Overview of Integrative Cardiology: Top Conditions, Testing, and Treatments

The field of cardiology has been life-saving for many individuals. However, treatment options for common conditions are often not individualized, and that is where integrative cardiology can shine. For example, did you know that lifestyle factors may help reduce the risk of up to 80% of strokes and premature heart attacks? This article will discuss what integrative cardiology is and the top cardiovascular conditions that may benefit from this type of medicine. We’ll then discuss functional medicine labs used in integrative cardiology and complementary and integrative treatment options that can aid in creating personalized treatment plans.

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What is Integrative Cardiology?

Integrative cardiology is the approach to cardiovascular conditions using both traditional medicine, including pharmacology and procedures, and integrative therapies, such as acupuncture, diet, exercise, supplementation, and mind-body medicine. Integrative cardiology aims to utilize the most effective therapies with the least risk. The goal is to create the best-individualized treatment plan for every patient. Many times that includes lifestyle modification and nutritional support.

There is a great need for integrative cardiology, where practitioners consider lifestyle and dietary choices in everyday practice. According to the American Board of Physician Specialties, 90% of cardiologists say they have received little to no nutrition education in their cardiology fellowship, which is the last part of training before becoming a cardiologist. Over half said they didn’t receive any nutritional education during their residency or the time of training before their fellowship, either. One-third said they didn’t receive any nutrition training during medical school. Even with that said, most cardiologists believed their patients needed nutrition recommendations as part of their treatment plan, as many cardiovascular diseases may be influenced by lifestyle.

What are Some of the Top Cardiology Conditions That May Benefit from Integrative Cardiology?

The top three cardiovascular conditions that integrative cardiology may help with include:

Hypertension

Hypertension, or high blood pressure, is common- affecting half of American adults. This condition may increase the risk of many medical conditions, including stroke, heart attack, dementia, kidney disease, and vision problems. High blood pressure often doesn’t have any symptoms, which is why it's referred to as the “silent killer.” However, symptoms of high blood pressure may manifest as chest pain, headaches, dizziness, vision changes, shortness of breath, anxiety, nausea, and vomiting. Lifestyle choices, including lack of exercise, can contribute to high blood pressure. Additionally, certain medical conditions, including kidney disease, obstructive sleep apnea, adrenal dysfunction, and thyroid disease, can also contribute to high blood pressure.

Hypercholesterolemia

Hypercholesterolemia, or high cholesterol, is a common condition that affects almost 94 million Americans. Cholesterol is a fat that we take in through our diets, and our livers also make it. Cholesterol can be beneficial, as it aids in the production of cell membranes, certain vitamins, bile acids, and hormones. However, too much cholesterol can negatively impact our hearts.

Cholesterol is transported in our bodies through carrier molecules called lipoproteins. Low-density lipoprotein, commonly known as LDL, takes cholesterol from our liver to various tissues in the body. High-density lipoprotein, commonly known as HDL, takes cholesterol from our tissues back to our liver for disposal. Hypercholesterolemia is defined as high non-HDL cholesterol. Risk factors for high cholesterol include genetics, lack of exercise, poor diet, and smoking. Hypothyroidism, diabetes, pregnancy, kidney and liver disease can also increase the risk of high cholesterol.

Coronary Artery Disease

In the United States, Coronary Artery Disease (CAD) is an extremely common form of heart disease. CAD is a disease in which plaque is built up (a process called atherosclerosis) in the coronary arteries of the heart. The plaques prevent blood from flowing properly, which impedes the delivery of nutrients and oxygen to the tissues of the heart. This can lead to symptoms of stable angina or temporary chest pain. Chest pain may occur when the person is under physical or emotional stress and stops when the stress resolves. Risk factors for CAD include family history, sex (CAD is more likely to develop in men than in women), diet, stress, lack of sleep, obesity, excessive alcohol consumption, and smoking. High cholesterol, diabetes, and high blood pressure also increase the risk of developing CAD.  

Top Functional Medicine Labs Commonly Used in Integrative Cardiology

Functional medicine labs used in integrative cardiology include the following:

Advanced Lipid (Cholesterol) Panel

An advanced lipid (cholesterol) panel, such as the NMR LipoProfile by Access Medical Laboratories, goes beyond a traditional lipid panel by showing the size and density of different lipids. These measurements give greater insight into the patient’s cardiovascular risk.

Inflammatory Markers

Specific inflammatory markers can increase the risk of cardiovascular disease. High sensitivity CRP (hs-CRP), as offered by BioReference Laboratories, can give great insight into the patient's cardiovascular risk. A hs-CRP level below 1.0 mg/dL is associated with a low risk, a level between 1.0-3.0 mg/dL is an average risk, and a level greater than 3.0 mg/dL is considered to be a high risk. When elevated, the amino acid homocysteine is known to increase the risk of many heart conditions, including blood clots, strokes, and heart attacks. The homocysteine test, as offered by BioReference Laboratories, can reveal levels of homocysteine. Ideally, levels should be below 15 mcmol/L.

Micronutrient testing

Micronutrient tests, such as the Spectracell Micronutrient panel, assess several vitamins and minerals to determine any nutrient deficiencies. Many vitamins and minerals are important for cardiovascular health, including sodium, potassium, magnesium, and calcium for blood pressure regulation and heart contraction. CoQ10 is another important micronutrient that affects energy production in the heart tissue. Micronutrient tests provide a convenient way to assess numerous vitamins and minerals at one time.

