease.                         supplementation is felt to         Health Study included
                                 have a postive effect, particu-    121,000 female nurses
Folic Acid, vitamin B6           larly in those individuals iden-   between 30 and 44 years
and B12 may be the               tified as having an elevated       old (57). Participants tak-
appropriate choice.              homocysteine level. Prior to       ing 100 IU of vitamin E
Homocysteine is an amino         supplementation with folic         daily had a 34% lower
acid which is abnormally         acid, and vitamins B6 and          incidence of coronary
elevated in 30% of people.       B12, consider the appropriate      heart disease after just
Its elevation in the blood       medical testing. The supple-       two years compared to
stream has been clearly          mentation level of folic acid is   those participants not tak-
linked to the formation of       800 mcg taken along with a         ing vitamin E.
plaque within the heart          multivitamin, which commonly
arteries (50). Low folic acid    supplies an additional 400         The above positive results
levels have been linked to       mcg, for a total daily dosage      also prompted large-scale
elevated homocysteine lev-       of 1200 mcg. The supplemen-        randomized trials to further
els and an increased risk of     tation level of vitamin B12 is     examine the benefits of
myocardial infarction, com-      1000 mcg, or 1 mg daily, and       vitamin E in patients with
monly known as a heart           for vitamin B6, 100 mg. For        known heart disease or at
attack (51). In affected indi-   effective treatment of elevated    very high risk. Initial stud-
viduals, folic acid taken        homocysteine, all three sup-       ies where very encourag-
along with vitamins B6 and       plements are required.             ing. The Cambridge Heart
B12 can reduce these lev-                                           Antioxidant Study
els (50,52-54). While this       Vitamin E is a good antioxi-       (CHAOS) focused on
combination of supple-           dant to remember. The bio-         whether supplements -
ments has been shown to          logic activity of vitamin E        either 400 or 800 IU of
improve blood flow through       appears to prevent damage to       vitamin E daily - would
the heart arteries in healthy    cell walls through a variety of    prevent future cardiovas-
volunteers, limited research     mechanisms in part due to its      cular events in patients
has been done demonstrat-        antioxidant effects. Its role in   with known coronary
ing a reduction in either        preventing heart disease in        artery disease (58). Of
plaques within the heart         patients without known heart       2,002 patients with docu-
arteries or the associated       disease has been encourag-         mented coronary artery
heart attacks, death, etc.       ing. The Health                    disease, treatment with
which result from plaque         Professionals' Follow-up           vitamin E instead of place-
formation (55). While it is a    Study examined 39,910              bo significantly reduced
logical extension to think       males without known disease        the incidence of non-fatal
myocardial infarction (heart    effective than the natural         prevention of cardiovascu-
attack) by 77%, without an      form, and therefore may have       lar disease may not be as
effect on mortality. This       minimized the benefit of E         great as originally predict-
reduction was due to a sig-     vitamins in high-risk patients.    ed this isn't to say that
nificant decrease in non-       They also studied a very high      benefit does not remain for
fatal heart attack, with no     risk group of patients who         select patients utilizing the
difference in cardiovascular    may have already had               correct form, dosage, and
death. However, this trial      advanced plaque formation          potentially the correct
was followed by two large       within their heart arteries,       combination of antioxidant
randomized trials that have     thus mitigating the potential      supplements. Thus, while
been less supportive. The       benefit of early prevention        the debate rages on, vita-
Heart Outcomes                  with supplementation.              min E supplementation
Prevention Evaluation                                              with 400 IU may be the
Study (HOPE) examined           Perhaps a combination of           best course of preventa-
9,541 patients with either      antioxidants may be required       tive action.
known heart disease or          to reduce plaque formation.
diabetes mellitus who           Vitamins E and C have been         Vitamin C may not be
received 400 IU of natural      studied in the Antioxidant         what the heart needs.
vitamin E for a mean of 4.5     Supplement Atherosclerosis         This vitamin is involved in
years (59). There was no        Prevention (ASAP) Study. In        many cellular processes
reduction in heart attack,      this trial, high-risk men taking   and acts as an antioxidant.
stroke or death for the         vitamin E (200 mg daily) and       Vitamin C consumption is
patients taking vitamin E       vitamin C (500 mg daily) for       certainly essential, and
instead of placebo. In the      three years had a 45% reduc-       vitamin C levels within the
GISSI-Prevention study,         tion in the progression of ath-    blood have been inversely
11,000 patients who had         erosclerosis (coronary artery      correlated with the inci-
recently survived a heart       plaque) (61). A reduction in       dence of coronary heart
attack were given 300 mg        cardiovascular events and          disease, the lower the
of synthetic vitamin E for a    death from all causes was          level, the higher the inci-
mean of 3.5 years (60).         also found in over 11,000 eld-     dence of disease (64,65).
Again, there were similar       erly persons taking a combi-       However, there really is no
rates of heart attack, stroke   nation of vitamins E and C         clinical research which has
and death for patients tak-     (62). However, a combination       found that vitamin con-
ing synthetic vitamin E         of vitamin E and beta-             sumption actually reduces
instead of placebo.             carotene has not been shown        your risk of developing
Therefore, no clear benefit     to affect symptoms or disease      cardiovascular disease.
of vitamin E has been           progression (63).                  Today's best advice is to
established for patients                                           eat plenty of fruits, espe-
who already know they           As the above discussion indi-      cially citrus fruits, as well
have heart disease or are       cates, vitamin E supplemen-        as vegetables rich in vita-
at very high risk.              tation for CHD prevention          min C. Additional supple-
Unfortunately, this study       remains controversial.             mentation cannot be sup-
utilized synthetic vitamin E,   Although the widespread ben-       ported for the prevention
which is felt to be less        efits for vitamin E for the        of CHD.
Superoxide Dismutase             important to recognize that        and magnesium supple-
(SOD) will not help the          while DHEA has been shown          mentation has been found
heart. SOD is felt to pre-       to lower triglyceride levels, it   to be useful in regulating
vent oxygen-related dam-         has also been demonstrated         blood pressure and poten-
age to the body's cells. It      to reduce HDL levels, the          tially treating mild to mod-
has been studied to exam-        "good cholesterol" (70).           erate hypertension (73-
ine its potential role in pre-   Finally, supplementation with      76). A dose of 600-1000
venting or decreasing heart      this hormone may actually be       mg of elemental magne-
muscle damage in the set-        harmful by potentially promot-     sium has been used for
ting of a heart attack           ing hormone sensitive tumors       patients with mild to mod-
(66,67). To date, the data       and altering the body's own        erate hypertension
does not support its use         natural hormone cycle. The         (73,74). Other trials have
and it is important to rec-      bottom line-DHEA is best           suggested little benefit to
ognize that SOD cannot           avoided for the prevention of      magnesium supplementa-
be absorbed if taken oral-       heart disease until further        tion on treating hyperten-
ly. SOD can only be              studies have been performed.       sion (77). Keep in mind
administered by injection.                                          that magnesium supple-
Therefore, SOD does not          Magnesium may reduce               mentation should be
appear to be useful for the      heart pains (also known as         avoided in individuals with
prevention of CHD.               angina). This essential ele-       renal insufficiency, which
                                 ment is found mainly in bone,      may lead to dangerously
DHEA won't soothe the            but it is also important in the    high levels of magnesium.
heart. Produced by the           function of every other cell in
adrenal glands, dehy-            the body. Magnesium plays a        Coenzyme Q-10 may aid
droepiandrosterone               key role in energy formation       in the relief of angina.
