Dr. Sinatra’s Story

Many years ago, a cardiologist called me to transfer a very sick patient from the emergency room where I was working to another hospital. The patient was too sick to transfer. His blood pressure was way down. He had chest pains. I tried to discourage the doctor, reminding him that the patient was very unstable, it was the middle of winter, and it was four o’clock in the morning. But the patient’s wife wanted him transferred. When she finally understood that her husband could die in the ambulance, she turned to me and asked, “Are you any good?” I looked her in the eyes and said, “I’m the best there is,” a line I remembered from a Clint Eastwood movie in which he was an ace pilot. That calmed her down. She had to hear that. She accepted the plan that her husband stay put, and happily we were able to help him.

Over the years, I’ve treated countless cardiac emergencies—people literally a heartbeat away from death. I’ve done middle-of-the-night heroics and slept in hospital beds next to critical patients. I felt I was the very best in an emergency. I became pompous in the process.

It’s hard to put into words all this running from one emergency to another. For four or five years, I never ate lunch. I had no time for it. My lifestyle was very hard on my family life. My beeper would go off in the middle of my son’s soccer game. This was before cell phones, and I’d leave to find a pay phone to call the hospital. It was a good life in the sense that I felt I was always needed but a hard life, nevertheless. When I got home from work, I couldn’t talk to my wife because I was all wired up and exhausted.

I would go into the hospital at eight in the morning and get home at nine or ten at night. On the weekends, I would make rounds on fifty or more people. I took an enormous amount of night calls and never saw my kids. I felt I was a terrible father because I wasn’t available. I can remember one Christmas morning. It was six o’clock. I had a one-year-old and a two-year-old, and I had to rush to the hospital to put in an emergency pacemaker for one of my patients. I left a cup of steaming coffee on the kitchen table and unopened packages under the Christmas tree.

One day, I woke up and seriously questioned what I was doing. I liked my job, but I also hated it.

After doing some heroics on a heart patient whom we had treated before, I told another doctor that we were barking up the wrong tree. We prescribed drugs and applied different therapies aimed at directly fixing the problem. For the short term, our efforts worked. We were doing all the things we were trained to do but we weren’t helping to heal our patients for the long term.

Often, we couldn’t save people. I vividly remember a case one year out of cardiology specialty training when a man was rushed into the emergency room. We couldn’t do anything for him. He was in his early forties. I had to go out and tell his wife that she lost her husband. When our eyes first met, I knew that she knew. She had two blond twins with her, about five years old. That was very hard to do. And I had to do things like that a lot.

In that same year—it was 1978—I encountered Jacob Rinse, a ninety-one-year-old Dutch petroleum chemist who changed my life. Years before, he had been diagnosed with severe coronary artery disease but had refused bypass surgery. Being an inquisitive scientist, he had investigated the nature of heart disease and formulated his own vitamin and mineral concoctions. He thrived on the home-made program.

One of my patients, a particularly difficult case, asked me to contact Rinse for suggestions. During a phone conversation, the chemist told me that he had the secret treatment for atherosclerosis. Being a cocky young cardiologist, I was initially amused, but I soon realized I was talking to somebody who described the chemistry of heart disease in a way I hadn’t heard before. He may have been “old” and far removed from the medical world, but he was as sharp as a tack, and his voice resonated with vitality. I listened as he told me about the formula he used to help himself and others who were interested. He described how lecithin, vitamin E, magnesium, and other nutrients could help prevent arterial clogging.

I was taken aback. I had never heard anything like that in medical school or my cardiology training. I began to think that maybe there was more to medicine than just drugs and surgery. That fleeting conversation with Rinse turned the path of my career in the direction of integrative medicine. I still continued my intense work, but I was formulating a different way to deal with heart disease before—and not just after—the heart attack.

I started recommending vitamins E and C and talking about diet and exercise to patients. Over time, I began to see improvement in patients who followed my suggestions. I was so impressed that I went for an advanced degree in nutrition.

In the early 1980s, I learned about CoQ10, a vitamin depleted by poor diet and the aging process. This substance is a major chemical participant in cellular energy production. As such, it’s critically important for strong pumping action of the heart. Plus it provides superb protection against arterial plaque formation.

An article in a medical journal had caught my attention. It reported how patients taking CoQ10 were able to be weaned quickly from the heart-lung bypass machine used during open heart surgeries. I had recently lost a dear patient after a successful mitral valve replacement operation because he failed to come off that same pump—a nightmare scenario that happens on rare occasions. The article made a strong impression. What if I had known about CoQ10 before I’d sent that kind man for surgery? His death had hit me hard.

