Application of the advice given by this guide helps the diabetic treat him or herself so that minimal or no medication should be needed. Changing the life style for the better can reduce the risk of complications and slow down their development.

1. by Dr Matti Tolonen and Dr Pentti Raaste
GUIDELINES
FOR GOOD
SELF-MANAGEMENT
OF
CARDIOVASCULAR
DISEASES
1

2. INDEX OF TERMS
INTRODUCTION AA: arachidonic acid, an omega-6 fatty acid, involved in cellular
signalling as a lipid second messenger. AA in the human body
"THE EMPEROR'S NEW CLOTHES" DISCLOSED usually comes from dietary animal sources, meat, eggs, dairy, or
is synthesized from linoleic acid, another omega-6 fatty acid.
AGEs: advanced glycation endproducts, the result of a chain of
chemical reactions after an initial glycation reaction. AGEs are
"The Emperor's New Clothes" (Danish: Kejserens nye known to play a role as pro-inflammatory mediators, e.g. in dia-
Klæder) is a short tale by Hans Christian Andersen about betes.
two weavers who promise an Emperor a new suit of ALA: alpha linolenic acid, an omega-3 fatty acid found in many
clothes invisible to those unfit for their positions or in- common vegetable oils. It is biologically inferior to EPA and DHA,
competent. When the Emperor parades before his sub- found in fish oil.
jects in his new clothes, a child cries out, "But he isn't Angina pectoris: commonly known as angina, is severe chest pain
wearing anything at all!" due to ischemia (a lack of blood and hence oxygen supply) of the
heart muscle generally due to obstruction or spasm of the coro-
The diet-cholesterol-heart theory is "The Emperor's New nary arteries (the heart's blood vessels).
Clothes". As a matter of fact, there is no scientific evi- Antioxidant: a molecule capable of slowing or preventing the
dence for a conclusion that dietary saturated fat is associ- oxidation of other molecules. Oxidation is a chemical reaction
ated with an increased risk of coronary heart disease or that transfers electrons from a substance to an oxidizing agent.
other cardiovascular diseases. Neither is there conclu- Oxidation reactions can produce free radicals, which start chain
reactions (cascades) that damage cells. Antioxidants terminate these
sive evidence that cardiovascular diseases are caused by
chain reactions by removing free radical intermediates, and in-
cholesterol. Thus, cholesterol-lowering drugs target nei- hibit other oxidation reactions by being oxidized themselves.
ther the origin nor the mechanisms of the disease. We Atherosclerosis, arteriosclerosis: commonly referred to as a hard-
believe that the origin may be infective and related to ening or furring of the arteries. It is caused by the formation of
deficiency of omega-3 fatty acids, vitamins and other pro- multiple plaques within the arteries in response to a chronic in-
tective micronutrients, and that the mechanisms of the flammatory process in the walls of arteries. The origin of the syn-
disease are chronic low-grade inflammation and oxidative drome remains unknown.
stress, which should both be suppressed. To this end we CHD: coronary heart disease, caused by atheromatous plaques
recommend regular exercise, at least 2,5 hours per week, within the walls of the coronary arteries that supply the myocar-
dium (the muscle of the heart) with oxygen and nutrients.
and a healthy diet which provides plentiful antioxidants.
Coronary arteries: blood vessels supplying blood to the heart
Modest reductions in dietary salt could substantially re-
muscle.
duce cardiovascular events and medical costs and should
Claudication: literally "limping" (Latin) indicates impairment in
be a public health target. We also recommend dietary walking.
supplements, such as fish oil, berberine, carnosine, vita- Sclerosis: a hardening of tissue and other anatomical features.
mins D, folic acid along with other vitamins and miner-
DHA: docosahexaenoic acid, an omega-3 fatty acid in fish oil.
als.
E-EPA: the ethyl ester of eicosapentaenoic acid (EPA), an omega-3
fatty acid in fish oil.
EPA: eicosapentaenoic acid, an omega-3 fatty acid in fish oil. EPA
and E-EPA are anti-inflammatory and antidepressive fatty acids.
2 3

3. Free radicals: atoms, molecules, or ions with unpaired electrons HEART AND ARTERY (CARDIOVASCULAR) DISEASES
on an open shell configuration. The unpaired electrons cause them
to be highly chemically reactive. See oxidative stress.