Complementary and Integrative Medicine Treatment of Cardiovascular Conditions

Complementary and Integrative Medicine (CIM) can be used as an adjunct to conventional treatment for cardiovascular conditions. Here are some examples of CIM treatments that have shown promise in managing these conditions:

Heart Healthy Diet

The Mediterranean Diet is an anti-inflammatory, whole foods-based diet that has mounting evidence for its potential benefits in heart health. The Mediterranean diet may aid in supporting healthy blood pressure and slowing the development of plaques in arteries. It’s thought that these effects are responsible for the cardiovascular benefits seen with following a Mediterranean diet. Research suggests a reduced risk of stroke and heart attack in high-risk populations for those who follow this way of eating. The Mediterranean diet includes beans and legumes, fresh fruit, vegetables, herbs and spices, olive oil, nuts, seeds, fatty fish, and minimally processed whole grains. Foods to be avoided are artificial sweeteners, processed foods, added sugars, trans fats, and refined seed oils such as soybean, canola, and sunflower seed oil.

DASH Diet

The DASH diet has many heart-healthy benefits. This diet focuses on foods high in heart-healthy minerals such as potassium, calcium, and magnesium, with special attention placed on reducing sodium, trans and saturated fats, and refined sugars. This way of eating has been associated with supporting healthy blood pressure, maintaining cholesterol levels, and reducing the overall risk of developing cardiovascular disease and type 2 diabetes.

Supplements and Herbs That May Support The Cardiovascular System

There are many supplements that integrative practitioners use to help with cardiovascular conditions. Here are the four most common:

Red Yeast Rice for Heart Health

Red Yeast Rice is the end product of yeast fermentation on rice. Red yeast rice contains an active constituent, monacolin K, which is similar to the pharmaceutical cholesterol-lowering drug lovastatin. Both red yeast rice and lovastatin work by inhibiting an enzyme that is used in the body’s production of cholesterol, thereby inhibiting cholesterol production. Studies suggest that red yeast rice may help maintain healthy cholesterol levels, including LDL cholesterol levels.

Dose: 1,200 mg twice daily

Duration: 6-8 weeks minimum

Magnesium

Magnesium is a mineral needed in over 300 reactions in our bodies. In relation to the cardiovascular system, magnesium deficiency is associated with heart disease and increased blood pressure. Through its role in vasodilation (the widening of the arteries) and increasing nitric oxide production (a substance that also causes vasodilation), magnesium supplementation has been shown to support healthy blood pressure. Magnesium has also been shown to support blood pressure when used in conjunction with medication.

Dose: 500- 1,000 mg/day

Duration: As needed

Fish Oil

Fish oil is an easy way to supplement omega-3 fatty acids, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). EPA and DHA both have anti-inflammatory effects and have been associated with cardiovascular health and cognition. Omega 3s found in fish oil may support healthy blood clotting by inhibiting clot-forming blood cells called platelets from sticking together. Fish oil may also support healthy blood pressure, reduce inflammation in the blood vessel, and help maintain triglyceride levels.

Dose: 3-6 grams/day

Duration: 1-4 years

CoQ10

CoQ10 is naturally found in heart tissue. CoQ10 is necessary for energy production and also serves as an antioxidant. CoQ10 may help prevent blood clots from forming and may also support healthy blood pressure. Because of these mechanisms, CoQ10 may support heart health and improve the functionality of the heart.

Dose: 100mg/day

Additional Complementary and Integrative Medicine Treatment Options for Cardiovascular Conditions

In addition to dietary and supplements, acupuncture, exercise, and mindfulness-based techniques all aid in supporting cardiovascular health.

Acupuncture for Heart Health

Acupuncture, a form of Chinese medicine, is thought to help balance spiritual, mental, physical, and emotional health. As a practice, it has been used for thousands of years. Tiny needles are used to stimulate the flow of qi (pronounced CHEE), which, in Chinese medicine, is the life force of the body. A meta-analysis of 24 randomized control trials with over 1,900 participants showed that acupuncture was an effective additional modality in managing angina.

Mind-Body Techniques for Heart Health

Meditation is a mind-body technique that may be helpful for heart health. Meditation practices involve focusing on the present while pushing away distracting or stressful thoughts. People often focus on a single mental object, their breathing, or a positive word or phrase. Meditation can impact heart rate variability (HRV), which is the change in time between heartbeats. The higher the HRV, the better; a low HRV may increase the risk of heart attacks and strokes by 32 to 45%. In addition to improving HRV, the American Heart Association suggests meditation to support healthy blood pressure, as studies have shown its potential benefits.

Exercise for Heart Health

Exercise is an important part of overall health, especially for cardiovascular health. A study published in the Journal of American Cardiology assessed the effect of exercise on over 15,000 people from all over the world with coronary artery disease. The participants were followed for 3.7 years, and results showed that the most benefit was seen in the sedentary and highest risk of mortality participants who began and maintained a physical exercise routine. Additionally, the more physical activity one participated in, the lower the rate of mortality.

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Summary

Cardiovascular health is something everyone should be paying attention to. Especially for those in the U.S. as every 34 seconds, one person in the U.S. dies from cardiovascular disease. Integrative cardiology focuses on incorporating life-saving conventional medicine treatments with lower-risk treatments, including nutrition, exercise, supplementation, and mind-body medicine that places emphasis on prevention. Functional medicine testing for cardiovascular health can aid in the prevention and individualized treatment of various heart-related conditions, including high blood pressure, high cholesterol, and coronary artery disease, by taking a deeper look into their root causes. Complementary and integrative treatment options offer additional treatment and prevention options to improve overall cardiac health.