Heart Attack and Stroke

Grape juice, like red wine, can help prevent blood clots and improve blood circulation.  Resveratrol, commonly found in grapes and other plants, is being studied for its antioxidant properties and its ability to minimize cardiovascular problems.  The “Dr. Sinatra recommended dosage” of Resveratrol is 2–5 mg daily.

Secondly, drinking flavonoid-rich green tea is an easy way to avoid cardiovascular problems and encourage resistance against chronic degenerative diseases, including chronic hypertension, heart attack and stroke.

While plain green tea itself has a delicate flavor, try it in one of the many formulas combining it with lemongrass and other herbs. Add a little honey and lemon, and I think you will find that this healthy heart nutrition tip really is quite delicious. If you can break your coffee habit in the process, you’ll be doubly rewarded, as you’ll also be reducing the amount of caffeine you ingest.

• Age 55 or older
• Heredity/family history
• Men
• History of heart attack and/or stroke
• Medical conditions such as diabetes, high blood pressure levels, vascular disease, atrial fibrillation, and sickle cell anemia
• Drug/alcohol abuse
• Poor diet
• Sedentary lifestyle
• Living in the southeast US (“stroke belt”)
• Low socioeconomic status

• numbness of the face or extremities;
• facial drooping, especially the mouth; 
• gait imbalances, staggering, falling;
• problems with numbness or  moving one side of the body (hemi- paresis or hemiparalysis);  and/or
• altered cognition or level of consciousness.

• Mild to intense mid-chest pressure
• Shortness of breath
• Dull pain between the shoulder blades
• Achiness in the jaw
• Pain in left arm or elbow
• Profuse sweating
• Indigestion (often overlooked)
• Nausea

• Dull, aching chest discomfort (vague)
• Acute breathlessness
• Sudden, profound fatigue
• Jaw or neck pain
• Pain in left arm or elbow
• Abdominal discomfort, nausea, vomiting
• Dizziness, even blackouts
• Vague flu-like symptoms

HMG-CoA reductase inhibitors, more commonly known as statins, are among the most aggressively marketed drugs for producing good cholesterol levels. In clinical studies, statins achieved a striking reduction in cardiovascular problems such as heart attack, bypass, and hospitalization.

Statins are potent anti-inflammatory drugs that have been shown to be able to do a good job of reducing cholesterol levels, while also decreasing the number of deaths from heart attack and stroke. However, they do come with a host of side effects, including a slight increased risk of breast cancer for women taking statin drugs. Because of the studies, I prefer to err on the side of caution when it comes to their use.

In my next blog post, I’ll share safe, natural solutions that can help you maintain healthy cholesterol levels.

C-reactive protein (CRP) is a little-known marker of heart disease that the medical world is starting to take note of. It’s a blood protein that, when found in elevated levels, may indicate risk of heart attack and stroke. CRP can be detected when there is inflammation resulting from trauma or infection.

Let’s look at some study results:

• A 1985 Finnish study found that half of patients with coronary heart disease had high levels of an antibody known as C-reactive protein, compared with only 17 percent of healthy controls.
• The Physicians Health Study indicated that C-reactive protein could predict future vascular events such as heart attack in healthy and high-risk individuals and that high levels of this protein increase risk for heart attack and stroke.
• In healthy postmenopausal women with levels of C-reactive protein and 11 other substances, the one-fourth with the highest C-reactive protein levels were 4.4 times more likely to have had a heart attack or other cardiovascular problems than the one-fourth with the lowest levels.

I encourage all of my patients to have their C-reactive protein levels checked annually.

C-reactive protein (CRP) is a little-known marker of heart disease that the medical world is starting to take note of. It’s a blood protein that, when found in elevated levels, may indicate risk of heart attack and stroke. CRP can be detected when there is inflammation resulting from trauma or infection.

Let’s look at some study results:

• A 1985 Finnish study found that half of patients with coronary heart disease had high levels of an antibody known as C-reactive protein, compared with only 17 percent of healthy controls.
• The Physicians Health Study indicated that C-reactive protein could predict future vascular events such as heart attack in healthy and high-risk individuals, and that high levels of this protein increase risk for heart attack and stroke.
• In healthy postmenopausal women with levels of C-reactive protein and 11 other substances, the one-fourth with the highest C-reactive protein levels were 4.4 times more likely to have had a heart attack or other cardiovascular problems than the one-fourth with the lowest levels.

A simple CRP blood test is as accurate as cholesterol and homocysteine screening in predicting a person’s risk of heart attack and stroke.