I couldn’t bring him back, but I could tell patients awaiting open heart surgery to start taking CoQ10 daily. Those patients have all come off the heart-lung bypass machine without a problem.

All through the 1980s, I found myself driven to learn all I could about mind/body and nutritional medicine. It consumed most of my spare time. I found major healing benefits for my patients using B vitamins, fish oil, green tea, and exciting natural substances with strange names like nattokinase and phospholipids. They transformed sick lives into revived and energized lives. They gave patients the optimism and encouragement to become more involved in their own healing process. They unclogged and defused arteries, revolutionizing my practice from crisis management to crisis prevention and from illness to health.

I saw patients reach levels of healing I could never imagine possible with conventional care alone. Instead of tears of sorrow, I repeatedly witnessed tears of joy. I received hearty hugs from rejuvenated patients.

The idea of stabilizing plaque and even reversing it became my obsession—the challenge of a career. I just had to keep connecting the dots and keeping an open mind to new ideas.

Dr. Roberts’s Story

I was a midnight warrior at the start of my cardiology practice. I was in the hospital all the time. There were eight coronary care unit beds in the hospital where I was on staff. One Tuesday afternoon, I was managing all eight patients. I was doing invasive procedures over and over.

In basketball they talk about triple doubles: players striving to reach double digits in scoring points, rebounding, and assisting other scorers in a game. The best players do it maybe a few times in a season. In my work, I strived for a triple double every day. That meant any three of the following “performances”: two pacemakers, two angiograms, two right heart catheterizations for heart failure, two balloon pumps, two admissions. That was my big macho thing. I got into the “performance” mode, sucked up into making a lot of money and admitting more patients to the hospital than anybody else. I wanted to be the number one producer and the number one savior. I worked hard and accomplished my goals, and I felt I was the best.

After four or five years in practice, I began to realize that I was falling into a frustrating pattern: treating the same people over and over without really getting them well. The same patients always came back. It was a revolving door. I would do heroics for their heart, but they might develop gastrointestinal tract bleeding or kidney failure as a side effect of the treatment. I felt like I was spinning my wheels.

I would treat someone with heart failure in crisis, a patient short of breath, his or her lungs full of fluid because of a stiff heart not pumping effectively. I would overcome the immediate danger and send the patient home. But because we weren’t dealing with the cause of the heart failure, the patient would return in crisis again.

A patient would be rushed in by ambulance with a heart attack, an acute coronary blockage. Our medical team would go into crisis mode, administering a clot-dissolving drug, doing an acute angiogram, dealing with the artery narrowing, and if we were lucky and good, getting the patient over the hump. But we didn’t do anything about what made that artery clog. Two years later, the same patient would be back because another artery was clogged or possibly even the same one. After a while, I realized these patients were always going to come back. I realized that unless something changed, my pager would always go off and I would always have to leave before my son got to bat in his Little League games. And I would be sleepless many nights during the rest of my life.

I began to think what if we could just prevent these emergencies in the first place. If we could just prevent the artery from going bad, then we wouldn’t have to do middle-of-the-night heroics. There had to be a better way.

I began thinking seriously about prevention and alternatives after encountering several older patients with alarmingly high cholesterol levels but totally normal coronary arteries. They told me they were taking vitamins and they felt that the vitamins were protecting them.

Around this time, a persistent patient hounded me about something called antioxidants. He gave me a research paper to read that contained information about free radicals and antioxidant vitamins—things I hadn’t learned in medical school. My eyes opened wide and so did my appetite for more knowledge. What I learned made sense to me. I started putting patients on vitamins C, E, and B complex, magnesium and selenium, and CoQ10.

Within a year, I noticed my hospital admissions dropping. My patients were doing better, and I was starting to feel that I could actually do something besides crisis management.

If the antioxidants worked, I wanted to know what else worked. That led to fish oils. I saw another level of improvement. I felt I was really onto something. I started going to meetings on nutritional medicine. I studied the medical literature on causation of heart disease. As I applied my new knowledge, the crises among my patients became fewer and fewer. I felt exceedingly gratified. I had more time to do prevention. The old patient/new crisis revolving door practically stopped.

New patients would come to me, having heard that there’s a doctor in town doing things differently and getting sick patients well. They would often be last-resort cases. Those challenges would spur more digging to learn even more to help them.

