HMDI Heart Health Q & A

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

Readers often e-mail us health related questions. Although we do not provide medical advice or consultation through HeartMD Institute, we do post general answers to inquiries with hopes of helping others who may have similar questions. Do you have a question about heart health that you’d like answered? E-mail us at and we’ll do our best to post an answer on this page.

Q: Hi! I am a 58 year old female with heterozygous hypercholesterolemia. My total number is 10.6 mmol (UK) or 409.89 mg/dl. I also have around 50% blocked carotid arteries. I have been tried on several statins and I have had serious side effects with them all.

As I have been told the situation is serious I suppose I can no longer avoid this issue. The cardiac specialist I spoke to today spoke of the PCSK9 inhibitors. Do you think they on their own would help my situation, especially if I increase my exercise and make more effort in the areas you’ve outlined above? 

A: Sounds like the PCSK9 could be a reasonable treatment for you. Just work closely with your cardiologist and relate any unpleasant side effects if they should occur. The use of PCSK9 inhibitors is new territory when it comes to cholesterol modification.

Q: My husband has been using your “awesome foursome” for a virus that attacked his heart and gave him cardiomyopathy for just over a year. He is doing pretty well. Fraction started at 27 last test up to 44. Anything else to suggest?

A: Continue the ATP support with the Awesome Foursome, and just to be complete, add a multivitamin and mineral supplement if he is not on one.

Q: I would like some information on testing for heart disease. If a person has no other symptoms of heart disease other than mildly high cholesterol, should he or she consent to a stress thallium scan intead of a cardiac scoring or regular stress test?

A: Most likely not. If the person does not have a history of hypertension, a regular stress test (which involves the use of an electrocardiogram, or EKG, to monitor the heart’s electrical activity while the patient exercises) is fine.

Both the stress thalium scan and cardiac scoring expose patients to ionizing radiation, especially cardiac scoring, which involves a CT scan. As ionizing radiation is carcinogenic, doctors and patients should together assess whether the potential harm of not conducting these tests outweighs the risk of radiation exposure.

Q: I’ve had a quadruple bypass. If I ever need another bypass surgery, could I try chelation instead?

A: Quadruple bypass surgery involves “bypassing,” or re-routing, (via a segment from a healthy artery elsewhere in the body) the blood around the arteries leading to the heart to improve the flow of blood and oxygen. As this is a major invasive surgery, many people don’t want to go through it and seek alternative options. Problem is, by the time a person is in a position to need quadruple bypass surgery (as opposed to regular bypass surgery), all four coronary arteries are usually pretty clogged, meaning that coronary artery disease (CAD or CVD, cardiovascular disease) is severe.

Some people, amazingly, have excellent ventricular function and a good quality of life, despite angiograms showing severe CAD; for these people, a “wait and see approach” may be appropriate. For others who are suffering from the symptoms of arterial blockages, which can increase risk of heart attack, surgery is probably the best option. Surgery is necessary when the left main coronary artery is blocked more than 70 percent, or where two or more other major coronary vessels are narrowed by 90 to 95 percent, and when the blockages have led to an “unsatisfactory” quality of life.

Symptoms that contribute to an “unsatisfactory” quality of life may include frequent attacks of angina (“heart cramps”), becoming short of breath with just minimal exertion, and not being able to walk up a short flight of stairs or enjoy physical hobbies like golf and playing with children or grandchildren. People whose lives are so limited are generally not in a position to wait for the gradual relief that bypass alternatives such as medication, targeted supplementation and lifestyle modification (e.g. eating healthy and managing stress) can bring. If you experience such symptoms, bypass surgery can give you another chance to try to prevent the need for a second or third bypass surgery by adopting alternative lifestyle options.

Now, chelation therapy involves administering a chelating agent to help leach heavy metals like lead, cadmium and aluminum out of the body. Doctors use it to help treat a variety of CVD-related conditions. EDTA is given intravenously through a series of 20 to 40 office treatments, or orally (Detox/MaxPlus is an oral formula). Some of the reported benefits of chelation include significant improvement in blood flow and symptoms for patients with atherosclerosis, hypertension, angina, circulatory disorders, and diabetes. The theory behind chelation therapy is that removing toxic metals from the blood improves the ability of endothelial cells (which form the lining of blood vessels) to fend off free radical activity and to produce nitrous oxide necessary healthy arterial dilation.

While many doctors use chelation for toxic metal removal in CVD patients, organizations such as the American Heart Association have not yet sanctioned its use. This is probably due to the lack of controlled studies needed to prove chelation’s efficacy. In 2003, however, the National Heart, Lung and Blood Institute and the National Institutes of Health began a double-blind study to test the effects of 40 infusions of standard EDTA chelation therapy on heart attack survivors. More scientific evidence, then, should be available about the effects of chelation therapy upon completion of the study in June 2012.