(DHEA), is the most abun-        within the cell, as well as        This supplement is both a
dant steroid in the human        playing a part in over 300 cel-    potent antioxidant and
body. Levels peak at             lular processes. It is not sur-    cofactor in the formation of
approximately age 30 and         prising that magnesium sup-        energy within the body's
decrease to 5 -15 percent        plementation is suggested for      cells. It has been advo-
of those levels by age 60        many medical conditions            cated in cardiovascular
(68). DHEA levels within         including heart-related ail-       disease as an aid to the
the blood stream have            ments. The intravenous form        treatment of congestive
been demonstrated to be          has been extensively studied       heart failure, hypertension
low in men with CHD (69).        for its role in the immediate      and CHD. With regard to
However, supplementation         stages of a heart attack (71).     the later, coenzyme Q-10
as a means of reducing the       In its role as a preventative      may play a role in reduc-
risk of CHD, has not been        agent, oral magnesium has          ing the frequency of angi-
studied. Therefore, the link     been supported in some             na (78). Research is limit-
cannot be drawn that by          research to reduce the fre-        ed and more needs to be
raising blood levels of          quency of angina (72). As          done before its use can be
DHEA one may actually            previously mentioned, hyper-       unequivocally accepted.
decrease their risk of heart     tension is a major risk factor     No specific dose has been
disease. It is also              for the development of CHD         identified; however, 200 to
300 mg per day in two or
                                                Daily Supplementation Levels
three divided doses is most
                                                 for Coronary Heart Disease
likely appropriate.
                                  Folic Acid                            1200 mcg
Garlic is one of the most
commonly ingested herbal          Vitamin B12                       1000 mcg or 1 mg
supplements with a wide
range of reported health          Vitamin B6                             100 mg
benefits. Its role in cardio-
vascular disease has mainly       Vitamin E                              400 I.U.
focused on reducing choles-
terol levels, but it has also     Magnesium                           600-1000 mg
been suggested that garlic
may play a role in lowering       Coenzyme Q10            200-300 mg in 2 or 3 divided doses
blood pressure and prevent-
ing plaque build-up in the
                                  L-Carnitine                   2 grams taken in 2 doses
body's arteries. Studies
have suggested that garlic
supplementation can reduce
age-related vascular              divided doses or 4 grams of       CHD, L-Carnitine levels
changes including plaque          fresh garlic.                     have been identified as
formation within the heart                                          reduced in heart muscle
arteries, also known as ath-      Hawthorn's potential bene-        during periods of activity,
erosclerosis, and may pre-        fits and its uses in cardiovas-   and its supplementation
vent recurrent heart attack       cular disease have mainly         has been shown to reduce
and death following an initial    focused on congestive heart       chest pain attributed to the
heart attack (79,80).             failure rather than CHD.          heart (angina), improve
Additional randomized trials      Research has suggested that       exercise tolerance, and
are necessary before these        hawthorn supplementation          improve the electrocardio-
claims can be fully support-      can increase the blood flow       graphic changes frequently
ed. When choosing to take         through heart arteries, but       identified in CHD patients
garlic, remember it is the        this has not yet been linked      during exercise (83,84). L-
ability of the supplement to      to any clear benefit in people    Carnitine 1 gram taken
yield allicin that confers ben-   with CHD (82).                    twice a day has been sug-
efit. When selecting a garlic                                       gested as the appropriate
preparation, make sure that       L-Carnitine may give the          dose. It is important not
it is stomach coated in order     heart a boost. It is also         to take D- or DL-carnitine
to avoid being broken down        known as simply carnitine.        which are found in some
by stomach acid. Lastly,          Manufactured in the liver, kid-   over-the-counter prepa-
some "odor free" garlic           neys, and brain, this B vita-     rations and may lead to
preparations may have no          min is important in the trans-    some severe side effects
active ingredients at all (81).   portation of energy mole-         or symptoms suggestive
The typical dosage is 900         cules within heart muscle         of L-Carnitine deficiency
mg daily, given in three          cells. For people living with     (70).
EXERCISE                          surgery or angioplasty (85).    or heavy gardening, and
Regular exercise should be        For those who already have      regular walking (>40
a part of life's daily routine.   CHD, The National Exercise      min/day) was associated
It has been well described        and Heart Disease Project       with a significant reduction in
to have many positive             randomized 651 men, 2 to        death from all causes includ-
effects on the risk factors       36 months after a heart         ing heart related (89). In
which contribute to CHD.          attack, to an exercise pro-     this study, even men who
                                  gram for 3 year (86). In        were sedentary and initiated
There are several other           these individuals, there was    light exercise derived some
benefits to routine exercise,     a 37% reduction in heart        benefit. The Centers for
which likely indirectly affect    related death and 5%            Disease Control and
the risk of CHD, such as          reduction in other cardiac      Prevention and the
stress reduction. Exercise        events such as heart attack.    American College of Sports
is well known to release          A second study examined         Medicine agree that even 30
endorphins which are the          303 men after a heart attack    minutes of moderate exer-
body's own chemicals that         and found a 42% reduction       cise on most days, if not all,
can reduce pain and invoke        in mortality after slightly     will lead to improved cardio-
mild euphoria. Perhaps it is      more than two years (87).       vascular health (90). So
this later benefit which          The findings in neither study   what does "moderate"
reduces emotional stress,         were statistically significant, mean? Walking at 3 to 4
and as a result, lowers           but they certainly suggest      miles per hour would be a
blood pressure and there-         the potential for a strong      good example. Of course
fore the risk of developing       benefit from a routine exer-    there are many other enjoy-
CHD. For individuals who          cise program.                   able forms of exercise and
do not yet have evidence of                                       all likely derive similar bene-
CHD, clinical research such       Marathon running is not         fits as long as the duration is
as The Harvard Alumni             required to see a heart         similar and the energy
Health Study have demon-          healthy benefit from regular expended is the same. In
strated that regular vigorous     exercise. In a recent study addition to walking, consider
exercise translates into a        of 772 middle aged men          swimming, rowing, biking, or
lower risk of future CHD          with CHD that were followed cross-country skiing.
events-chest pain, heart          for up to 5 years, recreation-
attack, heart-related death,      al activity of at least 4 hours Does duration matter? Up
and the need for bypass           on the weekend, moderate        until recently, it was

                                          * lowers LDL, the "bad cholesterol"

                                          * raises HDL, the "good cholesterol"

                                          * lowers blood pressure

                                          * lowers body fat

                                A recent study has found that short segments of
An interesting study            exercise throughout the day (as long as the energy
                                expended is the same) are as beneficial to heart
                                health as one long exercise session.
examined the benefit of an

                               commonly stated that daily exercise had to be
exercise program along         performed all at once rather than in shorter
                               segments. However, a recent study has found
with a diet program plus       that the duration of exercise did not matter on
                               the reduction of CHD risk as long as the ener-
psychological health           gy expended was the same (91). In other
                               words, short segments of exercise throughout
                               the day were equally beneficial to one long
education (88).
                               exercise session. This finding is especially
                               important to people who have a very busy
There was a significant        schedule or physical limitation which make it
                               very difficult to exercise for prolonged periods
reduction in heart-related     of time.