Homocysteine: a toxic amino acid, which the body makes from Cardiovascular diseases are common in become unnecessary if people would eat
proteins in meats. Deficiencies of the vitamins folic acid, B6, or Western populations: every third man, and a low-carb diet, exercise, take enough
B12 can lead to high homocysteine levels in blood and tissues. every tenth woman has or will be diag- antioxidants and achieve an ideal ratio
Inotrope: an agent that alters the force or energy of muscular con- nosed with a clinical cardiovascular dis- between omega-6 and omega-3 fatty ac-
tractions. Positively inotropic agents, like digitalis and berberine, ease. Moreover, as we age, almost every- ids in their blood. We are convinced that
increase the strength of muscular contraction. one’s arteries will become more or less if you follow our guidelines you may need
Interleukins (IL-1–20): a group of cytokines (secreted proteins/ stiff and narrower (sclerotic), thus impair- less or no medication and avoid its un-
signaling molecules) that are used extensively in cellular communi- ing the blood circulation. The most com- wanted side-effects.
cation. IL-1, IL-6, IL-8 and TNF-a. are pro-inflammatory and IL-4 mon causes of death in industrialised na- The mystifying cause of arterial diseases
and IL-10 are anti-inflammatory cytokines. tions are heart attacks and strokes. Car-
diovascular diseases kill 80% of diabetics The conventional wisdom is still firmly
Mitochondria: cellular "cellular power plants" which generate most and 70% of all those aged over 75. entrenched in the diet-cholesterol-heart
of the cell's supply of adenosine triphosphate (ATP). theory, created in the 1950s. We question
MPO: myeloperoxidase, a protein secreted by white blood cells. The origins of arterial diseases are ob- this hypothesis, as it has many flaws and
A risk indicator of CHD. scure. It is known, however, that inflam- weaknesses, and the true causes of arte-
mation and calcification (not cholesterol, riosclerosis still remain too obscure to
Myocardial infarction, heart attack. as commonly thought) are the main form a robust conclusion. We humbly
NO: nitric oxide, a gas is an important signaling molecule in the mechanisms in the narrowing and hard- admit that we understand very little about
body. Keeps the arteries flexible. ening of arteries. In the heart, impaired the pathogenesis of arteriosclerosis. While
Oxidative stress: caused by an imbalance between the produc- circulation may lead to heart burn (angina no definite cause has been identified so
tion of reactive oxygen and a biological system's ability to readily pectoris), and a total occlusion of a coro- far, the doctors have listed a long list of so
detoxify the reactive intermediates or easily repair the resulting nary artery will cause a myocardial inf- called risk factors, or indicators, in all
damage. arction (heart attack). A reduced blood about 250, which more or less associate
Pathogenesis: step by step development of a disease and the chain flow in the brain can cause a stroke. with the disease without actually causing
of events leading to that disease, due to a series of changes in the Deaths from cardiovascular diseases are it. Therefore modification of these indi-
structure and /or function of a cell/tissue/organ being caused by a largely due to coronary heart disease cators (e.g., lowering of cholesterol) can-
microbial, chemical or physical agent. (CHD) and stroke, but in addition, the not be expected to give much benefit.
PLA2s, Phospholipases A2: enzymes that release fatty acids from patient’s other arteries usually also harden Most popular (classic) risk indicators in-
the second carbon group of glycerol. Genetically overactive PLA2s and narrow, resulting in circulatory prob- clude: smoking; eating saturated fats; hy-
promote and maintain inflammation in the endothelium and lead lems, especially in the lower extremities. pertension; lack of exercise, large waist
to endothelial dysfunction. E-EPA counter- fights PLA2s. In this case a symptom may be intermit- circumference; "apple" body shape; non-
RLP-C: remnant-like particles of cholesterol, an indicator of CHD. tent claudication. Capillary sclerosis of the genetic form of transmission; persistent,
retina of the eye also indicates CHD. long-term, intense psychological stress;
Statins: a class of popular drugs that lower cholesterol levels in
people. Our aim with this guide is to give easy-to- dysfunction of the fat and glucose metab-
follow instructions, in order to reduce the olism; calcification of arterial walls; in-
Telomeres: "age clocks" located at the end of chromosomes. Their flammatory diseases; accumulation of
risk of cardiovascular diseases, or poten-
fast shortening speeds up cell death and cuts peoples life expect- homocysteine in the blood and tissues.
tially to slow down an alteration, which
ancy. Increased dietary intake of marine omega-3 fatty acids is Recently new risk factors have emerged:
is already in progress. Simply lowering
associated with prolonged survival in patients with coronary heart micro-organism infections and the lack of
cholesterol readings is not enough. We
disease. sunshine and consequent vitamin D in-
hope to highlight the importance of pre-
vention and non-medicated self-treat- sufficiency. We will present some other
ment. We also believe that the vast ma- "new" risk indicators later in this guide.
