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Angella
11th July 2012, 12:44 AM
The first step in preventing heart disease is to eat a healthy diet. Increase your consumption of whole foods rich in phytonutrients, plant molecules that give your body the nutrients it needs. Here are some practical tips:

To avoid the blood sugar imbalances that increase your risk for heart disease, eat protein with every meal, even at breakfast. This will help you to avoid sudden increases in your blood sugar.
Use lean animal protein like fish, turkey, chicken, lean cuts of lamb, and even vegetable protein such as nuts, beans, and tofu.
Combine protein, fat, and carbohydrates in every meal. Never eat carbohydrates alone.
For the same reasons, avoid white flour and sugar.
Eat high-fiber foods, ideally at least 50 grams per day. Beans, whole grains, vegetables, nuts, seeds, and fruit all contain beneficial fiber.
Avoid all processed junk food, including sodas, juices, and diet drinks, which impact sugar and lipid metabolism. Liquid sugar calories are the biggest contributors to obesity and diabetes and heart disease.
Increase omega-3 fatty acids by eating cold-water wild salmon, sardines, herring, flaxseeds, and even seaweed.
Reduce saturated fat and use more grass-fed or organic beef or animal products, which contain less saturated fat.
Eliminate all hydrogenated fat, which is found in margarine, shortening, and processed oils, as well as many baked goods and processed foods.
Instead use healthy oils, such as olive (especially extra virgin olive oil), cold pressed sesame, and other nut oils.
Avoid or reduce alcohol, which can increase triglycerides and fat in the liver and create blood sugar imbalances.
Don’t allow yourself to get hungry. Graze — don’t gorge — by eating every three to four hours to keep your insulin and blood sugar normal.
Try not to eat three hours before bed.
Have a good protein breakfast every day. You can start with a protein shake or may use eggs. Some suppliers offer omega-3 eggs, which are ideal.
Include flaxseeds by using two to four tablespoons of ground flaxseeds every day in your food. This can lower cholesterol by 18 percent. Flax is tasty in shakes or sprinkled on salads or whole grain cereal.
Drink green tea, which can help lower cholesterol.
Use soy foods such as soymilk, edamame, soy nuts, tempeh, and tofu, which can help lower cholesterol by 10 percent.
Eat at least eight to ten servings of colorful fruits and vegetables a day, which contain disease fighting vitamins, minerals, fiber, phytonutrients, antioxidants, and anti-inflammatory molecules. (vi)
Supplements Can Help Reduce Your Risk

Supplements are important. Along with a healthy diet and exercise program, they can dramatically affect your risk of cardiovascular disease. Combining these together can have the greatest impact on your cholesterol.

Here are the supplements I have found most useful in my practice to lower cholesterol and even prevent and reverse heart disease:

Everyone must take a good multivitamin and mineral, as well as a purified fish oil supplement that contains 1000 to 2000 grams a day of EPA/DHA. More may be necessary for those with low HDL and high triglycerides. (vii)
Red rice yeast (two 600-mg capsules twice a day), which is another powerful cholesterol-lowering herbal formula. (viii)
Plant sterols (beta-sitosterol and others) can help lower cholesterol. Take 2 grams a day.
Try policosanol (10 mg to 20 mg twice a day), which is from sugarcane wax and can help lower cholesterol. (ix)
A soy protein isolate shake can be helpful in lowering cholesterol by about 10 percent.
Fiber supplements such as WellbetX PGX (Konjac fiber or gluccomanan) — 4 before each meal with a glass of water — can both lower cholesterol and balance blood sugar metabolism. (x)
There are other suggestions and therapies, but these will work for most people. Working with a doctor specializing in nutritional therapy can help sort out questions or difficulties that arise.

Lifestyle and Exercise Changes for Heart Health

I encourage 30 to 45 minutes of cardiovascular exercise at least six times a week. You may try interval training (also known as wind sprints) if you are feeling stronger. I also encourage strength training to build muscle and reduce body fat composition.

Exercise is a necessity, not a luxury, in preventing almost all chronic disease, from heart disease to cancer, from dementia to diabetes, from osteoporosis to osteoarthritis. You cannot age successfully without it. It is how we are designed.

Stop Stressing Out Your Heart

Stress alone can cause a heart attack. It is often the trigger that leads to the cascade of events that causes that final, fatal heart attack. But all along the way, it contributes to heart disease by creating inflammation, raising your cholesterol and blood sugar, causing high blood pressure and even making your blood more likely to clot.