deaths of 19%, although no     While aerobic exercise such as walking, swim-
                               ming, etc is good for the person with CHD, iso-
                               metric exercise, such as lifting weights, may
difference in the number of
                               actually raise a person's blood pressure (92).
                               As a result, it has been suggested that weight
deaths due to all causes.      lifting and strength training may not be appro-
                               priate for some individuals. Recent research
Not surprisingly, this study   has shed some light on this question by exam-
                               ining 65 healthy elderly men who participated
emphasizes the need to         in a strength training program (93). In these
                               men, a strength training program was well tol-
                               erated with no adverse heart-related events. It
address the whole person
                               is important to point out that none had evi-
                               dence of CHD prior to initiating the program
through a variety of           and much different results may be found in
                               individuals who have CHD. Before initiating
modalities in order to         any weight lifting program, it is important to
                               consult a medical provider. If not strength
achieve heart wellness.        training, perhaps muscle toning with light
                               weights may still be appropriate. This likely
                               has little effect on blood pressure or underlying
                               CHD. It is important that when lifting any
                               weights for simple muscle toning or strength
training that a person contin-   attempts to remove the
ue to breathe throughout the     harmful effects of stress, tox-
exercise and not hold their      ins, and improper diet.
breath and bare down which       * Dhyana, or meditation, is
tends to increase blood          felt to have beneficial effects
pressure.                        on the autonomic nervous
                                 system, which regulates
Before starting out on an        excitability within the body
exercise program, make           as well as hemodynamic fac-
sure that one's CHD is con-      tors such as blood pressure
sidered stable by a medical      and heart rate. Clinical
provider and that high blood     research regarding the pre-
pressure is also under ade-      ventative benefits of yoga is
quate control.                   in its infancy within the
                                 United States. There have
YOGA/TAI CHI/QI GONG             been several non U.S. stud-       25% of those studied were able
                                                                   to stop using antihypertensive
Exercise and relaxation are      ies which have examined the
                                                                   medicine from a combination of
a healthy combination. Yoga      hemodynamic benefits of           yoga and biofeedback therapy.
was developed in ancient         yoga. Beginning in 1973, a
                                                                   through routine physical
India as a set of practices      study in London combined
                                                                   activity coupled with stress
intended to integrate the        yoga along with biofeedback
mind, body, and spirit. Yoga     and noted that 25% of those
has long been touted as          studied were able to stop
                                                                   Tai Chi was developed in
beneficial to those with car-    using anti-hypertensive med-
                                                                   China in the 1200's and has
diovascular disease or at        ications (94). A second
                                                                   become the most popular
risk of developing cardiovas-    study in 1993 examined
                                                                   form of exercise in that
cular disease. While there       physical fitness teachers
                                                                   country. Tai Chi is increas-
are many forms of yoga,          who practiced yoga for 3
                                                                   ingly popular in the United
Hatha yoga is the most com-      months. The participants
                                                                   States as a form of mild to
monly practiced form within      showed a significant reduc-
                                                                   moderate aerobic activity. It
the United States. There         tion in blood pressure, heart
                                                                   combines slow, graceful
are three basics practices       rate, respiratory rate, and
                                                                   movements combined with
which make up Hatha yoga.        body weight (95). While the
                                                                   deep breathing and mental
* Asanas involves a variety      role of yoga in the preven-
                                                                   attention. A typical work-out
of physical postures and         tion of CHD has not yet
                                                                   lasts only 15-20 minutes
exercises.                       been entirely defined, what
                                                                   and ideally is performed
* Pranayama comes from           data is available appears
                                                                   twice per day either individ-
the Sanskrit word prana,         very encouraging. In fact,
                                                                   ually or in a group. The
which means life energy and      yoga, like Tai Chi and Qi
                                                                   body's response to Tai Chi
ayam which means control.        Gong, may be ideally suited
                                                                   has been studied and found
Pranayama is similar to the      for the person who is unable
                                                                   to lower blood pressure and
"qi" in ancient Chinese medi-    to participate in regular aero-
                                                                   heart rate (96). In fact in this
cine. By utilizing breathing     bic exercises and yet wishes
                                                                   study, Tai Chi was found to
exercises, pranayama             to reduce their risk of CHD
                                                                   confer equivalent benefit to
brisk walking. However, not      cannot truly be healed with-        one of them.
all studies have found simi-     out healing the mind.
lar results. No studies have     Ancient Chinese medicine            Researchers suggest that
specifically examined tai chi    considered the mind and             the risks associated with
in the prevention of CHD,        body as comprising the              stressful occupations may
but as previously mentioned,     whole self. However, mod-           be equivalent to other major
light exercise has been          ern medicine has segregat-          CHD risk factors (98).
shown to reduce the risk of      ed these entities and               Meditation is a critical com-
CHD over a sedentary             focused on scientific meth-         ponent in both the reduction
lifestyle (89).                  ods, which provide targeted         of stress and the recovery
                                 therapies to the body, with-        from disease. Meditation
Qi Gong (pronounced chee         out examining the necessary         has been described as one
gong) also involves move-        "wellness" process needed           component to the behavioral
ments and deep breathing         to simultaneously treat the         approach to CHD (99, 100).
exercises. It too was devel-     mind-the Mind/Body connec-
oped in ancient China and        tion. For example, in cardio-
has become increasingly          vascular disease, medica-             People in high-stress
popular in the United States.    tions are provided to lower a
The qi is a person's vital       person's elevated blood               jobs may have 3.8 to 4.8
energy, which circulates         pressure. These medica-
within the body in small         tions certainly do not relieve        times as many heart
channels known as meridi-        stressors or spiritual con-
ans. Qi Gong is intended to      cerns which may be con-               attacks as their counter-
channel that energy and pro-     tributing to, or inhibiting, the
mote health. While limited       healing process.                      parts in low-stress jobs.
research is available in the
United States. A twenty-         Mind/Body therapies actually
year study completed in          include a wide array of
China in 1993 found lowered      modalities which all center         Transcendental Meditation
blood pressure and a 50%         around the connection in            was studied in 21 patients
decrease in death and ill-       healing between the mind            with CHD. After eight
ness from stroke in persons      and body. Extensive                 months of performing 20
utilizing Qi Gong.(97) No        research has been per-              minutes of these relaxation
specific research is available   formed in many of these             techniques twice a day
on Qi Gong in the preven-        areas:                              there was a 15% increase
tion of CHD, however the         * Meditation and relaxation         in exercise tolerance (101).
regular physical activity        are invaluable to the person        A second study was con-
along with stress relief         with CHD. These individuals         ducted of over 1000
appears ideally suited for the   are frequently involved in          patients who had recently
person at risk for CHD.          very stressful lives with little,   suffered a heart attack and
                                 if any, time to unwind.             were considered to be "type
MIND/BODY                        Emotional stress has clearly        A" personalities (102). After
If healing literally means "to   been linked to many medical         3 years, those patients who
make whole," the body            conditions and CHD is just          had adopted a lifestyle
more compatible with a type                                        in individuals with chronic
B personality had reduced                                          illness, such as CHD, who
their risk of a second heart                                       require permanent behav-
attack by half, compared to                                        ioral change and accept-
those who had not. Not sur-                                        ance of that change. These
prisingly, meditation is prob-                                     techniques teach individuals
ably the simplest, and per-                                        how to identify stress trig-
haps, most fulfilling of all                                       gers and actively treat
holistic therapies.                                                them. There are several
                                                                   components to cognitive
Imagery and Visualization                                          behavioral therapy including
are therapeutic techniques                                         behavioral rehearsal, edu-
which lead the participant                                         cation, group support, and
                                 Biofeedback utilizes instru-
through a series of images                                         training in coping skills and
                                 ments which monitor bodily
that promote relaxation with                                       motivation techniques.
