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Frequently Asked Questions
A Schematic Diagram of Human Heart
What is cholesterol?
What are LDL and HDL Cholesterol?
How can LDL cholesterol be lowered?
Is lowering LDL cholesterol enough?
What is LDL cholesterol particle size A and
B?
How can LDL cholesterol size be enlarged
even though LDL cholesterol particle size is inherited?
Why is HDL called good cholesterol?
How can HDL cholesterol be increased?
What is Lipoprotein Lp (a)?
How can Lp (a) be reduced?
What are triglycerides?
How can high triglycerides be treated?
What are the limitations of Statins?
What is nicotinic acid or niacin?
Who should undergo standard lipid profile
testing?
Homocysteine?
Who should undergo testing for Lp (a) and
LDL Particle Size?
What is Coronary Artery Disease (CAD)?
Is exercise stress testing helpful in screening
of heart disease?
Which stress testing is better?
Is Ultra Fast CT Scanner better?
What is the most diagnostic method of defining
CAD?
Do women have CAD?
How can I exercise, and how much should
I exercise?
Can stress cause heart disease?
How can you manage stress?
Does anger causes Heart Disease?
How can we treat Heart Disease?
Do you recommend Antioxidants?
Can we discuss with you about our Concerns?
Where can we buy your books and Antioxidants?
What is cholesterol?
Cholesterol is a substance that is a part of the outer
lining or membrane of cells in the body. The cholesterol
in a person's blood originated from two major sources,
dietary intake and production from the liver. Dietary
cholesterol comes from mainly meat, poultry, fish, dairy
products, and organ meats such as liver. The liver is
capable of removing cholesterol from the circulation,
as well as manufacturing the cholesterol.
What are LDL and HDL Cholesterol?
The cholesterol, like oil, cannot dissolve in the blood
unless it is combined with special protein called lipoprotein.
The cholesterol that is secreted by the liver into the
blood is combined either with the very low-density lipoprotein
VLDL or high-density lipoprotein HDL. The VLDL is then
metabolized in the blood stream to produce the LDL cholesterol.
The cholesterol combined with the low-density lipoprotein
is called LDL and the cholesterol combined with high-density
lipoprotein is known as HDL cholesterol.
How can LDL cholesterol be lowered?
In order to lower the LDL cholesterol, the activity level
of the LDL receptors must be increased, and that can be
increased by the diet that is low in cholesterol and saturated
fat, as well as medications. Exercise, losing weight,
and also eating food with lower saturated fat and cholesterol
also can lower it. The medications also can decrease the
LDL cholesterol.
Is lowering LDL cholesterol enough?
Unfortunately, the prevention and treatment of atherosclerosis
are more complicated than just lowering the LDL cholesterol.
The LDL cholesterol reduction is only half of the battle.
What is LDL cholesterol particle size A and B?
The LDL pattern A & B refer to the size of LDL cholesterol
particles in the blood. Small LDL cholesterol in the blood
may pose a greater risk of developing heart disease and
heart attacks than just the absolute number of LDL-cholesterol.
The size of the LDL cholesterol is inherited. Special
blood tests have to be done to determine the type of LDL
cholesterol. The person with the LDL cholesterol Type
A has large buoyancy LDL cholesterol, and they are most
likely to have normal blood levels of LDL cholesterol
and triglycerides The person with the LDL cholesterol
Type B has small dense LDL, and they are usually associated
with low HDL cholesterol, high triglycerides level, high
blood sugar, Type II diabetes. This is also known as insulin
resistance or metabolic syndrome.
How can LDL cholesterol size be enlarged even though
LDL cholesterol particle size is inherited?
Individuals with Type B pattern of LDL cholesterol can
increase the size by diet, exercise, medication, and also
taking niacin, which is vitamin B3.
Why is HDL called good cholesterol?
HDL is the good cholesterol because it protects the arteries
from atherosclerosis process. It also extracts cholesterol
particles from the arteries and transports them to the
liver to be disposed through the bile. People with the
low HDL have higher incidence of heart disease. The HDL
also can be measured; the people with the low large HDL
have more chances of heart disease.
How can HDL cholesterol be increased?
It can be increased by aerobic exercise, loss of weight,
cessation of cigarette smoking, moderate alcohol consumption,
reducing simple Carbohydrate intake niacin, and flaxseed.
What is Lipoprotein Lp (a)?
Lp (a) is the LDL cholesterol particle that is attached
to a special protein called apo (a) a large part of a
person's level of Lp (a) in the blood is genetically inherited.