jority of cholesterol-lowering drugs would
4 5

4. On the highest level of the "risk pyramid" lesterol boom, but it has now resurfaced
of a heart attack are diabetics and those again. Therefore, the prevention and treat-
suffering from metabolic syndrome, who ment of CHD must specifically target
in the past have already suffered a heart something other than cholesterol, namely
attack. On the next level down are dia- inflammation, which can be diagnosed
betics and those with a metabolic syn- from blood tests, e.g., the value of C-re-
drome who have not yet experienced a active protein (CRP), preferably high sen-
heart attack. Their risk is similar to those sitivity CRP (hsCRP). Despite the reference
non-diabetics who have survived a myo- value for CRP being under 6, even a value
cardial infarction. The common denomi- of 3 indicates a stealthy inflammation.
nators in the risk pyramid are insulin re- Other useful indicators of inflammation
sistance and dysfunction of fat and glu- include the interleukins 1 and 6 (IL-1, IL-
cose metabolism. Further down the pyra- 6) and the tumour necrosis factor alpha
mid are those people who have one or (TNF-a).
several of the aforementioned risk factors. A key event in atherosclerosis is a mala-
Arteriosclerosis usually starts early in life, daptive inflammatory response to suben-
sometimes during childhood or teenage, dothelial lipoproteins. A crucial aspect of Figure 1.
and stays latent for decades without nec- this response is a failure to resolve inflam-
essarily manifesting any symptoms or sen- mation. Defects in these processes pro-
sations. When symptoms eventually ap- mote the progression of atherosclerotic necrotic centre of the atherosclerosis. If to the inside of arteries, impairing the
pear, the disease has progressed quite far, lesions into dangerous plaques, which can the fibrous cap that prevents the necrotic blood circulation. Luckily, oxidative stress
and the changes are largely irreversible. trigger atherothrombotic vascular disease centre from spilling into the lumen of a can be prevented, suppressed and
Coronary arteries, which supply oxygen (Figure 1). This revolution in our thinking vessel ruptures, a thrombus can form quenched by strengthening the body´s
for the heart itself are, when young, flex- about the pathophysiology of atheroscle- which can lead to emboli occluding antioxidative capacity by means of a
ible and elastic like lycra; they are highly rosis has now begun to provide clinical smaller vessels. The occlusion of small healthy diet providing plentiful antioxi-
resistant to pressure and they enlarge with insight and practical tools that may aid vessels results in ischemia, and contrib- dants, and also by taking antioxidants as
the pulse waves. However, with age the patient management. utes to stroke and myocardial infarction, supplements, like alpha lipoic acid, ber-
elasticity decreases, blood pressure rises, We would like to elaborate further about two of the leading causes of cardiovascu- berine, carnosine, selenium, ubiquinone
and the blood does not circulate in the the infective origin and the role of inflam- lar-related death. We will later present (CoQ10) and vitamins C and E, as we will
arteries as freely as before. A result of this mation in process of arteriosclerosis: If therapeutic strategies designed to boost discuss later in more detail.
can be either a stroke or a heart attack. there were no resistance, attacks by germs inflammation resolution.
The hardening of arteries (sclerosis) is would continue to anabated until com- Cholesterol and Triglycerides
largely due to impaired dysfunction of the plete destruction of the artery occurred. Oxidative stress
Laymen and most healthcare profession-
endothelium in the inner cell layer in the Luckily, the body has some defense
In the 1950s Professor Denham Harman als alike consider cholesterol as the main
arterial wall. Therefore the emphasis of mechanisms to counteract foreign invad-
(University of Nebraska), presented a culprits of cardiovascular diseases. Mil-
the primary and secondary prevention ers. Different cellular, inflammatory and
theory about the oxidative stress caused lion of people take cholesterol-lowering
should be targeted to endothelial func- immunological mechanisms come into
by free radicals resulting in cell damage. drugs and statins, the vast majority prob-
tions. play in reaction to invasion, and damage
Today his theory has been generally ac- ably needlessly. The role of cholesterol,
the germs. A key element is the accumu-
A stealthy, chronic inflammation cepted as correct in medicine and biol- in our view, is enormously exaggerated.
