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Cardiovascular Disease: What is Your Risk?

In previous articles I have highlighted evidence showing that eating foods high in saturated fat and/or cholesterol, as well as transfats lower_cholesterol_downloadand deep fried foods, are main culprits in promoting high blood cholesterol levels (total cholesterol and LDL-cholesterol). Many studies have shown that consuming foods that lower in these fats, and higher in soluble fiber, help to reduce blood cholesterol and improve outcomes for cardiovascular disease patients. Although certain saturated fats raise cholesterol more than others, the principle saturated fats found in the North America and Western European diet, are the ones that raise cholesterol to the greatest degree. (1-6)

However, the over-consumption of carbohydrates can also contribute to higher cholesterol and triglyceride levels. Excess carbohydrate calories are converted into fat within the liver (some of them saturated fat), which turns on cholesterol production in order to transport the fat to adipose tissue and muscle tissue, which store and burn fat, respectively.  Thus, over-consuming carbohydrates also raises cholesterol, albeit to a lesser degree than saturated fat consumption, and also raises triglyceride levels and may lower HDL-cholesterol (HDL-cholesterol is capable of reversing arterial plaque). (7)

In the final analysis, it is a combination of dietary, genetic, inflammatory, lifestyle and other factors, which must be analyzed as a whole, to establish the patient’s overall risk for cardiovascular morbidity and mortality. Below, I have provided the Cardiovascular Risk Factor Form, which I developed and use with patients in the primary prevention of cardiovascular disease. If the patient scores outside of the ideal range, then I address the dietary, exercise and supplementation interventions that can help them improve their profile, in concert with any concurrent medical interventions that are being applied. I hope you find it helpful.

 

Practitioner Cardiovascular Disease Screening Form (James Meschino DC, MS, ND)

 

Patient’s Name
________________________  
Assessment Date
________________________  
Gender
________________________  
Age
________________________  
Systolic Blood Pressure
________________________  
Diastolic Blood Pressure
________________________  
Pulse
________________________ (bts/min)
Diabetes
Yes___ No____ comment: __ID______________
Smoking
Yes___ No____ comment: Number per day__________
Total Cholesterol
________________________ (at or below 3.9 mmol/L)
  (to convert any type of blood cholesterol reading from mmol/L to mg/dL divide by 0.025)
LDL-Cholesterol
________________________ (Below 1.8 or 2.0 mmol/L (72- 80 mg/dL))
HDL-Cholesterol
________________________ (Men: above 1.17 mmol/L (45 mg/dL) Women: above 1.42 mmol/L (55 mg/dL))
TC:HDL Ratio
________________________ 3:1 or lower
Fasting Glucose
________________________ (ideal is under 90 mg/dl or 5 mmol/L – conversion factor is .055)
Fasting Triglycerides
________________________ ( ideal is at or below 132 mg/dl or 1.5mmol/L – conversion factor is 88.57)
C-Reactive Protein
________________________ (less than 0.24 mg/dL or 2.4 mg/L) – conversion factor is 10
Fibrinogen
________________________ (less than 300 mg/dL or 0.88 umol/L -  conversion factor is 0.0294)
INR
________________________ (0.8 – 1.3)
 
Body Mass Index or BMI  (wt/ht squared) – wt is kg and ht is in metes-squared)
Multiply weight in pounds by .45 to get weight in kg
Multiply height in inches by .025 to get height in meters (then multiply height in meters by itself to get height in meters squared)
(BMI of 27 or higher increases risk of high BP, Diabetes, Dyslipidemia and some cancers) BMI = ________________________
     
Waist Circumference ________________________ inches
  (under 36 for men and 33 for women)
Personal History of Heart Disease, Stroke, Deep Vein Thrombosis, Chronic Renal Disease or any vascular problems  or vascular procedures (angioplasty, by-pass surgery, coronary stent) Yes___ No___
     
Comment:
_____________________________________________________________________________
_____________________________________________________________________________
Exercise Program
_____________________________________________________________________________
_____________________________________________________________________________
     
GFR (eGFR < 60 mL/min is a concern) ________________________  
Blood Creatinine ________________________ Normal is 0.6 to 1.2 mg/dl 60-110 μmol/L) in adult males and 0.5 to 1.1 mg/dl (45-90 μmol/L) in adult females
Albumin:Creatinine Ratio  - Urine Test (An elevated albumin/creatinine ratio (men: > 2.0 mg/mmol, women: > 2.8 mg/mmol) is associated with an increased risk of death from CVD, and progression of kidney disease_________________
Homocysteine - ________________________ Ideal is 6.3 umol/L or lower (0.85 mg/L)
Fructosamine - ________________________ Normal Range: 205 – 285 umol/L
Uric Acid ________________________ Men: 140 – 440 umol/L (2.4 – 7.4 mg/dL) Women: 80 – 350 umol/L (1.4 – 5.8 mg/dL)
 
Metabolic syndrome: Metabolic syndrome includes three or more of the following criteria: Abdominal obesity (waist circumference: men > 102 cm or 40 inches; women > 88 cm or 35 inches; Triglycerides ≥ 1.7 mmol/L; HDL men < 1.0 mmol/L, women < 1.3 mmol/L; BP > 130/85 mm Hg; Fasting glucose 5.7-6.9 mmol/L (103 -124mg/dl – conversion from mg/dl to mmol/L is .055). Is There Evidence of Metabolic Syndrome?           Yes_____ No_____
 
Framingham 10 Year Heart Disease Risk Score (based on LDL reference form)________________________%  -  completed in office
Framingham 10 Year Heart Disease Risk Score (based on Total Cholesterol reference form________________________% - completed in office
     
Current CVD Medications (cholesterol, triglyceride, blood pressure, other):
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
     
Are They A Candidate For Other CVD Tests:  
1. Chest Pain (stress test)  YES________ NO_______
2. Chest Pain upon exertion (stress test) YES________ NO_______
3. Shortness of Breath YES________ NO_______
4. Light-headedness or dizziness YES________ NO_______
5. Over Age 60 and not accustomed to exercise (consider stress test) YES________ NO_______
6 .Family History Of CVD before age 60 YES________ NO_______
7. Pectus Excavatum YES________ NO_______
8. Previous CVD episode (MI, stroke, TIA, angina, DVT etc) YES________ NO_______
     
Other Tests They Have Had Or Should Be Considered Based On History And Physical Examination Findings (Comment If Applicable):
Resting ECG ________________________  
Stress Test ECG ________________________  
Echocardiogram (valves)_ ________________________  
Thallium  Scan ________________________  
Angiography ________________________  
Other ________________________  
     

 

References:

  1. Jenkins D, Kendall C, Marchie A, Faulkner D, Wong J et al. Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants. Am J Clin Nutr. 200; 81:380-7
  2. Modern Nutrition In Health And Disease -10th edition (Shils ME et al). Lippincott Williams & Wilkins 2006. Pages 96-110 (Lipids, Sterols and Their Metabolites)
  3. Esselstyn Jr. C B. Resolving the Coronary Artery Disease Epidemic through Plant-Based Nutrition, Preventive Cardiology 2001; 4: 171-177
  4. Grundy SM. Dietary fat: at the heart of the matter. Science 2001;293:801–2.
  5. http://www.sciencedaily.com/releases/2006/08/060808091635.htm
  6. http://fh.ext.wvu.edu/r/download/23062
  7. Chapman J et al. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management. Eur Heart J. 2011 June; 32(11): 1345–1361.

 

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