                                 functions and allow the par-
the result of calming the                                          Support groups are one
                                 ticipant to regulate those
body's natural anxiety pro-                                        example of a therapy fre-
                                 functions. For instance, by
voking chemicals. These                                            quently utilized in patients
                                 listening to their heartbeat, a
"images" may involve sever-                                        with heart disease.
                                 person is able to consciously
al of the body's senses such
                                 increase or decrease their
as touch, sight, smell,                                           Hypnosis in essence is a
                                 heart rate. Likewise, such
motion, and hearing. With                                         form of deep relaxation. It
                                 techniques have been utilized
proper training, a person can                                     is a state of focused con-
                                 to effectively lower blood
learn to guide themselves                                         centration allowing the mind
                                 pressure, a major modifiable
through those states, which                                       to be highly receptive to
                                 risk factor for the develop-
provide a calming effect and                                      suggestion (68). While not
                                 ment of CHD (104). Like
can reduce their heart rate                                       extensively studied for the
                                 many Mind/Body therapies,
and blood pressure.                                               treatment of CHD, hyp-
                                 consistent utilization of these
Experiments in humans                                             notherapy has been demon-
                                 techniques serve to lower
have demonstrated the abili-                                      strated to lower blood pres-
                                 emotional stress and anxiety.
ty to control the hemody-                                         sure and heart rate, induce
                                 Such factors may not only
namic response of stress                                          a state of deep relaxation,
                                 play a role in the develop-
(103). This calming effect                                        and decrease the output
                                 ment of CHD, but also be
may reduce the need for                                           from nerve fibers-all effects
                                 important following a serious
medications or their associ-                                      which should be beneficial
                                 heart-related event like a
ated side effects. In addi-                                       to the person with CHD.
                                 heart attack or coronary
tion, these techniques may                                        Further studies on its
                                 artery bypass surgery.
help to alter behaviors and                                       longterm effects on this
risk factors which contribute                                     condition have yet to be
                                 Cognitive Behavioral Therapy
to the development of CHD.                                        performed.
                                 is a Mind/Body technique,
The benefits of such therapy
                                 which uses brief psychother-
can last even after the par-                                      SPIRITUALITY
                                 apy to reduce the stress
ticipant is no longer engaged                                     Spirituality is the belief in
                                 response and induce relax-
in the activity.                                                  something, not necessarily
                                 ation. It is particularly useful
someone, greater than one-        developed in the United           in 1995, religion was found
self. This should not be          States in the 1970's. It draws    to be beneficial to healing
confused with religious belief    much of its premise from          81% of the time, neutral
for a person can be spiritual     ancient Chinese medicine, as      15% of the time, and harm-
without being religious.          well as modern medicine. At       ful 4% of the time (108). In
Unfortunately with the            the root of therapeutic touch     cardiovascular disease, reli-
advent of modern scientific       is the belief in a common "life   gious older adults have
medicine came a clear sepa-       force" or energy field. By        been shown to have lower
ration between spiritual, reli-   interacting with this energy      blood pressure and lower
gious, and scientifically         field, it is believed a person    death rates from CHD than
founded beliefs. With the         can influence the healing of      their nonreligious peers
emergence of holistic thera-      another. Surprisingly, it does    (109). While not specifically
pies, there has been a            not actually involve touching     identified as treating cardio-
resurgence in promoting           a person, but instead the         vascular disease, faith,
spiritual and religious heal-     provider holds their hands at     hope and forgiveness are
ing and studying its effec-       a short distance from the per-    tenets of most religions and
tiveness in a whole host of       son receiving the care and        have also been identified as
disorders.                        the provider moves their          important to a person's
                                  hands throughout the per-         healing response. Prayer is
Spirituality includes an array    son's perceived energy field.     also a part of most
of beliefs including a feeling    These techniques have been        American religions and it
of love, compassion, empa-        widely embraced by nursing        too has important healing
thy, gratitude, and a sense       schools and now they are          power. A 1986 poll by MD
of inner peace. There is a        being taught throughout the       magazine found that one-
diminished focus on self          United States. In a 1984          half of doctors believe that
(68). Love and social sup-        study, these techniques were      prayer helps patients and
port are a part of a person's     provided to patients in a car-    two-thirds reported praying
spirituality which provides       diovascular unit and those        for patients (110). By pray-
healing and influences car-       receiving such treatments         ing, a relaxed state is
diovascular disease. A            showed a marked reduction         induced in which breathing,
study examining individuals       in anxiety, important to the      heart rate and metabolism
who described their parents       reduction of blood pressure       slow, blood pressure drops,
as providing loving support       and heart rate, key compo-        and brain waves become
in the 1950's went on to          nents to the treatment of indi-   less active.
show that these individuals       viduals with CHD (106).
developed less hypertension                                         PET THERAPY
and heart disease as well as Religious belief is a part of          Pet therapy could easily
fewer other non-cardiac con- the American fabric. In fact,          have been included in the
ditions later in life (105).   96 percent of Americans              Mind/Body or Spirituality
                               believe in God or a universal        sections of this article
Therapeutic Touch, a thera- spirit (107). These beliefs             because it crosses over to
py that draws upon some of impact healing. In a study               so many facets of holistic
the principles of spirituality conducted at Georgetown              therapies. Pets are loved
and spiritual beliefs, was     University School of Medicine        by their human companions
and in return can be power-       the heart. Music is enjoyed         cardiac surgery appears to
ful stimulators of health. A      by all in a great variety of        be of great value. Similar
study of people hospitalized      melodies and rhythms. The           research has been conduct-
for a heart attack found a        healing power of music rests        ed following a heart attack
significant association           within its ability to be utilized   and these positive effects
between subsequent sur-           in behavioral therapy and           may apply to other cardiac
vival and pet ownership           modification.                       conditions as well.
(111). In fact, having a pet
proved to be more important       Music has been shown to             NATUROPATHY
than having a spouse or           bring about changes in              Naturopathy focuses on the
other extended family sup-        behavior, emotions and phys-        body's own ability to heal
port. In a study at the           iology-all key elements in the      itself. Practitioners of natur-
University of Pennsylvania        modification of cardiovascular      opathy rely on a variety of
School of Veterinary              disease. Psycholological fac-       techniques founded in
Medicine, pet owners had          tors that have been exam-           ancient Indian, Chinese and
significantly lower blood         ined include anxiety, emotion-      Greek medicine. These
pressure when they were           al state, and pain intensity        include relaxation therapy,
greeting their pet than when      (114-117). Physiologic              counseling, psychotherapy,
they were reading neutral         parameters have included            herbal medicine, nutrition
text (112). A study of the        blood pressure, pulse, skin         counseling, physical thera-
therapeutic benefit of pet        temperature, respiratory rate       py, and homeopathy dis-
therapy on the elderly was        and myocardial oxygen               cussed below. While the
conducted with the Visiting       demand (114-117). Most, but         constituent parts of natur-
Nurses Association of             not all, have found a positive      opathy have been studied
Eastern Montgomery County         effect with music therapy. A        for their beneficial effects in
in Pennsylvania (113).            recent randomized study was         the treatment of cardiovas-
Retirement home residents         conducted at three hospitals        cular disease and specifi-
demonstrated a significant        in Minneapolis, Minnesota           cally CHD, there is little
reduction in blood pressure       examining the response of           research on naturopathy as
and pulse rate following a        music therapy on patients fol-      a whole in treating these
pet visit, this reduction did     lowing cardiac surgery (118).       conditions.