Today, I regard a hospital admission as a failure on my part. The hospital nurses who have known me for many years kid me when I admit a patient. Once the top admitter, I’m quite happy now as a distant also-ran. I still see acutely sick and inoperable people, but I can get them on a program that stabilizes their plaque. That means my sleep is stabilized.

My patients take their necessary medications. That’s important and often critical to their survival. But the difference is that they are taking supplements that stop or minimize the damage that ruins their arteries and heart cells. Over a ten-year period, this approach has totally revolutionized my practice.

Acknowledgments

To Jan Sinatra, as always, for sharing ideas and encouragement, and for giving our manuscript a sharp-eyed but caring review.

To Jo-Anne Piazza, invaluable assistant, adviser, and confidante, whose cheerful coordinating and research skills helped ensure productive, seamless interactions between multiple authors.

To Ralph E. Holsworth, Jr., D.O., of Pagosa Springs, Colorado, for sharing his unique experience with nattokinase, an amazing nutritional supplement.

To Richard M. Delany, M.D., F.A.C.C., of Milton, Massachusetts, a fellow traveler in the frontier of New Cardiology. Thank you for sharing your perspective on the potential of genetic testing.

To Paul H. Keyes, D.S.S., the esteemed dental researcher who years ago helped uncover the bacterial connection of caries and periodontal disease, which we now know can spread inflammation and disease to the cardiovascular system.

To Thomas Miller, Teryn Kendall, and Kimberly Monroe-Hill, our editors, for sound, practical advice on how to unclog a weighty manuscript, making it lean and more reader-friendly.

To Anna Ghosh and Jack Scovil, our agents at Scovil Chichak Galen Literary Agency in New York, for steady steerage through contractual issues.

To Linda Tenukas, our talented and rapid-response illustrator.

Introduction

The New Cardiology

In 1977, Joe was experiencing chest pain. The quality of his life was poor. To manage his pain, he was chewing on nitroglycerin tablets daily.

Dr. Sinatra performed an angiogram. Joe’s major coronary arteries looked like rosary beads full of plaque pockets. They were so blocked that the surgeon could not find a place to implant a bypass graft, although he would have tried if there had been no other options. Because Joe’s heart rate was so low, a pacemaker was inserted. With the pacemaker, beta blockers, and nitroglycerine, his chest pain improved.

In 1980, Joe read about intravenous chelation, an alternative therapy for cardiovascular disease that removes harmful substances such as lead, cadmium, and arsenic from the body. Dr. Sinatra suggested this therapy, so Joe had sixty intravenous (IV) chelation treatments. His overall health improved, but he still had recurrent bouts of angina. He was still taking nitroglycerin but less, and continued to be helped by the pacemaker.

During the next few years, Dr. Sinatra put Joe on a multivitamin, mineral, and antioxidant supplement program, and then on coenzyme Q10 (CoQ10). In 1987, Joe had another angiogram because of recalcitrant chest pains. One of the coronary arteries showed no progression of disease, another showed regression, and another some progression. From a physician’s perspective, it was phenomenal that Joe was still alive, let alone doing this well. Sixty percent of people in his condition die within five years. Clearly, the disease was more stable, but the progression in one vessel indicated he still needed help.

In the early 1990s, the amino acid L-carnitine was added to the program to support the action of CoQ10. Joe also did another round of thirty IV chelation treatments. He did exceedingly well. He was walking farther and taking less medication.

In the mid-1990s, Joe was walking two miles a day, but he still experienced some angina from time to time and had to stop to rest.

In the late 1990s, a fish oil supplement was added to his regimen. He improved again. But still there was some stubborn shortness of breath.

In 2004, Joe added D-ribose and nattokinase, two cutting-edge supplements, and improved even more.

To a cardiologist, this is a miracle. Today, Joe is in his nineties and doing great, a spiritual patient with a positive attitude. He exercises and eats a healthy diet. He is a model patient who has done everything asked of him. And all this has made a huge impact on his quality of life and longevity. Now he takes a minimum amount of medication. He takes nitroglycerin only on an as-needed basis, mostly in the winter when the cold weather causes the angina because his heart has to work harder.

Dr. Sinatra feels that the next time he sees Joe, there will be something else to add to the program and notch up his well-being even more.

Integrate, Not Separate

Joe’s story represents the power of integrative medicine and, we believe, the future of cardiology.

