Cardiomyopathy And Congestive Heart Failure

Everyone is aware that cancer is the scariest diagnosis. But the actual number one killer in the United States, killing twice as often as cancer, and most likely to strike a person is heart disease, whether you are a woman or man, Black/Hispanic/Asian or White. Heart attack, angioplasty. hardening of the arteries, bypass surgery and heart failure can be prevented. Such prevention/reversal is possible through a combination of smoking cessation, diet, exercise, alcohol control, and medication when necessary, and I honestly mean "prevented" at the 95%+ level.

In my own practice as a cardiologist, I now have only 1 patient a month who has a heart problem requiring hospital admission primarily because so many of my patients achieve a total cholesterol, blood pressure level and blood sugar of 130 or less. A total cholesterol level of 130 with the LDL (bad cholesterol) of about 75 is necessary to prevent heart attack, angina, angioplasty, bypass surgery from progressing to heart failure and cardiomyopathy. In fact, coronary artery disease, which is usually due to a total cholesterol above 130 is responsible for 2/3 of heart failure cases. Control of blood pressure is similarly essential to a value of 130 or less level. Alcohol intake should be less than 4 drinks a week. All cardiac risk factors must be attended to.

To be truthful, I believe such a low cholesterol or blood pressure level is natural ("the natural human design"), but in America "130" is usually achieved by using a combination of diet, exercise, and medication. The available "statin" medications are very effective for the purpose of lowering cholesterol to 130. Pravachol, Zocor, Advicor, Lipitor, Zetia or the still investigational super-statin Crestor (rosuvastatin) 80 mg a day, all can result in a profound lowering of the blood cholesterol. Recall, however, that the goal is a total cholesterol of 130 or less. Each day that a statin is used, I recommend that one also takes 100 mg well absorbed CoQ10 since statins lower the body level of CoQ10. There is evidence that low levels of CoQ10 may predispose to cardiomyopathy and heart failure. Blood CoQ10 levels can be checked.

There are other helpful medications that can lower the cholesterol, triglycerides, or raise the HDL (good cholesterol) or improve LDL subparticles from a small dense pattern B to a large bouyant pattern A. Tricor, niacin as Niaspan, or Slo Niacin and alternative vitamins/supplements such as CoQ10, garlic, "red yeast rice," gugul, various B vitamins, folic acid, L-carnitine, L-taurine, hawthorne berry and chelated magnesium all can contribute to improved cholesterol and/or blood pressure and also may enhance your response to traditional medications. There can be important interactions from using these medications and/or supplements together, and frankly, there is a limit to how many separate pills a person can tolerate. Relevant blood tests should be checked about every 4 weeks x 3 and then every 3-4 months or so and certainly with any symptoms you or your physician feel may be related to using these medicines/vitamins/supplements. As stated above, it is best to reach a blood pressure/cholesterol/sugar of 130 naturally by diet and exercise alone as, in fact, all drugs can and will be toxic in someone.

There is an increasing subset of heart disease which is a major cause of hospitalization/cost ($20-40 billion/year)/disability/death. Left ventricular hypertrophy, cardiomyopathy and heart failure contribute to each other and usually share common origins, can be very dangerous conditions, cause 250,000 deaths a year, are controllable/reversible to a point, and for which there are also very effective therapies. Heart failure occurs in 5,000,000 Americans with 500,000 new cases each year, and will double in frequency in the next 30 years. Heart failure is the most common cause of hospitalization in those over the age of 65. Echocardiograms, Cardiotron and nuclear (MUGA) tests are complementary and helpful in evaluating these conditions.

While I've already said that diet/exercise are essential for prevention, here are a list of some of the traditional Western (allopathic) medications and supplements, which are currently used to treat these conditions.

Aldactone or the generic "spironolactone" at 25-50 mg a day or as Aldactazide.
Beta blockers such as Coreg 25mg twice a day (has a better effect on insulin resistance and contains an antioxidant) orToprol (100-200mg a day), both in gradually increasing doses and as tolerated.
ACE Inhibitors (tissue specific are probably more effective) such as Accupril at 80 mg (40 mg twice a day or, 80 mg once a day), Ramipril 10 mg a day and Aceon 8 mg a day. Hawthorne berry (extract preferred) is an herb in this class.
Vasopeptidase inhibitors such as omipratilat will be very, perhaps the most, helpful when they become available.
Angiotensin receptor blockers such as Diovan, Avapro (reduces sympathetic stimulation), Cozaar (reduces irregular heart beat), or Atacand alone or in combination with an ACE inhibitor (but not when an ACE inhibitor and beta blocker are already being used together).
Endothelin antagonism (tezosentan and bosentan), and B-type naturetic peptide inhibitor (Natrecor or nesiretide).
Anticoagulants such as 20-8 1 mg aspirin twice a day, Coumadin, Plavix, Aggrenox and Pletal to thin the blood, prevent clotting, enhance blood flow, and additionally inhibit tumor necrosis factor = TNF. Pletal also likely inhibits restenosis (re-closure) after an angioplasty.
Trental and eternacept = Embrel both inhibit TNF. TNF is the most important cell mover (cytokine) and it predicts heart failure worsening. TNF may stimulate oxidative stress, and it stimulates endothelin (a vessel constictor) and inducible nitric oxide synthase = (i nos) which increases stress and heart muscle cell death (apoptosis).
Lanoxin at a dose of about .125 mg a day in the presence of normal kidney function.
EECP external enhance counter pulsation.
C0Q10 as Q-Gel Forte with L-Carnitine 60 mg 2-3 a day, 4 or 5 days a week, (but be certain to take your CoQ10 each day that you take your statin: Pravachol, Lipitor, Advicor, Crestor, Zocor, or lovastatin). Check C0Q10 blood levels.
L-carnitine and L-taurine in full dose daily for 30 days (thereafter at 1/2 dose 4-5 days a week) is documented to be a help.
Magnesium (chelated magnesium is preferred in the form of Magnesium Caps made by Biochem Country Life) at 1-2 a day for those who have normal kidney function.
Daily weights (a 2 lb. increase in I day or 4 lbs in a week are important signs of worsening heart failure) and a diary of symptoms (cough, increasing shortness of breath with effort, awakening at night short of breath, etc.).
Avoid salt and reduce alcohol.
Follow a low fat/high fiber/low sodium whole and unprocessed foods diet.
Biventricular pacing. (Endocardial may be more effective) or resynchronization.
Mitral/tricuspid annuloplasty.
Ventricular reduction surgery.
Statins to lower LDL cholesterol to about 75. LDL (the "bad") cholesterol is actually directly toxic to heart muscle and lowering LDL with statins has beneficial effects in reducing arrhythmia (irregular heart beat), assisting reversal of left ventricular hypertrophy (excess thickness of the heart muscle), and increasing the blood supply to the heart muscle.
Immune blocking: Embrel = eternacept and Trental both to inhibit tumor necrosis factor = TNF.

These medicines, supplements, and procedures can/should only be used after thoughtful consideration. You and your physician should discuss these treatments and their interactions.

Other natural behaviors that are helpful include weight lifting (resistance training) twice a week, weight loss to trim ("no pinchable body fat"), regular aerobic exercise, positive/healing imagination/visualization and behaviors, regular rest, etc. all known good and healthy things and the avoidance of personal stress/alcohol/ street drugs/tobacco.

H. Robert Silverstein, MD
Hartford, CT