Whether it’s through personal experience or something you read in the news, most of us have been shocked by the story of a fit and health-conscious individual who died of an unexpected heart attack in their early 40’s.

Stories like these can be devastating for the deceased person’s loved ones, and they can also be highly alarming. How could someone who looked so healthy suddenly have a heart attack? And why didn’t this person’s doctor catch the signs sooner?

The truth is that many doctors today only consider heart disease as a possibility for people who fit into a tight little box of risk factors. However, heart disease is rampant even among those who don’t smoke, aren’t obese, and don’t have high cholesterol, high blood pressure, or diabetes. In fact, cardiovascular disease (CVD) remains the leading cause of death, and accounts for one in every four deaths in the United States, in spite of our abundance of sophisticated technology and cutting-edge pharmaceuticals.

The fact is, there is not a small box of risk factors that you can solely rely on. There are actually hundreds of risk factors that science has linked to the development of heart disease, many of which never get any attention at all.

That’s why it’s so important to arm yourself with the knowledge of how your cardiovascular system works, and how you can make smart lifestyle choices to minimize your risk. As with most chronic illnesses, your best weapon against CVD is to prevent it altogether. I created this two-part series to explore some of the mechanisms behind CVD, as well as the tests you may be interested in doing to evaluate your personal risk.

With February being American Heart Month and Valentine’s Day, I thought this would be the perfect time to give you a few tools to ensure your heart continues to beat strongly for many more years to come!

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The Link Between Heart Disease and Autoimmune Disease

Since many of you have first-hand experience with autoimmunity, I thought this would be a great place to start. As a quick refresher for anyone who isn’t familiar, autoimmunity occurs when your immune system (which is designed to protect against foreign invaders) starts to attack your own tissues and cells. What does this have to do with cardiovascular health? More than you might think!

In fact, research suggests that people with certain autoimmune conditions have significantly higher rates of CVD than the average population. People with Lupus, for example, have been shown to have a 4-8 times greater chance of developing CVD. People with rheumatoid arthritis (RA) not only have a reduced life expectancy, but CVD is their leading cause of death.

So why are autoimmune patients more likely to have heart disease? One important factor is the medications used to treat the conditions, with steroids being at the top of the list. Chronic steroid use has been shown to induce obesity, insulin resistance, glucose intolerance, dyslipidemia (abnormally high levels of cholesterol or fat in your blood), hypertension, as well as direct endothelial damage (I’ll talk more about this in a minute), all of which can contribute to CVD.

This is not to say that, across the board, pharmaceuticals should never be used. I believe that, as with all chronic diseases, it is important to not be an extremist at either end of the spectrum. I will be the first to admit that pharmaceuticals can be lifesaving and necessary at times for rescue relief. With that being said, I am a firm believer that for long term success, the most effective strategy for treating autoimmune disease is to address and correct the root cause of the disease.

Another key factor in the link between autoimmunity and CVD is that people with autoimmunity have high systemic inflammation and an overly sensitive defense system. As you know, chronic inflammation can be very damaging to the tissues in your body, and it often sets off a negative chain reaction that can do more harm than good. Let’s look at how those effects can trigger two physical causes of heart disease – endothelial dysfunction and oxidative stress.

Understanding Endothelial Dysfunction

Endothelial dysfunction is a byproduct of chronic inflammation and is a major player in heart disease and strokes. So what is endothelial dysfunction and why is it important?

Your arteries are the blood vessels that carry oxygen-rich blood and nutrients throughout your circulatory system, giving the cells in your body the fuel they need to function. Arteries are made up of several layers, each having their own function and purpose. The endothelium is the innermost layer of the artery, and is in direct contact with your blood as it flows through your body. The endothelium is extremely important to vascular health and plays a variety of vital roles, including regulating blood pressure, governing inflammatory responses at the artery level, providing a barrier between your blood and the other layers of your arteries, and it also plays a part in controlling clotting.

Despite the important role it plays, the endothelial is surprisingly very thin, measuring only one cell deep, which leaves it vulnerable to damage and dysfunction. Toxin exposure, inflammation, oxidative stress, and excessive pressure can all damage the endothelium.