not occur following a visit       Not surprisingly, patient anxi-
from a human. Pet owner-          ety and pain was greatest           HOMEOPATHY
ship may also be an impor-        within the first 48 hours fol-      Homeopathy is relatively
tant motivator of daily exer-     lowing surgery. The addition        new compared to many of
cise, an important compo-         of music therapy to this popu-      the holistic approaches dis-
nent of a heart-healthy           lation had a significant effect     cussed already. Founded
lifestyle.                        on lowering anxiety and             in 1790 by Dr. Samuel
                                  blood pressure, with a trend        Hahnemann, homeopathy is
MUSIC THERAPY                     in lowering pain and heart          based upon the belief that
Music is a great "spice of        rate compared to those who          "like cures like."
life." It inspires the soul and   received standard care. The         Homeopathic therapies
perhaps it even heals the         addition of music therapy in        involve administering very
mind-or in this case,             the early period following          dilute solutions of herbal
substances felt to stimulate     for six months showed a sig-       assisted diagnosis in the
the body's own "vital force."    nificant reduction in chest        noninvasive evaluation of
By so doing, a person is         pain events from 8.87 to 3.3       patients with suspected
able to heal himself or her-     episodes per month. In addi-       coronary artery disease. J
self rather than relying on      tion, 5 of 11 participants had     Am Coll Cardiol
pharmaceutical agents. To        a drop in blood pressure.          1983;1:444-455
date, there is little research   There was also an insignifi-       3. Chesebro JH, Fuster V,
on homeopathic medicine          cant rise in HDL. Other com-       Elveback LR, et al. Strong
for the treatment of cardio-     ponents of Ayurvedic               family history and cigarette
vascular disease and specif-     Medicine have demonstrated         smoking as risk factors of
ically CHD. Therefore, its       benefit in reducing the risk       coronary artery disease in
use for these conditions         factors associated with the        young adults. Br Heart J
remains to be established.       development of CHD. For            1982;47:78
                                 instance, yoga has been            4. Phillips AN, Shaper AG,
AYURVEDA                         shown to lower blood pres-         Pocock SJ, et al. Parental
Ayurvedic Medicine was           sure (see Yoga). For now,          death from heart disease
founded in ancient India         more studies are needed in         and the risk of heart attack.
around 3500 B.C. It is           order to better clarify the role   Eur Heart J 1988;9:243
known in Hindu texts as the      of Ayurvedic Medicine as a         5. Second report of the
Vedas, meaning "science of       whole in the prevention and        expert panel on detection,
life." In Ayurvedic medicine,    treatment of CHD.                  evaluation, and treatment of
practitioners prescribe treat-                                      high blood cholesterol in
ment and preventative thera-         Study participants             adults. The National
py consisting of diet, herbal                                       Cholesterol Education
                                     treated for six
supplements, exercise and                                           Program. Bethesda (MD):
yoga, as well as other treat-        months with                    National Institutes of Health,
ments in order to maintain a         Maharishi Amrit                National Heart, Lund, and
person's balance in life.                                           Blood Institute;1993. NIH
Little research is available         Kalash 4 and 5                 Publication No. 93-3095. I-
with regard to the healing           (MAK-4 and MAK-                13
power of Ayurvedic medicine          5) demonstrated a              6. LaCroix AZ, Lang J,
for cardiovascular disease,                                         Scherr P, et al. Smoking
or specifically CHD. One             significant reduction          and mortality among older
study performed in India             in chest pain events.          men and women in three
examined the healing power                                          communities. N Engl J Med
of two Ayurvedic tonics in                                          1991;324:1619-1625
the reduction of chest pain                                         7. Wolf PA, D'Agostino RB,
(angina) attributed to the       REFERENCES                         Kannel WB, Bonita R,
heart (119). These tonics,       1. Heart and Stroke Facts:         Belanger AJ. Cigarette
Maharishi Amrit Kalash 4         1995 Statistical Supplement        smoking as a risk factor for
and 5 (MAK-4, MAK-5), both       by American Heart                  stroke: the Framingham
contain a large number of        Association                        Study. JAMA
ingredients. In this study,      2. Diamond GA, Staniloff HM,       1988;259:1025-9
those actively treated           Forrester JS et al. Computer.
8. Joint National Committee.      heart disease. In: Parmley        18. Wood PD, Stefanick
The Fifth Report of the Joint     WW, Chatterjee K, editors.        ML, Williams PT, Haskell
National Committee on             Cardiology. Philadelphia: J.B.    WL. The effects of plasma
Detection, Evaluation, and        Lippincott, 1987;1-41             lipoproteins of a prudent
Treatment of High Blood           13. Barrett-Connor E,             weight-reducing diet, with or
Pressure. Bethesda (MD):          Wingard DL. Sex differential      without exercise, in over-
National Institutes of Health,    in ischemic heart disease         weight men and women. N
National Heart, Lung, and         mortality in diabetics: a         Engl J Med 1991;325:461-6
Blood Institute;1993. NIH         prospective population-based      19. Manson JE, Colditz GA,
Publication No. 93-1088. 49       study. Am J Epidemiol             Stampfer MJ, et al. A
p                                 1983;118:489-496                  prospective study of maturi-
9. Stamler J, Wentworth D,        14. Larsson B, Svardsudd K,       ty-onset diabetes mellitus
Neaton JD. Is the relation-       Welin L, Wilhelmsen L,            and risk of coronary heart
ship between serum choles-        Bjorntorp P, Tibblin G.           disease and stroke in
terol and risk of premature       Abdominal adipose tissue          women. Arch Intern Med
death from coronary heart         distribution, obesity, and risk   1991;151:1141-7
disease continuous and            of cardiovascular disease         20. King H, Kriska AM.
graded? Findings in 356,222       and death: 13 year follow-up      Prevention of type II dia-
primary screenees of the          of participants in the study of   betes by physical training:
Multiple Risk Factor              men born in 1913. Br Med J        epidemiological considera-
Intervention Trial (MRFIT).       1984;288:1401-4                   tions and study methods.