When we see patients for the first time, it is often because their cardiologist has told them to stop taking vitamins and they’re confused. Some doctors are often uncomfortable with their patients taking supplements. In most cases, it’s fear of the unknown. They haven’t been trained to use supplements, so they aren’t sufficiently familiar, and therefore usually dismiss them. The dismissive attitude shortchanges patients, because today so much scientific evidence validates the potentially lifesaving benefits of many nutritional supplements.

On the other side of the medical practice spectrum, doctors who offer only alternative therapies to patients with very sick hearts may be foolishly denying them the full range of effective care. Such was the case of Janet, a patient who required urgent coronary artery bypass surgery. There was no other solution for her acute and potentially lethal blockage. Initially, she declined consent for the operation because she had read an article written by an alternative doctor who contended that bypass surgery was largely unnecessary. Obviously, he hadn’t witnessed cardiology patients die of heart attacks in his parking lot as we have. Fortunately, Janet was persuaded to have the procedure. Afterward, she safely embarked on a program of natural remedies that accelerated her recovery and improved her arterial, heart, and overall health.

Rates of complications from coronary artery bypass surgeries—such as heart attack, infection, stroke, and central nervous system dysfunction—are disturbing. People are naturally looking for less risky alternatives. However, bypass is a sound approach to improve quality of life and possibly advance longevity when other alternative or conventional medical therapies fail to correct persistent chest pain and shortness of breath caused by coronary artery blockage.

The two sides of the coin—conventional therapy alone or alternative therapy alone—represent misguided medicine. Health professionals entrenched solely in one camp do their patients a major disservice. Smart medicine doesn’t choose sides.

Sobering Numbers

The American Heart Association estimates that in 2002 approximately 70 million Americans had one or more forms of cardiovascular disease (CVD). In that year, CVD took 927,448 lives in the United States—that is, 1 out of every 2.6 deaths.

Coronary artery disease (CAD) alone accounted for 494,382 deaths, the single leading cause of death in the United States and the industrialized world. CAD develops when the coronary arteries supplying blood to the heart muscle narrow due to plaque buildup. About 335,000 people a year die of sudden cardiac arrest in hospital emergency rooms or before they ever receive medical attention.

Think Inflammation, Not Cholesterol

Cardiovascular disease (CVD) can kill in an instant by heart attack or stroke. Fifty percent of the time, the very first symptom is cardiac arrest. Without warning, half of all people who have the disease die without ever knowing they had it.

CVD can also silently and slowly strangle the vitality of the most important muscle in your body—the heart muscle—which pumps life-sustaining blood and nutrients through the sixty thousand miles of blood vessels. The lining of those blood vessels becomes inflamed and can even be destroyed. Blockages develop and blood can’t flow.

Medical science has come a long way in its understanding of what causes these scenarios. The pieces of the cardiovascular puzzle are coming together and new information is shoving aside cholesterol as the dreaded boogeyman of cardiovascular disease. If cholesterol were the omnikiller, then everyone with heart disease would have high cholesterol. Yet half of all heart attacks occur in individuals with normal cholesterol.

Recently, a radical shift has swept through cardiology. Inflammation has been identified as the most important factor in the formation of plaque and arterial disease. Along with this breakthrough have come new tools with which to precisely diagnose risk, identify specific inflammatory markers, and effectively treat both stable and unstable arterial disease.

The truth is that the body sustains a daily toxic assault and forms plaque as a result. We predict that plaque reversal will become the new buzzwords. In New Cardiology, we feel it is more important for you to know if your blood is toxic, the state of your dental health, how much insulin your diet produces, and how you handle stress.

We may prescribe a cholesterol-lowering drug but not for the reason you think. We may recommend it because it also beats down arterial inflammation. At the same time, we may want you to start on a simple supplement regimen of fish oil, magnesium, CoQ10, niacin, vitamin C, and nattokinase, which can offer you more lifesaving benefits than many medical drugs without side effects.

In New Cardiology, we check cholesterol, but we are more concerned about homocysteine, a troublesome substance that builds up in the body if you’re short of certain vitamins, creating inflammation and sticky blood. We want to check substances called Lp(a), fibrinogen, ferritin, and C-reactive protein (CRP). We want to determine the calcium score in your coronary arteries—a new measurement that predicts heart attack risk better than traditional tests.

You may not have heard about these things before. But they are very central to understanding how inflammation and plaque clog and consume arteries, consequently destroying heart function. We will tell you how you can extinguish the silent fire of inflammation, stop the destructive clogging of your arteries, and reduce your risk of heart disease, stroke, and sudden cardiac death.