I also want you to be aware that, because most cardiologists still see heart disease as a male phenomenon, they treat women less effectively and less aggressively than they treat men, often with catastrophic results. For example, if a 45-year-old woman and a 45-year-old man both come into the emergency room with chest pain, most physicians will probably admit the man and tell the woman her symptoms are due to stress and anxiety.
 

This is because most doctors are trained to believe that serious cardiovascular problems have a low probability in women. Not many realize that among peri- and post-menopausal women, the incidence of coronary events quadruples as women approach middle age (45 years old and older.)

Iron is necessary throughout life for stimulating the production of hemoglobin, the red blood cell pigment that carries oxygen to our cells. Without it, we couldn’t survive. And growing children and menstruating women do need to be mindful of their iron consumption.

However, newer research indicates that iron overload, or hemachromatosis, is one of the heart risk factors you need to be paying attention to.

Hemachromatosis is an acquired or hereditary defect of iron metabolism in which excess iron is deposited in tissues and not available for oxygen transport. Iron is stored in muscles and other tissues, and unless it is lost through menstruation or donating blood, over the years toxic levels can accumulate in your system.

No one is yet sure exactly how elevated levels of iron contribute to heart disease, but researchers have a number of ideas. In the early 1980s, Jerome Sullivan, a pathologist, noticed that women who had undergone hysterectomies had increased incidence of heart disease. He suggested that if losing blood protected menstruating women from heart disease, men donating blood might also have similar protection. Sullivan’s findings, published in Lancet in 1981, were years ahead of their time, yet his theories have been accepted only recently.

A 1992 Finnish study examined the role of iron in coronary artery disease. After studying 1,900 men ages 42 to 60 for five years, researchers found that those with excessive levels of ferritin were more than twice as likely to have heart attacks, and that every one-percent increase in ferritin translated into a four percent increase in heart attack risk.

Women and Iron

Half of American women will die of cardiovascular problems such as heart attack and stroke. Yet risk levels among women vary tremendously. Menstruating women produce estrogen, which is heart protective, and most lose a significant amount of iron in the blood each month. This can add up to 400–500 mg of ferritin iron per year (about equal to two pints of blood).

In contrast, postmenopausal women are four times more likely to have heart attacks. Not only do they lose the protection of regular menstrual iron depletion, their levels of ferritin begin to rise steadily after menopause, more than doubling between 55 and 65, and even more after that.

Are You in a State of Iron Overload?

Ten percent of American adults may carry the gene for hereditary hemochromatosis. Physicians are often perplexed by their symptoms of fatigue, abdominal pain, organ failure, immune dysfunction, skin bronzing, irritable bowel syndrome, menstrual irregularity, hair loss, and explosive diarrhea. Many people have such symptoms for years but iron overload is not diagnosed until years of damage have taken place.

CAUTION: If you complain of fatigue to your doctor, he or she might prescribe iron, which is the last thing you need! If you are already in iron overload, this can be dangerous. So before you take iron supplements, insist that your physician order up a special iron test called a serum ferritin. If your serum ferritin level is greater than 120, you need to take steps to reduce it. In addition, if two other parameters of iron measurement—serum iron binding capacity and serum iron—are elevated, you have iron overload or hereditary hemochromatosis.

The Dr. Sinatra Solution

1. Know your serum ferritin level. Women of child-bearing age should have ferritin levels roughly between 15 and 45. Men and postmenopausal women should be between 50 and 120. If your levels are over 120, reduce iron in your diet. If levels are over 200, donate blood at least two to three times a year.
2. Cut iron consumption. Remember, red meat is loaded with iron and high quantities of saturated fats and cholesterol. Be aware of “iron fortified” grains and cereals, and avoid any that contain more than 25 percent of the RDA of iron.
3. Do not take multivitamins fortified with substantial doses of supplemental iron.
4. Do not use iron cookware unless you are iron deficient.
5. If you are in an iron overload situation, do not take more than 300 mg of vitamin C per day. Vitamin C can enhance the absorption of iron and become a pro-oxidant rather than an antioxidant.
6. Have your water supply assessed for environmental toxins as well as iron. Iron is ubiquitous in vitamin/mineral preparations and foods, as well as in our water supply. Consider a water filter.

Historically, it was assumed that if you couldn’t keep good cholesterol levels, you were at risk for coronary artery disease and other cardiovascular problems. But there is now evidence that elevated homocysteine levels is another serious heart risk factor. 

Multiple studies have confirmed the connection between high-plasma homocysteine levels and occlusive artery disease, including coronary atherosclerosis, peripheral vascular disease, and carotid artery disease. In fact, some research shows that 42 percent of strokes, 28 percent of peripheral vascular disease, and approximately 30 percent of premature cardiovascular disease are directly related to excessive levels of homocysteine.