lation of immune cells called macro-
ogy. Cholesterol is a necessary building block
As far back as 1856, the father of immun- phages that are filled with cholesterol,
ology, the German Rudolf Virchow, wrote which gives the cells a foamy appearance. Oxidative stress is caused by external and for cells, which, when not oxidised or
that arteriosclerosis is an inflammatory Macrophages engulf and destroy germs. internal free radicals, which make the fats glycated, is entirely harmless. There are
process, and inflammation usually has an Foam cells are not dangerous as such, but turn rancid, including LDL-cholesterol. many different fractions of cholesterol, out
infective cause. This view was forgotten can become a problem when they accu- Cholesterol as such is entirely inert (harm- of which HDL is considered ‘good’, while
and was sidelined for decades by the cho- mulate at particular foci thus creating a less), but when oxidised, it starts to stick LDL, sdLDL (small dense LDL) and very
6 7

5. low density LDL (VLDL) are considered drugs, in the usual doses, do not reduce ratory reference values are 5–15 µmo/l. phron, in the kidney, which also drives
‘bad’. Oxidised LDL (oxLDL), can constrict TGs significantly, while the omega-3 fatty blood pressure up. Berberine counterfights
The Calcification of Arteries
and stiffen arteries. It is toxic, and there- acids in fish oil – EPA and DHA - do. angiotensin, which explains many of
fore the body produces antibodies against Therefore fish oil was recently added to Calcium deposits accumulate into the ar- berberine´s benefits in cardiovascular dis-
it. The more there is LDL in the blood, the the doctors´ guidelines for treatment of terial walls and lead to the hardening of eases and diabetes.
more easily it will oxidise. However, the dyslipidemias (disturbed fat profile in the the arteries. This has been ascertained by Fibrinogen, a protein in blood plasma,
oxidation of LDL can be prevented with blood) and artery diseases. computer scanning which also allows for causes blood to clot by breaking down
antioxidants, of which there are plenty in giving the so-called Agastson’s score as a into fibrine. That in turn is a fibrous pro-
Contrary to popular belief, the omega-3
vegetable-based foods (e.g. in salads, fruits measure of the calcification. If calcium is tein which promotes blood clotting.
fatty acid ALA found in vegetable oils
and berries), and dietary supplements. not discovered, the score as well as the
(rapeseed, flaxseed etc.) is not as effec- Endothelin, is a peptide, which is pro-
Increased blood glucose glycates LDL to risk of a heart attack equals zero, while a
tive as the omega-3s in fish oil, EPA and duced in arterial walls, kidneys, retina and
form AGE-LDL, which, like oxLDL, sticks bigger score indicates a risk of heart at-
DHA. In fact, they prevent effectively the in the heart muscle. Endothelin thickens
to the endothelium of arteries. The good tack and death. Vitamin D deficiency as-
synthesis of TGs in the liver and at the the heart muscle and stiffens arterial walls.
news is that vitamin B6 (pyroxin), ber- sociates with calcification of arteries, and
same time they prevent fatty liver. The The use of insulin when treating diabetes
berine and carnosine are able to prevent conversely, a sufficient intake of this vita-
ratio of cholesterol and TGs – non-HDL/ promotes formation of endothelin; exces-
and suppress glycation. min (or sunshine) may prevent this. To this
triglyseride + LDL can give a better pic- sive insulin can therefore be harmful. The
end, the daily requirement for vitamin D
In addition to cholesterol, there are other ture of the risk of illness than simply meas- detrimental effects of endothelin can be
for an adult is around 50 µg, i.e. about 7
"bad" fats, which need to be targeted in uring one or the other (cholesterol or minimised by losing weight, exercising
times the current official recommendation
the prevention and treatment of CHD. triglyserides). and taking fish oil and carnosine supple-
(7.5 µg/day). Also intake of vitamin C (500
Another fat called triglyceride (TG) is a Atherogenic metabolic triad to 1000mg daily) may decrease the risk ments.
significant risk indicator in CHD. Thirty of arterial calcification. Lipoprotein (a) [Lp(a)] is formed by an
per cent of men under 65 years and 14 Hyperinsulinemia, elevated apolipopro-
tein B (Apo B) and sdLDL, in the same LDL-particle, with an apoprotein (a) at-
per cent of women of the same age have Psychological Stress
individual, are strong indicators for CHD. tached to its apolipoprotein B. Lp(a) is an
their blood plasma significantly increased Long-term stress may increase the risk of independent risk indicator in atheroscle-
TGs (2,0 mmol/l or more). They originate The triad is usual both in diabetics and in
those with metabolic syndrome. Ethyl- a heart attack. E-EPA (1000mg daily) has rosis. The amount of it in blood is inde-
from the fats made up by the liver from been found to balance stress hormones on pendent of ageing, cholesterol, blood
alcohol and dietary carbohydrates. The esterised fish oil lowers simultaneously all
the different factors in this imminent triad. the hypothalamic-pituitary-adrenal axis pressure, diet and exercise. The concen-
liver converts, that is, any extra carbo- (HPA-axis) and hence reduces stress symp- tration is determined by hereditary factors,
hydrates and alcohol, that are not imme- Increased homocysteine toms and the risk of CHD. and it is quite stable in each individual
diately used for energy, into fats. For this (at<250mg/L). A larger concentration in-
reason we advise avoiding too much car- Homocysteine is a toxic amino acid, Other Risk Factors
dicates an increased risk of cardiovascu-
bohydrates and alcohol; moreover, they which the body makes from proteins in
An apparently healthy person – who has lar disease. Lp(a) decreases with niacin
may cause a fatty liver. meats. Homocysteine is associated to
not been diagnosed with any of the afore- and omega-3 fatty acids, but not with
arteriosclerosis, loss of memory and
Although the commonly used statins ef- mentioned risk factors – can suffer a sud- statins. This is yet another reason to take
Alzheimer´s disease and other types of
fectively lower cholesterol, they also have den heart attack. It can come with no fish oil in cardiovascular diseases.