Interestingly enough, the lining of your arteries and the lining of your gut have a lot in common. Many of you have probably heard the term “leaky gut” where your intestinal lining becomes compromised and allows unwanted substances to flow from the gut into the bloodstream. The same mechanism can happen to your endothelium, and it is called “leaky vessel”. When the endothelium becomes leaky or damaged (often because of the same factors that cause leaky gut) then problematic proteins, cholesterol particles, platelets, and inflammatory substances will accumulate below the vessel lining, forming a plaque.

This plaque buildup clogs your arteries, decreasing blood flow to your tissues. The plaque can also rupture suddenly, which then blocks the artery completely. Without adequate blood flow, tissues do not get the oxygen and nutrients they need, leading to tissue necrosis or death. If this happens in the arteries of the heart it is a heart attack, and if it happens in the brain it is called a stroke. The health of the endothelium is essential for preventing CVD, and monitoring endothelial dysfunction can be one of the best ways to detect the early stages of CVD.

Oxidative Stress Explained

I mentioned that oxidative stress can damage your endothelium, however, that term can be confusing. What exactly is oxidative stress? When you think of oxidative stress, picture jagged rusted particles floating around in your blood, bouncing against the vessel walls, tearing them up, and triggering a cascade of inflammation.

The cells in our bodies are constantly utilizing oxygen to produce energy. A byproduct of this metabolic process is a highly reactive set of substances known as oxidative free radicals. A free radical is a molecule that is unstable due to the fact that it is missing an electron. In an attempt to replace the missing electron and become stable, free radicals will steal electrons from healthy cells in the body, leaving those cells damaged. These damaged cells are the rusty particles traveling through your bloodstream and causing inflammation.

Your immune system actually uses the negative effect of free radicals to its advantage by using them to destroy pathogens and other substances it has deemed dangerous. Toxins, poor diet, smoking, elevated blood sugar, excessive stress, and many other inflammatory triggers can all signal to your body to produce more free radicals. Ideally, your body will have plenty of antioxidants like vitamin E, vitamin C, beta carotene, alpha-lipoic acid, CoQ10, and glutathione, which can all donate electrons to the unstable free radicals, stabilizing them and neutralizing their threat.

But, if you’re deficient in these antioxidant nutrients, or your free radical production is in overdrive because of chronic inflammation, an imbalance occurs. These excessive free radical species create what is called oxidative stress and this scenario is a major contributor to endothelial dysfunction and poor vascular health.

Multiple substances in the body can be damaged by oxidative stress including: tissues, proteins, DNA, and even lipids. As a matter of fact, when we look at cholesterol markers, oxidized LDL (an oxidized lipoprotein that carries cholesterol) is one of the best markers of oxidative damage to your circulatory system.

Oxidized LDL is one type of rusted particle that can cause destruction. It has been shown to promote inflammation in blood vessels and is a primary culprit of endothelial damage. New research also suggests that oxidized LDL might contribute to an autoimmune response to the endothelium lining, which in turn contributes to CVD.

If you are interested in knowing where your oxidative stress levels are, ask your doctor to run an oxidized-LDL level at your next blood draw.

LetsGetChecked’s home diabetes testing is a great way to test hemoglobin A1c levels and they also offer at-home diabetes and heart test, which also tests triglycerides, cholesterol, HDL cholesterol, LDL, cholesterol, and HDL% of total cholesterol. You can also get a basic at-home lipid panel test. The results are available online so you can share them with your functional medicine doctor. 

This test can now be processed through many standard laboratory companies, and in my opinion, it’s one of the best markers to evaluate if oxidative stress is contributing to your risk of CVD. There are also many other laboratory markers I use to evaluate oxidative stress, which I will discuss in part two of this series.

I know, that was a lot of information! Clearly CVD is a complex issue, and there is no single solution to prevent or cure it. To truly prevent cardiovascular disease and reduce its complications, you must tackle it with a systems approach that considers multiple factors, including genetics, nutrition, physiology, inflammation, and a whole host of environmental factors.

In part two of this series I dig deeper into how other factors like sugar can contribute to CVD. I also break down the ever so popular topic of cholesterol, as well as the statistics behind statins. I will conclude next week’s post with some useful tests that you can have done to identify where you stand on the spectrum of CVD.