study of strokes and undetected AF

[www.medpagetoday.com]

Once again, no mention of Lone AF... but it does serve to point out the need to be aware of measurable risk factors. These lab evaluations are available and every afibber should know their numbers. These tests are not usually considered standard tests by most physicians in general checkups or even by cardiologists.... so it's up to you to request the tests you want. Some may not be covered by insurance. Ask.

We can also make sure that we are taking the supplements that deter platelet aggregation... such as magnesium, Omega 3 fish oils, Nattokinase, CoQ10 for the antioxidant properties. Some the following directives have been modified and improved. This is just a guideline.



From the original post dated 12/29/02... Red Flags to Beat the Odds

PREDICTING YOUR RISK FOR HEART ATTACK OR STROKE –THE SILENT SYMPTOMS

Everyone interested in heart health must be aware of the need to identify components of toxic blood. Beyond standard screening tests for blood lipid levels (cholesterol and triglycerides), there are tests for risk markers that predict cardiovascular disease or stroke. These tests are beginning to become more routine but, generally, you must specifically request that your doctor order them. Some, are not covered by insurance.

Following are these markers with thumbnail sketch descriptions, an acceptable healthy range and natural remedies for prevention or therapeutics. The ranges will vary by doctor and lab and for this post, are meant to be just a general reference. Internet searches will provide a plethora of information. The intent of this post is to create awareness and stimulate independent research. Sources for my information include all my favorite natural health gurus, Julian Whitaker MD, Michael Murray, ND, Joseph Mercola, DO, Stephen Sinatra MD – just to name a few.

C-REACTIVE PROTEIN (The High Sensitivity or Cardiac CRP)- is an antibody-like substance and a marker of a future risk of symptomatic peripheral vascular disease and heart disease. It is a protein, and if elevated, indicates arteries are inflamed. Inflammation stimulates white blood cells and can cause cholesterol deposits to break off and clog arteries or weaken unstable plaque and trigger a heart attack or stroke.

Elevated standard CRP indicates inflammation from trauma, allergy, systemic diseases (rheumatoid arthritis), infection (including pneumonia, herpes, chlamydia and possibly viral infection that simulates a cold.) It is commonly found along with traditional risk factors such as smoking, obesity, high blood lipids, diabetes, hypertension and in victims of acute heart attack and unstable chest pains.

Reference range: .00 - .50 mg/dl… with ideal being as close to zero as possible.

Natural remedies include CoQ10, Beta 1/3/, 1/6 glucan, bromelain, ginger root, ginger tea. See Hans’ book - the chapter on Stroke prevention p. 124 and Inflammation p. 130.

HOMOCYSTEINE ( ho mo sis teen)
It’s been known since 1960 that homocysteine was linked to cardiovascular diseases, but the research community leaned toward the importance of “the cholesterol theory of heart disease” until about 4 years ago when national news officially recognized that vitamins B6 B12 and folic acid can prevent heart disease… thereby validating the significance of a nutritional approach to treatment. These B vitamins, folate, and choline neutralize this dangerous compound.

Homocysteine is a dangerous amino acid that promotes free-radical oxidative stress and accelerates aging of the circulatory system by disrupting cell membranes in blood vessels and damaging arterial walls… causing premature heart disease. Researchers think excess levels allow cholesterol to penetrate blood vessel walls and start plaque formation. Over 20 studies indicate men and women with high homocysteine levels continue to have heart attacks and strokes.

Homocysteine is produced during the metabolism of the amino acid, methionine. In a healthy body, homocysteine is either recycled back into methionine or altered to another harmless substance in a process called methylation.

However, if there are insufficient B vitamins for the recycling process (methylation), it converts methionine (amino acid in red meat) into homocysteine instead of a usable form. Elevated levels of homocysteine contribute, big-time, to inflammation in the linings of blood vessels and the heart; endothelial inflammation seems to be a risk factor for afib. Cholesterol deposits amass to fill in the area damaged by inflammation… setting the stage for heart attack or stroke.