dementia. Substances that counteract ho-
unwanted side-effects, like worsening the warning, like a lightning bolt. There are
mocysteine include folic acid, and vita- Myeloperoxidase (MPO), is a protein se-
balance between omega-6 and omega-3 many new explanations for this:
mins B6 and B12. Folic acid appears creted by white blood cells. The function
fatty acids in the blood. Statins also pre- mainly in vegetable foods, but it is unfor- of MPO is to destroy harmful bacteria,
Angiotensin, a protein, causes blood ves-
vent the synthesis of ubiquinone (coen- tunately not part of most ageing men’s which have made their way into the
sels to constrict, and drives blood pres-
zyme Q10) in the liver thus decreasing its diets. For them, we recommend vitamins bloodstream. At the same time, however,
sure up. It is part of the renin-angiotensin
content in the blood. These facts add fur- that will lower homocysteine. The read- it may inflame the inner walls of the ar-
system, which is a major target for drugs
ther weight to the use of omega-3 fatty ings can easily be obtained from a blood teries, constricting them and impairing the
that lower blood pressure. Angiotensin
acids and CoQ10 as supplements to sample. Whenever the reading exceeds 7 circulation up to ten years before the ap-
also stimulates the release of aldosterone
statins. micromoles/litre (µmo/L), we recommend pearance of clinical cardiovascular dis-
from the adrenal cortex. Aldosterone pro-
Statins and other cholesterol lowering vitamin supplements, although the labo- motes sodium retention in the distal ne- ease. This favours the hypothesis of the
8 9

6. infectious origin of arterial diseases. AA/EPA ratio goes under 1:1, the E-EPA dria. Therefore we suggest complement- or her glucose metabolism is impaired.
dosage needs to be reduced. E-EPA sup- ing the current treatment with cardio- However, those people who consume
MPO adds to the formation of the toxic presses the overactive PLA2 as well as in- protective dietary supplements to protect large amounts of fish and fish oil have ar-
substances called Advanced Glycation flammation, thus protecting the heart and the telomeres and mitochondria. teries that stay more elastic than average,
End products (AGEs) in the body. MPO arteries. The overactive PLA2 is also even if they eat greasy meals. Omega-3
oxidises LDL cholesterol and simultan- Meals which contain large amounts of
known to increase the risk of depression. fatty acids suppress inflammation and thus
eously MPO itself causes inflammation in trans and omega-6 fats will stiffen arteries
prevent the hardening of arteries. This is
the arteries. In addition, MPO alters "good" a few hours after eating, and cola drinks
Endothelial dysfunction as mechanism of why these supplements are beneficial,
HDL cholesterol in such a way that its will do this within half an hour of drink-
the artery disease especially for diabetics.
protective effect is lost, especially in dia- ing. If a person eats this type of pro-in-
betics. MPO also reduces the amount of The risk indicators mentioned above are flammatory junk food often, the arteries
nitric oxide (NO) in the blood, which re- "partners in crime", interacting with each will harden and stiffen, especially if his
sults in the lessening of arterial flexibility. other and strengthening and maintaining
Carnosine, on the other hand, increases each other. This leads to a vicious circle:
the formation of NO in blood, which pre- an arterial disease in its early stages feeds
vents hypertension, amongst other things. on itself. We consider it very important HOW IS ATHEROSCLEROSIS DIAGNOSED?
Both carnosine and E-EPA counteract that people learn how to break this vicious
MPO, which supports the use of these di- circle through lifestyle changes, at which Blood tests can give an indication about upper arm artery to the foot artery. An
etary supplements in cardioprotection. point the prognosis for the disease will the risk factors of the disease, but there is ophthalmologist can see arterial sclerosis
MPO and other "new" risk factors can be improve markedly. Not all of those suf- no convenient reliable diagnostic exami- by looking at the retina, where the arter-
measured from the blood, e.g. in physi- fering from arteriosclerosis possess the nation for asymptomatic persons. There- ies are visible in their natural state. CHD
cal checkups. common risk factors, but they all do have fore the true prevalence of CHD in the may affect the results of an electrocar-
calcium in their artery walls, as well as population remains unknown. The statis- diography (ECG) test, especially during
Omega-6/omega-3 ratio, calculated from quiet chronic inflammation and endothe- tics are based on diagnosis and mortality exercise. More precisely, the disease can
analysis of fatty acids in the blood, is an- lial dysfunction in the arterial walls. The of symptomatic subjects. In scientific stud- be diagnosed by angiography or by com-
other way of estimating the risk of heart understanding of these factors is vital so ies they measure the thickness of the ca- puter scanning and giving an Agastson´s
disease. Heart patients often have less that we are able to prevent the illness and rotid artery wall by ultrasound or deter- score.
