Did you know that one person dies of cardiovascular disease (CVD) every 33 seconds? Currently, one of every four Americans suffer some form of CVD, with almost 6 million hospitalizations each year, and more than one million deaths. In opposition to common belief, CVD is the leading cause of death in women, as well as men, and of people in their prime of life (35-64 years). Controlling potential risk factors seems to be the key to reducing the risk and halting the progression of CVD. Researchers are finding that nutritional therapies and other preventive interventions must begin at an early age since harmful conditions leading to cardiovascular diseases can start in childhood.

Q: How do I know if I 'm at risk for CVD?
A: Some of the well-known and controllable risk factors of CVD include smoking, poor diet, physical inactivity, obesity, and stress. Elevated blood pressure, poor circulation/blood flow, elevated blood cholesterol, and diabetes represent factors that are less easily controlled, but are certainly within the realm of factors that can be modulated by various nutrients and herbs, a healthy lifestyle, and proper eating habits. If any of these risk factors apply to you, now is the time to address them. 2,3

Q: Is CVD preventable?
A: Cultural studies and clinical research show clear evidence that there are multiple lifestyle, diet, and powerful nutritional measures that you can take to decrease your risk of developing CVD. The fact is, you can do plenty to get your cardiovascular system in shape, even if you already have heart disease. What researchers are realizing is that the sooner these measures are taken, the better. 1

Q: How can I make myself and my lifestyle healthier?
A: Achieve and maintain ideal body weight, get regular aerobic exercise, do not smoke, eliminate consumption of coffee, reduce stress and anxiety, consume less saturated and hydrogenated fats by reducing animal products and refined or processed foods in your diet, maintain normal blood sugar levels, and increase your consumption of soy foods and fiber-rich plant foods. In addition, consume adequate amounts of vital and targeted vitamins, minerals, herbs, and other nutrients that have been researched for their positive effects on the cardiovascular system. 3-12

Q: What role does stress play in CVD?
A: Stress can have serious negative implications for the progression of heart disease, especially chronic stress. Its impact on blood pressure, levels of harmful substances in the bloodstream, and its influence on the secretion of stress.

Hawthorn (Crataegus oxyacantha) has a long history of traditional use throughout Europe. Its main active ingredients exert a positive effect on the heart and circulation, making it useful for persons with weakened heart function, such as early stage congestive heart failure. Hawthorn works by improving blood flow through the coronary arteries, increasing the efficiency of the heart 's pumping activity, and making vessels less susceptible to damage by strengthening their structure. Additionally, it lowers cholesterol and blood pressure and has antioxidant properties. Hawthorn use can result in a stronger, healthier heart and better blood flow throughout the body. When choosing herbal products you should be aware that there are wide variances in product strength and quality. Verification of herb species, parts, and manufacturing procedures are necessary to ensure excellent quality, and the active constituents confirmed by a third party laboratory. Furthermore, formulas should be targeted for specific uses. The best formulas will use time-honored methods of herb preparation such as decoction combined with standardized extracts to create effective herbal formulas.

Q: I know it's important to keep my cholesterol down. Are there nutrients that can help me do that?
A: Yes. However, in addition to lowering your total cholesterol, it is equally important to have a good ratio of LDL:HDL (bad:good) cholesterol. Many nutrients and herbs have been found to have a significant, positive effect on these parameters. Inositol hexanicotinate (a time-released form of niacin), the essential fatty acids EPA and DHA, and herbs like guggul resin, arjuna bark, Inula racemosa, and garlic all have clinical evidence of their ability to lower total and LDL cholesterol, while raising HDL -the "good cholesterol." In addition, inositol hexanicotinate and CoQ10 are important nutrients for the reduction of lipoprotein(a), a cholesterol related risk factor for CVD.

Q: What is homocysteine and how does it relate to CVD? Are there nutrients that may be able to help?
A: Homocysteine is an amino acid that is an indicator of cardiovascular health. It is now suspected to play a role in the development of atherosclerosis by damaging the arteries, thereby reducing the integrity of the blood vessel walls, and by suppressing anti-clotting activity in the blood. People with premature vascular disorders have been shown to have elevated levels of circulating homocysteine. Low blood levels of folic acid, vitamins B6 and B12, choline, and trimethylglycine (TMG) can lead to the accumulation of homocysteine in the blood. Providing generous amounts of these key nutrients may help significantly reduce homocysteine levels and the risk of developing CVD. A factor that has been implicated in some cases of excessive blood levels of homocysteine is a deficiency of enzymes and coenzymes necessary for the conversion of dietary folate to the more active form used at the cellular level. By ingesting a form of folate that has already been converted, such as 5-formyl tetrahydrofolate, complicated enzyme pathways can be bypassed. This can result in higher levels of bioactive folate for improved reduction of homocysteine. The risk of CVD is omnipresent in our society and, because of its insidious nature, preventive measures need to be taken before or at the onset of clinical manifestation. Traditional clinical care is necessary and important, but is often lacking in preventive measures. By taking a close look at your lifestyle, habits, diet, and nutritional supplement intake, you and your health care practitioner can identify your risk of CVD and begin taking the measures necessary to help you avoid becoming a statistic.

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Causes of Death, United States * Total cardiovascular diseases Ü All cancers Unintentional injuries Chronic obstructive pulmonary disease Pneumonia and influenza Diabetes mellitus AIDS/HIV Suicide Homicide Other 0 50 100 150 Rate per 100,000 population 200 250 300 * All data are age-adjusted, 1970 total U.S. population. Ü Total cardiovascular disease death rate includes the rate of death due to ischemic heart disease (135.2 per 100,000) and the rate of death due to stroke (42.5 per 100,000). Source: National Center for Health Statistics and National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1995. "The realization has grown worldwide that clinical care - while remaining necessary and important - is not enough,,and it is critical that we prevent cardiovascular diseases by preventing,from childhood on,development of the risk factors leading to them." Rose Stamler, MA, Northwestern University Medical School Third International Conference on Preventive Cardiology (Preventive Medicine 1994;23:529) MET292 8/99 Copyright ©1999 Advanced Nutrition Publications, Inc.