© August 2004

Whole Foods Magazine

Coenzyme Q-10 and Heart Health

An interview with Dr. Stephen Sinatra: Part 6

Forecasting cardiovascular risk.

By Richard A. Passwater, Ph.D.

Last month, in the fifth part of our interview with cardiologist Stephen Sinatra, we explored several new non-invasive tools that can be wisely used to monitor our risk for heart disease. In earlier issues we had discussed the real risk factors in cardiovascular disease as well as the actions of coenzyme Q-10 that especially benefit heart and vascular health. Dr. Sinatra described how he uses coenzyme Q-10 in his cardiology practice. As he puts it, coenzyme Q-10 is "the fertilizer for the heart," and is becoming used as an adjunct treatment by more and more cardiologists. Our talk ranged over the reasons behind this acceptance, including some persuasive research efforts. We also covered congestive heart failure (CHF) and mitral valve prolapse, and we talked about a couple of dramatic cases.

In another installment, Dr. Sinatra again discussed coenzyme Q-10 and L-carnitine—what he calls the "twin pillars of heart health." To these he added a third nutrient, alpha-lipoic acid, to form a "triad" that may become the new frontier for metabolic cardiology. In June, Dr. Sinatra turned his attention to using nutrients to help lower high blood pressure. Now, in this final segment, he will discuss with us effective ways for forecasting and overcoming cardiovascular risk.

Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., is a board-certified cardiologist and a certified bioenergetic psychotherapist. He has more than 25 years of experience in helping patients prevent and reverse heart disease. He also is certified in anti-aging medicine. He is a fellow of the American College of Cardiology and former chief of cardiology at Manchester Memorial Hospital where he was director of medical education for 18 years. Dr. Sinatra is also assistant clinical professor of medicine at the University of Connecticut School of Medicine.

At his New England Heart & Longevity Center in Manchester, CT, Dr. Sinatra integrates conventional medical treatments for heart disease with complementary nutritional, anti-aging and psychological therapies that help heal the heart. He is uniquely qualified to give advice on nutritional supplements and the heart, since he is one of the few medical doctors who formulate their own vitamins. He knows how to pick quality ingredients and is expert in dosage, absorption and the effects of combining supplements with cardiac medications.

In addition, Dr. Sinatra has authored and/or co-authored several books on heart disease and is the editor of the monthly newsletter on heart health, The Sinatra Health Report. His most recent book, co-authored with his wife, Jan Sinatra A.P.R.N., is Lower Your Blood Pressure in Eight Weeks (Ballantine Books, 2003). Additional information can be found on his website at www.drsinatra.com.

Passwater: Dr. Sinatra, we left off last month with you mentioning how toxic "footprints" in the blood—homocysteinde, Lp(a), fibrinogen, CRP, tumor necrosis factor, and others—can provide clues to impending instances of heart disease. In the remaining minutes that we have together, could you describe some other life-saving innovations that are available.

Sinatra: There are several. The Electron Beam Computed Tomography (EBCT) of the heart increases our prognosis reliability. Basically, it is a 35- to 45-second CT scan that looks at calcium deposited in the coronary vessels. Calcium should not be in your coronary vessels. If it is, it is pathological. You don’t want calcium in any blood vessel.

Basically, if you do have calcium in your blood vessels, the story goes like this: the higher the coronary calcium, the more risk you have for coronary events. And the data are these: if an individual has a calcium coronary score of over 1,000, the chance of that person having a coronary event is about one in three over the next 30 months.

So if I do an EBCT scan on a patient’s heart and the score comes back at, say, 2,350, I get very concerned. That patient is at serious risk for plaque rupture in his or her coronary arteries. So that, along with the measurement of toxic blood markers, is a major step that can be taken to determine risk.

Passwater: Recognizing the risk helps only if you can do something about reducing the risk. What do you do with calcifications over 1,000? Can you reduce the calcification? If the calcium is stripped off, does the plaque become more vulnerable to rupture? Or do you treat the plaque itself?

Sinatra: I treat these patients very aggressively. Depending on the individual, I would consider a statin plus a multivitamin/multimineral, Coenzyme Q-10, nattokinase and fish oil as starters.

Passwater: What other new tools do you have to predict risk?

Sinatra: A third thing we can do now, is to analyze the Intra-Medial Thickness (IMT) of the carotids. This is very easy to do. You put a beta ultrasound on the carotid, and it measures the amount of any soft plaque that may be there.

Passwater: The carotids are the main arteries on each side in the neck and they are the chief supply of blood to the brain. Narrowing of the carotids diminishes brain function due to the decreased flow of blood. And, of course, a clot formed in the carotids, or a chunk of debris from soft plaque that has ruptured, can cause a stroke.

Is the amount of soft plaque in the carotids an indicator of the amount of soft plaque in coronary arteries as well?

Sinatra: The amount of soft plaque in the carotids is an indicator of the amount present in other arteries such as the coronaries. The scoring is A, B, C, D, and E. What is incredible is that we have found soft plaque even in an occasional 20-year-old. So we can determine if there is any soft plaque in the carotids with a five-minute test with ultrasound.

Passwater: OK, so you can now detect this vulnerable soft plaque. What can you do about it if you find it?

Sinatra: The best thing one can do to stabilize plaque, whether it is soft plaque, calcified plaque, ugly plaque or whatever, is to take fish oil. If I were stranded on a deserted island, I would want a few cases of fish oil and coenzyme Q-10 washed ashore.

Passwater: Surprisingly, the EBCT Screen and IMT Heart Scan are not available universally yet. We have discussed toxic blood markers, EBCT and IMT. What else is available to the modern cardiologist to help pick out those at high risk of having a deadly heart attack before they are treated?