omega-3 in their blood than healthy peo- manage it adequately. mine the speed of the pulse wave from an
ple, partly due to low dietary intake and
partly due to a genetically overactive en- Arteriosclerosis always begins with an
zyme called Phospholipase A2 (PLA2). endothelial inflammation and the acti-
The enzyme breaks down fatty acids in vation of immune cells, which may lead SIMULTANEOUS OTHER DISEASES – CO-MORBIDITY
cell membranes, which in addition liber- to the changes shown in diagram 1. If a
ate fatty acids of the omega-6 family, es- person has some of the risk factors men-
pecially arachidonic acid (AA). It pro- tioned above, this will speed up the dam- Many heart patients have simultaneously and worsen depression. One of the com-
motes and maintains inflammation in the age. In this case the endothelial cells’ high blood pressure, insulin resistance, mon denominators for these diseases is
endothelium and leads to endothelial dys- telomeres shorten more quickly than usual metabolic syndrome and diabetes. About overactivity of the PLA2-enzyme family,
function. The ratio between AA and EPA and the mitochondria are damaged. When 80% of diabetics become ill with and die which can be dampened with E-EPA, as
(AA/EPA) is a useful indicator of the risk the damage occurs in the coronary arter- of myocardial infarction or stroke, even we mentioned earlier. Heart patients also
of future heart disease and of the progres- ies, the heart muscle cells suffer from aci- when they are being treated according to run a risk of contracting Alzheimer´s dis-
sion of an existing condition. The larger dosis (low pH). Changes in the mitochon- the recommended treatment guidelines. ease or vascular dementia. A heart attack
is the ratio, the worse is the prognosis. The drial membranes are crucial in the onset The most common causes of death are will increase the risk of stroke 44-fold over
AA/EPA ratio should not exceed 3:1 in a and worsening of cardiovascular diseases. CHD (45%) other heart diseases (15%) the course of a month, and over the course
healthy individual and not 2:1 in a heart Dietary fats have a major influence on the and stroke (10%). One in three heart pa- of three years additionally 2 to 3-fold. This
patient. Whenever the ratio is larger, we condition and functions of ageing mito- tient suffers from depression, at some point risk may be lowered by taking dietary sup-
advise intake of E-EPA fish oil so that the chondria. Especially the omega-3 fatty of time, and the heart and blood pressure plements.
ratio comes down to ideal levels. If the acids and ubiquinone protect mitochon- medications seem to increase the risk of
10 11

7. PRINCIPLES OF PREVENTION A low concentration of EPA + DHA in the
blood is an independent risk factor for a
sudden heart attack, which is adjustable,
Practical tips for prevention of heart at- ously the supplements recommended in
according to professor William S. Harris
tacks: this guide. They may save your life. from Missouri University, one of the writ-
● Measure your waist circumference (the ● If there is diabetes in your family and ers of the AHA guidelines. He recom-
upper limit: men, 90cm; women, 80cm). you are overweight, get your blood sugar mends for heart patients 850 mg daily as
Exceeding the limits indicates that you are measured both after fasting and after a a combination of E-EPA and E-DHA. It
overweight. glucose tolerance test; also request an goes well as an extra treatment to statins.
● If you are overweight (obese) begin a HbA1c and an insulin secretion test. You
should also check your blood glucose lev- "Combined treatment of statins and fish
diet and maintain a sensible weight. oil is a safe and effective way of improv-
els 30 to 45 minutes after meal. This post-
● Follow a low-carb diet. Familiarise your- ing the fat profile in blood and therefore
prandial or HbA1c test may uncover pre-
self with the glycaemic index and load of also the patient’s prognosis as opposed to
diabetes of which you may not be aware.
carbohydrates. statins only", write the leading US cardi-
● If you have any of the following: im-
● Do not smoke, consume alcohol only ologists in the journal "Mayo Clinic Pro-
paired glucose tolerance, insulin resist- ceedings".
in moderation and do not eat sweet treats.
ance, diabetes, hypertension or metabolic
● Exercise regularly at least for an hour a syndrome, ensure you manage them with So far, the largest fish oil study in the Diagram 2. JELIS-study showed, that E-EPA
day (an average 7 hours a week). world, JELIS, suggests that E-EPA, 1800 mg (1800mg per day), taken with statins prevents
care (view our guide Guidelines for Good every fifth heart attack over five years.
