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Advanced Lipid Testing

Bret Scher, MD
Standard lipid tests evaluate total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG). These are well established and accepted biomarkers to assess and manage cardiovascular risk. These standard tests are reliable for predicting risk in most cases, but an estimated 15% of patients suffer a heart attack, stroke, or another cardiovascular event despite achieving target levels. Dr. Bret Scher, MD, is a cardiologist who favors advanced lipid testing as a way to refine risk assessment. The following discussion helps clinicians understand what advanced lipid tests can be ordered, how to interpret the results, and what interventions might improve advanced lipid biomarkers to reduce cardiovascular risk.


Depression and Cardiovascular Disease

Decker Weiss, NMD
Cardiovascular disease is the number 1 cause of death in the United States and in the world.   According to the 2015 update by the American Heart Association (AHA), cardiovascular disease claims more lives than all forms of cancer combined, with 1 in every 3 deaths in the United States resulting from heart disease, stroke, or other cardiovascular disease. The AHA promotes 7 key behaviors that this organization hopes will reduce the risk of cardiovascular disease by 20% by the year 2020: not smoking, increasing physical activity, following a healthy diet, maintaining a healthy body weight, controlling cholesterol, controlling blood pressure, and controlling blood sugar.

Depression as a risk factor for cardiovascular disease has also attracted increasing attention, with the AHA listing depression as a risk factor for adverse events after acute coronary syndrome (ACS) in 2014. Here Dr. Decker Weiss discusses how the functional pathophysiology of depression and cardiovascular disease overlap, how to assess these conditions with functional labs, and how to approach their treatment. This information is critical for any clinician who treats patients with either depression or cardiovascular disease.

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Alan Simon, R.Ph
Statin medications (e.g., Zocor, Mevacor, Lipitor, Crestor) have become the gold standard of conventional treatment of hypercholesterolemia despite their poor side effect profile and lack of efficacy in certain populations. Furthermore, the increased use of these prescription drugs has not had an impact on heart disease mortality and reduction of corresponding risk factors.

According to the Center for Disease Control and Prevention, nearly 34% or approximately 71 million Americans have high LDL cholesterol (>130 mg/dL). Conventional medicine focuses on lowering cholesterol, and LDL cholesterol in particular. The integrative approach, on the other hand, focuses on reducing glycation and inflammation, which causes oxidized cholesterol to inflame arteries, ultimately causing plaque formation. While all healthcare practitioners agree that it is important to lower risk factors for cardiovascular disease, there is significant debate as to the most effective way to do this. An integrative approach focuses on alternatives to statin drugs, while addressing diet and lifestyle factors in order to provide more broad spectrum cardiovascular disease risk reduction.





Kathleen Padgitt, MD, FACP
Hypertension is the most common form of cardiovascular disease (CVD) in America and a strong risk factor for other CVD, including coronary artery disease, peripheral artery disease, stroke, myocardial infarction, and congestive heart failure. Approximately 1 in 3 adults in the United States have hypertension, meaning that they either have documented high blood pressure or are taking antihypertensive medications. Blood pressure is controlled in only half of these adults, partly due to a lack of awareness and partly due to the challenges and side effects of drug therapy. In the context of our growing understanding of its functional pathophysiology, Dr. Kathleen Padgitt discusses the importance of dietary and lifestyle interventions as part of an integrative approach to the management of hypertension.




Ischemic Heart Disease in Women: An Integrative Approach

Marisa Pellegrini, ND
Ischemic heart disease is a clinical syndrome characterized by myocardial ischemia. The term ischemic heart disease is more inclusive than coronary artery disease, which refers specifically to atherosclerotic obstruction of the coronary arteries. Ischemic heart disease can have obstructive or non-obstructive causes, including microvascular dysfunction, abnormal coronary reactivity, or an imbalance between the supply and demand of myocardial oxygen. Ischemic heart disease is the leading cause of death in women in the United States, and although men are more likely to suffer a myocardial infarction, women are more likely to die within a year of myocardial infarction. Moreover, the majority of women with sudden cardiac death have not previously been identified to have heart disease. This discussion with Marisa Pellegrini, ND addresses the need for greater understanding of the presentation, diagnosis, treatment, and monitoring of ischemic heart disease in women.


Metabolic Syndrome

Metabolic syndrome, initially described in 1988 as syndrome X, is a condition that involves multiple cardiovascular risk factors: obesity, hypertension, hyperlipidemia, and blood sugar dysregulation. Central to the metabolic abnormalities of this condition are insulin resistance and hyperinsulinemia. Patients with metabolic syndrome have an increased risk of type 2 diabetes, atherosclerosis, and death from cardiovascular disease. According to National Health and Nutrition Examination Survey (NHANES) data through 2012, the overall prevalence of metabolic syndrome in US adults is 33%, with higher rates in women than in men and higher rates in Hispanics than in other ethnic groups. Among US adults over the age of 60, the prevalence of metabolic syndrome is as high as 50%.