While the complexities of a disease like heart failure can’t be overstated, preventative medicine—avoiding the risks in the first place—is the vastly preferable option, no matter who you are.
At Immunocorp, the focus is primarily on the causes and/or risk factors, as opposed to the symptoms that may not surface until it’s too late. Western medicine tends to focus on the latter, so here, we explore some potential early factors in heart disease, highlight potential links (including dietary supplements), and outline the emergence of novel therapies that offer hope for people with heart disease.
The good news is, heart failure can be preventable. Regular physical activity, maintaining a healthy weight, and consuming diets that contain plenty of plant foods and low in saturated fats can go a long way decreasing the risk of heart failure. Of course, it is also important to schedule regular checkups with your physician to monitor your heart’s health, especially for those with a personal or family history of cardiovascular disease.
Step 1: Know the Causes and Risk Factors
Heart failure may be due to a variety of factors and causes such as:
- Ischemic heart disease
- Elevated LDL
- Genetics and family history
- Physical inactivity
Recognition and mitigation of these factors and conditions may reduce heart failure risk that might prove problematic down the line. The most common cause of heart failure is ischemic heart disease due to coronary artery atherosclerosis—CAD—which is caused by high blood pressure, smoking, or high cholesterol.
Dietary and lifestyle factors associated with increased risk of heart failure include excessive alcohol consumption and nutritional deficiencies1-3. Smoking represents a major risk factor for developing heart failure, and quitting smoking has been shown to have a significant effect on lowering the risk of heart disease4-5. Physical inactivity, which is known to be a risk factor for many cardiovascular diseases, worsens the survival of patients with heart failure6.
Insufficient intake of fruits and vegetables is another risk factor associated with heart failure. In a study that assessed fruit and vegetable intake by way of serum beta-carotene level measurement, men with the lowest beta-carotene blood levels had an almost 3-fold increased risk of heart failure compared to those with the highest intake7.
Diabetes and insulin resistance are major risk factors for heart failure; diabetes not only increases the risk of heart failure, but it also worsens the outcome of patients with already existing heart failure. The diabetic heart is more susceptible to ischemic (low oxygen) injury, myocardial infarction, and oxidative damage8.
Step 2: Monitor Physical Signs and Symptoms
Some signs that may suggest heart failure include fatigue and difficulty breathing, which can lead to decreased capacity for physical activity, fluid retention, frequent nighttime urination, and symptoms of wheezing, and abdominal discomfort. These signs are typically progressive with the severity of heart failure, and some may not be present in mild cases, so it’s important monitor changes with your physician.
Additional tests that may help in the diagnosis and monitoring of heart failure include cardiovascular function parameters, biomarker testing, thyroid function tests, and electrocardiograms.
Step 3: Consider Novel and Emerging Therapies for Heart Failure
When heart failure occurs, energy metabolism gets flustered. One primary change that occurs in the failing heart is that the ability of cardiac myocytes to derive energy from fatty acids declines. This is a significant problem because fatty acids represent the primary energy source for the healthy heart. Therefore, the decline of cardiac function in heart failure is compounded by inefficient fatty acid utilization9-10.
A novel approach to overcoming this obstacle is use of the drug trimetazidine, which fires up glucose utilization in the heart, thus lessening the reliance on fatty acids for energy.
Stem cell therapy for cardiac regeneration is an emerging and rapidly evolving field. Studies show that stem cells in mice are capable of regenerating damaged heart tissue, such as that damaged by a heart attack11. It is believed that stem cells act by inducing the release of cytokines and growth factors that stimulate the body’s own regenerative capacities12, including promoting the growth of new blood vessels13-15.
Early research has established that stem cell therapy is safe, but additional clinical trials are necessary to thoroughly establish the utility of stem cell therapy for cardiac disease16-19
Inadequate levels testosterone can also contribute to cardiovascular diseases, including heart failure. However, this connection is overlooked by many mainstream physicians20. Testosterone is important for the maintenance of skeletal muscles, and a decline in circulating testosterone may exacerbate the exercise intolerance and loss of muscle mass (cachexia) seen in heart failure patents21. An estimated 25–30% of men with heart failure have evidence of testosterone deficiency22. In men with NYHA Class I-IV heart failure, circulating testosterone levels have been related to exercise capacity, and normal anabolic hormone levels (total and free testosterone, DHEA sulfate, and insulin-like growth factor) have been associated with better 3-year survival rates compared to those who have deficiencies in one, two, or three of these hormones23.
Testosterone replacement therapy (restoring physiological levels) has been demonstrated to improve exercise capacity in males with heart failure who have low circulating testosterone levels24-25 with no adverse effects noted. Some evidence suggests testosterone replacement may also benefit women with heart failure.
Step 4: Manage Your Lifestyle
Even though you may think you’re living a heart-healthy lifestyle, your body isn’t always getting what it needs. That’s why you should consider the following research-based lifestyle changes to enhance your overall heart health:
Smoking is a major risk factor for many medical conditions, including cardiovascular diseases. Stopping smoking provides benefits for patients with congestive heart failure, which are similar to the benefits offered by primary drugs used in this condition26-27. Several other studies found that people who quit smoking have a lower risk of cardiovascular disease28.