● If you belong to a risk group or you al- Management of Diabetes). a day taken together with statins, prevents
ready have CHD, or you have had an in- heart attacks and angina pectoris pain
farction or stroke, take daily and continu- considerably more effectively than statins
Omega-3-fatty acids alone (see diagram 2). According to JELIS,
E-EPA also reduces significantly the risk
DIETARY SUPPLEMENTS 1. Reduce intestinal (visceral) fat of recurrent stroke. So, at present there
2. Increase the Omega-3 index are two excellent options for heart pa-
Omega-3 fatty acids EPA and DHA tients, either E-EPA alone or a combina-
3. Reduce AA/EPA ratio
in fish oil tion of E-EPA + E-DHA. Both options pro-
4. Reduce elevated triglycerides in vide powerful protection against heart at-
The American Heart Association the blood tack and stroke. In contrast, traditional
(AHA) and the world’s leading
5. Reduce Apo B; sdLDL; remnant omega-3 products, such as cod liver oil,
cardiologists recommend fish oil
cholesterol particles; endo- are not as effective as the new generation
as a dietary supplement to prevent
thelin, and myeloperoksidase fish oils.
and treat heart and artery diseases.
UK’s critical watchdog, the National 6. Prevent and suppress inflam- The effect of the new fish oils goes "be-
Institute for Health and Clinical Excel- mation yond cholesterol", i.e. prevention and sup-
lence (NICE), recommends that doctors 7. Stabilise arterial plaques and pression of the principal mechanism of the
prescribe ethylesterised fish oil to patients prevents their ruptures disease, i.e. chronic low-grade inflamma-
who have had a heart attack during the Foto: Osmo Lehtinen 8. Prevent arrythmias tion. The omega-3 fatty acids are con-
last three months, especially if they do not verted in the body into powerful anti-in-
9. Prevent blood clots
eat fatty fish 2 to 4 times a week. Many usually lowers the readings by 20 to 50%. flammatory compounds (resolvins
top cardiologists recommend a combina- Two fatty fish meals a week may contain 10.Protect mitochondria from the docosatirenes and maresins). Resolvins are
tion of E-EPA and E-DHA for prevention up to 500 mg omega-3 (EPA and DHA side effects of statins produced even more when aspirin and
of cardiovascular disease (at least 500mg/ combined), but it is not enough for heart 11. Protect telomeres and thus EPA are taken together. For this reason,
day) and treatment (approx 1g/day). For patients with high TGs. In these patients, prolong survival of patients we recommend E-EPA or E-EPA + E-DHA
patients with high triglycerides (TG) the the ethylesterised fish oils almost halve the with coronary heart disease. for people using aspirin for cardio-
recommendation is 3 to 4g/day; this dose risk of sudden cardiac death. protection.
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8. Berberine ficiency which, when corrected, improves Vitamin D of this we recommend CoQ10 (100–
significantly the patient’s prognosis. A la- 300mg/day) for all heart patient who are
Berberine is a plant-derived folk medicine, Vitamin D is crucial for prevention of ar-
tent magnesium deficiency may cause ar- on statins.
which has been used for over 2,000 years terial calcification, but for this, around
rhythmia and conversely, magnesium sup-
in the Orient. Recently, scientists in the plements may prevent it. Magnesium de- 50µg per day is needed. The safe upper Vitamins C and E
West have shown that berberine is a pow- limit in continuous use is 250µg/day
ficiency may be detected in a blood test
erful positive inotropic substance (like (adults). Heart patients should have their Vitamin C is a water-soluble, and vitamin
up to five years before a clinical myocar-
digitalis), which increases the strength of serum vitamin D concentration (25-OHD) E a fat-soluble antioxidant. They both pre-
dial infarction manifests itself.
contraction of heart muscle (myocardial analysed in order to ensure sufficient in- vent oxidative stress and chronic inflam-
contractility). As such, we recommend Magnesium also works like statins, in take. The optimal level is between 35 and mation. One can safely take 500 to
berberine to support cardiac function in other words, it prevents the liver from pro- 50ng/mL (about 90 and 130nmol/L). The 1000mg of vitamin C and 100 to 200mg
conditions such as CHD, heart failure, ducing too much cholesterol. Magnesium upper safe limit is 100ng/ml or 250nmol/L. of vitamin E daily on a daily basis.