You can do so much for yourself, whether you have acute or chronic disease or just want to prevent CVD from developing. Many natural methods work superbly, even if you have a family history of serious heart disease. But there are also times when patients must resort to medication and perhaps even surgery. In those cases, lifestyle and nutritional supplements can make all the difference in recovery and long-term prognosis.

Here are some of the major points we’ll be covering in the pages ahead:

• How to tell if you are at risk for CVD and why it’s harder to tell in women

• How killer inflammation and plaque develop in your body, often silently

• The obsession with cholesterol and why we need to change our focus

• The most important causes of inflammation and plaque, including the smallest known bacteria in the world, the overconsumption of sweets, and the bad fat contained in 75 percent of processed foods

• Sophisticated new testing procedures that offer great lifesaving potential and hopefully will soon become part of a standard approach to prevention

• Medical drugs—their upsides and downsides

• Nutritional supplements that block inflammation, stabilize and perhaps even reverse plaque, and some that actually “eat” clots

• The amazing power of CoQ10, L-carnitine, and D-ribose—three super supplements that keep your heart pumping at the max

• Getting the lead out, along with mercury and other toxic substances that poison your blood and arteries

• An absolutely artery-friendly diet

• Exercise and a big secret that gets habitual exercise shirkers moving as well as people who don’t have the energy to exercise

• Attitudes and lifestyle

• Our detailed how-to program with suggestions for healing, prevention, and improving abnormal test results

Are You at Risk?

In the summer of 2004, former president Bill Clinton underwent quadruple coronary artery bypass surgery after experiencing chest pains and shortness of breath. In bypass surgery, also called open heart surgery, doctors remove one or more vessels from the chest, arm, leg, or stomach and attach them to arteries carrying blood to the heart, thus detouring blood around blockages.

Clinton thought his blockage was probably caused in part by genetics. His mother’s family has a history of heart disease. But he also admitted the possibility of self-inflicted damage during “those years when I was too careless about what I ate.” As president, he was known for his fast-food habit.

Clinton’s case underscores the importance of listening to your body. The ex-president hadn’t been feeling well, yet his doctors said all was well when they first checked him out. But he insisted that something was wrong and followed his intuition. Further tests showed that Clinton indeed had acute coronary artery disease (CAD), meaning severe blockage of the coronary arteries that feed the heart. He could have dropped dead at any minute. He chose to have bypass surgery.

Classic Cardiac Symptoms

These symptoms are not 100 percent gender-specific. Women generally experience more vaguely defined symptoms than men.

Men		Women
•	Midchest pressure	•	Acute breathlessness
•	Shortness of breath	•	Sudden, profound fatigue
•	Dull pain between the shoulder blades	•	Dull, aching chest discomfort (vague)
•	Achiness in the jaw	•	Jaw or neck pain
•	Pain in the left arm or elbow	•	Pain in the left arm or elbow
•	Profuse sweating	•	Abdominal discomfort, nausea, vomiting
•	Profuse sweating	•	Dizziness, even blackouts

The biggest reason that people die of CAD is they deny what their bodies are telling them. Clinton listened to his symptoms. He had chest pain. Shortness of breath. Something was wrong. He went back to the hospital. An angiogram revealed the high-grade blockages. His situation was life-threatening and required aggressive treatment. He was handled very well by conventional medicine.

Often, there is no such happy ending. You probably know somebody who died in his forties from a heart attack without any warning. Keep in mind that 90 percent of coronary disease is asymptomatic—a silent process eroding the arteries. In half those cases, sudden death is the very first symptom. Those with symptoms are lucky because they can be evaluated like President Clinton.

Usually, Americans seek medical attention regarding cardiac risk only when lab tests show their cholesterol, triglycerides, or blood sugar to be high. These tests have been done routinely for decades because of the famous Framingham Heart Study, an ambitious health research project organized by the National Heart, Lung, and Blood Institute in 1948 to uncover the general causes of heart disease and stroke. CVD was largely undiagnosed before 1920, but in the ensuing years became a public health concern as the death rates from heart attacks rose steeply and reached epidemic proportions.

The Framingham project sought to identify common factors or characteristics contributing to CVD based on long-term monitoring of a large group of participants who had not yet developed overt symptoms of disease or suffered a heart attack or a stroke. Over time, the Framingham research singled out age, family history of CVD, blood cholesterol, blood pressure, cigarette smoking, and diabetes. The research said that the more risk factors you have, the more you are at risk for heart attack. For example, if you have high blood pressure, high cholesterol, high triglycerides, and are a smoker, you stand a higher risk to develop a cardiac event than if you had just one or two factors.

