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Lowering risk of heart attack

Turn Up the Ratio

Your relative risk of heart attack may be lowered by as much as 80 percent by doing just three things: eating plenty of fruits and vegetables, getting regular exercise, and avoiding smoking.

That simple bit of information has to be one of the most valuable results of the new research I told you about in yesterday’s e-Alert, “Waking Up is Hard to Do” (9/20/04). Over the course of a 10-
year study, researchers matched about 15,000 heart attack patients with approximately the same number of heart-healthy subjects to examine heart attack risk factors. This was a worldwide study that included male and female subjects with a wide range of ages, cultural backgrounds and dietary habits.

The results showed that across the board, the number one heart attack risk factor is an unacceptable apo ratio. That information was hailed as ground-breaking by some media outlets. And while it is significant, it’s not really news to us, because long-time HSI members and e-Alert readers have known about the value of the apo ratio for nearly three years. And more importantly, they’ve known how to address that ratio when it moves into the danger zone.

Tipping the balance

Apolipoprotein is cholesterol’s protein component. ApolipoproteinB (apoB) is the protein found in LDL, and apolipoproteinA1 (apoA1) is found in HDL. The ideal apoB to apoA1 ratio is 1 to 2.

In the e-Alert “Learn Your Real Risk of Heart Attack with One Simple Test” (12/27/01), I told you about a Swedish study in which researchers tracked more than 175,000 men and women for about five and a half years. The average age of the subjects was 48. Researchers measured each participant’s total cholesterol, LDL and HDL cholesterol, triglycerides, and concentrations of apoB and apoA1.

Over the course of the study, 864 men and 359 women died from heart attacks. When researchers compared the blood profiles of these heart attack victims to the remainder of the participants, they found that an unacceptable apo ratio was the strongest predictor of heart attack death among all of the markers studied, and they were the ONLY markers that remained consistent over all age groups.

Men with the highest levels of apoB AND the lowest levels of apoA-1 were nearly FOUR TIMES as likely to have a fatal heart attack than those with opposite values. Women with similar ratios
had three times the risk.

Most importantly, the predictive power of the apo ratio was seen even when total cholesterol, LDL cholesterol, and triglycerides were within normal ranges.

The best defense

Shortly after I sent you that 2001 e-Alert, I asked HSI Panelist and medical advisor Martin Milner, M.D., for his advice on improving apo ratio. In the e-Alert “Three Simple Steps to Reduce Your Risk of Heart Attack” (1/28/02), Dr. Milner told us about the health factors he feels are most important for bringing apo ratio into line: diet, lifestyle and supplement intake.

Dr. Milner recommends these dietary guidelines:

  • Add more vegetables to your diet – a minimum of three to five
    servings per day
  • Avoid all refined carbohydrates, as well as carbs with a high
    glycemic index
  • Add more fiber to your diet (such as organic ground flax seeds or
    psyllium)
  • Garlic, onions, shallots and ginger can help manage
    inflammation, as well as cholesterol
  • Overall, aim for a diet of 30 percent protein, 50 percent
    carbohydrate and 20 percent fat

As for lifestyle changes, Dr. Milner recommends daily exercise
that includes 30 minutes of aerobic exercise every other day.
Exercise also relieves stress, which is another heart health risk
factor. Dr. Milner notes that if you need more help managing
stress, “try meditation, deep breathing, hiking in the woods, taking
a bath by candlelight – anything that helps you relax and unwind.”

And this is the list of supplements that Dr. Milner recommends to
help achieve an ideal apo ratio:

  • 200 mcg of chromium daily
  • 1 to 5 mcg of vanadium, three times daily
  • 50 to 200 mg of alpha lipoic acid, three times daily
  • 2 to 6 grams of fish oil daily
  • 300 mg l-carnitine two to three times a day

Revealing the ratio

In the 2001 e-Alert, I told you about a comprehensive blood test
that Dr. Milner uses in his practice to measure heart attack risk
factors, including C-reactive protein, fibrinogen (a globulin that
affects blood coagulation), homocysteine, total cholesterol, HDL,
LDL and, of course, apo ratio. The test is called the
Comprehensive Cardiovascular Report (CCR), and it’s available
from Great Smokies Diagnostic Laboratories (GSDL).

Talk to your doctor about requesting the CCR test from Great
Smokies. Physicians can find out more by calling GSDL at 1-800-
522-4762, or by visiting the web site at gsdl.com. You can also
contact the lab directly and ask for a referral to a registered
provider in your area. After the test is completed and returned to
GSDL, you’ll receive a full report that provides your score on each
important marker and a clear explanation of what your scores
reveal about your risk of heart disease.

From there, you and your health care provider will be able to plan
a realistic course of action to keep your heart as healthy as
possible.

To Your Good Health,

Jenny Thompson
Health Sciences Institute

Sources:
“High Apolipoprotein B, Low Apolipoprotein A-I, and
Improvement in the Prediction of Fatal Myocardial Infarction
(AMORIS Study): A Prospective Study” The Lancet, Vol. 358,
No. 9298, 12/15/01, thelancet.com
“Effect of Potentially Modifiable Risk Factors Associated with
Myocardial Infarction in 52 Countries (the INTERHEART Study)”
The Lancet, Vol. 364, No. 9438, 9/11/04, thelancet.com

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