In addition to arteriosclerosis and atherosclerosis, homocysteine increases the tendency for blood to clot, increases collagen deposition in arteries and other blood vessels making the arteries less flexible and increasing blood pressure and accelerates aging of endothelial cells.

The process of methylation is critical and since space is limited here, I suggest you research the process on your own and understand it. A great reference is the book, Methyl Magic by Craig Cooney, Ph.D. who says:
"Methylation helps give life, and it can take it away. In fact, without methylation there would be no life at all."
"In our bodies, methylation takes place more than a billion times a second.
A preview article by Dr. Cooney can be reviewed at [www.lef.org]

Natural approaches
B vitamins are important and easy to get from food – leafy green veggies, beans, legumes, freshly squeezed OJ, limit red meat to twice a week. Eliminate processed and packaged foods.

Supplementation includes B vitamins with emphasis on Folic Acid 400 mcg. daily, minimum of 3 mg. (Now changed from folic acid to natural Folate - the L-MTHF form). Vit. B 6, and 5 – 10 mcg. B12. Supplemental L-Methionine is also suggested with supervision. These are conservative recommendations…higher is more common.

10-15% of people are B-vitamin resistant, but respond to supplemental trimethylglycine (TMG) – 500 – 1000 mg. a day and recheck levels in 3 – 4 months.

Note: Niacin raises homocysteine as does theophylline, methotrexate and L-dopa. If you have a family history of heart disease, or are hypothyroid, have lupus or kidney disease, check your levels.
Safe Range:
High homocysteine is a serious health hazard. Protect your health and slow aging by keeping blood plasma levels below 10 micromolar and preferably below 7 micromolar. (http://www.methyl.org/researchupdates.html)

Cardiologist, Stephen Sinatra says “Generally, “normal” for homocysteine is anything between 5 and 15 micromoles per liter, but epidemiological evidence suggests that optimal levels are less than 8 mm/l. Population studies in the Mediterranean Basin (France and Spain) have low mortality from cardiovascular disease, with levels averaging 7 –8 mm/l. In countries with high mortality rates (Finland Scotland, Northern Ireland, Germany) homocysteine levels average 10 – 11 mm/l. He considers anything above 9 to be dangerous.” (Sinatra Health Report 3/01)

FIBRINOGEN
Is an independent risk factor and can indicate individual increased risk for heart disease in the absence of other indicators. While necessary for clotting when injured, a higher-than-normal level creates clumping blood.

It is influenced by genetic predisposition and high levels are enhanced by smoking and estrogen compounds as in birth control pills. Studies show a correlation between high fibrinogen concentrations and coronary artery calcification and conclude these to be markers for pre-clinical atherosclerosis- with stronger trends in women participants including younger women.

Ranges
Less than 300 mg/dL is considered favorable
More than 360 mg/dl is unfavorable.

Those with a family history of heart disease or coronary atherosclerosis must have fibrinogen levels checked.

Natural blood thinners – garlic, ginger, fish oil, Vitamin E, ginkgo biloba, bromelain – See Hans Book for details.
Nattokinase lowers fibrinogen

LIPOPROTEIN(a) [Lp(a)]
Is a cholesterol particle with an adhesive protein coating giving it sticky properties that cause inflammation and clogging of blood vessels because of its repair properties.

It is very effective UNLESS in the presence of a Vitamin C deficiency, and then, it is one of the most dangerous risk factors for atherosclerosis. Although it has been known for over 40 years, it isn’t common in screening tests.
What should your Lp(a) level be?
<10 mg/dL - acceptable
11-24 mg/dL -borderline high
>25 mg/dL - very high

NOTE: If your Lp (a) level is over 10 mg per deciliter (dL) of blood, you need to take action at once.
Lp(a) is entirely hereditary. Studies indicate people with the highest levels have 70% more heart attacks than with lower levels.