People with a level of Lp (a) higher than 30 in the blood
are linked to greater likelihood of atherosclerosis. People
with high Lp (a) and low HDL have about 20 times more
chance of heart disease than normal population.
How can Lp (a) be reduced?
Most of the medication Statins does not help in reducing
the Lp (a). The only way to reduce that is by niacin,
taking nicotinic acid in the higher doses, and estrogen
also is shown to reduce the Lp (a).
What are triglycerides?
Triglyceride is a fatty substance that is composed of
three fatty acids, each of which is attached to glycerol
molecule. Like cholesterol, triglycerides in the blood
either come from the diet or the liver. Like cholesterol,
triglycerides cannot dissolve and circulate in the blood
without combining with the lipoprotein. After a meal,
the triglycerides and cholesterol are then absorbed into
the intestine, packaged around particles that are called
chylomicrons before they are released into the blood circulation.
How can high triglycerides be treated?
Low fat diet, low sugar diet, regular exercise, loss of
weight, reduction of alcohol consumption, and controlling
the diabetes can easily achieve treatment.
What are the limitations of Statins?
Statins are currently the most important class of medications
to lower LDL cholesterol, but the Statins are not the
only answer. The statin will decrease the LDL, but really
does not do anything for the HDL or Lp (a).
What is nicotinic acid or niacin?
Nicotinic acid or niacin is vitamin B3. To treat high
blood cholesterol, triglycerides, and to increase HDL,
lower LDL, and decrease the Lp (a), 1 to 3 grams of niacin
is recommended. Nicotinic acid is excellent for insulin
resistance syndrome. It can cause irritation and flushing
of the skin, and can sometimes upset the stomach also
Who should undergo standard lipid profile testing?
Any body above 40 years of age should undergo lipid profile
testing, but if you have low HDL and you have family history
of heart disease, then it is better to check the size
of the LDL cholesterol and also Lp (a). This special test
is costly at between $100 - $200, but it is worth doing
this testing because it is the only way you can find the
type of LDL and you can treat accordingly. Otherwise,
the treatment of the LDL would be like shooting in the
dark, and it is not very helpful.
Homocysteine?
Homocysteine is another test that can be done, and has
been shown to cause CAD and this can be treated easily,
by taking Vitamin B6, B12, and Folic Acid.
Who should undergo testing for Lp (a) and LDL Particle
Size?
Premature heart disease, young age without risk factors
What is Coronary Artery Disease (CAD)?
Coronary Artery Disease is atherosclerosis of the inner
lining of the blood vessel that supplies blood to the
heart. CAD is a common form of heart disease, and is a
major cause of illness and death. The symptoms of CAD
include chest pain, angina, heart attack, and sudden death.
Is exercise stress testing helpful in screening of
heart disease?
Exercise stress testing is most widely used cardiac Stress
Test. The accuracy of the exercise stress testing predicting
CAD is variable, depending upon the pre-test likelihood
of CAD in a patient with high risk predicted, the presence
of CAD is about 90% accurate. However, normal stress testing
may not reflect the absence of significant disease and
vice versa.
Which stress testing is better?
It is better to do the radionuclide stress testing. The
nuclear images are obtained in the resting condition,
and again immediately after the exercise. The two sets
of the images are compared. If there is any obstruction,
then the radionuclide stress testing will increase the
accuracy of diagnosing the CAD.
Is Ultra Fast CT Scanner better?
This is a new noninvasive stress test detection of the
CAD is by the electron beam computerized Tomography, known
as Ultra fast CT scan. The Ultra fast CT is designed to
measure the calcium deposits in the artery. In patients
with CAD, the plaque, which makes up the blockage contain
a significant amount of calcium, which can be detected
by Ultra fast CT scan. This test will identify calcium
in blockages, as minimal as 10-20%, which would not be
detected by normal testing. The potential limitation of
the Ultra fast CT scanner, is that the calcium score for
each vessel is reported, and this is not entirely lesion
specific. Several minimal blockages in a given vessel
may result in a similar score in one severe blockage in
a vessel. So there are so many false positives, and this
should be used only for the screening purposes only, and
not for the diagnostic purposes.
What is the most diagnostic method of defining CAD?
Coronary angiography. During the Coronary angiography,
a small catheter is inserted through the skin and into
the artery. Guided through the X-ray, the catheter is
advanced into the coronary arteries, with the dye injected,
and the images produced are called angiogram. The angiographic
images reveal the extent and severity of blockages. That
is the Gold standard for defining the CAD.