Sinatra: The fourth thing we can bring to the table is cardiovascular genetics. This is really exciting. Basically, we can do 27 tests now that show genetic tendencies toward risk of coronary artery disease. These genetic tendencies range from the mundane—high blood cholesterol and high blood pressure genes—to the esoteric, such as genes that control one’s efficiency to methylate.

Passwater: Methylation is the process of adding a methyl group—a basic group containing a carbon atom and three hydrogen atoms—to another molecule. There are various enzymes in the body to aid this process and there are several nutrients that provide the methyl group for transfer. A handful of nutrients donate methyl groups to a pool, which then can be used by folic acid. Folic acid as tetrahydrofolate (THF) picks up the methyl groups to produce methyl-THF. This intermediate in turn reconverts homocysteine back into methionine.

Earlier, we mentioned that homocysteine was a risk factor that should be monitored in the blood.

Sinatra: Yes, not only is hyperhomocysteinemia a risk factor for cardiovascular disease, it’s also been implicated in osteoporosis, low birth weight, neural tube defects, some cancers and Alzheimer’s disease. Homocysteine is directly toxic to blood vessels in the brain and heart. Elevated levels wreak oxidative stress, and cause endothelial dysfunction, neuronal DNA damage, and even mitochondrial membrane weakening. High homocysteine levels in the brain cause cerebral microangiopathy and apoptosis of neural cells.

Normally. one of the most important factors in lowering homocysteine is the use of various B vitamin components, including folic acid, calcium folinate, vitamin B-6, vitamin B-12, pyridoxal phosphate, betaine hydrochloride (trimethylglycine) and dimethylglycine (DMG). Garlic, beets, broccoli, and SAMe are also potent methyl donors in reversing toxic homocysteine back to harmless methionine.

But genetic polymorphisms of 5,10-methyltetrahydrofolate reductase (MTHFR) exist in approximately 40% of the population. What this means is that a large percentage of people, particularly those of European and French Canadian descent, cannot adequately metabolize synthetic folic acid. They have this genetic disorder and cannot methylate properly. For these patients, refractory homocysteine levels will persist despite the use of B vitamin components and natural methylators.

People with hyperhomocysteinemia, resistant to usual B vitamin and methylator treatment, can be helped with a more advanced form of folate called methylfolate, a very highly bioavailable form of methyltetrahydrofolate that also readily crosses the blood brain barrier.

It’s unbelievable, but I have patients with homocysteine levels in their mid-20s and high-20s and I’ll try trimethylglycine, B-6, B-12, SAMe, folic acid, garlic, broccoli, the whole gamut—but if they are genetically lacking the enzyme, then there is really nothing that can be done except giving them this higher form of folate which bypasses the need for the body to methylate folate.

Passwater: What are acceptable levels of homocysteine?

Sinatra: A homocysteine level less than 7 µmol/L is ideal. Levels over 10 are unacceptable, especially in those with presenile dementia or arteriosclerotic cardiovascular disease. And remember that high homocysteine levels are treacherous, especially in the company of elevated Lp(a) because together they can induce the binding of Lp(a) to fibrin, a clot-promoting mechanism.

Passwater: Genetic testing adds much to the evaluation of risk.

Sinatra: When you do the genetic testing, coupled with the blood testing, and the EBCT and the IMT scans, I can look you right in the eye and tell you at how much risk you are for coronary disease. We didn’t have that 30 years ago, but we have that now. And I would say that only a handful of cardiologists in the country are doing this at this time.

Passwater: Well, this is why you are asked to lecture at so many medical meetings. Others will soon follow.

Sinatra: I call this Cardiology 2010 because, by then, metabolic cardiology will be the gold standard.

Passwater: What do you see for the future?

Sinatra: I really think that metabolic cardiology is the field of the future. I think that coenzyme Q-10, L-carnitine and D-ribose are going to be the three nutrients that are going to really rocket metabolic cardiology. And I think as more and more cardiologists become comfortable with these three nutrients, they are going to use them on a day-to-day basis. Fish oil is important, magnesium and all the nutrients we have been talking about. If people would take fish oil, magnesium and coenzyme Q-10, can you imagine how much illness we could prevent? Not just coronary disease, but diabetes, cancer and a many others.

Passwater: Agreed. Any other "take-home message" for our readers?

Sinatra: Basically I am just trying to teach people that conventional cardiology is absolutely here to stay. Some people need bypass surgery, some people need pacemakers, defibrillators, and even cardiovascular drugs. But there is a whole new area of cardiology, which I call nutraceutical cardiology, where I can offer patients a new world of opportunity. This is what I can offer my patients. And through my books and newsletter, I can offer this to everyone. The newsletter is very well referenced and I try to bring home the message that you can use the word integrative cardiology where people can have the best of both worlds. I can show them the conventional approach and also show them an alternative approach.

My message is that whatever works in these patients, whether it is drugs or high-tech procedures or simple omega-3 fish oils, I give my patients the opportunity or at least support them in trying these nutraceutical agents that can improve quality of life. The key here is to reduce human suffering. That is what Dr. C. Morisco showed with his study with coenzyme Q-10 in Italy—that 20% of patients treated with coenzyme Q-10 had reduced hospitalization. (Clin Investig 1993; 71: S134-36) There was a 20% reduction in pulmonary edema in hospitalization in patients given 150 to 250 mg of coenzyme Q-10 on a daily basis. That is my message—to reduce human suffering using whatever vitamins, minerals and nutraceuticals you can use

Passwater: Well, Dr. Sinatra, this has been a most informative conversation. I want to thank you on behalf of our readers for all of the information you have shared with us. We wish Jan and you continued success in helping others. Readers can keep up to date on Dr. Sinatra’s teachings via his newsletters and website www.DrSinatra.com. WF


© 2004 Whole Foods Magazine and Richard A. Passwater, Ph.D.

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