Modifying Lp(a) is very difficult but can be modified some with the following protocol – which should ONLY be followed by those who have tested out high… as the doses of the supplements are high.
Vit. C 2- 4 grams
Q10 120 mg.
L-Carnitine 1 – 2 grams
Omega 3’s 1 – 2 grams
L-lysine 500-1000 mg
L-proline 500-1000 mg.
No flush niacin – niacinamide 1 – 2 grams.
Eat fresh fish, reduce saturated fats, eliminate all hydrogenated fats; avoid soy products;
Exercise regularly. (Heart Sense 12/00)

Dr. Mercola’s comment:
Elevated levels of Lp(a) are frequently overlooked by traditional medicine as a cause of heart disease. Part of the reason why it is not looked for by traditional medicine is that they really do not have a good way to treat it. They have not discovered any drugs to lower Lp(a). The only thing that appears to work is the specific type of pharmacological nutrient manipulation discussed by Pauling. (www.mercola.com)

SERUM FERRITIN
Reflects iron stored in the body – excess iron is toxic and can injure every part of the body including the heart and brain.. and cause or contribute to arrhythmias.

Lab ranges 10-191 ng/ml. with a preferable below 100. (some reports now say 50)

Natural remedies are easy – just donate blood and keep checking the levels until within a normal range. Avoid supplements and foods containing added iron and limit intake of red meat.

High serum ferritin levels may be associated with inflammation, liver disease, megaloblastic anemia, hemolytic anemia, sideroblastic anemia, thalassemia, iron overload (hemochromatosis, hemosiderosis), malignant diseases including leukemia and malignant lymphoma. Very high levels indicate iron overload. Ferritin levels in hemochromatosis may be >1000 ng/mL. Increased serum ferritin may be a risk factor in primary hepatocellular carcinoma. [www.labcorp.com]

Serum ferritin levels, however, can be nonspecifically elevated in patients with inflammation and or liver disease, regardless of iron stores. This is attributed to hepatocellular leakage of ferritin from damaged cells.
Joint pain is the most common complaint of people with iron overload ( hemochromatosis). Other common symptoms include fatigue, lack of energy, abdominal pain, loss of sex drive, and heart problems. Symptoms tend to occur in men between the ages of 30 and 50 and in women over age 50. However, many people have no symptoms when they are diagnosed.

If the disease is not detected early and treated, iron may accumulate in body tissues and may eventually lead to serious problems such as
• arthritis
•liver disease, including an enlarged liver, cirrhosis, cancer, and liver failure
•damage to the pancreas, possibly causing diabetes
•heart abnormalities, such as irregular heart rhythms or congestive heart failure
•impotence
•early menopause
•abnormal pigmentation of the skin, making it look gray or bronze
•thyroid deficiency
•damage to the adrenal gland

Hemochromatosis is often undiagnosed and untreated. It is considered rare and doctors may not think to test for it. The initial symptoms can be diverse and vague and can mimic the symptoms of many other diseases.

Also, doctors may focus on the conditions caused by hemochromatosis--arthritis, liver disease, heart disease, or diabetes--rather than on the underlying iron overload. However, if the iron overload caused by hemochromatosis is diagnosed and treated before organ damage has occurred, a person can live a normal, healthy life.

OXIDIZED LDL
Oxidation of cholesterol is significant in the formation of cholesterol plaque leading to early stages of atherosclerosis. LDL cholesterol is the major culprit in that it builds up on arterial walls and becomes a problem when it is oxidized - known then as partially oxidized LDL.

This is caused by:
1. high triglycerides
2. low HDL levels
3. improper metabolism of blood fats because of inefficient fat metabolism –as in diabetes

Natural Remedies (changes in thinking have occurred since this original post)...