Do women have CAD?
Yes, the American Heart Association reports that 50% of
all deaths in women are from CAD. About 250,000 women
die from the disease each year. Clinically, the CAD is
seen in 1 of 9 women, age 45 to 65. But 1 in 3 women older
than 65. In women as compared to men, the onset of CAD
is about 10 years later in life, and the first Myocardial
Infarction is about 20 years later. But that is changing
now because of the stress that the women are exposed to.
So some women are having heart disease at early ages too.
How can I exercise, and how much should I exercise?
You should exercise in the aerobic level. Your physician
can calculate the aerobic level for you. Once that level
is established, then exercise 3-4 days a week. You don't
want to exercise for 4 hours once every week. Take about
5 minutes to warm up and then do the aerobic exercise,
and then take 5 to 10 minutes to cool down also. It is
better for you to schedule the exercise into the daily
routine. Plan to exercise the same time every day, and
exercise in a steady pace. Exercise strengthens the heart,
it reduces the heart disease risk, and it improves the
circulation. It lowers the blood pressure, it increases
serotonin, which helps with the stress management, and
makes you more relaxed. All these things can only be achieved
by exercising in the aerobic level only.
Can stress cause heart disease?
Yes. The medical researchers aren't sure exactly how stress
increases the heart disease, but stress itself might be
a risk factor, or it could be that the high level of stress
makes other risk factors worse. For example, if you are
under stress, your blood pressure goes up, you may over
react, you may exercise less, and you may be more likely
to smoke. Stress persistence has caused elevation of the
hormones like adrenaline and cordisol, and we know that
the increase of adrenaline and cordisol are linked to
changes in the way blood clots, and that increases the
risk of heart attacks. Whenever you are under stress,
the adrenaline glands release adrenaline, the hormone
that activates your body defense mechanism, your heart
pounds, the blood pressure raises, muscles tense, pupils
of the eyes open wide. This is normal, but if it is happening
again and again, that can cause problems with the heart
disease.
How can you manage stress?
First of all is recognizing that you are under stress
and then consider different stress management techniques
available. The meditation is one important technique that
can be and should be used. Exercise and do the other relaxation
techniques, but meditation is very useful. It has been
used for many years in Eastern culture. It is widely accepted
in the Western culture now as a relaxation technique.
The core of all meditative procedures, both religious
and therapeutic, is to quiet the mind so that it can relax.
With practice, meditation reduces stress hormone levels,
and elevates the mood. It should be done maybe 15 to 30
minutes a day, and it would be better if it is done at
the same time. The visualization meditation would be very
helpful, and there are so many meditation tapes available.
I do recommend the book written by Robert Eliot, "From
Stress To Strength". The stress management is an extremely
important part of the treatment, which we recommend for
the heart disease management.
Does anger causes Heart Disease?
Anger is another stressful emotion that has been linked
to cardiovascular complications. Anger is much apt to
be lethal when it is suppressed. Stress is of course,
difficult to define. That some people are hot reactors
means that they just get mad easily. But others are cool
on the outside, but inside they have sadness, frustration,
isolation, and these are the type of people that have
more incidence of CAD. The CAD in middle-aged men who
are under significant stress, are much more likely to
have heart attacks, as well as strokes. The contemporary
stress is more apt to come from the chronic mental rather
than acute physical stress. Depressed individuals, of
course are more likely to suffer from CAD also. It recently
was found that the periods of stress increase the level
of the Homocysteine and Cortical, which is known to be
a significant risk factor for heart disease.
How can we treat Heart Disease?
1st of all you must see your doctor and get him evaluate
the risk factors. Then make a plan for creating a healthy
Heart. I recommend you to read books written by Dean Ornish
M.D., Robert Eliott M.D. and written by me one for the
Western culture "Create a healthy Heart" and other for
South Asians " Straight from My Heart
Do you recommend Antioxidants?
Yes particularly Vit C, E, B3, B6, B 12, Folic Acid and
Selenium. Be care full with the Vit E intake if you are
taking Coumadin. It is always better to consult your Physicians.
Can we discuss with you about our Concerns?
Yes you could send me the E Mail to my web Site address
and I will get back to you at my earliest. Remember these
would be recommendations only and is in no way trying
to treat the disease.
Where can we buy your books and Antioxidants?
They are available on the website.
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