Coronary artery disease (CAD) is the most common type of heart disease, and the leading cause of death in the United States for both men and women. Chances are you have some questions about your heart health.

Q: What is coronary artery disease?

A: CAD occurs when the arteries that supply blood to the heart become hardened and narrowed by a buildup of plaque on their inner walls. The plaque buildup, known as atherosclerosis, ultimately restricts blood flow to the heart muscle.

Q: What causes atherosclerotic process?

A: Normally our blood vessels are coated with a smooth Teflon-like, secure, single layer of cells called the endothelium. Inflammation is now understood to drive the atherosclerotic engine by actively involving blood vessels in their own demise. What instigates inflammation? Free radicals, and elevated homocysteine levels render arterial decay, but LDL particles, which transport most of our body’s cholesterol, represent the greatest offenders. Small pores that dot the single-celled endothelial covering normally permit only a limited penetration of LDL particles into the blood vessel wall. However, as the number of these particles increases, the more readily they will penetrate the vessel barrier and come to rest beneath the surface. Once inside an artery’s wall, the process of inflammation begins its spiral of destruction. Specialized inflammatory cells engulf the cholesterol in an attempt to quell the problem, but the opposite often occurs. The cells themselves become transformed; they release a host of substances that summon other inflammatory cells, which in turn release more and more harmful products. Inflammation soars, the plaque grows, and the artery reshapes itself in an attempt to preserve an adequate lumen (the inner diameter, as in a hose or pipe) to maintain an ample flow of blood.

Q: What can CAD lead to?

A: The reduced blood flow and oxygen supply received by the heart muscle can lead to angina, or heart attack. Over time, CAD can also weaken the heart muscle and contribute to heart failure or arrhythmias. [NHLB]

Q: Are there natural solutions?

A: Lifestyle choices serve as the foundation for a healthy heart. Daily exercise, a healthful diet rich in fruits, vegetables, legumes, fiber, and plenty of water, as well as an active management of life’s stressors, and avoidance of harmful substances such as tobacco are all important.

Q: What can I do about cholesterol?

A: To shed a clearer light on your cholesterol levels, have your doctor perform specialized blood tests such as the LipoProfile from LipoScience labs in North Carolina. In order to make more refined recommendations, cardiologists need to know the number and size of your LDL and HDL particles (as well as other more esoteric elements of your lipids). If statin drugs are recommended to lower your cholesterol, a combination of CoQ10, L-carnitine, and lipoic acid can help combat the side effects such as muscle aches and weakness.

Q: What can I do about inflammation?

A: Ask for a PLAC test to examine the level of inflammation in your arteries. The well-known C-reactive protein (CRP) test demonstrates more widespread (or systemic) inflammation and, thus, will be elevated not only in patients with coronary disease but also in smokers, overweight individuals, and those with rheumatologic disorders. By contrast, the PLAC test reveals inflammation only when it exists within our arteries.

If you have evidence of inflammation, add a high-quality omega-3 fish oil supplement to your regimen, which decrease the risk of cardiovascular events. These fats are anti-inflammatory, antiarrhythmic (i.e., diminish abnormal heart rhythms), and antithrombotic (i.e., decrease the ability of our blood to clot). Omega 3s also lower triglycerides and may even lower your blood pressure. If you have coronary artery disease or two or more cardiovascular risks (diabetes, high blood pressure, tobacco abuse, a family history of coronary disease), the American Heart Association suggests taking 1,000 mg of combined EPA/DHA daily

Q: Are there any other test are should consider taking?

A: Additional specialized blood testing can determine your need for antioxidants, which are the body’s best defense against free radicals. For example, Spectracell Labs in Houston, Texas, offers an excellent way to evaluate your individual antioxidant needs. Through specialized blood tests, patients are better able to tailor their therapy to their own personal needs. After all, we are all individuals and must be examined and treated as such. Of course, when it comes to antioxidants, don’t forget that your food is your greatest ally. Fruits, vegetables, tea, and even dark chocolate offer a whole spectrum of antioxidants.

Finally, elevated homocysteine levels can damage our arteries. Homocysteine can lead to blood clotting, inflammation, and even DNA damage. High homocysteine levels increase our risk not only of heart attacks but also of osteoporosis, macular degeneration, strokes, and Alzheimer’s disease. Solid trials evaluating the impact of lowering homocysteine levels have yet to be completed, but given the magnitude of destruction that high homocysteine imparts, I advise my patients to lower very high levels of homocysteine. To accomplish this, I recommend starting with a combination of vitamins B6, B12, and folic acid (the latter being the most important of the three). After three months, if levels are not where we’d like them, add N-acetyl-cysteine (NAC) to the regimen. But don’t forget that lifestyle factors also contribute to high homocysteine levels: Excess weight, sedentary behavior, tobacco abuse, and copious coffee consumption are a few of these modifiable factors.

Health is best achieved when patients and doctors work together in a harmonious relationship. You are both on the same side, with the same goal: the pursuit of optimal health. Enlist your physician in your quest for health. More than likely, you’ll be pleasantly surprised by your doctor’s response.

For more information, visit the National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_WhatIs.html