-Ortho molecular doses of niacin B3 – the no flush type ( supervision of MD)
-2 grams (at least) daily of Omega 3 essential fatty acids to increase HDL levels
-One baby aspirin every other day to reduce clotting factors.. or ginkgo biloba...
-1.5 grams daily of Acetyl L-carnitine in divided doses to reduce levels of blood fats by increasing the efficiency of transport to cell mitochondria where fat is burned for cellular energy.
-NAC is the ulitmate antioxidant and should be on everyone's list... along with generous dosing of vitamin C.
- CoQ10 helps break down fat for ATP production. 100 mg. Q gels/day minimum. Many people benefit from the ubiquinol form of CoQ10.

The tocotrienol form of Vitamin E has significantly greater antioxidant capability than regular tocopherol and lowers LDL cholesterol which the regular does not. Dosage is 50-100 mg daily. (www.drsinatra.com)

Tocotrienol should be taken away from doses of supplemental Gamma E tocopherols to avoid competitiion. Take the Gamma E in the morning; the tocotrienol at night.

A couple of comments;

My fibrinogen raised considerably while taking nattokinase - tested three times over 9 months. I'm probably the bastard son of an extra-terrestrial tho', my mom's not talking...
Standard CRP readings are practically worthless, IMO, unless the test is specific to a particular diagnosis. I've had that test many times just for info's sake and it is sometimes very high, sometimes normal, with no changes in my health other than typical minor athletic activity-related aches and pains.

The reason I bring these up is that I sometimes wonder if we might get too caught up in the moment, regarding testing. Another example; my last cardiologist insisted I take a statin because my total cholesterol was 240. I pointed out that it was elevated due to the stress of a previous horrific afib episode and that my own monthy testing had indicated that stress greatly raised cholesterol levels. She scoffed, but was amazed when 4 months later, w/o drugs, it had fallen back to less than 200, my usual level. Point-in-time tests can be misleading - long-term testing for trends will provide a better indicator of potential issues, and help to eliminate unnecessary drug therapy or patient stress. I know, lots of luck getting a doctor to see things that way, that's why I get my own testing done now as part of my afib-source research.

Tom – We all know the fallacy about measuring cholesterol and meeting a specific number.

However, regarding blood viscosity, if you are pumping sludge, then the risk of stroke or MI is obviously higher. Testing is the only way to determine where you stand. If you have no concerns for adverse clotting, that’s your choice. However, with these Risk Markers, very often there is no symptom to signal an unfavorable deviation but the consequences can be severe. Elevated Homocysteine is an excellent example.

Nattokinase is very effective for reducing fibrinogen… I’d suspect that either your first or the second test had a lab error which is much more common than one might imagine. Retest if you are concerned about blood viscosity factors and then retest again several months later to verify. If your fibrinogen levels don’t come down, I’d be very suspect of the brand, itself. I’ve used NK for 9 years with consistent lab results.

The High Sensitive or Cardiac CRP is the only type my doctors ever look at as the regular CRP can be skewed by too many extraneous influences.

All the markers listed are important.

Jackie

No argument on the importance of the markers, just the context in which they are taken -. With regard to nattokinase...I have had it checked three times over nine months and the increased fibrinogen has been incremental and steady during the nine months I have taken it (i.e. unlikely a lab error) - the brand was changed from Source Natural to Drs Best.... so something's up - I plan to have another check w/o the nattokinase within a month or so. More extensive studies are needed for the nattokinase IMO, so interactions, patient history, etc. can be obtained and integrated to get a better picture of cause and effect for a broader cross-section of patient types - the documentation currently available is very limited, both at personal levels and study-wise. Just because something works for one person does not necessarily translate into a universal benefit - just like the drug products Dr's prescribe, supplements, etc., some work for some but not for others and some may even prove to be detrimental in some cases.

Sounds to me like the subjects of the studies are "lone" afibbers by definition. That is, no "overt" structural heart disease,
as defined by the physical examination, electrocardiography, chest radiography and EKG. That follows from "unknown cause".