JAMA 1986;256:2823-8              15. Larsson B, Bengtsson C,       Diabetes Care
10. Buchwald J. Varco RL.         Jjorntorp P, et al. Is abdomi-    1992;15(11):1794-9
Matts JP, et al. Effect of par-   nal body fat distribution a       21. Helmrich SP, Ragland
tial ileal bypass surgery on      major explanation for the sex     DR, Leung RW,
mortality and morbidity from      difference in the incidence of    Paffenbarger RS Jr.
coronary heart disease in         myocardial infarction? The        Physical activity and
patients with hypercholes-        study of men born in 1913         reduced occurrence of non-
terolemia: report of the          and the study of women. Am        insulin-dependent diabetes
Program on the Surgical           J Epidemiol 1992;135:266-73       mellitus. N Engl J Med
Control of Hyperlipidemias        16. Freedman DS, Jacobsen         1991;325:147-152
(POSCH). N Engl J Med             SJ, Barboriak JJ, et al. Body     22. Law MR, Wald NJ,
1990;323:946-955                  fat distribution and              Thompson SG. By how
11. Heyden S, Heiss G,            male/female differences in        much and how quickly does
Bartel AG, Hames CG. Sex          lipids and lipoproteins.          reduction in serum choles-
differences in coronary mor-      Circulation 1990;81:1498-506      terol concentration lower
tality among diabetics in         17. Leon AS, Connett J,           risk of ischaemic heart dis-
Evans County, Georgia. J          Jacobs DR Jr, Rauramaa R.         ease? BMJ 1994;308:367-
Chronic Dis 1980;33:265-          Leisure-time physical activity    373
273                               levels and risk of coronary       23. Ornish D, Brown SE,
12. Stamler J. Epidemiology,      heart disease and death: the      Scherwitz LW, Billings JH,
established major risk fac-       Multiple Risk Factor              et al. Can lifestyle changes
tors, and the primary pre-        Intervention Trial. JAMA          reverse coronary heart dis-
vention of coronary               1987;258:2388-95                  ease? The Lifestyle Heart
Trial. Lancet 1990;336:129-       Clin Nutr                         Connection 1999-2000;8(1)
133                               2000;71(Suppl);179S-188S          38. Busch F. "The New
24. Appel LJ, Moore TJ,           31. Rimm EB, Giovannucci          Nutrition: From Antioxidants
Obarzanek E, et al. A clinical    EL, Willett WC, et al.            to Zucchini" John Wiley &
trial of the effects of dietary   Prospective study of alcohol      Sons. New York, NY 2000
patterns on blood pressure.       consumption and risk of coro-     39. Keys, A. (ed.). Coronary
NEJM 1997;336(16):1117-24         nary disease in men. Lancet       heart disease in seven
25. Cappuccio FP,                 1991;338:464-468                  countries. Circulation
MacGregor GA. Does potas-         32. Gaziano JM, Buring JE,        41(Suppl. 1), 1970
sium supplementation lower        Breslow JL, et al. Moderate       40. Hu FB, Stampfer MJ,
blood pressure: a meta-           alcohol intake, increased lev-    Rimm EB, et al. A prospec-
analysis of published trials. J   els of high-density lipoprotein   tive study of egg consump-
Hypertens 1991;9:465-473          and its subfractions, and         tion and risk of cardiovascu-
26. Simopoulos AP.                decreased risk of myocardial      lar disease in men and
Essential fatty acids in          infarction. N Engl J Med          women. JAMA
health and chronic disease.       1993;329:1829-1834                1999;281:1387-94
Am J Clin Nutr                    33. Sato M, Ray PS, Laulik        41. Dulloo AG, Duret C,
1999;70(Suppl):5605-5695          G, et al. Myocardial protec-      Rohrer D, et al. Efficacy of
27. Harris WS.                    tion with red wine extract. J     a green tea extract rich in
Nonpharmacologic treatment        Cardiovasc Pharmacol              catechin polyphenols and
of hypertriglyceridemia:          2000;35:263-68                    caffeine in increasing 24-h
Focus on fish oils. Clin          34. Nigdikar SV, Williams NR,     energy expenditure and fat
Cardiol 1999;22(Suppl 6);II-      Griffin BA, Howard AN.            oxidation in humans. Am J
40-43                             Consumption of red wine           Clin Nutr 1999;70:1040-5
28. Hornstra G, Barth CA,         polyphenols reduces the sus-      42. Graham HN. Green tea
Galli C, et al. Functional        ceptibility of low-density        composition, consumption,
food science and the cardio-      lipoproteins to oxidation in      and polyphenol chemistry.
vascular system. Br J Nutr        vivo. Am J Clin Nutr              Prev Med 1992;21:334-50
1998;80(Suppl II):S113-S146       1998;68:258-65                    43. Hollman PC, Feskens
29. Rissanen T, Voutilainen       35. De Oliveira e Silva ER,       EJ, Katan MB. Tea flavonols
S, Nyyssonen K et al. Fish        Foster D, McGee Harper M,         in cardiovascular disease
oil-derived fatty acids,          et al. Alcohol consumption        and cancer epidemiology.
docosahexaenoic acid and          raises HDL cholesterol levels     Proc Soc Exp Biol Med
docosapentaenoic acid, and        by increasing the transport       1999;220(4):198-202
the risk of acute coronary        rate of apolipoproteins A-I       44. Larson DE. Mayo Clinic
events: The Kuopio                and A-II. Circulation             Family Health Book. William
ischaemic heart disease risk      2000;102:2347-2352                Morrow and Company. New
factor study. Circulation         36. Lichtenstein AH. Soy pro-     york, NY. 1st ed. 1990;408
2000;102:2677-2679                tein, isoflavones and cardio-     45. Thun MJ, Apicella LF,
30. Kris-Etherton PM,             vascular disease risk. J Nutr     Henley SJ. Smoking vs
Shaffer Taylor D, Yu-Poth S,      1998;128:1589-1592                other risk factors as the
et al. Polyunsaturated fatty      37. Hasler C. Public health       cause of smoking-attributa-
acids in the food chain in the    implications of the soy pro-      ble deaths: confounding in
United States. Am J               tein health claim. The Soy        the courtroom. JAMA
2000:706-12                      trial." Am J Clin Nutr           59. Yusuf S, Dagenais G,
46. Kannel WB.                   1999;69(1):99-104                Pogue J, et al. Vitamin E
Hypertension, blood lipids,      53. Woodside JV, Yarnell JW,     supplementation and car-
and cigarette smoking as co-     McMaster D, et al. "Effect of    diovascular events in high-
risk factors for coronary        hyperhomocysteinemia: a          risk patients. The Heart
heart disease. Ann NY Acad       double-blind, randomized,        Outcomes Prevention
Sci 1978;304:128                 factorial-design, controlled     Evaluation Study
47. Kaufman DW, Helmrich,        trial." Am J Clin Nutr           Investigators. N Engl J Med
SP, Rosenberg L, et al.          1998;67(5):858-866               2000;342:154-160
Nicotine and carbon monox-       54. Brattstrom LE, Israelsson    60. GISSI-Prevenzione
ide content of cigarette         B, Jeppsson JO, et al. "Folic    Investigators. Lancet
smoke and the risk of            acid-an innocuous means to       1999;354:447-455
myocardial infarction in         reduce plasma homocys-           61. Kehoe WA. Vitamin E
young men. N Engl J Med          teine." Scand J Clin Lab         and heart disease.