Exercise is now recognized as a valuable addition to other interventions and should be considered for all heart failure patients who are stable enough to participate. ACCF/AHA guidelines recommend that aerobic activity be performed for at least 30 minutes, 5 or more days per week. Published studies evaluating the efficacy of exercise training in heart failure patients report improvements in skeletal muscle oxygen utilization, increased exercise capacity, muscle strength and endurance, improved diastolic function, reductions in inflammatory cytokines such as TNF-α and IL-6, improvement of symptoms and quality of life measurements, reduction in NYHA functional class, and reduction in hospital stays and mortality29. Most of these benefits were seen when exercising at moderate-high intensity (70-80% of peak heart rate).
Step 5: Improve Diet & Nutrition
Heart failure can be an outcome of several disease processes, and nutrition plays an important role in the progression of heart failure. A high dietary intake of salt increases blood pressure, and is well-known to worsen hypertension, a major cause of heart failure. The American Dietetic Association guideline for dietary sodium in heart failure patients is <2 g/day, with the intent to improve both clinical symptoms, such as tiredness and swelling, and quality of life30. A sodium-restricted diet (<1.5 g/day) in patients with hypertension can help reduce blood pressure.
Insufficiency of potassium, zinc, magnesium, calcium, phosphate, and b-vitamins are of particular concern among heart failure patients. Making sure that these nutrients are in your diet can enhance your overall heart health.
Studies show that fatty acids represent the primary energy source for the healthy heart, however, most Americans don’t consume nearly enough. Calanus oil is the world’s most precious source of omega-3 fatty acids (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]), which are difficult to obtain from the diet in sufficient quantities unless large amounts of fatty fish are consumed but are nonetheless critical for several metabolic processes. Omega-3 fatty acids have been well studied for their prevention of cardiovascular disease and ability to reduce inflammation, hypertension, and the risk of cardiovascular mortality31-33.
When we understand the importance of preserving or restoring heart health, we can make choices to support our heart long into the future. Your heart works every day and night for you, so shouldn’t you do everything to ensure that it’s running at peak condition?
- Dunn, S. P., Bleske, B., Dorsch, M., Macaulay, T., Van Tassell, B., and Vardeny, O. Nutrition and heart failure: impact of drug therapies and management strategies. Nutrition in Clinical Practice. 2009;24(1):60–75.
- Kenchaiah, S., Narula, J., and Vasan, R. S. Risk factors for heart failure. Med. Clin. North Am. 2004;88(5):1145–72.
- Bryson, C. L., Mukamal, K. J., Mittleman, M. A., The Association of Alcohol Consumption and Incident Heart Failure. J Am Coll Cardiol. 2006;48(2):305–11.
- Suskin, N., Sheth, T., Negassa, A., Yusuf, S. Relationship of current and past smoking to mortality and morbidity in patients with left ventricular dysfunction. J Am Coll Cardiol. 2001;37(6):1677-82
- Conard, M.W., Haddock, C.K., Poston, W.S., Spertus, J.A., and the Cardiovascular Outcomes Research Consortium. The impact of smoking status on the health status of heart failure patients. Congest Heart Fail. 2009;15(2):82-6.
- Oerkild, B., Frederiksen, M., Hansen, J.F., Prescott, E. Self-reported physical inactivity predicts survival after hospitalization for heart disease. Eur J Cardiovasc Prev Rehabil. 2011;18(3):475-80.
- Karppi J, Kurl S, Makikallio TH, Ronkainen K, Laukkanen JA. Serum beta-carotene concentrations and the risk of congestive heart failure in men: A population-based study. International journal of cardiology. Jan 17 2013.
- Ansley, D. M., and Wang, B. Oxidative stress and myocardial injury in the diabetic heart. J. Pathol. 2013;229(2):232–41
- Ingwall JS. Energy metabolism in heart failure and remodeling. Cardiovascular research. Feb 15 2009;81(3):412-419.
- Lopaschuk GD, Ussher JR, Folmes CD, Jaswal JS, Stanley WC. Myocardial fatty acid metabolism in health and disease. Physiological reviews. Jan 2010;90(1):207-258.
- Orlic D, Kajstura J, Chimenti S, Bodine DM, Leri A, Anversa P. Transplanted adult bone marrow cells repair myocardial infarcts in mice. Annals of the New York Academy of Sciences. Jun 2001;938:221-229; discussion 229-230.
- USSCC. US Stem Cell Clinic. Clinical Research page. Degenerative Conditions. http://usstemcellclinic.com/en/degenerative/. Copyright 2016. Accessed 9/29/2016.
- Michler RE. Stem cell therapy for heart failure. Cardiology in review.May-Jun 2014;22(3):105-116.