A cardiac event refers to a blockage of life-sustaining blood and oxygen in an artery leading to the heart. Even though we are cardiologists, we are also concerned about the arteries to the brain. The similarity between a heart attack and a stroke is this: both events are caused by arterial blockages or plaque rupture in a vital vessel. Usually a clot (thrombus) or a piece of plaque from somewhere in the body or in the immediate artery breaks off, lodging at a point where it cannot pass through. The blockage then cuts off the circulation, leading to oxygen deprivation of the tissue that the artery serves. The brain or the heart infarct, meaning that downstream tissue dies from lack of nourishing oxygen.

In the heart, clots are more likely to occur in areas already partially blocked or where there is existing vulnerable plaque. A piece of plaque could break off from the aorta or a carotid vessel and travel to the brain, or a piece of plaque could break off in a vessel in the brain itself, leading to occlusion of a vessel. One difference in the brain is that some strokes are hemorrhagic in nature, meaning they result from a ruptured blood vessel. The local hemorrhage causes tissue damage. High blood pressure is the primary cause of hemorrhagic stroke.

When a heart attack occurs, the heart muscle—the pump—has been affected. In a stroke, the occlusion or a bleed occurs in the brain circulation and the affected tissue in the brain. Both can and usually do occur abruptly.

Angina (chest pain) is a warning sign of disturbed circulation in the heart and is transient. No damage is done, but it must be evaluated. In the brain, a transient ischemic attack, or TIA, is a temporary disruption in blood flow, and it, too, should be taken seriously in a medical workup.

Traditional Signs and Symptoms of a Stroke

• Arm and leg weakness on the same side

• Weakness in facial muscles: may progress to one-sided facial droop

• Sudden headache

• Staggering gait; leg weakness or instability

• Imbalance; stumbling; difficulty walking or picking up objects

• Difficulty speaking (aphasia) and slurred speech

• Double vision or loss of vision in visual field on same side for both eyes

If arteries are blocked in the legs, walking is impaired. Cramping pain and weakness develops in the calves. This condition is called intermittent claudication.

Cardiologists have learned that when plaque buildup and blockage occur in arteries in one part of the body, such as the arteries to the heart or to the brain, there is usually blockage elsewhere. Translation: systemic disease.

Conventional cardiology treatments are typically brought into play when a person has major narrowing of an artery to the heart or the brain. New Cardiology can be implemented for a mere 10 percent narrowing. We think people should get a full range of important tests—the standard tests and the new ones—before symptoms ever arise. We want to work with people at an early date instead of waiting until they need a bypass or multiple medications that will cause side effects. But even if we get patients with advanced blockage, we are still able to use many of the same New Cardiology techniques.

In New Cardiology, doctors turn over more stones than just cholesterol and the standard Framingham risk factors. Framingham remains an honored model, but we go far beyond. This is because for years we have seen arteries full of plaque in nonsmokers with normal cholesterol and normal blood pressure.

Gender-Specific Issues

Man or woman, should you experience traditional or nontraditional symptoms of a heart attack or a stroke, call your physician immediately or get to an emergency care facility. In case of severe symptoms such as chest pain, fluctuations of consciousness, slurred speech, or profound sudden weakness on one side of the body, call 911.

Men

If you are a man in your thirties or forties and you develop erectile dysfunction (ED), it could be a sign of impaired blood flow to the penis and possible heart trouble in the not-too-distant future. There is a strong link between the two if the erectile problem isn’t related to a psychological issue. Very often, young men will feign concern for their heart, asking their doctor for a Viagra prescription. Interestingly, Viagra was developed to treat angina. But men younger than fifty shouldn’t have erectile dysfunction. Those who do are at increased risk of developing premature coronary artery disease. ED is angina of the reproductive organs.

Women

Three decades ago, the ratio of people admitted to coronary care units was roughly nine men to every woman. Unfortunately, this was not because women required less treatment but because they received less treatment. In the past, women’s pain was often written off by physicians as anxiety or as having a psychological cause. Frequently, a woman with chest symptoms or shortness of breath was sent home with a prescription for Valium or an antidepressant.

The New Cardiology Risk Assessment

Here’s a short and simple checklist that can determine your risk of a cardiovascular event based on the New Cardiology approach. You’ll need to get blood work and an electron beam tomography (EBT) scan. But the time spent will be worth your while because you’ll get a good picture of your vulnerability. After you receive your test results, check the boxes that apply to you:

• A family history of cardiovascular events (heart attack, stroke) under the age of fifty.