High homocysteine levels can be caused by foods—red meat, avocados, sunflower seeds, wild game, poultry, and ricotta cheese. These foods contain the amino acid methionine. If you don’t get enough B vitamins, your body cannot break down methionine, resulting in homocysteine.

These deficiencies can be further exacerbated by caffeine and alcohol, which cause excessive urination and wash out precious B vitamins from our bodies. (That’s why it is so important to adhere to the healthy heart nutrition tips I often share here in this blog.)

Research also shows that five percent of the population may have inherited a rare genetic enzymatic defect that leads to higher homocysteine levels and premature heart disease (which can lead to heart attack and stroke). Because of this new genetic data, the evaluation of serum homocysteine levels should become standard in preventive cardiology, especially in anyone with a family history of premature heart disease.

When Should You Get Your Homocysteine Tested?

If you eat a healthy diet, supplement with vitamins and minerals, exercise, and have no family history of heart disease and or other heart risk factors, then you don’t need to be tested for homocysteine. But if there was a sudden death of a family member at a young age from stroke or heart disease, or if you have heart disease (especially if you are under age 60), you should be tested for homocysteine.

Research has shown that 400 mcg of folic acid a day will help prevent high homocysteine levels. However, to be safe, I recommend 800 mcg folic acid and 20 mg of vitamin B6 per day. Natural sources of folate include dark green leafy vegetables, beans, legumes, oranges, orange juice, and fortified cereals.

Many people trying to prevent blood clots are taking the blood thinner, Coumadin. But…

There’s something about Coumadin and its cousins that elicits an “anything-but-that-Doc” response from about half the folks who are on it. Many of my patients have asked to discontinue Coumadin because, in addition to the side effects and fear of bleeding, they dislike the nature of the drug (it’s rat poison in high quantities), as well as the discomfort and inconvenience of blood tests every 4–6 weeks.

In fact, whenever I lecture, someone in the audience always asks: “Is there some alternative to Coumadin?” So, let’s review anticoagulants like Coumadin and try and allay some of your concerns.

Before I discuss alternatives to Coumadin, let me tell you why this is the most frequently prescribed anticoagulant. In a nutshell, Coumadin has an unparalleled ability to thin the blood and prevent blood clots. More specifically, studies have shown that Coumadin can protect you from a stroke if you have:

• Mechanical heart valves (their surfaces encourage blood platelets to stick to them).
• Suffered an embolic stroke, one of three types of stroke caused by a fragment or clot of blood pumped from the heart to the brain.
• Atrial fibrillation (AF), where atria fail to contract; blood forms pools and becomes sluggish.
• Had an extensive heart attack (scar tissue weakens heart muscle tissue, which in turn weakens contraction of the left ventricle, possibly allowing blood to stagnate and clot).

Like any drug, Coumadin has side effects. Although the major one is excessive bleeding (bleeding gums, eye hemorrhages, blood in the urine and even a few bleeds in the brain), other rare reactions include weakness, cold sensations, itchy skin, fever and abdominal discomfort.

Indeed, blood thinning is a double-edged sword. While anticoagulants help prevent thrombotic and embolic strokes, I have to bear in mind that the risk of a stroke-induced hemorrhage is higher for those on Coumadin.

So now you can see why people trying to prevent blood clots struggle with this popular anticoagulant and often ask to trade it in for aspirin or other blood-thinning alternatives.

How Yolan Chose To Prevent Blood Clots

Yolan, 78, suffered with cardiovascular problems and, consequently, had a heart attack a few years ago. She began taking Coumadin but reported that she just didn’t feel right. Yolan experienced several unusual body sensations, which she attributed to the drug.

Against her doctor’s wishes, Yolan went off Coumadin and her symptoms abated. She now takes 324 mg of aspirin every other day (more about aspirin in a moment) and says she feels much better.

I’ve gotta tell you, folks, the decision to go off Coumadin can be a very difficult one; patients and their doctors often struggle together for the right answer. So let me offer some guidelines to help make this decision easier for you.

Coumadin is your best therapy—mandatory even—to prevent blood clots if you have mechanical heart valves. Studies show that it’s more effective than aspirin with other anti-platelet drugs. It should also be your first choice if you’ve suffered an embolic stroke.