- Vrtovec B, Poglajen G, Haddad F. Stem cell therapy in patients with heart failure. Methodist DeBakey cardiovascular journal.Jan-Mar 2013;9(1):6-10.
- Khanabdali R, Rosdah AA, Dusting GJ, Lim SY. Harnessing the secretome of cardiac stem cells as therapy for ischemic heart disease. Biochemical pharmacology.Aug 1 2016;113:1-11.
- Comella K, Parcero J, Bansal H, Perez J, Lopez J, Agrawal A, Ichim T. Effects of the intramyocardial implantation of stromal vascular fraction in patients with chronic ischemic cardiomyopathy. J Transl Med.2016;14(1):158.
- Marthur A; Queen Mary University of London. The Effect of Intracoronary Reinfusion of Bone Marrow-derived Mononuclear Cells (BM-MNC) on All Cause Mortality in Acute Myocardial Infarction. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). Last updated 2016 June 10. Available from https://clinicaltrials.gov/ct2/show/NCT01569178. NLM Identifier: NCT01569178.
- Ceylad. Efficacy and Safety of Bone Marrow-derived Mesenchymal Cardiopoietic Cells (C3BS-CQR-1) for the Treatment of Chronic Advanced Ischemic Heart Failure. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). Last updated 2015 May 18. Available from https://clinicaltrials.gov/ct2/show/study/NCT01768702. NLM Identifier: NCT01768702.
- Teva Pharmaceutical Industries. A Double-blind, Randomized, Sham-procedure-controlled, Parallel-group Efficacy and Safety Study of Allogenic Mesenchymal Precursor Cells (CEP-41750) in Patients With Chronic Heart Failure Due to Left Ventricular Systolic Dysfunction of Either Ischemic or Nonischemic Etiology. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). Last updated 2016 Aug 9. Available from https://clinicaltrials.gov/ct2/show/study/NCT02032004. NLM Identifier: NCT02032004.
- Kalicinska E, Wojtas K, Majda J, Doehner W, Haehling SV, Banasiak W, . . . Jankowska EA. Anabolic deficiencies in men with systolic heart failure: do co-morbidities and therapies really contribute significantly? The aging male : the official journal of the International Society for the Study of the Aging Male. Jun 26 2013.
- Volterrani, M., Rosano, G., and Iellamo, F. Testosterone and heart failure. Endocrine. 2012;42(2):272–7.
- Malkin CJ, Channer KS, Jones TH. Testosterone and heart failure. Current Opinion in Endocrinology, Diabetes & Obesity. 2010;17:262-68.
- Jankowska, E. A., Filippatos, G., Ponikowska, B., et al. Reduction in circulating testosterone relates to exercise capacity in men with chronic heart failure. J. Card. Fail. 2009;15(5):442–50.
- Stout, M., Tew, G. A., Doll, H., et al. Testosterone therapy during exercise rehabilitation in male patients with chronic heart failure who have low testosterone status: a double-blind randomized controlled feasibility study. Am. Heart J. 2012;164(6):893–901.
- Toma M, McAlister FA, Coglianese EE, Vidi V, Vasaiwala S, Bakal JA, . . . Ezekowitz JA. Testosterone supplementation in heart failure: a meta-analysis. Circulation. Heart failure. May 1 2012;5(3):315-321.
- CDC (Centers for Disease Control and Prevention) (US); National Center for Chronic Disease Prevention and Health Promotion (US); Office on Smoking and Health (US). How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2010. 6, Cardiovascular Diseases. Available from: http://www.ncbi.nlm.nih.gov/books/NBK53012/
- Suskin, N., Sheth, T., Negassa, A., Yusuf, S. Relationship of current and past smoking to mortality and morbidity in patients with left ventricular dysfunction. J Am Coll Cardiol. 2001;37(6):1677-82.
- Clair, C., Rigotti, N.A., Porneala, B., Fox, C.S., D’Agostino, R.B., Pencina, M.J., Meigs, J.B. Association of smoking cessation and weight change with cardiovascular disease among adults with and without diabetes. JAMA. 2013;309(10):1014-21.
- Downing, J., and Balady, G. J. The role of exercise training in heart failure. J Am Coll Cardiol. 2011;58(6):561–9.
- Tyson, C. C., Nwankwo, C., Lin, P.-H., and Svetkey, L. P. The Dietary Approaches to Stop Hypertension (DASH) eating pattern in special populations. Curr. Hypertens. Rep. 2012;14(5):388–96.
- Kotwal, S., Jun, M., Sullivan, D., Perkovic, V., and Neal, B. Omega 3 Fatty acids and cardiovascular outcomes: systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2012;5(6):808–18.
- Kwak, S. M., Myung, S.-K., Lee, Y. J., Seo, H. G., Korean Meta-analysis Study Group. Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials. Arch Intern Med. 2012;172(9):686–94.
- Marik, P. E., and Varon, J. Omega-3 dietary supplements and the risk of cardiovascular events: a systematic review. Clin Cardiol. 2009;32(7):365–72.