• You are a male, or a “vitally exhausted” (meaning chronically fatigued, stressed-out) female

• An HDL (high-density lipoprotein) cholesterol level lower than 35 mg/dl (men) or 40 mg/dl (women)

• Triglycerides¹ higher than 150 ml/dl

• Triglyceride/HDL ratio higher than 4 to 1

• Homocysteine higher than 10 µmol/L

• Lp(a) higher than 30 mg/dl

• CRP (C-reactive protein) higher than 1.5 mg/L

• Fibrinogen higher than 350 mg/dl

• Fasting insulin above 17 microunits/L

• Resting blood pressure above 140/90

• EBT (scan for calcified plaque) score above 200

Each checkmark means 1 point. Add your points to get your total score. This informal test is not based on any official or medical association criteria but on our combined clinical experience. We would interpret your results as follows:

0-1 Minimum risk

2-3 Low risk

4-5 Moderate risk

6 Moderate to severe risk

over 7 Severe risk

You’ll notice we have left off total cholesterol. As we will explain in the coming pages, there are other factors that we believe are more important.

Notice that we also left out smoking. That’s because we assume you don’t smoke. If you do, add 3 points. Smoking is a killer by anybody’s standards.

Even today, when a woman sees her doctor for symptom assessment, she may find herself caught up in a diagnostic dilemma. Because her symptoms are often less definitive or dramatic than those of men, her doctor may underestimate them or fail to order follow-up tests.

When a man over forty with arm or chest pain enters the ER, there’s a good chance he’ll be admitted to the hospital. But CVD symptoms in women might include discomfort in the chest that mimics indigestion—that feeling that if you could just burp you would feel more comfortable. Or it might be pain in the neck that radiates into the jaw or profound fatigue. Many women will write off their symptoms as the flu and not even seek medical attention. Cardiologists call these confounding cardiac signs atypical, meaning they don’t fit the textbook scenario.

Even after many years as cardiologists and being aware of the unusual symptoms displayed by many women, we still find that CAD in women can be confusing. New research also suggests that women may more often experience nonclassic symptoms of a stroke than men.

Since symptoms can frequently be different and not the textbook presentation we quickly diagnose and treat in men, we encourage women to tune in to their intuition when they realize something is wrong. Act immediately. Avoid denial and don’t rationalize symptoms. Remember that the leading cause of death and disability in women is heart disease and stroke.

You and Your Doctor

We are both information hounds. We regularly attend medical conferences and talk to researchers and clinicians in the fields of cardiology, nutrition, and environmental medicine. Much of our clinical work is innovative and, in a sense, five or ten years ahead of standard care. So, many doctors may not feel comfortable with some of the ideas we discuss in this book.

Our methods, however, are based on solid science that we have validated with countless patients. We often work with patients being seen by other cardiologists and coordinate our efforts. We give these patients additional options and a better chance to heal, with methods that may be unfamiliar to their doctors.

The worst-case scenario would be no improvement with the nutritional supplements and other methods we recommend. But in our clinical experience, we usually see significant improvement when patients follow the New Cardiology suggestions.

Cardiologists often see restenosis (renarrowing of the artery) after an initial angioplasty. Many doctors will do another angioplasty. But in New Cardiology we want to know why the artery narrowed and then address the underlying cause. We may not be able to take away the plaque, but we can take away the vulnerability. The patient may stabilize and do great.

If you have been sick for years, be patient. This approach can get you feeling better within a matter of months, sometimes within weeks. Don’t give up if you don’t feel dramatically better overnight. Our recommendations don’t generate quick, temporary fixes. They generate a lasting fix that arrests deterioration that would otherwise continue. Your physiology—the way your body functions—indicates your future. And our approach influences physiology in a positive way. Your anatomy determines your present. We can’t change your present, but we can influence your future.

Do Not Discontinue Any Medication Unless Your Doctor Says So

If you take prescription medication for your condition under a doctor’s care, please do not discontinue or alter your program without checking with your physician. For your own protection, ask your doctor about any of the information you read here.

Your doctor takes care of many other patients like you and may not have the time to study the new and complementary methods we discuss. Show your doctor this book. Hopefully, he or she may be interested in learning more about some of the ideas presented here.