Coumadin has been shown to protect patients with left ventricular clots and from AF, which can cause thrombotic strokes. Now, if you have AF, a common cardiac condition—you may wonder if you can take aspirin instead of Coumadin. If you have AF, your best bet is still Coumadin. If you’re not on conventional blood thinners like Coumadin, your risk of stroke is at least 5–6 times greater than those who are. This in itself is a disaster! In fact, approximately 75,000 strokes a year are attributed to AF.

Remember, with AF, the upper chambers of the heart may fail to empty completely, creating a perfect breeding ground for blood clots and poor blood circulation. As clots are formed and pumped out from the heart, they can wander around in the bloodstream until they find a vessel too small to get through and then you can have a major log jam in the brain, the leg, the kidney, in fact, anywhere at all. But the carotid artery is the number one spot to worry about because it’s a direct shot to the brain as the blood is pumped out of the left ventricle.

At least 90 percent of my AF patients take Coumadin; the other 10 percent take aspirin. But aspirin is less effective for preventing clots and strokes, particularly in women and people over 75. The best advice I can give anyone with more than two episodes of AF a year is to take Coumadin. If you have fewer episodes of AF and no other health problems like diabetes, congestive heart failure, leaking heart valves, or an enlarged heart, aspirin is a second choice.

As a cardiologist and a holistic health practitioner, I take blood pressure levels of every patient who comes into my office. And sadly enough, oftentimes, I find that that their blood pressure levels are too high. As you probably know, high blood pressure levels are often a precursor to serious cardiovascular problems, including heart attack and stroke, so this is a situation that I take very seriously.

Some of these patients, however, tell me that they are doing all they can to control high blood pressure and that when they go home and measure it themselves, their blood pressure levels are normal. Occasionally they’ll ask if the instruments in my office are off, or if my staff misread the result.

The actual problem, however, is a common condition called white-coat hypertension (WCH). It’s used to describe people who become anxious over a visit to a physician, dentist, or medical facility. The visit evokes a fight-or-flight response, and their blood pressure levels go up.

Research has shown that abnormally high blood pressure readings in a medical setting could be more than just a benign byproduct of anxiety.  Although the condition is poorly understood, WCH could be a precursor to high blood pressure levels, poor blood circulation, and other cardiovascular problems.

A Danish study published in the Journal of Human Hypertension found a heightened cardiovascular event risk for patients with WCH over a 10-year period. A Japanese study reported in the journal Hypertension Research suggests that WCH contributes to carotid arteriosclerosis. And in another Japanese medical report, based on eight years of observation, researchers suggest that WCH is a “transitional condition to hypertension” and may carry a “poor cardiovascular prognosis.”

If you experience WCH, I suggest you take the following high blood pressure remedies to get it under control and avoid potential cardiovascular problems:

• Introduce a regular stress-reduction program into your life. That could include activities such as exercise, tai-chi, meditation, or yoga. This is a wonderful way of lowering blood pressure naturally.
• Watch the salt (again). This cardiovascular nutrition tip can’t be stressed enough.
• Start taking blood pressure-friendly supplements on a daily basis—such as fish oil (2,000-3,000 mg), magnesium (400-800 mg), hydrosoluble CoQ10 (50-150 mg), and a garlic supplement high in allicin (500-1,000 mg). You can find these supplements in most health food stores.

One of the many things you can do to control high blood pressure levels is to carefully watch your salt intake. Doing so is one of those simple high blood pressure remedies that doesn’t involve a doctor’s visit or a pill -- and that’s a very good thing!

Your body requires sodium (a component of salt) to regulate fluid balance and distribution, as well as nerve and muscle cell function. But, while you need some sodium, the standard diet includes way too much. This is one of the reasons why so many people have blood pressure levels that are too high and suffer with a myriad of other cardiovascular problems.

The current recommendation for salt consumption is less than 2,400 mg of sodium a day, which amounts to about one teaspoon of salt. Recent research suggests that people ingesting less than 1,500 mg of sodium a day are better able to maintain healthy blood pressure. If you have high blood pressure levels, you should definitely aim for that number. Don’t use salt from the shaker, and read labels to add up the amount you’re taking in.

Many items at fast food restaurants are high in salt, so you can easily exceed the recommended level with one serving.   That’s why I’ve always strongly urged people who are looking for natural ways to lower blood pressure levels, improve blood circulation, or to reduce their risk of heart attack and stroke to avoid fast food restaurants. Going to one once in a while is okay for most people, but regular visits are a sure way to cause cardiovascular problems.

You can easily make up for the reduced salt in your diet by cooking with fresh herbs and spices such as basil, garlic, oregano, rosemary, chives, parsley, and onion. What’s more, all of these flavorings contain natural substances that make them good for any cardiovascular nutrition program, but also good for your overall health.