myocardial infarction and cardio- also protects the heart from the side ef-
myopathy. Berberine also lowers elevated fects of the drug digitalis (Digoxin). Folic acid (folate) and other B-vitamins Alpha lipoic acid
blood glucose readings and HbA1c. Alpha lipoic acid is another versatile and
A long-standing magnesium deficiency Low vitamin B status has been linked to
Moreover, berberine lowers elevated cho- effective universal antioxidant, which is
can cause the hardening of the aorta and inflammation, oxidative stress, and an in-
lesterol like statins although by a distinct recommended in doses of 300–600mg per
the carotid artery. Magnesium strength- creased risk of cardiovascular diseases.
mechanism, without risk of side effects. day to combat and prevent oxidative stress
ens the inside walls of the arteries and 300 microgrammes (µg) folic acid is the
The effective and safe daily dose is 1 to and inflammation.
prevents them collapsing inwards (like a recommendation for healthy people, but
1,5 grams.
rusted exhaust pipe), which is often an a heart patients may need as much as
immediate cause of heart attack and 800µg/day. It is impossible to get that
Carnosine stroke. A heart patient needs magnesium much from food, so a supplement is nec-
Carnosine is a cardioprotective protein 350 to 700mg per day as supplement. essary. Folic acid and other B-vitamins are
All the aforementioned dietary supple-
(peptide) that occurs naturally in humans, Magnesium works most efficiently when anti-inflammatory, anti-oxidative, and
ments can be taken continuously on a
e.g. in the brain and heart muscle. When taken together with folic acid, and vita- they lower the homocysteine, protecting
daily basis, and if need be, together with
taken as a supplement carnosine prevents mins B6 and B12. thus the heart, the blood vessels and the
any medication. These supplements do
the acidification of cardiac muscle cells, brain.
not cause any side effects when used ac-
which is always present in arterial disease Selenium cording to the guidelines given here. On
Vitamin B3, or niacin
(when the heart is lacking in oxygen). Selenium is an excellent and versatile the contrary, they protect the liver, brain
Carnosine also produces nitric oxide in antioxidant, which protects both the heart This is the most effective substance known and heart from the side effects of drugs.
the body, which maintains arterial wall and the arteries from oxidative stress. Or- to increase “good” HDL-cholesterol. Ni-
elasticity. In this way carnosine prevents ganic selenium is more effective than in- acin lowers high triglycerides and lipo-
and treats hypertension. Carnosine acti- organic. A suitable daily dose of organic protein A. Combining niacin with statins
vates vitagenes, which prevent premature selenium in self-treatment is 100 to 200 protects against heart-related deaths bet-
ageing. We recommend 400 to 800mg/ microgrammes (µg). ter than statins on their own. In fact, the
per day for prevention and 800 to1200mg/ FDA has recently approved this combi-
per day for treatment. Carnosin does not Chromium nation as a medicine. The European Con-
have side effects, and it can be taken with sensus Panel also recommends the com-
all medications and other dietary supple- Organic chromium, e.g. as picolinate or bination of niacin and statins for preven-
ments. nicotinate, may prevent the increase in tion and treatment of CHD and diabetes.
LDL-cholesterol and normalise glucose
Magnesium metabolism. Chromium is especially use- Ubiquinone (Coenzyme Q10, CoQ10)
ful as a weight control agent in obesity,
Magnesium is an essential mineral for the This vitamin-like substance helps the cells’
diabetes and metabolic syndrome. A heart
heart and arteries. Heart patients often power plants, mitochondria, to produce
patient’s daily need is around 100 to
suffer from a sub-clinical magnesium de- energy. CoQ also prevents damage to mi-
300µg.
tochondria produced by statins. Because
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9. In this guide we provide practical advice and guidance for self-treatment
of cardiovascular diseases, so that everyone could take care of their health
and wellbeing. We intend to impart the latest information on cardiovas-
cular risk factors and to advise on how they can be mitigated naturally.
We emphasise the importance of self-care and the responsibility every-
one has for their own health. We emphasise a healthy lifestyle, regular
exercise, avoiding smoking, salt and excessive alcohol and a healthy and
varied diet, which aids permanent weight-control. We especially high-
light the dangers of fat deposits around the waist area and visceral fat,
and recommend that you reduce it through exercise, low-carb diet and
supplements. In this guide, we do not cover drug treatments, except where
supplements can be used to strengthen the positive effects of some drugs
and where they can prevent side-effects, e.g. of cholesterol-lowering
statins.
Matti Tolonen (right), MD, is docent at the University of Helsinki. He is
reknowned as one of the pioneers of complementary or integrative medi-
cine. He resides on Costa del Sol, Spain. Pentti Raaste, MD, is a GP
with a private practice in Fuengirola, on the Costa del Sol in Spain. His
contact number is +34 952 47 52 90.
Foto: Osmo Lehtinen
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