PART ONE

How We Get Clogged

Chapter 1

Death by Inflammation

Inflammation is our body’s first line of defense against injury or infection. It’s what causes a burn to turn red or a bruise to swell. It’s nature’s design to help us heal. But if inflammation becomes chronic and goes into constant overdrive, it can cause disease.

In 2000, doctors at Harvard University published the first of a series of landmark research studies revealing the central role of inflammation in cardiovascular disease (CVD). Evidence from the Women’s Health Study, a project that monitored the status of twenty-eight thousand initially healthy postmenopausal women, put a new risk factor into the spotlight: C-reactive protein (CRP), a key biochemical substance indicating the presence of vascular inflammation. People with the highest level of CRP had five times the risk of developing CVD and four times the risk of a heart attack or a stroke compared to individuals with the lowest level. CRP predicted risk in women who had none of the standard risk factors and was the best predictor among twelve risk factors studied, including cholesterol. The cardiologist Paul Ridker, who led the study, said that “we have to think of heart disease as an inflammatory disease, just as we think of rheumatoid arthritis as an inflammatory disease.”

Ridker estimates that approximately 25 percent of Americans have a normal to low cholesterol level, lulling them into complacency, but at the same time they have an elevated CRP without knowing it. Millions of Americans are unaware that they have an increased risk for future CVD, heart attack, or stroke.

Ridker’s research confirmed what we as clinicians had suspected for years: that low-grade inflammation, like a silent, creeping fire, consumes arterial tissue and causes CVD. It leads to the weakening and eventual rupture of arterial plaques that directly trigger heart attacks and strokes. The CRP-inflammation link helps explain why more than half of heart attack and stroke victims have normal cholesterol levels.

Medical research has introduced us to other far-reaching and complex risk factors that go beyond the solitary threat of high cholesterol. Indeed, we have moved so far forward in recent years that the familiar model of diseased arteries as a network of inanimate pipes clogged by cholesterol-laden plaque seems almost as outmoded as the typewriter.

Life-threatening plaque is now regarded as an inflammatory injury—a lesion—that develops, almost like a boil, along the inner surface of the arterial walls where vital biological functions take place as blood rushes by. The walls become damaged by the inflammation—a process influenced by lifestyle, environment, and genetics. In some cases, the process unfolds slowly, stifling arterial wall chemistry and causing vessels to narrow. In other cases, deterioration occurs surprisingly fast, leading to vessel closure, stroke, or sudden death.

Plaque can be of two types. Stable plaque, covered with a fibrous cap, slowly expands inward and shrinks the diameter of blood vessels. Of greater danger is the vulnerable, unstable plaque, which can rupture and spill its noxious contents into the arteries and shut off blood flow. Identifying and combating the latter type of plaque has become the number one priority of today’s cutting-edge cardiologists.

Indicative of a turnaround in thinking about the causes of CVD, the American Heart Association and the Centers for Disease Control and Prevention published new recommendations for CVD screening in 2003 that included a test for CRP. Today you may see posters on laboratory walls with information for patients about this new and potentially lifesaving blood test. There is more to inflammation than CRP and more to CVD than inflammation, but we see this kind of public awareness effort as a good first step in getting out the message about inflammation and CVD.

Cardiovascular System 101

The heart and its network of blood vessels deliver oxygen and metabolic fuel to the cells. Think of your heart as a fist-sized, cone-shaped muscular pump wrapped around four chambers. The chambers are connected by a series of one-way valves that let blood flow in one side and out the other. Oxygen-poor “used” blood returning to the heart collects in the right atrium chamber and is funneled into the right ventricle, which pumps it into the lungs to pick up oxygen. Oxygenated blood returns to the left atrium, passes through the mitral valve into the left ventricle, and is pumped out with great force (in a healthy heart) into the main artery of the body, the aorta. From the aorta, other arteries branch off to feed the body, including the two coronary arteries that supply the heart muscle.

The heart

Blood moves through your body’s sixty thousand miles of blood vessels known as the circulatory system. Think of this system as the branches of a tree with many offshoots or a river with many tributaries. Large arteries branch off into smaller arterioles. These, in turn, branch off into the smallest vessels, called capillaries, which feed the cells of the body, then carry wastes and deoxygenated blood back out into venules (small veins), then into larger veins, and finally back to the right atrium.

This elaborate system needs to be clear to accommodate the forceful contractions of the heart and permit strong blood flow. The walls of the blood vessels have to be smooth and free of obstruction. We will concentrate on the arteries, since CVD primarily affects arteries rather than veins.

As Goes the Endothelium, So Go You