Therefore, finding ways to manage stress, to relax, and to find the pause button is essential for dealing with nearly all chronic health conditions, including high cholesterol.

Learn to reduce stress by doing regular relaxation exercises such as yoga, tai chi, meditation, breathing, guided imagery, or whatever it takes to engage the relaxation nervous system, which can lower cholesterol, reduce your overall level of inflammation, balance your blood sugar, increase metabolism, and help with your overall health.

Try classes, buy tapes, try therapy, or just go out and have fun. But you must do something to switch daily out of the alarm response to maintain your health.

Heart Medications

Occasionally I will recommend medications if I feel that my patient is swimming upstream genetically, or if there is significant heart disease present already. Then I can carefully weigh the risks and the benefits of medications.

However, it is possible to achieve most of the benefits of medications through lifestyle changes. Dr. David Jenkins from the University of Toronto compared treatment with statin drugs (the number-one cholesterol medication) to a diet high in viscous fiber, almonds, soy, and plant sterols and found they were equal, although the diet was more effective in lowering inflammation and homocysteine. (xi)

In fact, many of my patients have lowered their cholesterol over 100 points by following the comprehensive program I outline above.

In the rare occasions when I do need to use medications, here are the ones I have to choose from:

1. Statins – These work by blocking the production of cholesterol in the liver. They can also lower inflammation and very high doses may even reverse plaque or fatty deposits in the arteries.

Though now widely prescribed, statin medications do have significant side effects, in that they deplete the body’s stores of the vital component Coenzyme Q10. If you’re on statins, it’s a good idea to supplement with at least 100 mg of CoQ10 a day.

Many patients have to stop taking statins because of muscle pain and aching, known as statin myopathy. It is more common that most people think.

And you must have your liver function checked regularly and have your muscle enzymes (CPK) measured to make sure you can continue the medications safely. However you can have symptoms, pain, and muscle injury without having an abnormal CPK test.

2. Niacin – This is also known as vitamin B3, and in very high doses (1000 to 3000 mg a day) can be very helpful for raising good cholesterol (HDL) and lowering high triglycerides — something that statins are not very effective at.

I use niacin often in my patients who have insulin resistance or pre-diabetes. The major side effect is flushing (sort of like hot flashes), which are benign, subside after an hour, and reduce completely over a few weeks. You can stop flushing by taking a baby aspirin (81mg) half an hour before your take the niacin.

I usually recommend long-acting Niaspan and build up slowly over the course of 2 to 6 weeks to the desired dose of 1500 to 2000 mg daily. This needs to be done only under a doctor’s supervision.

3. Ezetimbe (Zetia) – This drug prevents absorption of cholesterol from the intestine. It can interact with the statins to increase the risk of liver toxicity. However recent studies have shown that combining Zetia with a statin actually increases plaque in the arteries even though it lowers cholesterol. Another reason to not assume that lowering cholesterol is what protects us against heart disease.

4. Fibrates – This class of medications includes drugs such as fenofibrate (Tricor) and gemfibrozil (Lopid) and helps to lower triglycerides and raise HDL. These drugs also act on a class of receptors that control inflammation and blood sugar called PPAR.

The verdict is still out on their effectiveness and safety. I prefer to use niacin, which achieves the same results, at lower cost with less risk.

5. Bile Acid Binding Agents – Drugs like Questran and WellChol bind up bile in the gut and promote the elimination of cholesterol from the body. Bile is comprised of cholesterol among other things, and getting rid of bile helps lower your cholesterol. These are somewhat difficult to take, and not often used.

Remember, cholesterol is only one of many factors that lead to cardiovascular disease, and it may not even be the most important one. Inflammation and insulin resistance or pre-diabetes are much more important. There are many causes. We have to look at all of them. We focus on cholesterol because it is what we have the best medication for. But remember if all you have is a hammer, then everything looks like a nail.

Comprehensive diet, supplements, exercise, and other lifestyle approaches can have a huge impact your risk of heart disease and can dramatically improve cholesterol. And this approach reduces your risk of nearly all chronic diseases.

Medications are available as a last resort, but I never start them without trying an integrated approach to cholesterol management and heart disease prevention. In fact, the cholesterol comes way down as a side effect of changing lifestyle. You often don’t have to treat it directly.

source - Mozaffarian D, (cardiovascular disease)