1983;308:409                     Invest 1988;48(3):215-221        Pharmacist's Letter
48. Larson DE. Mayo Clinic       55. Chao CL, Chien KL, Lee       2000;16(3):160307
Family Health Book. William      YT. Effect of short-term vita-   62. Brzezinski A,
Morrow and Company. New          min (folic acid, vitamins B6     Adlercreutz H, Sheoul R, et
York, NY. 1990;1st ed:413-       and B12) administration on       al. Short-term effects of
415                              endothelial dysfunction          phytoestrogen-rich diet on
49. Neve J. "Selenium as a       induced by post-methionine       postmenopausal women.
risk factor for cardiovascular   load hyperhomocysteinemia.       Menopause 1997;4:89-94
diseases." J Cardiovasc          Am J Cardiol 1999;84:1359-       63. Tornwall ME, Virtamo J,
Risk 1996;3(1):42-7              1361                             Haukka JK, et al. The effect
50. Landgren F, Israelsson       56. Rimm EB, Stampfer JJ,        of alpha-tocopherol and
B, Lindgren A, et al. "Plasma    Ascherio A, et al. Vitamin E     beta-carotene supplementa-
homocysteine in acute            consumption and the risk of      tion on symptoms and pro-
myocardial infarction:homo-      coronary heart disease in        gression of intermittent
cysteine-lowering effect of      men. N Engl J Med                claudication in a controlled
folic acid." J Intern Med        1993;328:1450-1456               trial. Atherosclerosis
1995;237(4):381-388              57. Stampfer MJ, Hennekens       1999;147:193-197
51. Christensen B, Landaas       CH, Manson JE, et al.            64. Gey FG, Moser UK,
S, Stensvold I, et al. Whole     Vitamin E consumption and        Jordan P, et al. Increased
blood folate, homocysteine       the risk of coronary disease     risk of cardiovascular dis-
in serum, and risk of first      in women. N Engl J Med           ease at suboptimal plasma
acute myocardial infarction.     1993;328:1444-1449               concentrations of essential
Athereosclerosis                 58. Stephens NG, Parsons A,      antioxidants: an epidemio-
1999;147(2):317-326              Schofield PM, et al.             logical update with special
52. Brouwer IA, Van              Randomised controlled trial      attention to carotene and
Dusseldorp M, Thomas CM,         of vitamin E in patients with    vitamin C. Am J Clin Nutr
et al. "Low-dose folic acid      coronary disease: Cambridge      1993;57:787S-97S
supplementation decreases        Heart Antioxidant Study          65. Manson JE, Gaziano
plasma homocysteine con-         (CHAOS) Lancet                   JM, Jones MA, Hennekens
centrations: a randomized        1996;347:781-786                 CH. Antioxidants and
cardiovascular disease: a      72. Lasserre B, Spoerri M,         experience. Am J Cardiol
review. J Am Coll Nutr         Moullet V, et al. "Should mag-     1989;63:26G
1993;12:426-32                 nesium therapy be consid-          78. Kamikawa T, Kobayshi
66. Flaherty JT, Pitt B,       ered for the treatment of          A, Yamashita T, et al.
Gruber JW, et al.              coronary heart disease? II.        "Effects of coenzyme Q10
Recombinant human super-       Epidemiological evidence in        on exercise tolerance in
oxide dismutase (h-SOD)        outpatients with and without       chronic stable angina pec-
fails to improve recovery of   coronary heart disease."           toris." Am J Cardiol
ventricular function in        Magnes Res 1994;7(2):145-          1985;56(4):247-51
patients undergoing coro-      53                                 79. Blumenthal M, et al. Ed.
nary angioplasty for acute     73. Preuss HG, Gondal JA,          The Complete German
myocardial infarction.         Lieberman S. "Association of       Commission E
Circulation 1994;89(5):1982-   macronutrients and energy          Monographs: Therapeutic
91                             intake with hypertension." J       Guide to Herbal Medicines.
67. Murohara Y, Yui Y,         Am Coll Nutr 1996;15(1):21-        Trans. S. Klein. Boston,
Hattori R, et al. Effects of   35                                 MA: American Botanical
superoxide dismutase on        74. Yamori I, Nara Y,              Council, 1998
reperfusion arrhythmias and    Mizushima S, et al.                80. Newall CA, Anderson
left ventricular function in   "Nutritional factors for stroke    LA, Philpson JD. Herbal
patients undergoing throm-     and major cardiovascular dis-      Medicine: A Guide for
bolysis for anterior wall      eases: international epidemi-      Healthcare Professionals.
acute myocardial infarction.   ological comparison of             London, UK: The
Am J Cardiol                   dietary prevention. " Health       Pharmaceutical Press, 1996
1991;67(8):765-7               Rep 1994;6(1):22-27                81. Imai J, Ide N, Nagae S,
68. Pelletier KR. "The Best    75. Sanjuliani AF, de Abrue        et al. Antioxidant and radi-
Alternative Medicine: What     Fagundes VG, Francischetti         cal scavenging effects of
Works? What does not?"         EA. "Effects of magnesium          aged garlic extract and its
Simon & Schuster. New          on blood pressure and intra-       constituents. Planta Med
York, NY 2000;108-110          cellular ion levels of Brazilian   1994;60:417-420 82.
69. Herrington D, et al.       hypertensive patients." Int J      Schussler M, Holzl J, Fricke
DHEA and coronary athero-      Cardiol 1996;56(2):177-183         U, Myocardial effects of
sclerosis. Ann of New York     76. Widman L, Wester PO,           flavonoids from Crataegus
Acad Science 1995;774:271-     Stegmayr BK, et al. "The           species. In:
80                             dose-dependent reduction in        Arzneimittelforschung
70. Natural Medicines          blood pressure through             45(8):842-845, Aug, 1995
Comprehensive Database.        administration of magnesium.       83. Cacciatore L, Cerio R,
3rd ed. Stockton, CA.          A double blind placebo con-        Ciarimboli M, et al. The
Therapeutic Research           trolled cross-over study." Am      therapeutic effect of L-carni-
Faculty. 2000                  J Hypertens 1993;6(1):161-         tine in patients with exer-
71. Micromedex(r)              165                                cise-induced stable angina:
Healthcare Series:             77. Whelton, P.K., and Klag,       a controlled study. Drugs
Micromedex Inc.,               M.J.: Magnesium and blood          Exp Clin Res
Englewood, Colorado.           pressure: Review of the epi-       1991;17(4):225-35
(Vol.101, expires 9/1999)      demiologic and clinical trial      84. Cherchi A, Lai C,
Angelino F, et al. Effects of L   90. Manson J, et al. A            97. Wang. Effects of Qigong
carnitine on exercise toler-      prospective study of walking      on preventing stroke and
ance in chronic stable angi-      as compared with vigorous         alleviating the multiple-cere-
na: a multicenter, double-        exercise in the prevention of     bro-cardiovascular risk fac-
blind, randomized, placebo        coronary heart disease in         tors; a follow-up report on
controlled crossover study.       women. N Engl J Med               242 hypertensive cases
Int J Clin Pharmacol Ther         1999;341:650-658                  over 30 years.