Chelation therapy is a gradual process that can help improve quality of life. However, substituting it for surgery can increase one’s risk of a heart attack, if surgery is in fact necessary. Bottom line: surgery is the best option to increase blood flow for a symptomatic patient with 4-vessel disease, but only if the patient has unsatisfactory quality of life.

Q: My ferritin levels are slightly elevated and my carotid arteries are approximately 75 percent blocked, yet my doctors don’t seem concerned. Any suggestions?

A: Your body requires ferritin (iron) to make hemoglobin, the red blood cell pigment that carries oxygen to the cells. The normal range of ferritin for men is typically 12-300 ng/mL. Research suggests that elevated ferritin can contribute to cardiovascular disease (CVD). Too much ferritin can promote inflammation, especially because it can oxidize LDL cholesterol and result in unstable plaques. When plaques rupture, blood clots form and break off into the bloodstream and increase a person’s risk of having a cardiac event. According to a 1992 Finnish study, if your LDL cholesterol level is high (above 193), ferritin levels above 200 can significantly increase risk of heart attack.

Decreasing cardiac risk, then, is threefold: it involves decreasing arterial inflammation, small particle LDL cholesterol and ferritin levels. For more information about preventing cardiovascular disease, check out the articles in this (Cardiovascular System) section, specifically Cardiovascular Disease Awareness and Let’s Clear Up the Cholesterol Confusion Once and For All. As for ferritin, once you know why your levels are elevated, you can start taking measures to lower them. You may want to ask your doctors to run a total iron, TIBC (total iron binding capacity), ALT/AST (to assess liver function), and ultrasound of the liver to determine the causes and to assess organ function.

While women naturally lose iron through menstruation, men and post-menopausal women lack this natural iron-reducing mechanism; for the latter, donating blood can serve the same protective purpose. Other ways to decrease iron levels include avoiding red meat, iron-fortified foods,supplements containing iron, and using iron cookware. You may also want to test your water to see if it is high in iron and use a water filter.

Since vitamin C promotes iron absorption, taking no more than 500 mg per day can also help prevent excess ferritin.This is especially important if you have hemachromatosis, an acquired or hereditary defect of iron metabolism in which excess iron is deposited in tissues and not available for oxygen transport. It’s estimated that 10 percent of Americans carry the gene for hereditary hemochomatosis.

Q: I have a mild regional wall motion abnormalities consistent with CAD (coronary artery disease). I have normal valvular structures and no significant valvular abnormalities. I do not have diabetes or high cholesterol, and I do not smoke. How can I help reverse this condition?

A: In Reverse Heart Disease Now (Wiley & Sons, 2007), you can find detailed information about plaque stabilization as well as plaque reversal – we encourage you to read this book as it puts together a strategic plan to optimize your cardiovascular health.

In the meantime, here are some basic lifestyle tips that can help you as you continue to work with your cardiologist or general practitioner:

  • Diet is probably one of the most important changes you can make to reduce complications associated with CAD. We suggest eating a pan-Asian modified Mediterranean-type diet that consists primarily of whole foods… This means eating a “rainbow” assortment of vegetables and fruits with every meal, as well as raw and/or cooked grains (try quinoa, buckwheat, brown rice, etc.) and legumes (lentils, beans). Be sure to choose healthy fats (like omega-3s, coconut oil and olive oil), and have small servings of organically raised grass fed meats. Try to eat 1-2 servings of wild-caught fish per week. Make sure to consume very little sugar because it causes inflammation, so be mindful of what foods contain sugar in them (juices, pastries, sodas, processed foods). Try grinding up 1-2 Tbsp of flax seeds every morning and consuming with rice milk or on top of your cereal or oatmeal. Doing so will help you get essential fatty acids and the extra fiber you need to help support your gastrointestinal tract and liver.
  • Get moving! Try walking every day to increase circulation. Being outside in the sun will also support your condition, as Vitamin D is good for heart health.
  • Relax… Find a meditation practice or stress reduction technique that feels right for you.
  • Nutritional supplementation. For CAD, taking coenzyme Q10, magnesium, L-carnitine, and D-ribose is suggested because these four supplements support ATP production. With CAD, the heart works very hard and needs energy (ATP) support. For more information about dosing, you may want to read The Sinatra Solution: Metabolic Cardiology (Basic Health, 2011). You may also want to consider a good fish oil (minimum 3 g/day), an antioxidant multivitamin and/or a resveratrol product. Try drinking 4 oz of pomegranate juice a day (diluted in 4 oz of water). Hawthorne extract has also shown great results with CAD.
  • Do something FUN everyday. Engage in something that makes you laugh or smile, or brings peace into your heart.

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