Toxicol, 1985;23(10):569-72       91. Lee IM, Sesso HD,             Proceedings, Second World
85. Sesso, HD, Paffenbarger       Paffenbarger RS Jr. Physical      Conference for Academic
RS Jr, Lee IM. Physical           activity and coronary heart       Exchange of Medical
activity and coronary heart       disease risk in men: Does the     Qigong, Beijing, China.
disease in men: The               duration of exercise episodes     1993;123-124
Harvard Alumni Health             predict risk? Circulation         98. Karasek RA, Theorell T,
Study. Circulation                2000;102:981-986                  Schwartz JE, et al. Job
2000;102:975-980                  92. Grossman E, Oren S,           characteristics in relation to
86. Shaw LW. Effects of a         Garavaglia GE, et al:             the prevalence of myocar-
prescribed supervised exer-       Disparate hemodynamic and         dial infarction in the US
cise program on mortality         sympathoadrenergic respons-       Health Examination Survey
and cardiovascular morbidity      es to isometric and mental        (HES) and the Health and
in patients after a myocardial    stress in essential hyperten-     Nutrition Examination
infarction. Am J Cardiol          sion. Am J Cardiol                Survey (HANES). American
1981;48:39-46                     1989;64:42                        Journal of Public Health
87. Carson P, Phillips R,         93. Bermon S. Medicine and        1988;78:910-18
Lloyd M, et al. Exercise after    Science in Sports and             99. Dath NNS et al.
myocardial infarction: a con-     Exercise 2000;1845-1848           Behavioral approach to
trolled trial. J R Coll           94. Patel C. Yoga and bio-        coronary heart disease. J
Physicians Lond                   feedback in the management        Person Clin Stud
1982;16:147-151                   of hypertension. Lancet           1997;13(1-2):29-33
88. Hamalainen H, Luurila         1973;1053-1055                    100. Van Dixhoorn J.
OJ, Kallio V, Knuts L-R.          95. Telles S, et al.              Cardiorespiratory effects of
Reduction in sudden deaths        Physiological changes in          breathing and relaxation
and coronary mortality in         sports teachers following 3       instruction in myocardial
myocardial infarction             months of training in Yoga.       infarction patients. Bio
patients after rehabilitation:    Indian Journal of Medical         Psychol 1998;49(1-2);123-
15-year follow-up study. Eur      Sciences. 1993;47(10):235-        135
Heart J 1995;16:1839-1844         238                               101. Zamarra J, et al.
89. Wannamethee SG,               96. Jin P. Efficacy of tai chi,   Usefulness of the transcen-
Shaper G, Walker M.               brisk walking, meditation, and    dental meditation program
Physical activity and mortali-    reading in reducing mental        in the treatment of patients
ty in older men with diag-        and emotional stress.             with coronary artery dis-
nosed coronary heart dis-         Journal of Psychosomatic          ease. Am J Cardiol
ease. Circulation                 Research 1992;36(4):361-          1996;77(10):867-870
2000;102:1358-1363                370                               102. Castleman, M.
                                                                    Blended Medicine: The Best
Choices in Healing. Rodale.      110. Does prayer help              on physiological and psy-
St. Martin's Press. 2000(1st     patients? MD                      chological outcomes for
ed);338                          1986;December:35                  patients having open heart
103. Sharpley C.                 111. Friedmann E, et al.          surgery. (submitted for pub-
Maintenance and generaliz-       Animal companions and one-        lication)
ability of laboratory based      year survival of patients after   119. Dogra J. Indigenous
heart rate reactivity control    discharge from a coronary         free radical scavenger MAK
training. Journal of             care unit. Public Health Rep.     4 and 5 in angina pectoris.
Behavioral Medicine              1980;95(4):307-12                 Is it only a placebo? Journal
1994;17(3):230-233               112. Katcher AH, Friedmann        of the Association of
104. Nakao M, et al. Clinical    E. Potential health value of      Physicians of India
effects of blood pressure        pet ownership. Continuing         1994;42(6):466-7
biofeedback treatment on         Education 1980;2(2):117-121
hypertension by auto-shap-       113. Dossey L. The healing
ing. Psychosomatic               power of pets: A look at ani-
Medicine 1997;59:331-338         mal-assisted therapy.
105. Russek LG, Schwartz         Alternative Therapies
GE. Narrative descriptions of    1997;3(4):8-16
parental love and caring pre-    114. Bolwerk, CAL. Effects of
dict health status in midlife:   relaxing music for patients
A 35-year follow-up on the       with AMI music on state anxi-
Harvard Mastery of Stress        ety in myocardial infarction
Study. Alternative Therapies     patients. Critical Care
1996;2(6):55-62                  Nursing Quarterly
106. Quinn JF. Therapeutic       1999;13:63-72
touch as energy exchange:        115. Updike P. Music therapy
Replication and extension.       results for ICU patients.
Nursing Science Quarterly        DCCN 1990;9(1):39-45
1989;12:78-87 107. Elgin D,      116. White J. Effects of relax-
LeDrew C. Global con-            ing music on cardiac auto-
sciousness change.               nomic balance and anxiety
(Unpublished manuscript,         after acute myocardial infarc-
1997)                            tion. American Journal of
108. Matthews DA, Larson         Critical Care 1999;8(4):220-
DB. The faith factor: An         230
annotated bibliography of        117. Zimmerman LM, Pierson
clinical research on spiritual   MA, Marker J. Effects of
subjects. National Institute     music on patient anxiety in
for Healthcare Research          coronary care units. Heart
1995;3                           and Lung 1988;17(5):560-
109. Koenig HG. Intrinsic        566
religiosity and depression.      118. Miller Eh, Sendelbach
American Journal of              SE, Doran KA, Halm MA.
Psychiatry 1998;110-114          Effects of music therapy
             Lifestyle Changes May Reduce Your Need for
                     Antihypertensive Medications.
High blood pressure, also        In the present study, 42% of individuals were able to main-
known as hypertension, is a      tain normal blood pressure for one year following the
major risk factor for cardio-    supervised withdrawal of medication.
vascular disease. This silent
killer frequently has no         first 6 months following with-    This article concludes that
symptoms until a devastat-       drawal of medication, but         appropriate individuals for
ing event such as stroke or      some individuals had return       consideration of withdrawal
heart attack occurs.             of hypertension even after 6      of antihypertensive medica-
Approximately 10% of peo-        months. It is important to        tion are those people who
ple in Western countries         keep in mind that blood pres-     are on only one medication
take medication to control       sure may rapidly escalate fol-    and have been well con-
their blood pressure. If sim-    lowing discontinuation of ther-   trolled for a long period of
ple steps are taken to           apy, so called "rebound           time. It is important to
reduce the need for drug         hypertension.”                    never stop taking medica-
therapy, perhaps some med-                                         tions without the consent of
ications may not be            As noted by the researchers,        a doctor.
required. In a recently pub-   lifestyle modifications play an
lished article in the American important role in reducing the      Lifestyle changes which
Journal of Hypertension, Dr.   need for medications and            may reduce your need for
Mark Nelson analyzed the       perhaps facilitating their with-    blood pressure
results of 12 studies that     drawal. Previous studies            medications include:
examined the effects of with-  have demonstrated that              • Losing weight
drawal of high blood pres-     lifestyle interventions can         • Decreasing sodium
sure medications over at       double the success rate of            intake
least a one-year period. He    maintaining a normal blood          • Reducing alcohol
and his colleagues identified  pressure after withdrawal of          consumption
several predictors of suc-     medication. Weight loss and         • Increasing physical
cessful withdrawal of med-     sodium restriction were               activity
ication with continued main-   important predictors of suc-
tenance of normal blood        cess in this study. Reducing        Title: A Systematic Review
pressure.                      alcohol intake and increasing       of Predictors of
                               physical activity have also         Maintenance of
The risk of return to elevated been shown to be beneficial.        Normotension After
levels was greatest in the                                         Withdrawal of
                                                                   Antihypertensive Drugs
 Those factors most associated with successful withdrawal of       Authors: Mark Nelson,
 high blood pressure medications included:                         Christopher Reid, Henry
 • Mild blood pressure elevation before drug therapy was           Krum and John McNeil
                                                                   Source: American Journal of
 • Few drugs required for effective treatment (preferably one)
 • Lifestyle intervention                                          Hypertension. 2001;14:98-

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